What is OCD?
Obsessive-compulsive disorder (OCD) is a mental health condition in which an individual has frequent, unwanted thoughts (obsessions) that cause them to perform repetitive behaviours or rituals (compulsions).
Studies show that OCD affects 2-3% of people in the United States. The NHS in the UK estimates that around 12 people out of every 100000 have OCD. If left untreated, OCD can become debilitating. Fortunately, treatment can be very effective and, with suitable therapies, can be successful in more than 80% of cases.
What are the treatment options for OCD?
Cognitive Behavioural Therapy (CBT)
Cognitive-behavioural therapy (CBT) is a talking therapy for obsessive-compulsive disorder (OCD) that uses two scientifically based techniques – exposure and response prevention (ERP) and cognitive therapy – to help people understand and change their thought patterns and behaviours.
A psychologist or cognitive-behavioural therapist provides CBT, which may involve weekly face-to-face or online sessions, with homework and exercises to practice between sessions.
The heart of CBT is to help people learn new ways of thinking and reacting to anxiety-producing situations. This includes providing psychoeducation about the treatment, teaching new behaviours to address fears or anxiety, and engaging in exposure and response prevention. Cognitive therapy is also used to help identify the beliefs causing the person’s anxiety and evaluate them against reality.
Overall, CBT is an effective treatment for OCD.
Exposure Response Prevention (ERP)
Exposure and response prevention (ERP) is used to treat OCD. It involves exposing yourself in a controlled manner to the anxieties and obsessions you have been avoiding while resisting or reducing any compulsions.
ERP works on the principle of habituation, which is when the body adapts or gets used to something over time. A good example is when a person jumps into a cold pool on a hot day—initially, the body will feel the temperature of the water, but if the person stays in the water for some time, eventually, their body will become used to it and no longer feel the cold.
When it comes to ERP, the person gradually puts themselves into situations that bring on their obsessions without resorting to compulsions. This can be done by imagining what it would be like in a situation or by actually going out and confronting it. It is important to plan the exposure carefully so that it can be done gradually and one is not overwhelmed by it.
In addition to this, the response prevention part of ERP is just as important. Response prevention involves stopping any repetitions or compulsions that the person may have been doing so that the habituation to the anxious thoughts and sensations can occur. Sometimes this consists in finding other ways to cope with the distress, but the important part is that the person is not doing anything that decreases their anxiety.
Overall, exposure and response prevention is an effective way to treat OCD by gradually teaching people to confront their fears and stop performing compulsions. While it can be uncomfortable, it is worth it to reduce the anxiety and fear associated with OCD.
Selective Serotonin Reuptake Inhibitors (SSRIs) are antidepressants that block serotonin’s reabsorption, a naturally occurring chemical in the brain that helps regulate emotions and moods. By blocking the reabsorption of this chemical, SSRIs can help reduce symptoms of OCD, such as anxious thoughts, intrusive thoughts, and compulsive behaviours. In some cases, additional therapy, such as Cognitive Behavioural Therapy (CBT) with ERP, may also be recommended.
Deep brain stimulation
People have asked me about deep brain stimulation so I have included a paragraph here, but am very clear to point it, it not a recommended treatment by NICE. OCDUK has a good article on why it is not a recommended treatment.
Deep brain stimulation (DBS) is a surgical procedure involving implanting electrodes in targeted brain areas and not used in UK.
As with deep brain stimulation, NICE guidance do not recommend neurosurgery as a treatment for OCD.
OCD can be debilitating if left untreated, but with the help of researched and recemmended models of therapy such as CBT and ERP, not only will you understand your OCD better, but you can start to get your life back.