Working with Obsessive Compulsive Disorder
The focus of the session will be cognitive behavioural therapy. The principal aim of this therapeutic approach is to enable the person to become their own therapist and to provide them with the knowledge and tools to continue working towards complete recovery from OCD. What therapy will teach someone with OCD is that it's not the thoughts themselves that are the problem but how you respond to them which is the key to recovery.
In other words it is not the thoughts themselves that are the focus of the treatment, it's what we make of those thoughts in the first place.
Cognitive Behaviour Therapy uses two techniques, Cognitive therapy which looks at how we think and Behavioural therapy which looks at how this thinking affects what we do. Exposure and Response Prevention therapy (ERP) is used as part of the behavioural approach to help explore alternative ways to respond to the obsessional thoughts or doubts. The aim of CBT is not about learning not to have these thoughts in the first place as intrusive thoughts cannot be avoided. Instead it's about helping a person with OCD to identify and modify their patterns of thoughts that cause anxiety , distress and compulsive behaviours.
More about ERP
ERP uses controlled, gradual exposures to the situations that trigger a person’s obsessions and compulsions. Over time, the person learns to respond differently to these triggers, leading to a decrease in the frequency of compulsions and the intensity of obsessions. OCD symptoms often become so mild that they’re easily ignored; sometimes they disappear. This type of therapy deliberately creates anxiety for the purpose of getting better, but at a level the person is ready to tolerate.
It takes courage to begin ERP, but people can find that exposures aren’t as difficult as they had imagined. And as their fears fade and they experience success, they get a boost in confidence that motivates them to continue with more difficult exposures.
The first step in ERP is for the person to provide the therapist with a detailed description of his or her obsessions and compulsions. A list is then formed in which symptoms are ranked from the least bothersome to the most difficult. Beginning with one of the easier symptoms, the therapist designs “exposures” or challenges that put the individual in situations that trigger obsessions. The person then avoids performing compulsive behaviors (“response prevention”) for increasingly longer periods of time. Through repeated exposures, individuals with OCD can realise that anxiety increases temporarily, peaks and then decreases — without performing compulsions.
In cases where creating the actual situation that triggers a compulsion is impossible, therapists can use imagined exposures, visualizations and recordings that can effectively increase anxiety levels for ERP exercises. When therapeutic exposures are repeated over time, the associated anxiety shrinks until it is barely noticeable or actually fades entirely. The person then takes on more challenging exposures from the list until they, too, become manageable.
Effective ERP leads to “habituation,” which means that anxiety will eventually go down without doing anything but letting time pass. Imagining life with more free time and without crippling anxiety helps many people with OCD stay motivated to stick with ERP until the end of treatment. Following therapy, people can look forward to returning to work or finding a better job, restarting an active social life, or taking up new hobbies to fill the hours that used to be consumed by obsessions and compulsions.