Cognitive Behavioral Therapy
The most accepted OCD rituals treatment option is cognitive behavioral therapy (CBT). This therapy focuses on "retraining" the brain, or actually changing the activity in the brain due to a specific stimulus. The main technique used in cognitive behavioral therapy is exposure and ritual prevention (ERP), which allows the person to experience the stimulus to his compulsions without actually acting on them. For example, a person who is terrified to shake hands with someone else, and washes his hands after any contact with another person, would intentionally shake another person’s hand and hold back from washing his hands. Doing this over and over again would eventually reprogram his brain to know that shaking another person’s hand does not require hand washing. Eventually, the person’s anxiety would be lowered and the therapy could move to treating other OCD symptoms.
Medication can also be helpful in treating OCD. Specifically, most psychiatrists will prescribe SSRIs (Specific Serotonin Reuptake Inhibitors), which can be helpful in controlling OCD symptoms. Some people with OCD take medication side by side with therapy sessions. The major downside of medication is that the person with OCD cannot usually be weaned off the medication without the symptoms reappearing. Therapy, on the other hand, can lead to improvement even once the therapy has been discontinued.
Some people prefer herbal treatments over traditional medication because they are more "natural," and usually cheaper than prescription drugs. On the other hand, many alternative treatments can cause serious side effects if they are not carefully researched, even if they are made purely from herbal sources. Most herbal treatments for OCD have not yet been tested well enough to ascertain whether they are effective and have no side effects. One possibility, however, is St. John’s Wort, which has been tested in several small-scale studies. Although some studies have found that it has no greater effect than a placebo, others have found that it mimics the effects of SSRIs. Passiflora, a herb that is usually given alongside St. John’s Wort to increase its effectiveness, has not been shown to help OCD on its own.
For most people with OCD, therapy or medication should be able to help them control their disorder. Some people, however, have what is called "treatment resistant OCD." This type of OCD does not respond to typical treatments, and it is often far more extreme in its ability to minimize the person’s quality of life, which can lead to complications with the disorder. In these cases, psychiatrists may suggest brain surgery. Because this option is controversial – because it requires the destruction of one portion of the brain – modern brain surgery is reserved for those with the most extreme cases of OCD, and only after all other treatments have been tried and have failed. Brain surgery for OCD usually focuses on using radio-frequency waves to destroy the corticostriatal circuit, a circuit that has been implicated in OCD.