Treatment options for OCD
75Diagnosis: DSM: OCD is a very serious disorder and can be extremely disabling. The World Health Organization ranks OCD in the top 20 most disabling conditions, and it is estimated that 1-2% of people have OCD worldwide. Obsessive Compulsive Disorder (OCD) is characterized by someone having uncontrollable obsessions that come in the form of thoughts, and/or compulsions which come in the form of behaviors and are often a response to obsessive thoughts. As noted in the Encyclopedia Britannica, “Obsessions are accompanied by compulsions in approximately 80 percent of cases” (2010). According to the most recent version of the DSM, for someone to be diagnosed with OCD, they must have recurrent obsessions or compulsions, a recognition that these thoughts and actions are both unreasonable and excessive, and that extensive distress and impairment is caused by these symptoms for at least one hour per day. In most cases, OCD will develop by early adulthood and the condition is indiscriminate towards race or gender. It is probably impossible to pinpoint exact causes of the disorder; although, certain biological connections can be made. For example, many people with OCD have decreased levels of the neurotransmitter serotonin and have an increased level of activity in certain brain regions, such as the orbitofrontal cortex and the caudate nuclei.
Behavioral Model: This model focuses on the behavior people exhibit in response to their environment. The model explores ways people learn when exposed to different stimuli and rewards. The three main ways this is accomplished is through modeling, classical conditioning, and operant conditioning. In modeling, people learn through observing and imitating others. During classical conditioning, people learn through associating two events that occur close together until they fuse in a person’s mind and cause the same response even when presented without the other associated event. Operant conditioning takes place when someone is rewarded for something and is thereby more likely to repeat that satisfying act.
The goal of behavioral therapies is to eliminate behaviors that are causing problems and replace them with behaviors that are conducive for the society they are living in. The most widely used technique in this model is exposure therapies which are often performed through systematic desensitization. This treatment teaches clients to relax and eventually face the objects or situations that cause fear or anxiety for them. It is a step by step process and it has been effective for treating phobias.
The most successful approach to control OCD compulsions is through exposure and response prevention therapy. In this therapy, clients are exposed to their compulsions and are prevented from responding to them. It is important to note that this therapy is effective more so for those with compulsions rather than obsessions. Consequently, there will be scenarios where it is impossible to use this technique. For example, if someone is having thoughts about killing someone, this therapy cannot be carried out for obvious reasons.
Cognitive Model: The cognitive model attributes abnormal functioning to errors in thinking. Proponents of this model believe that when people make assumptions and have attitudes that are inaccurate, problems in functioning are possible and a psychological disorder may eventually develop. Moreover, illogical thinking processes are the leading cause for the disorder one may be suffering from and faulty thinking must be corrected for the client to overcome their problem(s). As a result, it is imperative that clients develop rational thought processes. The most common form of therapy is Aaron Beck’s cognitive therapy where the goal is to challenge the accuracy of the client’s thoughts in hopes that the client will recognize their maladaptive thinking patterns.
With OCD, clients have thoughts that eventually turn into obsessions. These obsessions are usually what cause the compulsions. To begin therapy using this model, a therapist would likely say something along the lines of, “everyone has unwanted thoughts at one point or another and no one is a bad person for having thoughts alone.” The main goal would be making clear to the client their flaws in thinking. Over time, the hope is that the client will eventually begin to change their thinking to a more rational line of thought and their obsessions should subside.
Biological Model: Biological psychologists believe that abnormal functioning can be explained by the malfunctioning of chemical and electrical processes throughout the brain and body. The brain has billions of neurons and these neurons communicate with each other through neurotransmitters. Neurotransmitters are stimulated when an electrical impulse reaches a neuron’s ending that then travels across the synapse (a tiny space between each neuron) to the neighboring neuron. There are several different types of neurotransmitters and each is responsible for something different. The abnormal functioning of any one of them has the potential to be linked to a specific disorder. For example, low levels of the neurotransmitter serotonin have been linked to depression, as well as several other disorders. While neurotransmitters play an important role, any malfunction in any part of the brain or body can have significant consequences on one’s mental health.
Ways to treat patients with biological abnormalities include drug therapy, electroconvulsive therapy, and psychosurgery. The latter two of the three are only used in extreme conditions when all other forms of therapy have failed. The primary source for biological therapy is through the use of psychotropic medications. There are numerous types of drugs that are aimed at specific areas of functions in the brain. To cite some of them, there are anti-anxiety drugs to reduce tension, antidepressants to reduce symptoms of depression, and antipsychotic drugs to reduce symptoms associated with psychotic disorders like schizophrenia.
Patients who have OCD have been found to have low levels of serotonin and increased activity in the brain regions called the orbitofrontal cortex and caudate nuclei. The orbitofrontal cortex is located directly above each eye and has been linked to primitive impulses that are often connected to aggression and sex. The caudate nuclei process this information into thoughts and actions. If these thoughts and actions become powerful enough, they may reach the thalamus which may turn these thoughts into actions.
Seeing that people with OCD tend to have low levels of serotonin and are depressed, it is logical that anti-depressant drugs that target serotonin levels would be helpful. It is imperative that the drug specifically targets serotonin levels. Increasing levels of serotonin have been shown to help regulate activity in the orbitofrontal cortex and the caudate nuclei regions of the brain.
Fortunately, scientific studies have shown that these types of anti-depressant drugs help between 50-80 percent of people they are prescribed to with OCD. Patients will eventually experience a reduction in symptoms by up to half after their first eight weeks of use. The only drawback is that patients tend to have a relapse of symptoms when they stop taking the drug. According to the Encyclopedia Britannica, Prozac has “been found to markedly reduce the symptoms in about 60 percent of cases and have thus become the treatment of choice” (2010).
Conclusion:The best therapy for OCD would be Cognitive-Behavioral Therapy, coupled with prescribing an anti-depressant drug.The anti-depressant drug would have to raise levels of serotonin to be effective for treating OCD.Like many other disorders, an eclectic approach that encompasses as many aspects of the disorder as currently possible is best.This strategy for therapy would first treat the obsessions people with OCD have and explain to the client how these thoughts that turn into obsessions are irrational.Thereafter, controlling the compulsions would be done through the behavioral part of therapy using the exposure and response prevention technique.Since the obsessions usually cause the compulsions, the cognitive aspect of therapy makes the behavioral part of therapy easier to treat.During this process, prescribing an anti-depressant drug to elevate serotonin levels which would then work towards normalizing activity in the orbitofrontal cortex and caudate nuclei would be helpful.Using only one therapy would be better than no treatment at all; however, using this approach covers more aspects of the disorder and therefore helps more people who suffer from it.
