Treatment of Obsessive Compulsive Disorder - A Look at Exposure and Response Prevention
Obsessive Compulsive Disorder
Double checking the car locks or that the coffee pot has been turned off, is completely normal but for someone with an obsessive compulsive disorder the checking of these and/or other items interferes with the functioning of daily life.
Effective treatments of obsessive compulsive disorder include medications, therapy and self help. The most supportive and suggested treatment for OCD is cognitive behavioral therapy which consists of exposure and response prevention (ERP) and cognitive therapy.
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Exposure and Response Prevention
Exposure and response prevention is the most recognized behavior therapy for obsessive compulsive disorder. This style of cognitive behavior therapy is broken down into two sections of direct therapy.
The first step is to treat the obsessive behaviors by introducing controlled exposure. The person is exposed either directly or indirectly to the situations, objects or places that trigger the obsession and heighten anxiety. The goal is to promote exposure to the obsessive trigger in small doses in order to decrease the amount of experienced anxiety. Over time the person will become accustomed to the trigger and through habit be able to control the level of anxiety.
Those suffering with any of the different types of OCD will experience the obsessions as well as the compulsions. The compulsive behavior involves the rituals that often follow the obsession. For example, an obsession with germs will result in the compulsion to continuously wash to remove germs.
The second part of the exposure and response prevention involves the prevention of response, or compulsion that follows the obsession. The person learns healthy behaviors to resist the compulsion to perform the rituals. The goal is to eventually completely control the urge to perform ritualistic behaviors.
How Exposure and Reponses Prevention Works
During the initial phases of therapy, the therapist will instruct the client to make a list of all the situations that provoke the obsessions. The list is known as a hierarchy of situations.
A list for a person with fears of contamination would include triggers that are placed in order of the greatest fear. For example;
(1) a pet licking their hand
(2) emptying the trash can
(3) going to the bathroom
(4) shaking someone’s hand.
Since shaking the hand of someone produces the lowest amount of anxiety, the person would be asked to shake the therapist’s hand and to resist the compulsive behavior that follows. The person would be gradually introduced to their obsessions and continually asked to resist all compulsive behaviors that would typically follow.
Cognitive Therapy
Cognitive therapy, when used in conjunction with cognitive behavior therapy, encourages the client to verbalize their thoughts and feelings during the exposure and prevention sessions. During the ERP phase, the client will be required to recognize their feelings and thoughts relating to the situation.
The client is asked to interpret what they assume or believe about their obsessions, their attitude toward them, and why they believe they have them. For example, therapy for a person who is fearful of shaking hands because they are worried about germs being passed to them helps the client to re-evaluate the consequences surrounding their obsession. Cognitive therapy also challenges the client’s beliefs about the reasoning for their rituals.
A primary technique used in cognitive therapy is helping the individual to challenge, identify and correct any negative interpretation of their intrusive thoughts. The person is requested to record the specific obsession and their interpretation of what they associate it with. They are asked to write the details in a “thought record” each time an obsession occurs. So they detail what their thoughts were at that specific time, the meaning they gave to them and what they did it about it.
How Effective Are Cognitive Behavioral Treatments For OCD?
According to the International OCD Foundation, studies have shown that approximately 70% of patients with OCD will benefit from either medicine or cognitive behavior therapy. Those who participate in cognitive behavioral treatment of obsessive compulsive disorder without the use of medications will have a sixty to eighty percent decrease in their OCD symptoms. In order for the cognitive behavioral therapy to be an effective treatment for obsessive compulsive disorder, active participation in the therapy is required.
References:
Center for Addiction and Mental Health, Treatments for OCD: Cognitive-Behavioral Therapy. https://www.camh.net/About_Addiction_Mental_Health/Mental_Health_Information/OCD/ocd_treatments.html
International OCD foundation - What You Need To Know About Obsessive Compulsive Disorder https://www.ocfoundation.org/uploadedFiles/WhatYouNeed_09.pdf
