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.
Showing posts with label Obsessive-Compulsive Disorder. Show all posts
Showing posts with label Obsessive-Compulsive Disorder. Show all posts
Thursday, June 4, 2009
Sunday, April 19, 2009
Obsessive-Compulsive Disorder Part One: The Do Do Do, The Da Da Da
OCD is a very common diagnosis. It is extremely debilitating and interferes profoundly with relationships, accomplishments and personal happiness. It manifests itself with 2 profound elements. First is the obsessive, irrational thought. There is a perceived danger in the personal environment and it is magnified in the mind to the point that one can think of nothing else. These repetitive thoughts are cause for a compulsion to do something about that perceived danger and to act on removing or altering the magnitude of that danger and alleviating fear. When the urge to perform that task is insurmountable, it creates tremendous discomfort and interferes with important daily functions that must be performed to maintain one's well-being. These urges can be categorized into types. Some frequent recognized categories are Washers (obsessed with cleanliness), Checkers (consistently check on things they associate with danger), Counters (seek order, evenness and symmetry), Sinners (believe there will be severe consequences for a past action and seek to undue it), and Hoarders (take survivalist behavior to an irrational extreme).
OCD is commonly co morbid with other diagnoses. It is frequently diagnosed with depression and the inability to satisfy the compulsion feeds into the other hopeless feelings that fuel a low mood. It is also associated with other mood disorders, such as Bipolar and PTSD. In the case of ADHD, attention enhancing medicines are often cause for people to form "loops of thought," and a repetition of ideas that often lead to repetitive actions. Pharmacologically treated ADHD can often help manifest compulsive behavior as a side effect. Psychiatrists will commonly address this effect by prescribing an SSRI/antidepressant along with the attention enhancing drug. This patchwork approach is limited in its effectiveness.
Treatment of this illness focuses on interrupting the chain of thoughts and behavior associated with the idea and the action. It is generally conceded that the compulsive thoughts will exist at some level, but the OCD client can find ways to diminish the intensity of that thought and seek secondary cognitions and behaviors that diminish the urge to wash, go back, doubt or stack up. What helps reinforce the intensity of the obsession and compulsion is that it is positively reinforced. The hand washer does not catch the disease after repeated washing and the checker does not have his house broken into. The therapist is effective in supporting and validating the client's fears initially, but diminishing the intensity of those fears and helping the client find less intrusive behaviors to satisfy his now less intense fears. The hope is to find a new and viable chain of behavior. The compulsion to "do" will become the more comfortable, socially acceptable and less debilitating "da." Once the client is able to experience the contingency between the tone-downed thought and the less-profound action, this will be reinforced to the point that the old extreme thoughts and behaviors will fade away.
I am optimistically simplifying the course of treatment as described above. Alternative behaviors that are satisfying to the client are difficult to find and require allot of probing and problem solving with the therapist. OCD behaviors are often ingrained over a long period of time and are difficult to shake. In the next section I will get more specific about the treatment approaches that are taken to cure this illness.
OCD is commonly co morbid with other diagnoses. It is frequently diagnosed with depression and the inability to satisfy the compulsion feeds into the other hopeless feelings that fuel a low mood. It is also associated with other mood disorders, such as Bipolar and PTSD. In the case of ADHD, attention enhancing medicines are often cause for people to form "loops of thought," and a repetition of ideas that often lead to repetitive actions. Pharmacologically treated ADHD can often help manifest compulsive behavior as a side effect. Psychiatrists will commonly address this effect by prescribing an SSRI/antidepressant along with the attention enhancing drug. This patchwork approach is limited in its effectiveness.
Treatment of this illness focuses on interrupting the chain of thoughts and behavior associated with the idea and the action. It is generally conceded that the compulsive thoughts will exist at some level, but the OCD client can find ways to diminish the intensity of that thought and seek secondary cognitions and behaviors that diminish the urge to wash, go back, doubt or stack up. What helps reinforce the intensity of the obsession and compulsion is that it is positively reinforced. The hand washer does not catch the disease after repeated washing and the checker does not have his house broken into. The therapist is effective in supporting and validating the client's fears initially, but diminishing the intensity of those fears and helping the client find less intrusive behaviors to satisfy his now less intense fears. The hope is to find a new and viable chain of behavior. The compulsion to "do" will become the more comfortable, socially acceptable and less debilitating "da." Once the client is able to experience the contingency between the tone-downed thought and the less-profound action, this will be reinforced to the point that the old extreme thoughts and behaviors will fade away.
I am optimistically simplifying the course of treatment as described above. Alternative behaviors that are satisfying to the client are difficult to find and require allot of probing and problem solving with the therapist. OCD behaviors are often ingrained over a long period of time and are difficult to shake. In the next section I will get more specific about the treatment approaches that are taken to cure this illness.
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