Obsessive Compulsive Disorder Treatment (OCD)

Obsessive compulsive disorder (OCD) is a mental disorder of immense impact. Individuals with OCD are desperate for a treatment that relieves even a portion of their obsessions and compulsive behaviors. Continue reading to learn how medications, psychotherapy, brain stimulation, and lifestyle changes are effective obsessive compulsive disorder treatments.

What is Obsessive Compulsive Disorder (OCD)?

Obsessive compulsive disorder, also known as OCD, is a mental disorder characterized by unwanted thoughts (obsessions) that provoke immense anxiety. The negative emotional state from obsessions is frequently relieved by the strong urge to repeat a behavior (compulsions). Some individuals with OCD have obsessions and compulsions, while others have both.

Children and adults can develop OCD. The disorder is often portrayed as people who have perfectionistic tendencies that involve repetitive cleaning or arranging objects in certain order. However, the disorder manifests in many ways. For a mental health professional to diagnose OCD, symptoms must occur most days for at least two weeks.

Symptoms of Obsessive Compulsive Disorder

OCD is characterized by obsessive thoughts that are temporarily relieved by behaviors known as compulsions. Individuals with OCD experience high levels of anxiety when they attempt to suppress their obsessive thoughts. This eventually leads to compulsive behaviors or repetitive behaviors to relieve the anxiety.

An example which supports the thought process in OCD: “If I don’t wash my hands, I will become sick and die.” In this case, “I will become sick and die” is the obsessive thought, and excessive hand washing relieves the anxiety that accompanies the fearful thought.

Common obsessions are:

• Fear of contamination or germs
• Fear of harming oneself or others
• Fear of acting impulsively
• Unwanted thoughts about sex or religion
• Having objects or items in order

Likewise, common compulsions that relieve the obsessions include:

• Excessive handwashing, showering, or disinfecting
• Repeating certain thoughts aloud
• Rechecking things (alarm clocks, locks on the door, the stove, etc.)
• Reorganizing objects

Obsessive Compulsive Disorder (OCD) Treatment: Psychotherapy and Exposure and Response Prevention

Cognitive behavioral therapy is a type of psychotherapy in which a trained therapist helps someone identify problematic thoughts and beliefs that lead to unwanted behavior. This is the therapy that is often applied in cases of OCD.

Exposure and Response Prevention is a subcategory of cognitive behavioral therapy is the most effective therapy for OCD. While guided by a therapist, the patient is exposed to thoughts, images, or objects that are known to trigger their obsessions and compulsive behaviors. Exposure to known triggers is a huge cause of anxiety. The patient with OCD would normally engage in compulsive behaviors to eliminate that anxiety, but through Exposure and Response Therapy, the therapist prevents the patient from partaking in their compulsions. Over time, the there is a significant decrease in overall anxiety levels, and the patient eventually learns to control their behaviors in real-life situations when the therapist is not present. The drop in anxiety is called habituation.

Obsessive Compulsive Disorder (OCD) Treatment: Antidepressants

Medication is an effective treatment for OCD. According to the International OCD Foundation, 7 out of 10 people with OCD will demonstrate up to 60 percent improvement in symptoms from either Exposure Response Therapy or medication.

A class of antidepressants known as selective serotonin reuptake inhibitor (SSRIs) are the first medication treatments prescribed for patients with OCD. Antidepressants work by increasing the amount of serotonin in the brain. Serotonin is a neurotransmitter—a chemical in the brain used to send messages between nerve cells. It is responsible for regulating mood, emotions, and even digestion. Although low amounts of serotonin have not been proven in OCD patients, and experts are unsure about the reasoning behind the effectiveness, antidepressants reduce OCD symptoms in many.

Obsessive Compulsive Disorder (OCD) Treatment: Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation targets parts of the brain that are involved in the symptoms of OCD. The treatment is most effective when completed for 20-minutes five days per week for six weeks. The device sends magnetic waves to the brain through a coil. These magnetic waves are delivered directly to the anterior cingulate cortex and medial prefrontal cortex.

Transcranial magnetic stimulation is for patients who have not seen benefits from medication or Exposure and Response Prevention. However, transcranial magnetic stimulation has the best results when it is combined with other therapies.

Obsessive Compulsive Disorder (OCD) Treatment: Deep Brain Stimulation (DBS)

Deep brain stimulation is similar to transcranial magnetic stimulation in the sense that they both deliver electricity to the brain. Deep brain stimulation, however, is more invasive because the device can only be implanted during surgery. Electrodes are placed in the targeted areas of the brain, and wires leading to a device are under the skin below the collarbone. The physician can activate the device and change the settings via a hand wand. Deep brain stimulation originated in the 1980s and is a treatment for Parkinson’s disease.

Obsessive Compulsive Disorder (OCD) Treatment: Residential Treatment Programs

Residential treatment programs offer inpatient programs to combat OCD. Patients remain at a facility for days to months where they have access to intensive therapy. These programs are best suited for those who are a danger to themselves or others. In the program, they receive 24-hour care from a team of physicians, psychologists, social workers, and nurses. There they can easily implement a combined regimen of medication and cognitive behavioral therapy. Studies investigating the success of residential treatment programs show that 72 percent of patients experienced OCD recovery (Hansen).

Obsessive Compulsive Disorder (OCD) Treatment: Group Therapy

While individual cognitive behavioral therapy is effective for OCD, so group therapy! Group therapy is a safe, cost-effective therapy where groups of people suffering from similar life struggles can undergo the therapy process together. One of the befits of group therapy is increased social support. Patients are more apt to attend therapy when they do not feel alone in their disorder. The encouragement from others is also motivation to continue therapy.  

Obsessive Compulsive Disorder (OCD) Treatment: Education

Education is essential to recovering from OCD. Through education, patients learn about their disorder. It is the ideal opportunity to debunk any misconceptions about OCD, as well as to establish self-help techniques to ease their anxiety. Education is also useful for the families of someone with OCD. Families and caregivers are given the resources on how to assist their loved one through their diagnosis. OCD education is obtained through a trained psychologist or physician. Various mental health organizations provide education too.   

Obsessive Compulsive Disorder (OCD) Treatment: Lifestyle Changes

Aside from various medications and therapies, lifestyle changes are an ideal adjunct to OCD treatment. Lifestyle changes are great because the patient can address them both in and out of therapy.

Stress Management

Having a mental disorder increases the likelihood someone copes with stress in unhealthy ways (i.e., using alcohol or drugs, isolation, blame, etc.). Unfortunately, poor coping skills worsens OCD. Finding appropriate coping mechanisms lessens the chance of an exacerbation during stressful situations. For example:

• Meditation
• Social support
• Sleeping 8 hours per night
• Form a routine
• Participate in treatment regimens

Set Realistic Goals

Patients with OCD should set realistic goals. Firstly, the goal must be specific. It also needs to be measurable. A large goal is often intimidating, so breaking a large goal into a set of smaller goals is achievable. It allows someone to focus on one goal at a time as to not become overwhelmed.

Participate in Hobbies

Hobbies are an excellent outlet for distraction when OCD symptoms are prevalent. Participating in an enjoyable activity is enhances one’s wellbeing. However, it is important the person with OCD confronts their anxiety first. The relief of distraction is not long lasting if the stressor is not managed.  

Diet and Exercise

Poor diet and a lack of exercise does not cause OCD, but a healthy lifestyle can improve OCD symptoms. A diet which includes serotonin boosting foods is key. Experts recommend foods in tryptophan—an amino acid that regulates serotonin production. Foods high in tryptophan are eggs, turkey, beans, nuts, seeds, dark chocolate and whole grains. Further, vitamin D, vitamin B12, omega-3s, beta-carotene, and vitamin C are known to reduce anxiety. Fruits, vegetables, and fish are important foods to incorporate for those vital nutrients.

There is a relatively new theory that OCD is correlated with hypoglycemia or low blood sugar due to insulin signaling from the nervous system. Researchers suggest consuming a diet that keeps blood sugar levels balance and is less likely to lead to insulin resistance and diabetes (van de Vondervoort, 2019).  

References

Hansen B, Kvale G, Hagen K, Havnen A, Öst LG. The Bergen 4-day treatment for OCD: four years follow-up of concentrated ERP in a clinical mental health setting. Cogn Behav Ther. 2019;48(2):89-105. doi:10.1080/16506073.2018.1478447

van de Vondervoort, I., Amiri, H., Bruchhage, M., Oomen, C. A., Rustogi, N., Cooper, J. D., van Asten, J., Heerschap, A., Bahn, S., Williams, S., Buitelaar, J. K., Poelmans, G., & Glennon, J. C. (2019). Converging evidence points towards a role of insulin signaling in regulating compulsive behavior. Translational psychiatry, 9(1), 225. https://doi.org/10.1038/s41398-019-0559-6

Cheyanne Perry

Cheyanne is currently studying psychology at North Greenville University. As an avid patient advocate living with Ehlers Danlos Syndrome, she is interested in the biological processes that connect physical illness and mental health. In her spare time, she enjoys immersing herself in a good book, creating for her Etsy shop, or writing for her own blog.