OCD is usually treated with a combination of behaviour therapies and prescription medications, which aims to improve the daily function of the individual.
Cognitive-behavioural therapies (CBT)
These treatments aim to examine and evaluate a person's fears and to develop appropriate methods of coping with stress and anxiety. People react differently to CBT, and although it is not associated with many side effects, people will experience some anxiety during treatment. Common therapies include the following:
- Exposure and response prevention (ERP): With this therapy, a person with OCD is exposed to situations that provoke obsessive thoughts, but is prevented from performing the usual compulsive ritual. For example, the person may be asked to touch a dirty cup and then wait for a predetermined length of time before washing their hands. This is one of the most common types of CBT. This is one of the most common types of CBT. Studies have found that up to 75% of treated patients experience long-term improvement in their symptoms after 2 to 3 years of therapy.
- Habit reversal: In this therapy, the person is asked to substitute a different response (such as deep breathing) for the usual compulsive ritual.
- Thought stopping: This therapy involves thought stopping and distraction whenever an obsessive thought appears. However, this is usually less effective than other types of CBT.
- Saturation: This approach asks the patient to concentrate intensely on the obsessive thought until the thought loses its impact and becomes meaningless. As with thought stopping, this technique is usually less effective than other types of CBT.
Most medications used to treat OCD affect levels of serotonin, a chemical messenger in the brain. The most effective medications for OCD are antidepressants such as fluoxetine, paroxetine, fluvoxamine, and sertraline. These medications belong to a class of medications called selective serotonin reuptake inhibitors (SSRIs). SSRIs work by increasing levels of serotonin in certain areas of the brain. Clomipramine, a nonselective serotonin reuptake inhibitor, is also commonly used.
Clomipramine and the SSRIs are used in their normal antidepressant dosage ranges to treat OCD. Note that it may take up to 12 weeks of therapy to produce a noticeable change in OCD symptoms and that a minimum 6-week trial at full dosages is required to fully evaluate the medication's effectiveness.1 Other medications used to treat OCD may include newer antidepressants such as venlafaxine, benzodiazepines, and buspirone to relieve anxiety, as well as mood stabilizers and some anti-psychotic medications. People with OCD must work closely with their doctor and pharmacist to find the most effective medication with tolerable side effects.
Children with OCD usually have additional psychiatric problems, such as depression, learning disorders, panic disorders, and social phobias. Medication may be helpful in treatment, but is often only used when cognitive-behavioural therapy has proven ineffective.
What the family can do to help
OCD affects the entire family of a person who has it. Family members may have difficulty accepting that the person with OCD cannot stop the disruptive behaviour. They may feel angry and resentful. But families can learn ways to encourage and support the person with OCD to seek help and follow through with treatment. Some families find that family therapists trained in OCD can help them deal with their loved one's disorder.
For more information, contact the Canadian Mental Health Association.
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