Samantha just arrived home from work. She immediately undressed and entered the shower. She soaped and repeatedly soaped the washcloth and rubbed it forcefully all over the body – not missing an inch. In her thoughts, she keeps on saying “I must get rid of these germs. I can’t miss a thing!” She was in the shower for almost an hour. After showering, she was cautious to step on the floor towel. She was preparing to get dressed when she accidentally brushed off her vanity table, and a powder keg was toppled over, leaving all the talcum powder on her feet. With this incident, she rushed to the shower room again and started all over again.
The Clinical Picture Of OCD
Obsessive-compulsive disorder (OCD) is a type of anxiety disorder that is characterized by obsessions (thoughts, impulses, or images) and compulsions, which are repetitive behaviors or mental acts) that attempts to neutralize anxiety. A person with OCD experiences recurrent, persistent, unwanted, intrusive thoughts, impulses, or images beyond worrying about real-life problems (Videbeck, 2013). In the clinical vignette, Sam is exhibiting obsessions or intrusive thoughts of germs and dirty surroundings. With this constant thinking and anxiety over contaminating microbes all over the body, this resulted in repetitive actions of getting rid the body of the imagined germs. Thus, Sam would continuously wash hands or have showers for an extended period until she is satisfied that the “germs” are no longer in her body.
Early Treatments For OCD
Medical literature presents early treatments for OCD to include systematic desensitization and aversion therapy.
Systematic Desensitization. Intended initially for phobias, this therapy involves gradual and guided exposure to the feared object. A therapist guides the patient to varying levels or degrees of provoking stimuli while training the patient to perform relaxation techniques. This approach can help the person in the future when faced or if they encounter the cause of their anxiety. Systemic desensitization mainly targets the obsessive thoughts and not more on the compulsions. Experts believe that once the obsessions (thoughts) are eliminated, the compulsions (actions) will also be controlled or averted (Foa, 2010).
Aversion Therapy. This may sound vicious because of the notion that punishment is required as a response to every unfavorable action that the patient performs. The premise of this therapy that if an activity is repeated, it is accompanied by an unpleasant experience that is capable of extinguishing it. In OCD, the most common aversion technique is the “rubber-band snapping technique.” The person wears a rubber band in the wrist and is directed to snap it every time they have some obsessive thoughts coming up. But according to Dean McKay, Ph.D. “the reason for the ineffectiveness of thought-stopping comes from the now well-understood problems associated with thought suppression.”
The early treatments were not very successful in reducing the obsessive and compulsive actions. It only addressed minimal changes towards limiting the OCD behaviors, but its totality, the therapeutic effects were nil.
The Effective Treatment
“Like most mental health issues, a lot of people have elements of OCD in their personality,” says Dr. Jacqueline Baulch, a clinical psychologist. OCD can be treated with a combination of medications and behavioral therapies. The goal of behavioral therapies is to reduce the anxiety levels brought about by the obsessions and compulsions by exposing the person to the origin that causes the distress. In gradual steps, the person then develops habituation and becomes adapted to the situation. The whole process of behavioral therapies involves exposure and response prevention. The exposure context consists in assisting the person to deliberately confront the specific circumstances or objects that he or she usually avoids. The response prevention allows the person to practice on delaying or preventing the rituals by developing behaviors that can divert them from doing the repeated acts. Studies show that 80% of OCD patients respond well to this type of therapy.
OCD responds well to behavioral therapy in conjunction with selected medications. According to Jerry Bubrick, PhD, “we were pleased to see the results of a recent study on the effectiveness of treatments for children with obsessive-compulsive disorder. Pleased in part because there are so few studies involving children, but also because researchers were testing not just medication for OCD, but cognitive behavioral therapy.”
Current research is still being undertaken to fully understand and address the concerns of persons with OCD, particularly the subtypes such as “washers,” “checkers,” “orderers,” and “hoarders.” Most OCD has other psychological problems and may need different types of treatments that are specific to these problems.
Videbeck, S., & Videbeck, S. (2013). Psychiatric-mental health nursing. Lippincott Williams & Wilkins.
Foa, E. B. (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues in Clinical Neuroscience, 12(2), 199–207.