Though it may be difficult to imagine a life without the daily anguish of OCD, it is an ideal worth pursuing. Powerful treatment is available to those who are willing to put in the time and energy necessary. Psychotherapy sessions 1 - 2 times weekly with a cognitive-behavioral psychologist will provide you with an understanding of the condition, and the tools to control it.
- Step 1: Assessment
- Step 2: Psychoeducation
- Step 3: Hierarchy
- Step 4: Planned and Unplanned Exposures
- Step 5: Coaching, Encouraging, and Collaboration
The Cognitive Behavioral Treatment - What's Involved?
Assessment of obsessions and compulsions is conducted with the help of the therapist. Patients keep track of their occurrence outside of sessions. Things to be looking for:
- Various triggers (Antecedents) for obsessive thoughts and compulsions/rituals. Be aware of the situations, settings, people, etc. that lead you to obsess and to become anxious. Evaluate how much of your day is spent monitoring the environment or thinking about your concerns. The OCD brain is on guard against its fears. How much of your day is that taking up?
- Behavior/Thoughts (Reaction): Thoughts and feelings when confronting OCD challenges. There are various types of rituals/compulsions that need to be identified. What are the risks associated with NOT following through with the ritual? What is your ability to postpone the ritual or delay solving the problem in your head? What is the level of distress associated with not engaging in a ritual/compulsion (not "undoing" or neutralizing the obsession)?
Psychoeducation: Teaching patients about the relationship between obsessions and compulsions - short term relief, long term problems. Pushing thoughts away, trying to solve the problems presented by an obsessive thought, and/or engaging in behavioral or mental compulsions make the problem worse!! Understanding the paradox of OCD will assist in taking the necessary steps to recovery.
Hierarchy: The hierarchy is a list of threatening situations, in order of the challenge that would be experienced in following through with the behavior. Patients will be able to pace themselves to progressively climb the hierarchy to the point where they are able to confront the most feared scenario. The hierarchy enables patient to see progress and can be applied to any type of OCD (e.g., hierarchy of behavioral challenges, bothersome thoughts, etc.).
Planned and unplanned exposure: Exposure exercises take place both during and in between psychotherapy sessions. This is probably the most important component in the treatment of OCD. Learning how to approach what was previously avoided or simply changing the response to a feared situation will allow patients to gain control of OCD and the anxiety that goes with it.
Coaching, Encouraging, and Collaboration: Treatment is a team effort. Assignments are agreed upon ahead of time and the pace is set by each patient. While there may be a frank discussion about the progress of therapy, some pushing or encouragement during difficult times or during actual exposure sessions, as well as coaching during and in-between sessions, a patient will never feel that they are "made" to do something.
- Adjustment To Treatment Plan: While it is important that treatment be structured and that efforts are made to plan ahead, there is no way to predict how people will respond to treatment. The therapy will always adjust to the individual needs of each patient.
- Getting Others Involved: Family members and friends can be both helpful and harmful to the progression of the disorder. Therapy often involves teaching the significant people in your life how to assist and how not to interfere with the progress of treatment.
- Never Give Up Completely: Progress may at times be slower than desired and symptoms may initially increase, but the situation will never be hopeless.
- Ongoing Stressors: Real life stressors can trigger an OCD flare up and can make recovery more difficult. Issues that arise will need to be discussed, but the emphasis will always return to the treatment of the OCD. When your anxiety is under better control, you will be able to manage life's ups and downs more easily.
- Medication: Though cognitive behavioral treatment for OCD is often enough for considerable progress, some people are unable to participate in the therapy without the assistance of medication. When this becomes apparent, collaboration with a psychiatrist is recommended.