Bangkok Hypnosis

Treatment for Obsessive-Compulsive Disorder (OCD)

Posted by Sun on May 30, 2012

Cognitive-behavioral therapy for OCD is extremely effective. Studies have demonstrated that people improve when either behavioral exposure and response prevention therapy (ERP), or cognitive therapy, are delivered alone (Emmelkamp, Visser, & Hoekstra, 1988). Other studies suggest the combination of these two techniques appears to be the most effective method (Abramowitz, Taylor, & McKay, 2005). Improvement rates in the literature vary from 40% to 97%, but 50% is a conservative estimate.

Exposure and response prevention (ERP) is most effective when conducted with the therapist guiding the patient during therapy sessions, coupled with follow-up homework assignments. In vivo ERP (meaning in-the-moment, live, real-time exposure to actual anxiety-provoking circumstances) consists of gradually and systematically confronting anxiety-provoking situations specific to the person’s obsessions. For example, a person with germ contamination, who avoids touching doorknobs in public places, would be directed to actually touch doorknobs (exposure), while preventing their compulsive behaviors such as washing hands (response prevention), until habituation occurs.

Cognitive therapy consists of challenging the core beliefs and the cognitive distortions that are commonly found among people with OCD. Cognitive therapy may address thoughts and beliefs regarding:

1) an overestimation of harm

2) the tendency to overestimate the importance of thoughts

3) the powerful desire to control thoughts

4) an inflated sense of responsibility to protect against harm

5) perfectionism

6) an intolerance of uncertainty

7) an intolerance of anxiety/discomfort

Challenging and restructuring these underlying beliefs and distortions leads to a better treatment outcome than simply challenging a person’s belief that public doorknobs are dirty.

While treatment outcomes are certainly improved by challenging core beliefs and cognitive distortions, overvalued ideation (OVI) is another type of belief that may affect treatment outcomes and can predict a poorer response to treatment (Basoglu Lax, Kasvikis, & Marks, 1988; Neziroglu, et al., 2000). OVI refers to a person’s insight; the sensibility of their beliefs; and the tendency to cling to their beliefs despite evidence to the contrary.

For example, a person with OCD that has low OVI may enter treatment saying, “I know I can’t really get AIDS from touching a doorknob or a toilet seat, but I still want to avoid touching them. I understand that logically these worries are an expression of my disorder, but the anxiety is just too much for me to tolerate.” This low degree of belief in the obsession helps the person more readily participate in the challenging and uncomfortable ERP exercises.

People with high OVI, on the other hand, may be less sure that their beliefs are illogical or untrue which leads to a reluctance to participate in ERP therapy. Higher OVI can be modified with cognitive therapy and exercises designed to test the accuracy of the beliefs, but this can take longer and can be a more challenging task for therapists and therapy participants alike. When people with high OVI are ready for ERP, they may also need to proceed at a much slower and more gradual pace.

In addition to traditional cognitive-behavioral therapies, several other therapies have been successfully applied in the treatment of OCD.Acceptance and Commitment Therapy (ACT) has proved useful to assist people to better tolerate and accept the discomfort of their obsessions. Researchers in the field of OCD have also begun to investigate the impact of family variables in determining treatment outcomes (see Steketee & Van Noppen, 2003 for a review of literature). Therefore, the inclusion of family therapy may be very beneficial. As with other anxiety disorders, some people with OCD may benefit from certain medications.



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