OCD: A Half-century of Evolving Treatments

Obsessive-Compulsive Disorder (OCD) is said to affect 2% to 3% of the Australian population (that is: more than 500,000 Australians). OCD is classified as an anxiety disorder and is characterised by:

• Intrusive thoughts that engender uneasiness, apprehension, fear, or worry (that is: obsessions)
• Repetitive behaviours which the OCD individual undertakes in order to reduce the worry (compulsions), or
• A combination of obsessions and compulsions (Wikipedia, 2013a).

Below we illustrate an example of obsessive-compulsive behaviour:

After laying out the laundry items in exact rows to be dried and re-adjusting the knickknacks on the lounge shelf following on from the maid, your partner signals readiness to go to the important appointment you have together. You gather up your things and start out the door. Her constant arranging and rearranging has delayed you, and you know that you need to leave within the next two minutes in order to get there on time. “Oh, wait,” she says. “Let me just check that the back door is locked.”

“You checked it about five minutes ago, and a half hour before that,” you protest. “No one has gone in or out since then.” “True, but you never know.” She checks it again, then realises that the windows were not checked in the last hour either, so she re-does that procedure, too, occupying a further six minutes. Upon finishing those tasks, she remembers that you have not checked whether the stove was turned off after boiling the kettle for afternoon tea: another minute and a half gone!

You are frustrated but think: well maybe we can get going now; perhaps we will only be an excusable five or six minutes late. As your partner is nearly out the door, however, she remembers that she has forgotten an important paper for the appointment, so off she goes to the office to rummage through piles upon piles of unfilled papers. As she is a hoarder, it takes some time to dig out the missing document. Four and a half minutes later, she emerges triumphant: “I have it!” By this time you have given up arriving on time, but think, maybe we can just drive a bit faster. Your partner, however, seems to read your thoughts.

“And we’re not going faster to make up time. That is how accidents happen. You have no regard for how dangerous life is! Death could occur to either one of us at any time.” You shrink a little in the car seat and sigh in resignation. How can a carefree, easy-go-lucky guy like you deal with someone so anxious and obsessive?

In this article, we explore the different treatments that can be used to assist clients suffering from OCD and its related behaviours.

Developments in therapy for OCD

Before the late 1960s, traditional talk therapy based on psychoanalytic principles was considered the conventional therapy for OCD; the only problem was that it wasn’t effective at reducing the severity of the obsessions or compulsions. Many were the patients who came to understand more deeply the workings of their minds, but they still couldn’t stop doing the repetitive behaviours! Two developments mark the beginning of the modern era for OCD treatment:

• 1966: British psychologist Victor Meyers’ report that two cases of OCD had responded to a behaviour therapy technique later referred to as “exposure and response prevention”.
• Late 1960s – early 1970s: European psychiatrists reported that a medication called clomipramine (an early SSRI-class medication) was effective in a series of cases of OCD (Goodman, 2006).

Both medication and behaviour therapy affect brain chemistry, which in turn affects behaviour. Thus, what these developments have evolved into constitute the mainstay of contemporary OCD treatment. We look at behaviour therapy, medication, and auxiliary forms of support.

Behaviour therapy

Behavior therapy – usually cognitive behaviour therapy – aims to change patterns of thinking, beliefs, and behaviours that may trigger anxiety and obsessive-compulsive symptoms by educating the client in order to promote control over symptoms.

Part of the therapy is “exposure and response prevention,” (ERP) in which the client is gradually exposed to situations that trigger their obsessions and, at the same time, prevented (or at least discouraged) from carrying out the compulsion. For example, a compulsive hand-washer may be urged to touch an object he or she believes is contaminated and denied the opportunity to wash for several hours.

This type of treatment is effective for many people with OCD. When the treatment works well, the client gradually experiences less anxiety from the obsessive thoughts and becomes able to refrain from the compulsive actions for extended periods of time.

Several studies suggest that medication and behavior therapy are equally effective in alleviating symptoms of OCD. About half of the clients with this disorder improve substantially with behaviour therapy; most of the rest improve moderately (Better Health Channel, 2013; National Alliance on Mental Illness, 2003).

Medication

As noted above, antidepressant medications enhancing serotonin levels have been found to reduce the symptoms of OCD. Prescribed by medical practitioners, these must be taken consistently for ten to twelve weeks in order to judge their effectiveness.

Some of the medications used more effectively are: Anafranil (clomipramine); Luvox (fluvoxamine); Paxil (paroxetine); Prozac (fluoxetine); Zoloft (sertraline); Celexa (citalopram). Side effects may include nausea, headaches, dry mouth, blurred vision, dizziness, and tiredness. The effects often decline after the first few weeks of treatment.

Response to medication varies from person to person, but most people treated with such medications find their symptoms reduced by about 40 to 50 percent. That can often be enough to change their lives, transforming them into more well-functioning individuals. A small number of people are fortunate to go into total remission when treated with effective medication and/or behaviour therapy.

Sadly, a few clients find that neither behaviour therapy nor medication produces significant change (Better Health Channel, 2013; National Alliance on Mental Illness, 2003). For those, anxiety management techniques, psychotherapy, hospitalisation, and support groups may be the only options.

Anxiety management techniques

Relaxation training, slow breathing techniques, meditation, and hyperventilation control are all techniques which can help a person to reduce anxiety, thus managing their own symptoms. They work best in conjunction with behaviour therapy, and require regular practice to do effectively.

Psychotherapy

While many writers on OCD have cautioned that psychotherapy does not directly reduce the severity of OCD symptoms, it may still be useful for some clients in order to deal with issues and problems that have been caused or made worse by the disorder: for instance, relational troubles.

Hospitalisation

When someone has just begun treatment for OCD or their symptoms are severe, a stay in hospital for assessment and treatment (usually lasting several days to a few weeks) may be helpful.

Support groups and education

Support groups help people with OCD and their families to meet comfortably and safely, and to give and receive support. The groups also have educative and social functions, providing the opportunity to learn more about OCD and to develop networks (Better Health Channel, 2013).

This article is an extract of the upcoming Mental Health Academy “Understanding Obsessives: OCD and OCPD in the therapy room” CPD course.
Click here for more information.

References

• Better Health Channel. (2013). Obsessive-Compulsive Disorder. Better Health Channel. Retrieved on 17 April, 2013, from: hyperlink.
• Goodman, W. (2006). Treatments for Obsessive-Compulsive Disorder. Psych Central. Retrieved on April 23, 2013, from hyperlink.
• National Alliance on Mental Illness. (2013). Obsessive-Compulsive Disorder. National Alliance on Mental Illness. Retrieved on 23 April, 2003, from: hyperlink.
• Wikipedia. (2013a). Obsessive-Compulsive Disorder. Wikimedia Foundation, Inc. Retrieved on 21 April, 2013, from: hyperlink.