Obsessive-compulsive disorder psychotherapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sonya Gelfand, Usama Talib, BSc, MD [2]
Overview
According to the Expert Consensus Guidelines for the Treatment of obsessive-compulsive disorder, behavioral therapy (BT), cognitive therapy (CT), medications, or any combination of the three are first-line treatments for OCD. Psychodynamic psychotherapy may help in managing some aspects of the disorder, but there are no controlled studies that demonstrate effectiveness of psychoanalysis or dynamic psychotherapy in OCD.[1] Though there is no known treatment for full remission of OCD yet, there are a number of successful treatment options available to promote significant improvement.
Psychotherapy
One may be referred by their doctor to a mental health specialist, such as a psychiatrist, psychologist, social worker, or counselor for evaluation of treatment, however OCD is usually medically managed by psychological and pharmacological interventions.[2]
Behavioral Therapy
- Cognitive behavioral therapy teaches patients alternative ways to think, behave, and react to their obsessions and compulsions. [2]
- Cognitive behavioral therapy (CBT) is a highly effective psychological treatment strategy for OCD patients. It is helpful both when used in group sessions or individually.[2]
- CBT consists of two components either used together or individually:[2]
- Behavioral techniques and
- Cognitive restructuring
- The specific technique used in the behavioral therapy (BT/CBT) is called exposure and ritual prevention (also known as "exposure and response prevention") or ERP; this involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior. At first, for example, someone might touch something only very mildly "contaminated" (such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school.) That is the "exposure". The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once (exposure) without going back and checking again (ritual prevention). The person fairly quickly habituates to the anxiety-producing situation and discovers that their anxiety level has dropped considerably; they can then progress to touching something more "contaminated" or not checking the lock at all — again, without performing the ritual behavior of washing or checking.
- This can consist of 13-20 weekly sessions or 3 weeks of daily session on week days. Reinforcement sessions can be offered periodically within 3 to 6 months following initial treatment.
- This has been demonstrated to be the most effective treatment for OCD.
References
- ↑ Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB; American Psychiatric Association. Template:PDFlink Am J Psychiatry 2007; 164(7 Suppl): 5-53. PMID 17849776.
- ↑ 2.0 2.1 2.2 2.3 Hirschtritt ME, Bloch MH, Mathews CA (2017). "Obsessive-Compulsive Disorder: Advances in Diagnosis and Treatment". JAMA. 317 (13): 1358–1367. doi:10.1001/jama.2017.2200. PMID 28384832.