A note from Joanna…
As debilitating as OCD can be, there is hope for individuals who seek help.
Step One: Diagnosis
If you suspect you might have this disorder, the first step is to meet with an experienced physician or psychologist to get an accurate diagnosis. Many practitioners use an assessment called the The Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), which contains 54 common obsessions and compulsions and rates them according to a variety of criteria including the frequency and the amount of distress they cause.
Diagnosing OCD can sometimes be difficult, because symptoms are most often experienced internally and many individuals have limited insight as to the impact symptoms are having on their lives. They may also experience shame and embarrassment about the nature of their obsessions and compulsions and may be reluctant to share honestly and openly about them.
It can help to remember that a competent provider understands this reluctance and does not in any way see OCD and the content of obsessions or compulsions as a shameful thing.
Step Two: Treatment
Once a diagnosis is established, the next step is to pursue an effective treatment.
For OCD, the gold standard treatment includes medication + therapy. But exactly which medication and which therapy can be complicated.
There are some medications (mostly SSRI’s) that work well for people with OCD, but there can be some trial and error in figuring out the right one. It can take several weeks to see symptom improvement and adjunct medications may be needed.
For these reasons, it is very important to work with a psychiatrist or nurse practitioner who has experience diagnosing and treating OCD. It is also helpful to go into the process with a tremendous about of patience and perseverance. You will need to collaborate with your prescriber to determine the best medication regimen.
As for therapy, it is also very important to work with a therapist who understands and has experience treating OCD. The symptoms can be easy to miss and misunderstand — even for therapists — so doing some research ahead of time can save time and frustration.
The one therapy that consistently demonstrates symptom improvement is a type of cognitive behavior therapy called termed exposure and response prevention (ERP). According to authors affiliated with the OCD Program at Stanford Medicine, ERP is most effective for individuals who suffer from compulsions related to cleaning and checking.
Much easier said than done, ERP involves voluntarily exposing oneself to a feared trigger or situation, and then avoiding the compulsive activity associated with it.
Initially this can cause a significant amount of distress, but over time and with persistence, that distress will lessen until eventually new thinking patterns and behaviors emerge.
Many individuals are extremely reluctant to try ERP because of the fears associated with being exposed to their triggers (we call this the “fear of fear”).
To alleviate some of this fear, OCD sufferers may be interested in one emerging treatment for OCD called Eye Movement Desensitization and Reprocessing, or EMDR. (I will be writing in more detail about EMDR in a future post. In short, it is a therapy used to treat trauma and PTSD.)
EMDR is similar to ERP in that the person is “exposed” to the feared stimulus by being directed to think about the most disturbing aspect of the thought or image. The thought alone generally creates a significant amount of anxiety or distress for most people.
As the individual thinks about this and experiences the associated distress, they participate in what is called “bilateral stimulation” either through eye movements or holding a small set tappers in their hands.
If you’ve never heard of this, it sounds a little outlandish, I know, but it works. As the person holds the tappers or move their eyes, their distress eventually begins to dissipate. The person then becomes “desensitized” to the disturbing image or thought.
I have seen several of my clients experience almost immediate relief from specific intrusive thoughts with EMDR. Once the thoughts stop causing distress, the person is typically no longer driven to perform the associated compulsive behaviors.
On the other hand, I have found that EMDR is not as effective in reducing compulsions, especially if they are not directly connected to an intrusive thought — such as having to walk around your room three times before going to bed — but for no apparent reason. In this case, I would recommend traditional ERP and other medications.
EMDR can also be helpful in combination with ERP, especially if the individual has had previous trauma, or can connect a previous traumatic event to the onset of OCD.
Although there are few studies looking at the efficacy of EMDR with OCD, one study did find EMDR to be at least as effective as ERP, so it is definitely worth considering as a treatment.
I know this is a lot of information, so feel free to reach out to us if we can help you sort through it. I’ve also included a few helpful resources at the end of this post.
If you are in the Greenwood/Indianapolis, Indiana area and are interested in learning more about how the therapy process works, give us a call at 317-743-8202 or email [email protected]. Even if you’re not in the area and have questions, we would be glad to help if we can.
Resources for OCD:
The International OCD Foundation – The mission of the IOCDF is to ensure that no one affected by OCD and related disorders suffers alone. This is a community that provides help, healing, and hope.
Peace of Mind Foundation – A part of IOCDF, in addition to other services, provides resources and support for caregivers of individuals with OCD.
OCD Challenge – a website and app designed to give individuals the tools they need to successfully manage their OCD. An interactive experience allow individuals to customize the tools they need to help manage symptoms more effectively.
Overcoming Unwanted Intrusive Thoughts: A CBT-Based Guide to Getting Over Frightening, Obsessive, or Disturbing Thoughts, by Sally M. Winston and Martin N. Seif – a very helpful book with practical tools to manage intrusive thoughts.
Needing to Know for Sure: A CBT-Based Guide to Overcoming Compulsive Checking and Reassurance Seeking, by Sally M. Winston and Martin N. Seif – a very helpful book with practical tools to manage compulsive behaviors.
Brain Lock: Free Yourself from Obsessive-Compulsive Behavior, by Jeffrey M. Schwartz
References for this blog post:
https://med.stanford.edu/ocd/about.html
https://www.nimh.nih.gov/health/statistics/obsessive-compulsive-disorder-ocd
