Because adversity is a non-negotiable fact of life and because people struggle with that in a variety of ways, my work over the past 22 years as a therapist has been focused on helping people find their individual path to peace, clarity, authenticity and strength. With practice and insight we can learn to be less driven by our fears, less reactive to our own thoughts as well as the actions of others. Through developing the ability to pause and think before we act, we can pay attention to all of the parts of us that want to be heard, make better decision and ultimately feel better about our lives.
Some good reasons to seek help include but are not limited to times when:
What Is CBT and E/RP?
CBT is a behavioral therapy, with cognitions, or thoughts, being the behavior to be changed. CBT stands for Cognitive Behavioral Therapy. Behavior therapy helps people learn to change their thoughts and feelings by first changing their behavior. Behavior therapy for OCD involves exposure and response prevention (E/RP).
Exposure is based on the fact that anxiety usually decreases after extensive contact with the feared object. For example, people with obsessions about germs are told to stay in contact with “germy” objects (e.g., turning doorknobs or door handles, using a pay phone or handling money) until their anxiety is extinguished. The person’s anxiety tends to decrease after repeated exposure until he or she no longer fears the contact.
For exposure to be of the most help, it is best to combine it with response or ritual prevention (RP). In RP, the person’s rituals or avoidance behaviors are blocked. For example, the client must not only stay in contact with “germy things,” but must also refrain from ritualized washing.
Exposure is generally more helpful in decreasing anxiety and obsessions, while response prevention is more helpful in decreasing compulsive behaviors. Despite years of struggling with OCD symptoms, many people have surprisingly little difficulty tolerating E/RP once they get started.
Cognitive therapy (CT) is the other component in CBT. CT is often added to E/RP to help reduce the catastrophic thinking and exaggerated sense of responsibility often seen in those with OCD. For example, a teenager with OCD may believe that his failure to remind his mother to wear a seat belt will cause her to die that day in a car accident. CT can help him challenge the faulty assumptions in this obsession.
Armed with this proof, he will be better able to engage in E/RP, for example, by not calling her at work to make sure she arrived safely.
Other techniques, such as thought stopping and distraction (suppressing or “switching off” OCD symptoms), satiation (prolonged listening to an obsession usually using a closed-loop audiotape), habit reversal (replacing an OCD ritual with a similar but non-OCD behavior), and contingency management (using rewards and costs as incentives for ritual prevention) may sometimes be helpful but are generally less effective than standard CBT.
Traditional psychotherapy, aimed at helping the patient develop insight into his or her problem, is generally not as helpful for OCD. However, a specific behavior therapy approach called “exposure and response prevention” is effective for many people with OCD. In this approach, the patient deliberately and voluntarily confronts the feared object or idea, either directly or by imagination. At the same time the patient is strongly encouraged to refrain from ritualizing, with support and structure provided by the therapist, and possibly by others whom the patient recruits for assistance. For example, a compulsive hand washer may be encouraged to touch an object believed to be contaminated, and then urged to avoid washing for several hours until the anxiety provoked has greatly decreased. Treatment then proceeds on a step-by-step basis, guided by the patient’s ability to tolerate the anxiety and control the rituals. As treatment progresses, most patients gradually experience less anxiety from the obsessive thoughts and are able to resist the compulsive urges.
Studies of behavior therapy for OCD have found it to be a successful treatment for the majority of patients who complete it. For the treatment to be successful, it is important that the therapist be fully trained to provide this specific form of therapy. It is also helpful for the patient to be highly motivated and have a positive, determined attitude.
The positive effects of behavior therapy endure once treatment has ended. A recent compilation of outcome studies indicated that, of more than 300 OCD patients who were treated by exposure and response prevention, an average of 76 percent still showed clinically significant relief from 3 months to 6 years after treatment (Foa & Kozak, 1996).
Another study has found that incorporating relapse-prevention components in the treatment program, including follow-up sessions after the intensive therapy, contributes to the maintenance of improvement (Hiss, Foa, and Kozak, 1994).
One study provides new evidence that cognitive-behavioral therapy may also prove effective for OCD. This variant of behavior therapy emphasizes changing the OCD sufferer’s beliefs and thinking patterns. Additional studies are required before the promise of cognitive-behavioral therapy can be adequately evaluated. The ongoing search for causes, together with research on treatment, promises to yield even more hope for people with OCD and their families.