OCD Treatment: An Overview

Obsessive-compulsive disorder, or OCD as it’s usually known, is a label that gets kicked around a lot in our everyday conversations. You might tell a friend to “stop being so OCD” when she keeps checking her phone or is constantly cleaning her computer screen. But the reality is, OCD is relatively uncommon—only about 1 in 50 people have it.

To be diagnosed you’d have uncontrollable, anxiety-inducing thoughts (obsessions), repeated behaviors (compulsions), or a combination of both.

OCD is treatable. The recommended “first-line” treatments are cognitive-behavioral therapy (CBT) and medication management, usually one that targets serotonin. Many clinicians believe the combination of these two treatments is more effective than either alone. If OCD is resistant to the standard forms of treatment, there are other alternatives.

Cognitive behavioral therapy (CBT) focuses on training your brain to think and act differently to stressors. Think of it this way: the part of your brain that solves problems and makes rules for how to respond to problems develops a glitch and through CBT, you can detect that glitch and correct it.

Cognitive therapy uses all kinds of different strategies to get to that point, including deep breathing, self-talk, journaling, and what’s known as ‘playing the script until the end’—a sort of thought experiment where you imagine the outcomes of the worst-case scenario. Letting this scenario play out shows that even if your worst fears come true, you’ll still be able to find ways to manage and overcome the situation.

There are two main branches of CBT, exposure and ritual prevention (ERP) and acceptance and commitment therapy (ACT). Both share the same principles and strategies, but ACT, adds a little nuance.

Acceptance and Commitment Therapy (ACT)

In general, CBT says “this thought is a problem, let’s get rid of it.” But ACT therapy says, “it’s not this thought that’s so much a problem, it’s how you’re interpreting this thought.” The subtle change can make a big difference for some people. “When you try to change a thought, you’re elaborating the network that gave you the thought,” explains Dr. Steven Hayes, PhD, Foundation Professor in the Behavior Analysis program at the department of psychology at the University of Nevada and author of “A Liberated Mind: How to Pivot Toward What Matters.” It’s the kind of thing where when you tell yourself, “stop thinking about that horrible meeting” all you can do is think about that horrible meeting.

Exposure and Response Prevention (ERP)

With ERP, you’re pinpointing your obsessions and/or compulsions and consciously replacing them with other thoughts or behaviors. To do this, you’d work with a therapist to compile a list of all your obsessions and compulsions. These are then ranked from the least difficult to the most difficult to deal with. The therapist will start by working on the least bothersome ones by introducing challenges. For example, if you’re obsessed with checking that you locked the front door, a therapist conducting ERP therapy may work with you to get to make it all the way to your car without going back to check. Then the challenge might be to make it to the end of your street before turning around. Over time, this exposure and delayed response helps you respond differently to your obsessions, lessening the anxiety that comes along with them and the need to perform certain behaviors.

Read More: Panic Attacks & Panic Disorder

Certain psychiatric medications are often prescribed to control the obsessions and compulsions. Most commonly, antidepressants are prescribed first, though your doctor may also suggest other types of selective serotonin reuptake inhibitors (SSRIs) or antipsychotic medications to reduce OCD symptoms.

Deep Brain Stimulation (DBS)

Deep brain stimulation (DBS) is an emerging treatment for severe OCD when all other treatments fail. DBS involves placing electrodes in targeted areas of the brain by opening the skull. The electrodes are connected by wires under the skin to pulse generators which are controlled by a doctor using a hand-held wand and a small computer. DBS has not been approved by the FDA for the treatment of OCD, but recent studies suggest it could be a promising treatment option for patients who have had very little to no response to all available behavioral therapies and medications for OCD.

Repetitive Transcranial Magnetic Stimulation (rTMS)

Repetitive transcranial magnetic stimulation (rTMS) involves using a magnet to target and stimulate certain areas of the brain. Sessions of rTMS are non-invasive and typically last between 30 minutes to an hour and most treatments require daily sessions for a few weeks. During rTMS, electromagnetic currents are applied to the skull and directing them to specific brain regions. The amount of stimulation and target of stimulation is always specific for each patient. Patients are awake during the procedure and can continue with regular daily activities following the treatment.

The American Psychiatric Association (APA) recommends somatic therapies like rTMS and DBS should only be considered after first- and second-line treatments have been exhausted.

OCD can be a scary diagnosis and it may not go away, but with the treatments it can be (at least a little) more manageable.