Basic Psychology, Psychopathology

Obsessive-compulsive disorder (OCD) – Treatment

Obsessive compulsive disorder (OCD) is a treatable condition. The treatment recommended will depend on how much it’s affecting your life.The two main treatments are:

  • psychological therapy – usually a type of therapy that helps you face your fears and obsessive thoughts without “putting them right” with compulsions
  • medication – usually a type of antidepressant medication that can help by altering the balance of chemicals in your brain

A short course of therapy is usually recommended for relatively mild OCD. More severe OCD may require a longer course of therapy and/or medication.These treatments can be very effective, but it’s important to be aware that it can take several months before you notice the benefit.

Psychological Therapy

Cognitive-behavioral therapy is a treatment for OCD that uses two scientifically based techniques to change a person’s behavior and thoughts: exposure and response prevention (ERP) and cognitive therapy. CBT is conducted by a cognitive-behavioral therapist who has special training in treating OCD. The ultimate goal of therapy is to translate exposure to the real world, where you can resist your compulsions and where you can embrace uncertainty rather than fear it.

  • Exposure Therapy
    The psychotherapy of choice for the treatment of OCD is exposure and response prevention (ERP), which is a form of CBT. In ERP therapy, people who have OCD are placed in situations where they are gradually exposed to their obsessions and asked not to perform the compulsions that usually ease their anxiety and distress. This is done at your pace; your therapist should never force you to do anything that you do not want to do.

The first step is for you to describe all of your obsessions and compulsions. Then you treatment-for-ocd-300x199and the therapist will arrange them in a list, ordering them from things that don’t bother you much to things that are the most frightening. Next, the therapist will ask you to face your fear of something on your list, starting with the easiest. Let’s say you have an obsessive fear of germs in public places, and that fear is pretty low in how much it scares you. Your therapist will design a task for you that exposes you to that fear. Your task might for you to touch a public doorknob. Here’s where the response-prevention part comes in. If your usual response is to wash your hands immediately after touching the doorknob, the therapist would ask you to wait before you wash your hands. As you repeat this exposure task, the therapist will ask you to wait longer and longer before washing your hands. Over time, this gradual exposure and delayed response would help you learn to control your fear of germs in public places without washing your hands.

It may seem weird, but this new way of confronting your fears directly will lead to fewer and less intense fears or obsessions about germs. Your brain learns that nothing bad happens when you stop performing compulsive rituals.

You’d probably feel very upset when you first touched the doorknob — maybe even feel a little panicked. But the body has a wonderful capacity for something called habituation, and anxiety will eventually lessen without doing anything but letting time pass. It’s something like jumping into a pool of cold water. When you jump in, the water may feel very cold. But after a while, your body gets used to the cold, thanks to habituation, and you feel fine.

When your therapist helps you with exposures over a period of time, your anxiety shrinks until it is barely noticeable or even fades entirely. The therapist can then help you gain confidence and learn special skills to control the compulsions through a cognitive therapy

  • Imaginal Exposure
    For those who may be resistant to jumping right into real world situations, imaginal exposure (IE), sometimes referred to as visualization, can be a helpful way to alleviate enough anxiety to move willingly to ERP. With visualization, the therapist helps create a scenario that elicits the anxiety someone might experience in a routine situation. For someone who fears walking down a hallway in a way that diverts from their “perfect” pattern, the therapist may have them picture themselves walking in that divergent manner for several minutes every day and record their level of anxiety. As they habituates to the discomfort, with decreased anxiety over time, they are gradually desensitized to the feared situation, making them more willing to move the process to real life, and engage in the next step, ERP.
  • Habit Reversal Training 
    This intervention includes awareness training, introduction of a competing response, social support, positive reinforcement, and often relaxation techniques. Awareness training may be practicing the habit or tic in front of a mirror, focusing on the sensations of the body and specific muscles before and while engaging in the behavior, and identifying and recording when the habit or tic occurs. These techniques increase awareness of how and when the urges develop, making it more likely that an individual will be able to intervene and make a change.

That is where the competing response comes in, with the individual and therapist working together to find something similar to the movement or tic that is not noticeable to others. Someone with a vocal tic who learns awareness of the developing urge may practice tensing the muscles around their cheeks and mouth to ride out the urge and prevent the tic. Or someone with a compulsion to touch things symmetrically may be directed to tense the opposite arm, holding it tightly against their body, preventing them from completing the ritual.

This method of treatment takes time, diligent practice, and patience, as well as integrating relaxation skills prior to beginning. Also extremely critical to success is the support and positive reinforcement of family

  • Cognitive Therapy
    When applied to treating OCD, cognitive therapy helps you understand that the brain is sending error messages. Your therapist will help you learn to recognize these messages and respond to them in new ways to help you control your obsessions and compulsions. Cognitive therapy focuses on the meanings we attach to certain experiences that we misinterpret. For example, if a friend passes you without acknowledgment, you might interpret her action incorrectly and think “Mary doesn’t like me because she did not say hello.” And you might believe your thought is very important or meaningful. Cognitive therapy helps you stand back from these thoughts, look at the evidence closely, and tell yourself something more realistic or accurate; in this case it might be, “Something is on Mary’s mind, but I don’t know what it is.”

Cognitive therapy for OCD focuses on the experience of negative thoughts. While most people easily dismiss such thoughts (e.g., “That’s a silly thing to think”), some people have certain beliefs that thoughts are always important. So instead of being able to just forget about these negative thoughts, their beliefs cause them to react differently and might make them think “I’m a bad person for having such a thought!” Research shows that believing that negative thoughts are important and attempting not to have “bad” thoughts actually produces the opposite effect.

Medication

WARNING :Please do consult a doctor as I am only a psychology student who is not much aware on medicines and the given data is just for an information.

You may need medication if psychological therapy doesn’t help treat your OCD, or if your OCD is fairly severe.

The main medications prescribed are selective serotonin reuptake inhibitors (SSRIs). These can help improve OCD symptoms by increasing the levels of a chemical called serotonin in your brain.You may need to take the medication for 12 weeks before you notice any effect.Most people require treatment for at least a year. You may be able to stop if you have few or no troublesome symptoms after this time, although some people need to take medication for many years. Your symptoms may continue to improve for up to two years of treatment.Don’t stop taking SSRIs without speaking to your doctor first, as this can cause unpleasant side effects. When treatment is stopped, it will be done gradually to reduce the chance of this happening. Your dose may need to be increased again if your symptoms return.

Side effects

Possible side effects of SSRIs include:

  • feeling agitated, shaky or anxious
  • feeling or being sick
  • diarrhoea or constipation
  • dizziness
  • sleeping problems (insomnia)
  • headaches
  • low sex drive

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