Treatments for Obsessive-Compulsive Disorder (OCD)
Our Program provides a range of evidence-based psychotherapeutic and pharmacological treatments tailored to the specific needs of each patient and their family.
Psychotherapy for OCD
The basis of our psychotherapeutic care is cognitive-behavioral therapy (CBT), with exposure and response prevention (ERP) at the core of many of our treatments. CBT is a type of therapy that focuses on the interplay between thoughts, feelings, and behaviors. ERP (a type of CBT technique) is the gold standard treatment used for OCD. This treatment does not focus on the meaning of the obsessions; rather it targets the thinking process. The OCD thinking pattern can be described as the following: one gets an intrusive thought, image, or impulse, which is accompanied by discomfort and/or anxiety. To relieve the painful emotion, a person engages in either a ritual or avoidance. This pattern works in the short run, but in the long run it only serves to strengthen the OCD.
In the past, many therapists told their patients “to just stop thinking about it,” but that strategy only leads to more obsessive thinking and compulsive behavior. ERP is the exact opposite of “thought stopping,” which is why it works. This technique involves confronting one’s fears without performing rituals. Following repeated exposures, the link weakens between obsessions and anxiety through a process called habituation. Habituation occurs when one stays in an anxiety-producing situation long enough for the anxiety to eventually reduce on its own. However, the process only works if one does not engage in any type of rituals or reassurance-seeking behaviors. As it may sound, this is the difficult part of treatment, which is why our Program augments the exposure and response prevention with the most cutting-edge techniques to help people face their fears.
Mindfulness/acceptance based techniques, writing scripts, imaginable exposure, motivational techniques, and cognitive therapy are all techniques that our program uses to enhance ERP. It is our mission to provide the most comprehensive care for our patients, and to tailor the treatment to the specific needs of each patient. We will combine techniques as needed to ensure that the OCD is being treated in the most effective way.
The frequency of our psychotherapy sessions ranges from one to four meeting per week with length of sessions ranging from 45-75 minutes. Sessions are held in our clinical offices or outside the office, as indicated. Our team also offers home visits as a part of our treatment services.
Medications for OCD
The medications that consistently work in the treatment of OCD are antidepressants (SRIs) that interact with the brain chemical serotonin. Serotonin is one of the brain's many chemical messengers (neurotransmitters) that allow nerve cells (neurons) to communicate with each other. SRIs, like clomipramine (Anafranil®), block the serotonin pump in neurons and increase the availability of serotonin where neurons meet (synapse). In addition to clomipramine, several selective serotonin reuptake inhibitors (SSRIs) have also proven effective in treating OCD, including fluvoxamine (Luvox®), fluoxetine (Prozac®), sertraline (Zoloft®), and paroxetine (Paxil®). Other SRIs have been found to be effective in treating OCD, as well as the addition of other medications to augment the effects of SRIs.
Deep Brain Stimulation (DBS) for OCD
For patients with intractable, treatment-resistant OCD, the FDA has provided a humanitarian device exemption (FDE) as of January 2010 for treatment with Deep Brain Stimulation (DBS). DBS is a neurosurgical technique, already approved and effective for the treatment of Parkinson’s disease, tremors and dystonia, that involves the implantation and stimulation of electrodes in brain regions known to be involved in these disorders. Studies have demonstrated that placement in and stimulation of the ventral striatum (an area of the brain implicated in the pathophysiology of OCD) can reduce the frequency and severity of OCD symptoms. DBS is available at our program but is only an option for patients who have failed multiple SRI trials, including the addition of other medications (augmentation), as well as CBT.