Established psychological treatments
When it comes to psychological treatment, research suggests the most effective treatment is some form of Cognitive Behaviour Therapy (CBT). This would usually involve Exposure and Response Prevention (ERP) which means the OCD sufferer is asked to repeatedly confront the triggers of their OCD behaviour and refrain from doing any neutralising rituals. For example, someone who compulsively checks locks when they leave their house, would be asked to leave the house and only check once. Someone who fears contamination and washes repeatedly, would be asked to touch something dirty and not wash, and to allow the anxiety to go down with time. While this may initially cause considerable anxiety, OCD sufferers soon learn that the anxiety goes down even when they do not ritualise. By repeatedly doing the ERP, they will create new pathways in their brain and the urge to check or wash will decrease.
Because ERP is a challenging task, often seeming too scary to even contemplate, it is broken down into manageable steps, sometimes beginning with delaying the ritual, or changing it in some way, before being able to resist doing it all together. Cognitive Therapy (CT) is often used before ERP to help reduce any anxiety about doing ERP.
Cognitive therapy with obsessional thoughts differs from traditional CT with “negative thoughts” as instead of questioning the evidence for and against the obsession, (eg “I might harm someone”) and trying to convince someone they would not harm anyone, it challenges the thoughts about the obsession ;(eg, “Having these obsessions means I need to take precautions because it could happen"). Learning to step back and observe obsessions rather than argue with them or try to stop having them is key to managing them.
Newer psychological treatments
While CBT is a well established treatment for OCD, more recent developments in psychotherapy are also being trialled with some success. For example, Acceptance and Commitment Therapy (ACT) has been found to help with OCD. A new form of Cognitive Therapy, called Inference based Therapy (IBT) has also been effective with OCD. IBT sees doubt as the basis of OCD. Persons with OCD may doubt their senses (“Even though I can see it is locked, is it really?“ ) and themselves (”Could I be someone who sexually abuses children?"). IBT helps the OCD client distinguish between “normal” doubt and “obsessional” doubt and understand how they have been confusing real probabilities with imagined possibilities. I have found both these newer approaches to therapy very useful to use along with ERP to help my OCD clients gain back control over their lives. For more information on IBT see this article.
Family members can get unwittingly caught up in the OCD. Attempts to help, while calming the OCD sufferer in the short term, may end up making it worse in the long run. Moreover, hostility from relatives toward the OCD sufferer can lead to a poor response to treatment. Thus, educating family members about OCD and how to assist with ERP is also very important.
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