OCD treatment - what to expect
What is OCD?
OCD is a neuropsychological disorder that includes two characteristics:
- Obsessions, which are recurrent and persistent thoughts, impulses or images that are experienced as intrusive and inappropriate and cause significant anxiety or distress, and;
- Compulsions/rituals, which are repetitive behaviors, thoughts or images that the person feels compelled to perform in response to an obsession or a certain rule that must be applied rigidly.
Most of the time there is a relationship between the compulsion and the obsession in that the compulsion is performed to neutralize or reduce the distress that accompanies the obsession.
The symptoms of OCD may include unwanted or upsetting doubts or other thoughts about harm, sex, contamination, health, religious themes, or other topics. Rituals may include excessive hand or body washing, checking and re-checking, praying in a specific rigid way, repeating routine activities or actions, or special thoughts designed to counteract negative thoughts. Certain situations, places or objects may trigger the obsessions and urges to ritualize.
How common is OCD?
Experts estimate that several millions of people in the United States suffer from OCD. The onset of OCD typically occurs between early adolescence and young childhood, although in some people OCD begins as young as 2 years old or as late as age 60. Males generally develop the disorder earlier in their teenage years, while females develop the disorder in young adulthood. Among adults the incidence of OCD is equal for men and women. In most cases, OCD symptoms develop gradually, although in a small number of people they start suddenly. Without treatment, the course of OCD is chronic and can fluctuate in severity. Although effective treatment significantly improves quality of life among individuals with OCD, many persons with OCD suffer for years before seeking treatment.
How is OCD treated?
In the past five decades, significant knowledge about the specific symptoms and potential causes of OCD has greatly increased and this knowledge has led to more effective treatment strategies for sufferers. The psychological treatment program that has received the most scientific evidence is called Exposure and Response Prevention (ExRP or ERP). The ExRP treatment program includes the following components:
1. Introductory phase
- I will provide an explanation of the Cognitive-Behavioral model of OCD and the treatment program.
- I will ask questions to collect information about the specific clinical features of your OCD, including inquiring about the history of your OCD, exploring the onset and course of your OCD symptoms, identifying triggers that elicit your obsessions as well as outlining your compulsions (rituals) and avoidance patterns.
- I will teach you how to monitor your obsessions and compulsions on daily basis.
2. Treatment phase
- We will collaboratively create a hierarchy of situations and activities that trigger your distress and you will rate them on a subjective distress or discomfort scale.
- We will designate in vivo (‘real life’) exposures to help you confront cues, including objects, words, images or situations that make you anxious or distressed; today, you do compulsions in reaction to these or you try to avoid them altogether.
- We will design imaginary exposures to help you confront in your imagination the details of the negative consequences you expect if you do not avoid or ritualize after confronting situations that trigger your obsessional distress.
- I will teach you how to practice ritual prevention, which means helping you refrain from doing the behavioral or mental acts that you currently do to reduce your obsessional distress or prevent the negative consequences from happening.
- In our meetings, we will discuss what happened to your obsessional anxiety/distress during exposure and ritual prevention and re-evaluate the merit of the beliefs about the predicted feared consequences.
- We will discuss strategies to maintain the gains made in treatment and prevent relapsing in the future.