What are some non-chemical cures for OCD?

The best cure for OCD is actually a non-chemical cure. The method is called graded Exposure and Response Prevention (ERP). This therapy is a very specialized technique, developed 60 years ago, as part of Behavior Therapy. A book that describes the technique well is by Edna Foa who has researched OCD for many years. The book, called “Stop Obsessing”, is very specific in how to set up daily exercises whereby you learn to stop some of your small compulsions before moving on to the more difficult ones.

Many people claim that OCD can be treated with Cognitive-Behavior Therapy, (CBT). In reality CBT has little effect on OCD, unless it incorporates the ERP technique. So it is extremely important, if you seek out treatment, to make sure that the therapist is well practiced at using ERP.

OCD is the most crippling of the anxiety disorders, but at least 75% of the sufferers can escape from the torment with the ERP method. For the most severe cases where this method has failed, there are several excellent residences in the country where people can go for intensive treatment for this disorder.

In general, the best referral source for information about this disorder is the International OCD Foundation, (http://iocd.org). It also has a list of out-patient therapists, many of whom use the ERP technique.

There are no effective medicines are presently available for treating this disorder, although some can give temporary relief from the anxiety.

OCD, and other kinds of irrational fears, are becoming more understood as neuroscience explores the internal workings of the brain. The major problem appears to be that there is a mismatch between two learning mechanisms in the brain.

1. The first is a subcortical mechanism for handling threats. which works extremely quickly, usually referred to the Fight or Flight system. It functions by the most primitive of learning mechanisms, called Classical Conditioning.

2. And then we have a very sophisticated cortical mechanism for handling threats in the future, but it takes time to think. Here we can voluntary change our behavior to increase our chances of future rewards, and decrease our chances of failure. This elaborate system is referred to as Operant Conditioning .

In OCD, and in anxiety disorders , this more primitive brain has taken over too much control, and our intellectual cortex is at the mercy of many subcortical defense patterns. ERP is a counter-conditioning method, based on Classical Conditioning, where we can slowly teach the primitive brain to cool it, and let our sophisticated cortex make more rational decisions without the irrational fears.

Most people agree we should face our fears. So why do psychiatrists prescribe medicine to get rid of our fears?

Here’s my guess of why psychiatrists do what they do. Medication is the quickest way to block fear.

When a psychiatrist first meets a new patient suffering from acute stress, fear or anxiety, he or she is quite likely to prescribe fast-acting medications, such as Xanax or Klonopin. For most psychiatrists, this is the first line of defense for helping distressed people begin to gain some control over their emotional problems . They prescribe it because it works. The distressful feelings magically melt away, at least temporarily.

(It is recommended that these types of medications should be discontinued after two months, as longer use can result in chronic addiction).

At this point, the psychiatrist, if following protocol, will slowly taper the patient off the benzodiazepines, and probably switch to alternate medications such as a long -lasting antidepressant with less addictive qualities. If the second type of medication works, all well and good. Some patients can live comfortably on this second class of drugs for years. Many fail on the second medication, and so a third is tried, and so a fourth……

The problem with this approach is that medicines do not cure the uncomfortable emotion. They simply block it. If the medication is stopped, especially too quickly, there is emotional chaos, with most people experiencing more fear than they felt before they started the medication regimen. It is extremely important that you very gradually come off these medications, as any self-respecting psychiatrist is likely to emphasize. The slower the taper, the better.

So medications work well for about one-third of the people who try them. They are the lucky ones, as long as they never need to come off the medications, and as long as the medications continue to work.