Tag: OCD

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How do I overcome OCD?

In overcoming OCD, the use of Exposure and Response Prevention (ERP) is absolutely essential. But CBT is often mentioned as the treatment of choice. So, what is the difference? Let me explain:.

  • Behavior Therapy, BT, starting using ERP in the late 1950s, and was the first treatment that showed consistent success for OCD.
  • Cognitive Therapy, CT, worked well with Depression, but initially showed poor results in treating Anxiety Disorders.
  • Cognitive Behavior Therapy, CBT was born when the CT therapists added the BT technique of ERP to their regimen.
  • Studies show that BT and CBT work equally for treating OCD,
  • So there is little evidence that the Cognitive part of CBT is needed.

Even Aaron Beck, the “father” of CT and CBT, emphasizes the importance of using ERP when treating OCD. In his book, “Cognitive Therapy for Anxiety Disorders” he states:

….exposure is perhaps the most powerful behavioral intervention for fear reduction. Whenever possible, employ this therapeutic tool in the treatment of anxiety disorders. p. 247

Cognitive interventions should be introduced in the early sessions with with frequent and intense exposure-based behavioral exercises employed throughout the course of the treatment. p. 486

Clients should engage in daily exposure between sessions. p. 246

Unfortunately, in many CBT training programs, the emphasis is on learning the cognitive techniques, and less on the behavioral techniques. So, if you seek treatment with a CBT therapist, it very important that you enquire how experienced the person is in using ERP.

To learn more about ERP, please read this article by Fred Penzel, PhD, where he gives 25 excellent tips for increasing your chances of success.

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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.

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How do people with OCD deal with their irrational thoughts?

The most effective treatment for OCD is the technique of graded exposure to the uncomfortable situation, and a prevention of the usual response of trying to escape from that event, (usually abbreviated to ERP). I have found in my practice that this technique works well with people, whether the fear is about an external event, such as germs, or an internal event, such as a scary irrational thought. In both cases, there are well established cognitive and behavioral procedures where one learns to walk towards the uncomfortable situation, whether it is a external from your body, or inside your head.

On a slightly deeper level of explanation, with OCD, the germs or irrational thoughts are not the villain. It is the constant attempts to ESCAPE from the discomfort that keeps making matters worse. In general, the more you try to escape from the discomfort, the more fearful you may become.

OCD is the most crippling of the anxiety and fear disorders. It is controlled by a primitive part of your brain which unfortunately can function independently from your more rational self. This is usually called the “Fight or Flight Response”. In anxiety disorders this mechanism has got the upper hand.

In ERP therapy it is possible to teach that primitive part of your brain to “cool it”. ERP teaches you how to act as if you are not in danger, despite the fact that the primitive animal is screaming that you will die if you don’t try to escape. You won’t.

The more you learn how to put the fear mechanism to sleep using ERP, the more you can go through life using this skill in any area where fear raises its ugly head.