Understanding Obsessive Compulsive Disorder - Part 2
This article follows Part 1, which focused on describing the OCD cycle, with a focus on obsessions about harm. Part 2 focuses on treatment.
As you may recall, in Part 1, we provided the specific example of an individual with OCD who had an obsessive thought about running over pedestrians while driving. This thought became so distressing and the compulsions so time-consuming that they eventually gave up driving altogether. We will use this example to describe how cognitive-behavioural therapy (CBT) is used to address OCD.
The compulsions that temporarily alleviate the anxiety keep the OCD cycle going
Cognitive-behavioural therapy (CBT) is focused on changing unhelpful thinking styles and behaviours, and is generally considered the most effective psychological intervention for OCD. As a first step in treatment for individuals with OCD, we provide education about the cycle of OCD, and come to a good understanding of the individual’s particular obsessions and compulsions.
Our treatment approach for OCD focuses on Exposure and Response Prevention (ERP). Essentially, the individual is exposed to the trigger for their anxious thoughts, and resists engaging in the compulsions. With repeated exposure to the trigger, the individual learns that they can tolerate the distress and uncertainty of not performing their compulsions, and that over time the anxiety decreases. They may also learn that the compulsions are not necessary to prevent harm.
We work through exposures gradually, with the client taking ownership for this process and the therapist acting as a guide. There may be a series of steps on the exposure ladder, starting with those situations that are less distressing (e.g., driving around an empty parking lot) to those that are more distressing (e.g., driving through a busy urban area with lots of pedestrians).
Exposure practice for OCD focused on fear of harming pedestrians while driving
In the case of someone who is afraid of running over pedestrians, driving over speed bumps may be something they avoid because this triggers the thought that they actually ran over a person. As part of their exposure practice, they may need to drive over speed bumps over and over again while resisting the urge to check their rearview mirror or to go back later and check. They eventually learn that their compulsions were not necessary to prevent them from harming a pedestrian. Over time, the OCD cycle is gradually broken.
How exposures work to decrease reliance on compulsions
The exposure and response prevention approach can be challenging, especially early on, but exposures are one of the most effective methods of overcoming frightening or upsetting obsessions. Indeed, CBT is considered a first line treatment for OCD with much research showing it is an effective treatment for this condition. We find that for people who are able to stick with it, they learn how to be their own therapist, and can address new obsessions or compulsions that pop up before they become really problematic. However, if you are wondering about alternatives, some individuals also find medication helpful either alone, or in addition to therapy. Others do not feel ready to tackle the OCD directly, but may find some supportive counselling or family counselling helpful in dealing with stressors associated with the OCD.
If you are interested in learning more about CBT for OCD, please contact Waterloo CBT Clinic at 226-686-0848.