There is Hope…
Obsessive Compulsive Disorder (OCD) is an anxiety disorder which is characterized and named for its symptoms. As we explored last week, people with OCD have obsessions, which are persistent thoughts they can’t control, and often have compulsions, which are repeated actions that for at least a time, relieve the anxiety caused by the obsessive thoughts. Typically, and without treatment, this cycle provides a feedback loop that keeps the obsessive thoughts and compulsive actions reinforcing one another.
OCD is Treatable!
The great news is that Obsessive Compulsive Disorder is a treatable condition! This week let’s explore the treatment approaches and every day helps that can improve lives and provide freedom to those who deal with this debilitating condition.
Primary Approaches
When we talk about treatment for Obsessive Compulsive Disorder, the primary approaches fall into one of two areas, or a combination thereof- Cognitive Behavioral Therapy and medications. Cognitive Behavioral Therapy (CBT) is a goal-oriented psychotherapy that focuses on understanding and managing negative thinking, behavior, and emotions. Within this framework is the belief that disorders and symptoms can be minimized by learning new ways to process information and develop coping habits. When we’re able to break the unhelpful thinking and behaviors that OCD injects into our lives, the result is less anxiety around the same or similar situations that previously created extreme anxiety and obsessive thought patterns. The work of CBT continues outside of the therapist’s office and, as with all things, practice makes perfect! Applying the skills learned in session to every-day experience helps make change possible.
What’s the Most Effective?
It is important to note that medication in the treatment of OCD have been shown to be most effective when taken in tandem with a psychotherapeutic approach like CBT. It should also be mentioned that only a medical professional is able to prescribe and monitor the effectiveness of medication options with you. Medications have been shown to help as they affect chemicals in the brain which can lend more control when working with a therapist in practicing, challenging, and managing obsessive thoughts. The best type of medications to treat OCD are a type known as Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs are medications that have been around for more than 40 years and have been shown to increase levels of the chemical Serotonin in the brain when it is too low. SSRIs are non-addictive and the side effects are typically manageable compared to other medication options out there. Lower levels of Serotonin have been linked to emotions, mood, memory, and sleep. SSRIs are often used to treat depression, anxiety disorders, eating disorders, trauma, phobias, and OCD.
Exposure and Response Prevention
The type of Cognitive Behavioral Therapy that has shown the most impact in treating OCD is Exposure and Response Prevention (ERP). In this type of therapy, we voluntarily work to expose ourselves to the distressing experience over and over again as a way to neutralize or stop the fear. By repeatedly facing something distressing in this way, we are forcing our brain to recognize the irrationality of the obsession. Even gentler, and if exposure is too disturbing to begin there, the therapist may choose to start with Imaginal Exposure- which is simply visualizing the situation instead of experiencing it firsthand. This would be done for a time until the ability to handle the direct exposure is possible. Additionally, if the direct exposure is too stressful of a place to start, a combination of psychotherapy and medication may be helpful, as discussed above.
Acceptance and Commitment Therapy
Acceptance and Commitment Therapy, or ACT, is another type of CBT that works to develop more flexible thinking patterns with the use of acceptance and mindfulness practices. The goal is not to eliminate intrusive thoughts, but to learn how to be at peace with them and to understand who we are apart from the symptoms of OCD. ACT teaches people to recognize their negative thoughts and accept them just as they are. In this type of thinking, it’s understood that suffering becomes more prominent when we try to resist pain or discomfort. A way to describe this thinking is to suggest that you not think about chocolate cake. Chances are, just telling you not to will guarantee that you will. So to, as we struggle to not think about how the shopping cart is covered in germs, we will only think on this more and cause ourselves more distress. Through working with the six core principles of ACT we learn to give less weight to negative thoughts, gain acceptance, stay present in the current moment, observe ourselves, identify our values, and take committed action. ACT is work that can be done in either one on one or group therapy.
Remember, there is hope for change and next week I’ll share a story that highlights a great example of that. Keep pressing on and remember that you are not alone. God is with you in your struggle and you can reach out for help.
Next Steps:
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