Is Your OCD off the Chain?

Exposure therapy may help with OCD


Did I close the garage door? I know that I'm halfway down the cul-de-sac, but I really should check to see if the garage door is closed. I don't want somebody to steal my Nautilus home fitness equipment. I should drive back home and check to see that the garage door is closed. Okay, I'm driving home ...  Oh good, I did close the garage door. I'm driving away now. Wait ... maybe I didn't check right.

I should turn around and take another look ....

Although a common dimension of obsessive-compulsive disorder (OCD), "checking" is only one manifestation of the disorder. In fact, the precise nature of obsessions and compulsions vary among people with obsessive-compulsive disorder and are sometimes just as distinct as those individuals suffering from the condition themselves. Despite such heterogeneity of obsessions and compulsions, however, many people with OCD are united by its resulting debilitation, and the toll OCD takes on global functioning, quality of life and personal relationships.

In recent years, exposure with response prevention (ERP) combined with cognitive therapy (CT) has emerged as a first-line form of psychotherapy treatment for OCD. It's estimated that ERP alone could help an estimated 50 percent of people with this disorder.

What is OCD?

Obsessive-compulsive disorder is an anxiety disorder which affects an estimated 2.2.

million Americans. People with OCD have obsessions or disturbing and recurring thoughts. In order to provide some measure of very temporary relief or reprieve from these obsessions, people with OCD perform repetitive and ritualized behaviors (AKA compulsions). For example, a person obsessed with the thought that bacteria make their hands dirty may perform ritualized hand-washing behaviors using antibacterial soap.

  In other words, with OCD, unflagging obsessions will catch you in a mental loop and perpetuate compulsive behaviors without stopping.

Although we all perform some ritualized behaviors every day--like checking that the door is locked once or maybe twice before leaving the house--people with OCD spend an hour or more each day engaged in such anxious behaviors. Furthermore, many people with OCD realize that their obsessions are unfounded and compulsions detrimental, yet, despite such insight, are unable to control these symptoms. Of note, OCD may have a heritable component, and for many, symptoms begin in childhood.

Many people with OCD find that antidepressants help manage symptoms of the disorder. However, besides medication, psychotherapy or cognitive-behavioral therapy has also proven effective in managing both obsessions and compulsions.

What is ERP + CT?

Cognitive-behavioral therapy (CBT) is a form of psychotherapy where a therapist helps you focus on your thoughts and how they relate to your feelings and behaviors.

Results from a growing body of evidence-based research suggest that exposure with response prevention (ERP) combined with cognitive therapy (CT)--two types of CBT--are particularly good at treating OCD.

In general terms, ERP involves exposing a patient to anxiety-provoking stimuli (exposure) all while preventing (or encouraging the patient to avoid) compulsive behavior. With continued ERP, therapists hope to extinguish the cycle of anxiety and compulsion (a phenomenon known as extinction). Of note, if a person undergoing ERP were to engage in compulsion, the anxiety-provoking stimulus would be immediately reintroduced. Additionally, this person is also engaged in CT thereby helping him understand and reappraise intrusions or obsessions and thus modify behavior or compulsions.

For example, let's once again consider a person whose OCD involves contaminating stimuli; a person who is scared of bacterial contamination and is thus compelled to wash her hands over and over again with antibacterial soap. In this case, a treatment team could hole up with this person for a weekend and turn off all running water to the patient's house. This treatment team would then continuously facilitate patient recontamination (think getting her to touch toilet seats or dirt) all while encouraging her to reappraise such anxiety-provoking stimuli as harmless.

As could probably be expected, ERP has some definite limitations. First, many people find such exposure too distressing to endure. Second, some obsessions and associated compulsions are hard to target and treat like those with sexual and religious dimensions. Finally, ERP and CT both are resource-intensive treatments which are unavailable to many.

If you or someone you love is suffering from OCD, please meet with a psychiatrist (or request a referral to a psychiatrist). Remember that with OCD, obsessions and compulsions are hard to rein in without the help of mental health professionals who can provide medication and psychotherapy. Moreover, with respect to OCD, there's no reason to feel guilt or shame--remember that this condition has strong biological underpinnings that are out of your control. Finally, many specialized clinics, therapists, organizations and support groups exist which can help with OCD, too.

Selected Sources

Review article titled "Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder" by D. McKay and co-authors published in Elsevier Psychiatry Research in 2014.  Accessed 2/16/2015.

Thompson T, Hollon SD. Chapter 10. Behavioral and Cognitive–Behavioral Interventions. In: Ebert MH, Loosen PT, Nurcombe B, Leckman JF. eds. CURRENT Diagnosis & Treatment: Psychiatry, 2e. New York, NY: McGraw-Hill; 2008. Accessed February 16, 2015.

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