OCD Action

Support & Info

Treatments Available

September 7, 2009

There are two main treatments for OCD – Cognitive Behavioural Therapy (CBT) and Anti-Obsessional Medication. Habit Reversal Therapy is also used by some professionals.

CBT and medication can be used alone or in combination with one another. CBT is often recommended as a first line of treatment; medication as a second line of treatment when an individual fails to make progress with CBT, or if an individual has severe problems, or is significantly depressed. However, there are often long waiting lists for CBT on the NHS and you may be offered medication as a first treatment by your GP or Consultant. The choice, however, is yours.

For most people with OCD professional help will be needed at some time. This usually means working with a a psychiatrist, psychologist or a nurse therapist. If you think you need professional treatment, your general practitioner (GP) is usually the best place to start. Your GP may refer you to a psychiatrist. You should be aware that not all GPs know about OCD. OCD Action has created our ‘GP Information Card’ specifically for this purpose. Please contact the office to receive a copy. If you are worried about seeing your GP, you could take a friend along with you, ask OCD Action to forward an information pack directly to your GP or take along a and/or the GP Information Card yourself. In the unlikely event that your GP refuses to give you any treatment or refer you for cognitive behavioural therapy, you can get advice from your Citizens Advice Bureau or the General Medical Council.

Even if you do get referred to mental health services, you need to remember that waiting lists are likely to be long. However, your GP should have provided some support while you are waiting, such as medication. Treatment does not work for everybody, but it rarely makes symptoms worse. It is common for people to be given a combination of treatments, such as medication and cognitive behaviour therapy. You may have to persevere to find treatment that works for you. Research shows that about 75% of people treated for OCD find it beneficial.

People with OCD can often be afraid or embarrassed to go to their GP for treatment. It is common for people with OCD to hide their symptoms for many years. However difficult it feels to tell other people, you should remember that hiding the symptoms will not help you cope with OCD and that your GP will have an understanding of psychological disorders and is there to help you. To help you explain what you feel, you could write down the main points beforehand. All the information that you tell your GP is confidential and cannot be shared without your permission. OCD is often referred to as an ‘anxiety disorder’ or a ‘psychological condition’. Sometimes, the term ‘mental illness’ is used. If you are worried about job applications that ask about ‘mental illness’, talk to your GP.

In addition to professional help, self-help groups, books, leaflets and the Internet are useful ways of learning how to cope with OCD. The more you know about OCD, the better equipped you will be to deal with it.

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Cognitive Behavioural Therapy (CBT)

September 3, 2009

CBT is based on a programme of structured self-help.

Behaviour therapy began in the late 1960s and is the most researched psychological treatment for OCD. It involves repeatedly confronting feared situations that are avoided (a process called ‘exposure’).

For the treatment to be successful, the exposure needs to be long enough for the anxiety to subside. The fear needs to be constant and the exposure should be repeated often. Exposure needs to be done without performing a compulsion (a process called ‘Response Prevention’) and in this way allow the person to tolerate the discomfort that occurs. If a compulsion is performed, then the exposure should be repeated in order to ‘undo’ the compulsion.

Each individual has a personal hierarchy. This means that each person starts by confronting relatively easy situations and then gradually works up to more difficult ones. Facing up to each fear becomes easier and easier and the anxiety gradually subsides. The short-term side effects consist of anxiety and distress, but these will gradually decrease and, in the long term, the fear will subside. No one is forced to confront their fears but the person with OCD is encouraged to take responsibility for devising their own programme. A therapist does not have to be present, although it may help some individuals at the start of their treatment programme. Tasks need to be challenging but not overwhelming. There are a number of excellent self-help books which explain such programmes in more detail.

In research trials, about 25% of patients either refuse to take part in a programme of Exposure and Response Prevention (ERP) or fail to adhere to a programme. Of those that do adhere, about 75% are helped significantly after 10-20 sessions as an outpatient. The risk of relapse after treatment is about 25%, when the person may require additional treatment. More severe cases (especially washers) may be helped by a more intensive programme as an inpatient or at home. Due to the high drop-out rate and partial success with ERP, research is being carried out to make this treatment better. One approach is adding cognitive therapy.

Cognitive therapy suggests that OCD results when an individual misinterprets intrusive thoughts or urges as a sign that not only will harm occur, but that they may be responsible for it through what they do or what they fail to do. Therapy seeks to help the individual understand that their problem is one of anxiety rather than danger and to react accordingly. Individuals with OCD are therefore trying too hard to prevent harm. The solution becomes the problem. For example, a mother may try to suppress or neutralise intrusive thoughts about stabbing her baby. This has the effect of increasing the frequency of intrusive thoughts. The problem is not the intrusive thoughts but the meaning the individual with OCD attaches to them; for example “having such thoughts means I might act upon them” or “I shouldn’t be having such thoughts”. This has the effect of increasing the degree of threat and responsibility felt, and will lead the person to avoid having knives around their kitchen or being alone with their baby. This will further maintain their fears and prevent the person from demonstrating that their fears are just ‘thoughts’.

Cognitive therapy will also try to help the person overcome the need for certainty and to alter the criteria they may use to terminate a compulsion (eg, when “I feel comfortable” or “just right” – beliefs that will tend to maintain a compulsion.).

When a person is receiving CBT, the most important ingredient is the homework that must be done between the sessions. The therapist can only act as a guide or teacher and the more patients practise on their own, the sooner they will get better. When patients have completed a successful course of treatment for OCD, most experts recommend follow-up visits for at least six months to a year.

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