For those coping with obsessive-compulsive disorder – better known as OCD – new research shows that a form of cognitive-behavioral therapy improves outcomes for patients for whom antidepressants alone aren’t effective, which is often the case. According to OCD specialist Francine Rosenberg, Psy.D., of Morris Psychological Group, the study offers hope for OCD sufferers who wish to use their brain power to control their obsessive thoughts and compulsive behaviors rather than letting the condition control them.
Published in the September 2013 issue of JAMA Psychiatry, the research indicated that 80 percent of those unresponsive to antidepressant therapy who underwent exposure and response prevention – a form of cognitive-behavioral therapy (CBT) that retrains the brain’s habit-forming circuitry to unlearn compulsive rituals – responded compared to 23% receiving an antipsychotic medication and 15% receiving a placebo pill. Forty-three percent of the CBT patients reported that their OCD symptoms fell to a minimal level following this treatment.
Since current guidelines for non-responders to drug therapy – commonly combined with CBT to tackle many OCD cases – tend to emphasize more or different drugs, the new research highlights Dr. Rosenberg’s belief that CBT alone can provide dramatic relief for the relentless anxiety inherent in OCD.
“To get rid of the unwanted fears that characterize OCD, people often do the same tasks repeatedly and completely avoid many common situations,” Dr. Rosenberg explains. “But this cycle can take over their lives, hurt their relationships and limit their ability to work or go to school. Many people with the disorder go without treatment because they’re embarrassed to talk to a medical professional. But talking to us is the first step to managing the issue and reclaiming a more normal way of life.”
Facts about OCD
Nearly everyone routinely washes their hands when they feel dirty or double-checks things sometimes, like making sure the stove or iron is turned off before leaving the house. But for people with OCD – which affects about 2 million Americans of all ages – the need to check things repeatedly, for example, seriously interferes with daily life. According to the U.S. National Institute of Mental Health, OCD is typically first diagnosed before the age of 19. Some scientific evidence indicates the condition runs in families.
Typical OCD symptoms include:
- Repeated thoughts or images (obsessions) about various things, including fear of germs, dirt or intruders; acts of violence; sexual acts; or being overly tidy.
- Repeatedly performing the same rituals (compulsions) such as washing hands; locking or unlocking doors; counting; or keeping unnecessary items.
- Lack of control over the unwanted thoughts and behaviors.
- Brief relief from performing the behaviors or rituals, followed by renewed anxiety from obsessions.
Symptoms may come and go and range from mild to severe, Dr. Rosenberg says. “Anyone dealing with these issues should be seen by a doctor to rule out other causes,” she adds. “But once OCD is diagnosed, psychotherapy that focuses on the dysfunctional thoughts and behaviors is often an effective approach.”
Exposure and response prevention therapy highly effective
How does exposure and response prevention therapy work to ease OCD? This form of CBT slowly increases an OCD patient’s contact with the thing that triggers worries or false beliefs. For example, someone worried about getting germs from things he touches would touch the undesirable object and then not wash his hands afterward, continuing that until he no longer feels anxious when doing so. Desensitizing patients to these behaviors takes time and persistence, Dr. Rosenberg notes, but eventually teaches different ways of thinking, behaving and reacting to situations without suffering from as many obsessive thoughts or compulsions.
About 7 of 10 people with OCD will benefit from either CBT or medicine, according to the International OCD Foundation, but for the people who benefit from CBT, they typically see their OCD symptoms reduced by 60 to 80%.
“Perhaps the most important thing people with OCD should remember is that they are not their OCD – it doesn’t define who they are,” Dr. Rosenberg says. “Psychotherapy can make an enormous difference in how much these patients feel in control of their own lives.”
