Psychological Therapies are Effective
Psychological Therapies are Effective
Psychological therapies are recognized by both researchers and healthcare providers as effective treatments for reducing the frequency and intensity of symptoms of OCD. Effective psychological treatments for OCD stress changes in behavior and/or thoughts (sometimes called cognitions). When appropriate, behavioral and cognitive treatments are combined alone or with medication to get the best result.
Behavior Therapy: Facing Your Worst Fears
Although there are a variety of behavioral therapies for treating OCD, almost all focus on exposing you to those things that you fear most such as contamination or the troubling content of an obsessional thought. This exposure provides you with an opportunity to gain new information in hopes of disconfirming your worst fears.
One of the most popular and effective forms of behavior therapy for OCD is exposure and response prevention or ERP. ERP involves exposing you to the anxiety that is provoked by your obsessions and then preventing the use of rituals to reduce your anxiety. This cycle of exposure and response prevention is repeated until you are no longer troubled by your obsessions and/or compulsions.
ERP usually involves 15 to 20 exposure sessions that last about 90 minutes. These sessions usually take place at the therapist’s office, although you are usually asked to practice ERP at home. While some therapists prefer to begin with exposure to the most feared stimuli (this is sometimes called flooding), others prefer to take a more gradual approach. For example, it is not uncommon to have people begin ERP by simply thinking about being exposed to the things they fear most.
Although behavior therapy is highly effective for about two-thirds of people who complete treatment, there are drawbacks.
* Behavior therapy involves facing your worst fears; many patients dropout before treatment is complete.
* Behavior therapy is hard work and requires completing homework in between sessions.
* Behavior therapy may not be that effective for people who experience primarily obsessions without compulsions.
* Behavior therapy can be expensive, although your insurance plan may cover all or part of the cost.
Cognitive Therapy: Opening Your Mind to New Possibilities
Cognitive therapy for OCD is based on the idea that distorted thoughts or cognitions cause and maintain harmful obsessions and compulsions. For example, although the majority of people report experiencing intrusive, and often bizarre, thoughts on a daily basis, if you have OCD you may over inflate the importance or danger associated with such thoughts. You may even believe that by having such thoughts, you increase the likelihood of the feared thought, event or action taking place or being true.
In another example, if you have OCD, you might dramatically overestimate the degree to which you are responsible for a catastrophic event taking place and feel you have to take actions to prevent it. For instance, you might experience an uncontrollable urge to count or order a particular object to prevent a plane crash. Of course, counting or ordering a particular object couldn’t possibly have any impact on whether a plane crashes or not. This illogical thought pattern is often called magical thinking.
Cognitive therapy involves examining these harmful thought patterns and coming up with plausible alternatives that are more realistic and less threatening. It is not uncommon for you to be unaware of some of the distortions that are present in your thinking and the therapist may help to point these out. Cognitive therapy often integrates elements of behavior therapy. For example, your therapist may have you test out some of the plausible alternatives you have come up with through exposure therapy.
Like ERP, cognitive therapy is usually done over the course of 15 to 20 sessions, although the cognitive therapy sessions are often shorter in duration, lasting 50 to 60 minutes. As with ERP, you are often asked to do homework, which usually comprises keeping a daily journal of your t