Effective Treatments for OCD

Biological Treatments
Drugs traditionally used to treat anxiety have not been found to be very effective at reducing obsessions and compulsions. However, a number of medications originally developed as antidepressants have been shown to be useful for treating OCD. All of these medications affect the brain neurotransmitter serotonin. Examples of these medications include:

Type of Medication Generic Name Brand Name
Tricyclic Antidepressants Clomipramine Anafranil
SSRI Antidepressants Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Celexa
Cipralex
Prozac
Luvox
Paxil
Zoloft

The decision of whether to take medication for OCD, and which medication to take should be based on the individual’s past treatment history, the individual’s medical history, possible interactions between the medication and other drugs that person may be taking, potential side effects, and other factors.

In rare cases, individuals with OCD may benefit from combining more than one medication. For example, some people (particularly those who do not respond to an SSRI alone, or those have difficulty recognizing that their obsessions and compulsions are excessive or unreasonable), may benefit from the combination of an SSRI antidepressant and a medication such as risperidone (a medication that is also used to treat psychotic symptoms such as hallucinations and delusions).

In very rare cases, individuals with OCD may undergo cingulotomy, a type of brain surgery. This intervention is reserved for the most severe forms of OCD, after all other treatment options have failed. A significant percentage of individuals who undergo this procedure experience a reduction in OCD symptoms, despite not having responded to the usual treatments previously.

Psychological Treatments
Research has shown two types of psychological treatment to be effective for treating OCD: behavior therapy and cognitive therapy. Because techniques from these two treatments are often used jointly, this general type of treatment is often known as cognitive behavioral therapy (CBT). To date, the most evidence exists for the effectiveness of the behavioral component of CBT.

CBT is based upon the following understanding of OCD: Obsessions, with their power to elicit such distress, lead the individual to engage in behaviors (e.g., compulsions, avoidance), which may provide a temporary relief. However, these compulsive behaviors are problematic for several reasons:

1) They cause the person to become very sensitized to their obsessions. That is, the “quick fix” of the compulsion takes away the opportunity to “ride out” the anxiety and logically evaluate both the reasonableness of the thought as well as one’s true ability to bear the anxiety. This strengthens the power of the obsession to cause distress.

2) Because they may at times provide partial temporary relief, compulsions are self-perpetuating: even partial anxiety reduction on one or two occasions will prompt the person to respond quickly with a similar behavior the next time anxiety arises.

3) Compulsive behaviors themselves quickly begin to cause problems in day-to-day life (e.g., taking priority over other more important activities).

So, CBT has two general aims: a) controlling compulsive rituals and avoidance, and b) reducing the anxiety associated with obsessions, and through this, reducing their intensity and frequency.

Behavior Therapy – The building blocks of behavior therapy for OCD are exposure and ritual prevention (ERP). ERP involves a) confronting a distressing situation or experience repeatedly, until it no longer triggers distress, while b) resisting the drive to engage in problematic anxiety-reducing behaviors. In the case of OCD, it is the obsessions that prompt the distress. So, in ERP for OCD, exposure is to obsessions, accomplished through deliberately seeking out situations that have the power to provoke them. For example, an individual with contamination obsessions about germs could be encouraged to practice touching items that have been in public places, with no compulsive washing or avoidance — something that would quickly prompt their obsessive thoughts — until this no longer causes notable anxiety. A new situation could then be added, and practiced until it also loses its power to cause anxiety, and so on. Over time, exposure first weakens the distress caused by obsessions, then the frequency and intensity of the obsessions themselves. ERP works best when it occurs frequently (e.g., at least four or five times per week), and lasts long enough for the anxiety to decrease (up to two hours).

Cognitive Therapy – Involves learning to identify one’s anxious beliefs about the meaning of obsessions and to replace them with more realistic thoughts. For example, if an individual is concerned that having an obsession about harming someone may make it more likely that that will actually happen, the individual might be taught to examine the evidence for the specific belief (e.g., I’ve had that thought hundreds of times and it has never happened) or for the more general belief that all thoughts that pop into one’s mind are always meaningful.

Combined Treatments
Generally, medications and CBT work about equally well in the short term, although some people may respond better to one approach or the other. In addition, some individuals appear to respond best to the combination of CBT and medications, whereas others do just as well with only one of these treatments. In the long term, CBT or combined approaches may be more useful that medication treatment alone. Once treatment has stopped, individuals who have been treated with a full course of CBT are less likely to experience a rapid return of symptoms than are individuals who have been treated with medication alone. In addition, should symptoms increase in another OCD theme area (e.g., doubts about harming someone, concerns about contracting a disease), the techniques learned in CBT can be applied to the new area of difficulty.

Did you know …?

• OCD affects about one percent of the population, although estimates are somewhat inconsistent across studies.

• In adults, OCD is slightly more common in women than in men, but in children the pattern is reversed. More boys than girls have OCD, and OCD often has an earlier onset in boys than in girls.

• About 90% of people have occasional intrusive thoughts and repetitive behaviors that are very similar to those that occur in OCD. The main difference is that people with OCD experience obsessions and engage in compulsions much more frequently than the average person, and are much more distressed by their symptoms.
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Information courtesy of the Anxiety Treatment and Research Centre