How OCD is treated

How is OCD treated?

OCD is typically treated by a combination of therapy and/or medication. Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP), and pharmacological medication are considered the most effective forms of treatment. ^[1]

OCD is a draining neurological disorder with a lifetime prevalence of 2-3 percent across the nation and is estimated to be the 10^th most prominent cause of disability worldwide. [2[ However, roughly 70% of patients will show signs of improvement after undergoing a course of ERP and/or medication for their OCD. ^[1]

Therapy for OCD

Cognitive behavioral therapy (CBT) is the frontline psychotherapy used to treat OCD. There are two aspects of CBT commonly used to modify a person’s behavior and thought patterns: exposure and response prevention (ERP) and cognitive restructuring. You and your licensed therapist will work together to choose a course of action that makes sense for your unique situation. ^[3]

CBT is typically carried out at a therapist’s office in an outpatient setting, for a prescribed number of times per week. The more severe your OCD, the more sessions you may require. ^{[1] [3]}

ERP

During ERP, you are gradually exposed to your obsessions, and encouraged to avoid the compulsions you typically perform to soothe the anxiety you feel. ^[3] This process is carried out at a pace that suits you. Therapists will never force patients to do anything they are unwilling to do. ^[3]

You will learn coping techniques to manage any guilt and anxiety associated with the obsession. With work, determination, and patience, you will learn to manage your obsessions and compulsions and live a more fulfilling life. 

Below is an example of the ERP process: ^[3]

1. First, you will list all your obsessions and compulsions. Then, alongside your therapist, you will order them from what bothers you the most to least.
2. Your therapist will ask you to confront the obsession that you decided bothers you least. For example, if you have a fear of germs in public places, your therapist may ask you to touch a public doorhandle.
3. Following this, your therapist will encourage you to not respond with the compulsion you would usually perform. For example, if your typical response to touching a doorknob in public is to wash your hands immediately, your therapist will ask you to refrain from doing so.
4. You will repeat this exercise over multiple sessions and each time your therapist will ask you to wait longer and longer before washing your hands. The idea is that over time, this exposure and response therapy will stunt the urge to wash your hands after touching things in public places.
5. Gradually, you will recognize that confronting your fears directly will lead to fewer obsessions. Additionally, you will realize that compulsively performing rituals to combat anxious thoughts is unnecessary.

Cognitive Restructuring

Cognitive restructuring, a technique within CBT used in the treatment of OCD. Cognitive restructuring focuses on identifying and challenging irrational or distorted thoughts and beliefs that contribute to OCD symptoms. Your therapist will help you learn that your brain is causing you to misinterpret certain experiences while also supporting you in responding to your thoughts in new, healthier ways. ^[3]

For example, if a friend walks by you without acknowledging you, you might think she doesn’t like you because she didn’t greet you. Your OCD can make you strongly believe this to be the case. Your therapist will encourage you to take a step back, examine the evidence and gain a rational perspective. ^[3]

You will be encouraged to recognize that there are myriad reasons your friend could’ve walked past without saying hello; she could not have seen you, she could’ve been distressed herself, or she could’ve had anything on her mind.

By identifying and replacing negative or irrational thoughts with more realistic and balanced ones, individuals can reduce the distress and anxiety associated with their obsessions.

Medication for OCD

You may be prescribed medication, typically alongside talk therapy, to help treat your OCD.

The primary class of medications used to treat OCD is selective serotonin reuptake inhibitors (SSRIs), although other types of antidepressants may also be prescribed. ^[4].

SSRIs: SSRIs are antidepressant medications that work by increasing the levels of serotonin, a neurotransmitter in the brain. ^{[4] [5]} They are considered the first-line medication treatment for OCD. Commonly prescribed SSRIs for OCD include: ^[5]

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Escitalopram (Lexapro)
• Citalopram (Celexa)

Can side effects occur?

Yes, most patients will experience one or more side effects from the medications listed above. Each person may respond differently to specific medications, so finding the most suitable one may require some trial and error.

Side effects include ^[4]:

• Increased feelings of anxiety, shakiness, or agitation
• Diarrhea or constipation
• Dizziness
• Sleeping troubles
• Nausea
• Headaches
• Sexual dysfunction

Keep your doctor informed of any side effects you experience from your medication. Sometimes switching up the dose or changing the time you take the medication can reduce or eliminate the side effects. Do not alter or stop taking a prescribed course of SSRIs without speaking to your doctor first. Together you can weigh up the benefits of the medication against the impact of the side effects. ^{[4] [5]}

It is essential to take medication as prescribed for at least 10 to 12 weeks. Many patients experience no positive changes for the first few weeks of treatment, but then notice marked improvements. ^[5]

There’s a small chance that SSRIs could cause you to have suicidal thoughts or want to harm yourself. ^[4] If this happens, contact your doctor or other medical professional immediately to get the help you require.

Who should not take SSRIs?

• Pregnant women – It is recommended that pregnant women should refrain from SSRI usage, particularly during the first trimester. ^{[4] [5]} The baby’s wellbeing may be compromised, and you should weigh up the risks and benefits with your doctor to decide on the best course of action for both you and your unborn child. However, this recommendation is evolving and doctors may tell pregnant woman who already on SSRIs to continue taking them.
• Very elderly patients - should avoid using Anafranil as its side effects impair thinking and can cause confusion. ^[5]
• Patients with heart issues – should exercise caution especially when taking Anfranil. ^[5]

Alternative treatments for OCD

While CBT with ERP and medication are considered front-line treatments for OCD ^[1], there are a range of self-care techniques you can deploy alongside them that may help manage your OCD symptoms.

1. Healthy lifestyle choices: Focus on maintaining a balanced diet, getting enough sleep, and avoiding excessive caffeine and alcohol consumption. These lifestyle factors can have a positive impact on overall mental health.
2. Physical exercise: Engage in regular physical activity, such as walking, jogging, or swimming. Exercise not only improves physical health but also promotes mental well-being and can reduce symptoms of anxiety and depression. That said, exercise must be performed with care by people with OCD. If you find you are compulsively exercising to escape obsessive thoughts, consult your doctor or therapist to discuss next steps.
3. Support groups: Seek support from friends, family, or support groups. Sharing your experiences with others who understand OCD can of comfort, reassurance, and provide a sense of community. ^[4]
4. Stress managementtechniques: Practice stress-reducing techniques such as deep breathing exercises, meditation, mindfulness, or yoga. These practices can promote relaxation and help manage OCD-related anxiety.

It is essential to note that self-care alone is not sufficient to manage your obsessions and compulsions. OCD is a mental health disorder that typically requires a comprehensive treatment approach involving therapy and, in some cases, medication.

However, self-care practices can complement professional treatment and help individuals manage their symptoms more effectively.

How to seek treatment for OCD

The first step to getting treatment for OCD is receiving an official diagnosis. This can only be made by a doctor or mental health professional. ^[6]

Make an appointment with your doctor and list the symptoms you’ve been experiencing. They will conduct a general physical with blood tests to make sure the symptoms are not being caused by another mental illness, medical disorder, or other variable, such as illicit drugs. ^[6]

To be diagnosed with OCD a person must exhibit: ^[6]

• Obsessions, compulsions, or both.
• Obsessions and compulsions that are distressing and causing disruption with a person’s work life, personal life, and relationships. These obsessions and compulsions must last for an hour or more per day.

Following your diagnosis, a doctor will typically refer you to an array of therapists, among which you can choose the one you feel most comfortable with. Together, you can construct a treatment plan that bet suits your needs and symptoms.