It is often said that OCD, in one form or another, is a life-long condition. However, evidence shows that OCD can be treated so that in time the worrisome thoughts no longer have such a strong hold on a sufferer. This is a very important fact to bear in mind, especially when OCD is at its worst, when there are often very frightening feelings of hopelessness and fears that nothing can be done to relieve the anxiety. Here are the main treatments used for OCD.
The main recommended form of treatment for OCD is cognitive behaviour therapy (CBT). OCD sufferers tend to interpret their troublesome thoughts in negative, unrealistic and catastrophic ways, which lead to the strong urge to perform the compulsions. CBT offers a way out of this. The cognitive part of CBT, teaches a sufferer, e.g., that intrusive bad thoughts are a universal human experience, and it is the mistaken interpretation of these (normal) thoughts by the sufferer that has lead to their OCD. This helps a sufferer think about their worries in ways that are more realistic and compassionate. The behavioural part of CBT helps the sufferer retrain their mind to tolerate the anxiety and doubt. This may be done in a number of ways, such as seeking to refocus on more rewarding tasks, or by actively performing exposure tasks. The latter, sometimes called exposure and response prevention (ERP), encourages a sufferer to seek anxiety on purpose, but without performing compulsions. The aim is to allow their brain to get used to the anxiety so that it no longer troubles them (a processes called habituation). ERP requires the sufferer to confront their fears head-on, which is a very difficult task to do initially.
A good programme of CBT should be tailored to the specific fears and concerns of each sufferer. Excellent introductions to the use of CBT in the treatment of OCD are given in many publications on-line and in books. Please follow these links to books, organisations (e.g. OCD charities), and other internet resources for a wealth of further information on OCD.
Some people who have tried CBT may say that it didn't help them very much. If someone has told you that CBT didn't work for them or you have unsuccessfully tried it in the past, don't be put off trying (or trying again) - CBT has to be done properly to be of benefit. That means doing exposure tasks, feeling anxious, and not doing compulsions or safety behaviours. Anything else is not thought to be useful CBT, which may be a reason why CBT attempts may fail to help OCD in some people. Exposure tasks may be graded though so that the therapy starts with the easiest tasks and then become more and more anxiety provoking. The ultimate aim is to have exposure to the things that your own OCD finds most distressing. Don't beat yourself up though if you do find CBT too much for now. OCD is a horrible condition, and you can always try again when you are feeling ready.
If there is no pain, there is no gain: real CBT is difficult, but it is a means to escape OCD in the long run.
There are many ways that CBT can be done:
Sitting in a room face-to-face with a therapist, followed by homework tasks. This is the traditional way of conducting CBT.
Talking on the telephone with a therapist, followed by homework tasks.
Reading self-help books, followed by homework tasks.
Computerised CBT (CCBT), followed by homework tasks.
There are many routes to finding a CBT therapist:
Private practice. A list of accredited therapists in the UK is available via the British Association for Behavioural and Cognitive Psychotherapies. We have a special page on private therapists.
Community Mental Health Teams (CMHT). You may need to go through your GP to access these services. In Berkshire in the UK, a link to this service is here.
Improving Access to Psychological Therapies (IAPT). In Berkshire this is called Talking Therapies and you may ask your GP to refer you, or you may refer yourself.
An upcoming therapy that is sometimes used to treat a whole range of physical and mental illnesses, including OCD is mindfulness meditation. Mindfulness is a means of living wholly in the present moment without any reflection of the past or future and without making any judgements. While it has not yet been subject to formal clinical trials for the treatment of OCD (as we are aware), it is viewed with promise among leading psychologists.
It is common for a doctor to prescribe medication for OCD, which is a useful complement to psychological therapies. The medications most commonly prescribed are so-called selective serotonin reuptake inhibitors (SSRI). This is a family of drugs that includes Prozac and Seroxat (trade names for fluoxetine and paroxetine respectively), but there are many others available. There are other families of drugs available, but an SSRI is usually a doctor's first choice. SSRIs are probably best known as anti-depressants, but they also effective at combating OCD. Bear in mind that SSRI medication is unlikely to start helping immediately, and may take several weeks for its therapeutic effect to become evident. Often users report side effects that mostly wear off in time. SSRI medication on its own is unlikely to remove OCD symptoms completely, but could provide relieve to the point where therapy is easier and more effective. This link contains more information about medication.
Deep brain stimulation
This involves the implantation of electrodes in the brain - obviously a major and risky procedure. It is successful in some people with extreme refractory (treatment resistant) OCD. It is unlikely to remove OCD completely, but may allow someone with, e.g., extreme OCD to shift to moderate OCD symptoms.
If you believe that you are suffering with OCD, your first port of call is usually your general practitioner (GP) who will advise on the treatments that are available to you. Most GPs will be very sympathetic to OCD sufferers. If you are unlucky to find that your GP does not know about the condition, or is not eager to help immediately you should consider seeing another GP or refer your GP to the NICE guidelines that set-out what what you should expect from your GP. OCD is a genuine, frightening and disabling medical condition for which you are entitled to treatment. In any case, you may find it helpful to approach your GP with one of the OCD summary sheets produced by OCD charities in the UK for GPs. OCD Action's sheet is available via this page, and OCD-UK's sheet is available via this page. It is likely that you will be offered an SSRI medication to help you in the short-to-medium term and/or referral to psychological therapy (usually CBT) for longer term help. In the UK, expect a waiting list of a few months for access to NHS funded CBT. Private therapists are available, although the advice is to see someone who is competent with treating OCD as it sometimes requires an approach that is slightly different to those treatments for other conditions such as depression (see the"useful references" section of this site for link to the BABCP).