Treating OCD

OCD is typically treated with medication, psychotherapy, or a combination of the two. Although most patients with OCD respond to treatment, some patients continue to experience symptoms.

Medication

Serotonin reuptake inhibitors (SRIs), which include selective serotonin reuptake inhibitors (SSRIs), are used to help reduce OCD symptoms. SRIs often require higher daily doses in the treatment of OCD than of depression and may take eight to 12 weeks to start working, but some patients experience more rapid improvement.

If symptoms do not improve with these types of medications, research shows that some patients may respond well to antipsychotic medication. Although research shows that an antipsychotic medication may help manage symptoms for people who have both OCD and a tic disorder, research on the effectiveness of antipsychotics to treat OCD is mixed.

Psychotherapy

Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, CBT and other related therapies (e.g., habit reversal training) can be as effective as medication for many individuals.

Exposure and Response Prevention

Research also shows that a type of CBT called exposure and response prevention is effective in reducing compulsive behaviors in OCD, even in people who did not respond well to SRI medication. In ERP, the patient first identifies the things that trigger obsessive thoughts, such as external situations like people, places, and thoughts. Therapists then examine the distress caused in those situations and what the feared outcome will be if they do not perform rituals to lower the distress. For example, a person may lock the door ten times after coming inside because they fear an intrusion. The patient will work with the clinician to discuss this fear, evaluate and rank its severity, and practice imagining ways to tolerate the distress. Eventually, the patient is exposed to the anxiety-provoking situation (keeping the doors unlocked) without performing a response and they learn strategies to cope with the distress.^[1] Ultimately, ERP means spending time in the very situation that triggers compulsions (e.g. touching dirty objects) but then being prevented from undertaking the usual resulting compulsion (e.g. handwashing).

As with most mental disorders, treatment is usually personalized and might begin with either medication or psychotherapy, or with a combination of both. For many patients, ERP is the add-on treatment of choice when SRIs or SSRIs medication does not effectively treat OCD symptoms or vice versa for individuals who begin treatment with psychotherapy.

Treating Hoarding Disorder

Cognitive-behavioral therapy (CBT) is a commonly implemented therapeutic intervention for compulsive hoarding. As part of cognitive behavior therapy, the therapist may help the patient to

• discover why they are compelled to hoard.
• learn to organize possessions in order to decide what to discard.
• develop decision-making skills.
• declutter the home during in-home visits by a therapist or professional organizer.
• gain and perform relaxation skills.
• attend family and/or group therapy.
• be open to trying psychiatric hospitalization if the hoarding is serious.
• have periodic visits and consultations to keep a healthy lifestyle.

CBT usually involves exposure and response prevention to situations that cause anxiety and cognitive restructuring of beliefs related to hoarding. Furthermore, research has also shown that certain CBT protocols have been more effective in treatment than others. CBT programs that specifically address the motivation of the sufferer, organization, acquiring new clutter, and removing current clutter from the home have shown promising results. CBT typically involves in-home work with a therapist combined with between-session homework, the completion of which is associated with better treatment outcomes. Research on internet-based CBT treatments for the disorder (where participants have access to educational resources, cognitive strategies, and chat groups) has also shown promising results both in terms of short- and long-term recovery.

Habit Reversal Training

Habit reversal training (HRT) has the highest rate of success in treating trichotillomania and other BFRRs. Habit reversal training (HRT) is a “multicomponent behavioral treatment package originally developed to address a wide variety of repetitive behavior disorders.”^[2] It consists of five components: awareness training, competing response training, contingency management, relaxation training, and generalization training. HRT has also been shown to be a successful adjunct to medication as a way to treat trichotillomania. With HRT, the individual is trained to learn to recognize their impulse to pull and also teach them to redirect this impulse. In comparisons of behavioral versus pharmacologic treatment, CBT (including HRT) has shown significant improvement over medication alone. HRT has also proven effective in treating children. Biofeedback, cognitive-behavioral methods, and hypnosis may improve symptoms. Acceptance and Commitment Therapy (ACT) is also demonstrating promise in trichotillomania treatment. A systematic review from 2012 found tentative evidence for “movement decoupling,” a self-help variant of HRT.^[3]