Thursday, June 4, 2009

Obsessive-Compulsive Disorder Part 2: Breaking the Behavior Chain

In part one I discussed the need to diminish the connection between the strongly linked obsessive thought and the compulsory action. These elements of OCD and the strong bond between them are the essence of the client's discomfort. So addressing each element and their connection is the strategy to be deployed in treating the illness.

Refuting the irrational thoughts that solidify the obsession should be the first step taken in treating OCD. Pointing out the false beliefs that the repetitive behavior will significantly advance the client's well-being is one approach. Another is too point out how the wasted time dwelling on these thoughts interferes with other significant events in the person's life. These tenets will help motivate the client to take on the arduous task of breaking the association between the thought and the behavior.

When the compulsion to act is so overwhelming that something has to be done, the therapist should point out alternate behavior that approximates the compulsion to act. For instance, the use of alcohol wipes for hand washers vs going to the rest room and running their hands under the sink with soap and drying their hands. It saves time, satisfies the urge, is generally more socially acceptable and and is one gradual step that moves the client away from the fixed thought and action.

The last step should entail a technique that helps break the overall behavior chain. Systemic desensitization or graduated exposure therapy has been proven the most successful in treating OCD. With this technique a client is taught relaxation techniques (see my 3 part blog treating anxiety) to be used to quell anxiety when client is experiencing discomfort from not performing the desired act. A hierarchy of fears is created and one step at a time the client tries to distance the time between the obsessive thought and the compulsive action. Gradual exposure to the negative stimuli (i.e. germs and sweat on hands) is enacted while the client utilizes the newly mastered SRT to battle the associated anxiety.

The technique of flooding has also been proven successful in treating OCD. In this case, the client is exposed to the negative stimulus is a superficial and dramatic manner. A hand washer, for instance, may be asked to soil his hands with dirt for an extended period of time. This technique has been found more successful when used in tandem with an SSRI medicine.

The treatment of OCD is best approached as a method to break up the repetitive antecedents, behaviors and consequences that are linked together to form the unwanted repetitive thoughts and actions. The hope is that in time the strong urge to act on these thoughts will fade away, and the chain will be broken. The client can then live a normal, happier life, free of the distracting thoughts and the encumbering actions.