OCD Treatment Options
Obsessive-compulsive disorder (OCD) is a serious, chronic, and treatable anxiety disorder, which often co-occurs with depression and other anxiety disorders. Left untreated, it may follow a progressive, deteriorating course and become disabling. Health care providers can offer patients a variety of effective treatment options that have helped many people break free from OCD.The goals of OCD treatment include decreasing the frequency and severity of symptoms, improving function, and helping the patient to improve his or her quality of life. Effective treatment varies from person to person, but typically includes one or more of the approaches below; for many patients it often involves a combination of behavior therapy and medication.
Cognitive-Behavioral Therapy (CBT)
Many therapists use a combination of psychiatric therapies that actively involve the patient in his or her own recovery and provide a sense of control. The American Psychiatric Association recommends that patients receive CBT sessions at least once weekly, generally for 13 to 20 weeks.
Cognitive Therapy
The goal of cognitive therapy is to help patients identify and change unwanted and disturbing thought patterns. The individual examines his or her feelings and learns to separate realistic from unrealistic thoughts.
Behavior Therapy
The goal of behavior therapy is to modify and gain control over unwanted behaviors. The individual learns to cope with difficult situations, often through controlled exposure to them.
Exposure and Response Prevention (ERP)
A form of behavioral therapy, ERP has demonstrated the greatest success in OCD. This approach gradually exposes patients to their feared obsessions by making them less sensitive, and teaches them techniques that prevent them from engaging in their ritualistic behavior.First ERP slowly breaks the connection between obsessive thoughts and the anxiety they produce. Then it severs the connection between the compulsion and the reduction in anxiety that follows.
Example: A patient obsessed with contamination in the kitchen may be instructed to touch an object he believes is unclean. Then he is discouraged from washing for several hours. Over time, he experiences less anxiety from the obsessive thought and is able to abandon the accompanying ritualistic behavior of repeated hand washing.
Medication
Medication can be very useful in the treatment of OCD, often in conjunction with one or more of the therapies above. For some people with OCD, a combination of CBT and medication may be the most effective treatment. Depending on the person, medication may be a short-term or long-term treatment option. Medication can even help decrease anxiety enough for patients to start ERP and stay with it.Selective serotonin reuptake inhibitors (SSRIs) are considered safe first-line medications that have shown to be effective in reducing anxiety in placebo-controlled studies. SSRIs increase the level of the neurotransmitter serotonin. Several SSRIs have been approved by the U.S. Food and Drug Administration for OCD. Higher doses and longer trials of SSRIs are often needed for OCD, compared with other disorders commonly treated with these medications. It can take four to twelve weeks for a patient to respond to a particular SSRI. A patient may try different SSRIs before a physician might consider other classes of antidepressants. Newer SSRIs, more effective in treating OCD, have fewer of the unpleasant side effects that were associated with an older generation of the medications.