Treatment for the OCD Cycle: Evidence-Based Treatment and Therapy Options for OCD

Obsessive Compulsive Disorder (OCD) is a neurological and psychological disorder that affects roughly 1.2% of the population, including both adults and children. It causes those affected to experience anxiety-inducing, stressful obsessions about something bad happening, and they feel an urge to perform a certain behaviours or rituals to counteract this obsession which acts as a temporary relief from it.

This can be a very challenging pattern to overcome, whereby people may fall into a downward spiral of experiencing the obsessions, and then being forced by their thoughts to complete rituals. Often, the more this goes on, the more they confirm their own thinking loop that they will only feel slightly better if they complete this behaviour upon having this thought. The behaviours themselves are often be unpleasant and stressful. This is why it is so important for those with OCD to seek professional help.

In this blog, we will look at the various different options, including CBT, ERP and medication. We are a provider of specialist OCD psychological therapy, so this is drawn from research and experience.

Exposure Response Prevention (ERP) Treatment for OCD

ERP is a behaviourally-focused treatment, meaning it works on changing how people respond to their obsessions and compulsions. This is done by creating a hierarchy of what the person does or does not do in response to their OCD, and, at their pace, beginning to work up from least-to-most challenging.

ERP is based on the theory that anxiety settles on it own (called habituation): once it goes up, it can only naturally come down, even if we do absolutely nothing. Compulsions interrupt this, tricking the brain into thinking it is only safe if it does a compulsion: ERP seeks to reverse this.

The exposure aspect of ERP involves facing what happens if someone experienicng OCD does not complete their rituals or compulsions. They first think about the obsession and anxiety that usually causes them to do. The exposure aspect of this technique supports to experience their obsessions without performing the compulsions to see what happens. This will often be very scary and anxiety-inducing for them, however over time, it will rewire their thinking and brain connections to not fear or stress over not completing these compulsions. This can be conducted small step by small step, or all at once whereby they are exposed to their worst obsessions and fears at once (which is called flooding).

To paint the picture, here is an example. Tara used her oven to cook dinner before she goes out in the evening. She checks it is off before she leaves, and it is off. She is on her way to her destination when her mind (her OCD) is obsessing over the thought that her oven is still on, and feels the compulsion to come home and check it again. She feels suddenly very anxious about her oven being on. However, using her ERP techniques, she consciously decides not to come back, and although for this period she feels very anxious, after 20 minutes she is able to neutralise her anxiety and rationally decide that she did check and it is likely off.

Over time and with support, she is able to address multiple compulsions using this approach, such that she does not feel an anxiously-driven need to respond to any intrusive thoughts.

Cognitive Behavioural Therapy (CBT) for OCD

Cognitive Behavioural Therapy (CBT) is a well-known, researched, and used method of treatment for many mental health conditions. It is a talking therapy that works to equip the patient with the necessary skills to overcome your patterns of thinking, feeling and behaving and to cope with future triggers by themselves.

In OCD therapy, CBT for OCD incorporates ERP, but adds a focus on understanding and addressing the way people think and feel alongside addressing their behaviours.

CBT considers their negative thought patters that lead to their problem, and works to undo them and replace them with more helpful and balanced thinking patterns. This means when they encounter a situation that may have previously been somewhat triggering of the problem, they are able to cope with it in a much healthier way. They work closely and collaboratively with their therapist to figure out what needs to be worked on, and the approach they will take to do so. It is used for a wide range of mental health conditions, such as anxiety, depression, ADHD, PTSD, and of course OCD.

In CBT for OCD, there is a focus on understanding why obsessions come to be. This is often due to intrusive thoughts - random, disturbing or unusual, out-of-character thoughts - becoming deemed to be important, meaningful and reflecting something about the person having them. For example, in the case of taboo intrusions, someone having a thought that is contrary to their values, morals or cultural norms might think 'this means I might believe this' or 'this is unacceptable'. This might make them feel guilty, anxious, fearful or ashamed. They might then be driven to block out, remove or swap this thought for something more acceptable.

The same goes for contimation intrusions, harm-based intrusions or violence-based intrusions, where the mind believes that the thought is likely to come true, reflects reality, or is somehow the individual's responsibility.

CBT for OCD therefore looks into how the person thinks about their thinking, and how they behave as a result. Through supportive experiments and education, thoughts can become less meaningful, scary and impactful, making more space for life outside of OCD.

Medication Treatment for OCD

Usually, only if therapies don’t work (or work well enough) will medication become the best option for someone struggling with OCD. Typically, someone with OCD will be prescribed selective serotonin reuptake inhibitors, also known as SSRIs. These are a form of antidepressant that work on altering the mechanisms of certain functions in the brain. As the name would indicate, SSRIs will increase the serotonin levels. Serotonin is a chemical neurotransmitter which has different functions including regulating mood and sleep. SSRIs also block the reabsorption of serotonin into the neurons (brain cells) after the serotonin signal has been sent, so that the levels remain higher and there is more in the synapses to strengthen the signal and have an effect. Usually, after a signal has been sent, the neurons will such up the serotonin that is left over and this mechanism is called reuptake. This is why they are called selective (they target only serotonin and no other neurotransmitter) serotonin reuptake inhibitors.

There are various reasons why talking therapies are recommended over medications if someone if just starting to seek help for their OCD. One of the reasons is because therapy tackles the root issue, and aims to rewire the brain permanently so their thought process no longer follows that of an OCD thought process. This will eliminate their symptoms. However, medication doesn’t tackle the root issue. Although it may work faster in some people (but it might take up to 12 weeks still), it doesn’t teach skills or alter faulty thought patterns and behaviours. It also has numerous side affects, such as sickness, dizziness, insomnia, headaches, and can be risky if they are pregnant. For more information from the NHS on these treatments, click here.

We hope this blog has helped you learn about different treatment and therapy options for OCD. Please remember, if you are experiencing distressing OCD symptoms, it is important for you to reach out. Talk to a friend, family member, colleague, or anyone you trust because if you are struggling, telling someone is the best thing you can do for yourself and those around you.

If you are seeking specialist assessment and treatment, we provide specialist OCD psychological therapy using both CBT and ERP, by qualified clinical psychologists and CBT practitioners.