OCD Behavioral Techniques

Other behavioral techniques that have been tried with OCD are systematic desensitization, muscle relaxation, thought stopping and modeling. At first blush, systematic desensitization would appear to be ideally suited for the treatment of OCD. Patients build fear hierarchies for their obsessive thoughts or images and progressively confront the elements in the hierarchy while in a state of relaxation.

Theory predicts that pairing relaxation up with the obsession should break the connection between the obsession and the distress that sets the occasion for performance of a ritual. However, this procedure lacks the most important element needed to break this connection: habituation. Thus, we would have to predict that systematic desensitization is not an effective treatment. As it turns out, this is more or less correct, at least for patients who have had their obsessions for awhile.

However, while desensitization has not been very helpful in general, patients whose symptoms are recently acquired do seem to benefit to some extent. Muscle relaxation therapy by itself, on the other hand, does not seem to have any significant effect on rituals.

In thought stopping, target thoughts or images are punished in one or more ways when they occur. For example, a patient may yell `stop!', or snap a rubber band that is worn around the wrist, when an obsessive thought appears. Thought stopping has not proven to be very effective in the treatment of obsessions.

However, it has most often been used in an attempt to stop both the obsessive thoughts that cause distress and the covert rituals that reduce the distress indiscriminatel. Thought stopping will fail if it is used on anxiogenic thoughts, since this amounts to avoidance. Thought stopping may yet prove to be an effective response prevention technique.

In modeling, the therapist performs the exposure exercise first, while the patient watches. For example, in treating a patient with a contamination obsession, the therapist might touch the objects that the patient fears are contaminated, thus showing the patient that there is no danger in doing so.

In general, modeling has not been very effective. Rachman et al. (1973) found no difference between in vivo exposure with and without modeling. Marks et al. (1975) found that modeling of exposure did not increase the effectiveness of exposure alone in most patients but was helpful for some, perhaps because it helped decrease their fear of exposure. I have found modeling to be of great value in treating some patients with hoarding obsessions.