Treatment Options for Obsessive-Compulsive Disorder

Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder

Cognitive-behavioral therapy is a form of psychological therapy that uses special techniques to change the way a person thinks about and responds to problems and issues that arise in everyday life situations. The cognitive aspect of this therapy focuses on helping people think more clearly and rationally about daily events by teaching them how to counteract and change negative or irrational thought patterns. The behavioral aspect of cognitive-behavioral therapy focuses on helping people develop more appropriate and acceptable behavioral responses when they are confronted with distressing everyday problems or situations.

Cognitive-behavioral therapy differs from other more traditional forms of psychological therapies by focusing and targeting current problems and issues confronting the patient that are the source of significant anxiety and distress. The goal of this type of therapy is to deal with the problem as it exists currently as opposed to searching for reasons or clues in the patient's past history that may have led to the way that they perceive, think about, or respond to the problem. Unlike other types of psychological therapies that may last for several years, cognitive-behavioral therapy is a relatively short course of treatment which can be completed in several weeks or months. In-between formal sessions with a trained therapist, each of which may last from 1-2 hours, the patient is encouraged to practice at home by performing homework exercises to reinforce positive thought patterns and more appropriate behavioral responses that they learned during the formal treatment sessions.

Cognitive-behavioral therapy is used to treat a variety of both mental and physiological disorders including:

• Psychosis
• Bipolar disorder
• Schizophrenia
• Eating disorders
• Alcohol and drug abuse
• Chronic pain syndromes
• Insomnia
• Early-stage dementia
• Mood swings
• Psychological stress

Cognitive-behavioral therapy is the first-line treatment of obsessive-compulsive disorder (OCD) in children and adolescents and may be used together with drug therapy for the management of OCD in adults. The underlying theory that is the basis of cognitive-behavioral therapy for the treatment of OCD is a strategy known as exposure and response prevention (ERP). Initially developed in 1966, ERP involves the following two steps:

• Exposing the patient to specific anxiety-provoking stimuli (e.g., obsessional thoughts or compulsive behaviors) that are the source of the OCD.
• Helping the patient to prevent their abnormal OCD response to the anxiety-provoking stimuli.

An example of how a trained cognitive-behavioral therapist may apply the principle of ERP may involve a patient with OCD who is excessively anxious and fearful of becoming contaminated with dirt and responds by repeatedly washing their hands with soap for long periods of time many times each day. Using the ERP approach, the therapist gradually exposes the patient to increasing amounts of dirt (i.e., the anxiety-provoking stimulus in this example) over a period of several treatment sessions until the patient learns to tolerate the exposure without becoming overly anxious or fearful. During subsequent sessions, the therapist helps the patient to overcome their irrational compulsive handwashing response by demonstrating the "normal" technique of handwashing using a little bit of soap and rinsing it off with water. With practice over time, the patient learns to overcome their irrational fear of becoming contaminated with dirt and also learns to respond in a more acceptable manner by refraining from repeated episodes of handwashing.

In general, the results of numerous clinical trials have shown that cognitive-behavioral therapy is effective for controlling symptoms of OCD in about 85% of patients. The number of treatment sessions required to achieve an improvement in symptoms varies, however, most patients require about 15-20 weekly sessions, each lasting about 1-2 hours. In order to achieve optimal results, it is extremely important for patients to practice the ERP technique at home to reinforce and supplement the formal treatment sessions with a trained therapist.