Overcome Ocd

The targets of OCD treatment can be seen from the sequence of events that is hypothesized to take place. Some event, such as touching a doorknob, activates an obsessive thought, such as that of contamination. The obsessive thought next generates feelings of anxiety and discomfort, which are relieved by performance of a compulsive ritual, such as hand washing. The goals of successful OCD behavior therapy are to:

(1) break the connection between the obsessive thought and anxiety it produces;

(2) break the connection between the performance of a ritual and the reduction in anxiety that follows.

The former is accomplished by Obsessive Compulsive Disorder exposure and the latter by response prevention. These are the two key elements in the behavioral treatment of OCD.

In exposure, OCD patients confront (expose themselves to) the object, thought or situation that frightens them and is avoided by them when possible. Obsessive Compulsive Disorder Exposure can consist of real contact with the feared object (`in vitro' exposure) or only in the patient's imagination (imaginal exposure). In response prevention, compulsive rituals that function to decrease the distress brought on by obsessive thoughts are delayed or prevented entirely.

Habituation is the process by which exposure therapy is thought to work. Obsessive thoughts or images produce feelings of anxiety or distress that continue to increase to very uncomfortable levels. In the absence of a neutralizing ritual, this distress will eventually decrease to levels that are tolerable or vanish almost entirely. At this point, the rituals will disappear because there is nothing left to escape from and they are no longer reinforced by reductions in anxiety.

An excellent description of these hypothesized processes is given by Steketee (1993). Support for this hypothesis came from a classic study by Rachman, who exposed compulsive checkers to situations in which they had the urge to check and observed both the degree of anxiety brought on by the exposure and the strength of the urge to check.

Consistent with the behavioral model, the anxiety and urge to check increased upon exposure and decreased following the checking behavior. When checking was not allowed for three hours (response prevention), anxiety and urge to check decreased significantly, with the greatest decreases taking place within the first hour.

OCD Response prevention and exposure have differential effects: OCD response prevention is more effective in the treatment of rituals and OCD exposure is more effective in the treatment of distress associated with obsessions. However, as powerful as the combined technique of exposure and response prevention is, the two components are not nearly as effective when practiced in isolation.