Treatment Options
Obsessive-compulsive disorder treatment may not result in a cure, but it can help bring symptoms under control so that they don’t rule your daily life. Depending on the severity of OCD, some people may need long-term, ongoing or more intensive treatment. The two main treatments for OCD are psychotherapy and medications. Often, treatment is most effective with a combination of these.
Psychotherapy
Cognitive behavioral therapy (CBT), a type of psychotherapy, is effective for many people with OCD. Exposure and response prevention (ERP), a component of CBT therapy, involves gradually exposing you to a feared object or obsession, such as dirt, and having you learn ways to resist the urge to do your compulsive rituals.
Another part of therapy is psychoeducation, learning about the disorder and learning about how anxiety is natural. The main focus of therapy is to first unlearn unhealthy coping behaviours and understand the impact of attaching unhelpful meanings with obsessions. ERP takes effort and practice, but you may enjoy a better quality of life once you learn to manage your obsessions and compulsions.
ERP
A fear ladder is made with the client. It starts with objects that might be low in intensity and ends with the highest anxiety provoking object at the top. The therapist asks the patient to slowly imagine themselves in these situations during which the anxiety is then simultaneously regulated.
As the patient goes up the ladder, their anxiety increases but their ability to regulate it also increases, thus decreasing overall anxiety eventually. In other words it starts by listing all of your fears on a scale from 1-10 and each day taking an action that goes against the corresponding fear, starting from the least scary and working up to the scariest.
Dia needs to follow her exposures little by little everyday so that she learns to regulate her anxiety, as she goes up the fear ladder her anxiety will increase but her ability to regulate it will increase hence decreasing her anxiety slowly.
If Dia is afraid of dogs, the first task might be just drawing a cartoon dog with the therapist. The last step would be to see a dog in real life.
Example of a fear ladder:
Medication
- In certain cases, the severity of obsessions (worries) and Compulsions (compensatory actions) are very severe, ERP is unable to be tolerated. In these cases, medications are indicated to decrease the intensity of the symptoms, enough to allow the basic functioning at home and school and participate in therapy meaningfully.
- The medications often used are in the category of SSRI’s (selective serotonin reuptake inhibitors) like Sertraline, Fluoxetine, Fluvoxamine, Escitalopram. These medications are newer medications with fewer side effects and are better tolerated. These medications if started are only used for a few months to upto a year. But all medication decisions are taken together with the child and family.
Starving the monster: “OCD is so treacherous because it forces you to question your own instincts! We are taught to trust our gut and if we feel something is wrong, even if we don’t know what specifically, we take steps to keep ourselves safe.
The problem with that, is that while that works for people without OCD, it’s not that simple for folks with OCD. In fact, if an individual with OCD follows his or her instincts, then oftentimes they actually feed the OCD. However you can (and should) do something to fix this. Naturally, everyone wants to prevent distress, but what to do when the “preventative” thing causes more distress than the ‘harmful thing’?”
“The more I gave in, the stronger the thoughts became. OCD is like a monster living inside you. The more you feed it, the bigger and stronger it grows. The more you starve it, the smaller and weaker it becomes. But when that monster is living in your head, starving it is tricky and often terrifying.” – CJ (living with OCD)
When Dia listens to the thought in her head that if she doesn’t clap her hands something bad will happen, she is feeding the monster. If she imagines the situation where she didn’t clap her hands during therapy and stays with that anxiety, that would be starving the monster.
Intensive outpatient and residential treatment programs are sometimes needed for some people. Comprehensive treatment programs that emphasize ERP therapy principles may be helpful for people with OCD who struggle with being able to function because of the severity of their symptoms. These programs typically last several weeks.
About 70% of patients with OCD will benefit from either cognitive behavioral therapy (CBT) or medication. However, obstacles to getting effective treatment for OCD like hiding symptoms due to embarrassment and stigma get in the way of treatment.
Source:
https://www.theanxietydoctor.com/blog-on-the-pulse/the-key-to-controlling-your-ocd-lies-in-understanding-how-to-starve-it
https://www.nimh.nih.gov/health/publications/obsessive-compulsive-disorder-when-unwanted-thoughts-take-over
https://www.psychalive.org/its-not-me-its-my-ocd-overcoming-obsessive-compulsive-disorder/
https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/diagnosis-treatment/drc-20354438
Something to keep in mind
Stigma is one of the biggest problems faced by people with OCD, but oftentimes, people don’t realize that their words or actions are stigmatizing or trivializing the suffering of those with OCD. The next time you hear someone say that someone or something is “so OCD,” engage them in conversation about what OCD really means and why what they’re saying is dismissive and inaccurate.