WHAT IS OBSESSIVE COMPULSIVE DISORDER (OCD)?
Obsessive Compulsive Disorder (OCD) is characterized by recurrent, unwanted thoughts, impulses, or doubts that elicit distress; and, by repetitive behaviors or mental rituals that are performed to reduce the distress. An example is someone who is worried about contracting germs (obsession), and needs to wash his/her hands repeatedly (compulsion) to reduce the worry that s/he has been contaminated. Certain types of obsessions and compulsions occur together. Contamination fears can be paired with decontamination behaviors (for example, inappropriate washing and cleaning); obsessions regarding responsibility for harm are associated with reassurance seeking rituals (for example, compulsive checking); and unwanted, repugnant, or blasphemous obsessional thoughts are often combined with offsetting strategies such as mental rituals, praying, or repeating routine actions.
Although many OCD sufferers recognize that their obsessional fears and rituals are senseless and disproportionate, others strongly believe that their rituals function to prevent the occurrence of devastating consequences. The lifetime prevalence rate of OCD is 1-3%. Although symptoms typically wax and wane, a chronic and sometimes deteriorating course is the standard if adequate treatment is not sought. OCD can range from mild to severe, and obsessions and compulsions impair various areas of functioning, including job or school performance, interpersonal relationships, and leisure activities. Many individuals with OCD also experience mood and anxiety difficulties.
HOW DO YOU TREAT OCD AT THE KOCH CENTER?
Both pharmacological (medication) treatment and psychological interventions are supported by research. However, recent research has demonstrated that Cognitive Behavior Therapy (CBT) using Exposure and Response Prevention (ERP) is the most effective short- and long-term treatment for OCD and is superior to medication alone. ERP begins with a thorough assessment of the triggers of the obsession, the role of the compulsions, and ratings of the distress. A series of behavioral ‘exposures’ are then carefully planned through collaboration between the therapist and client and implemented both in session and as homework between sessions.
Despite the encouraging findings of CBT/ERP, full remission is not achieved by some. Researchers are encouraged by the role that Dialectical Behavior Therapy (DBT) can add in the treatment of people with OCD. Dialectical Behavior Therapy (DBT), developed by Marsha Linehan, includes and expands upon traditional CBT/ERP. Many components of DBT such as problem-solving, exposure, skills training, contingency management, and cognitive modification have been found to be helpful for people struggling with OCD. DBT helps people manage emotions and maintain emotional equilibrium through training in four basic skills areas: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance (MacKay et al., 2012). DBT can help people learn to respond more flexibly and effectively (Izadi et al.,2013). Recent research by Marsha Linehan et al. (2015) has demonstrated that DBT’s hierarchical structure of individual psychotherapy, group skills, training and counseling are appropriate for treating OCD.
Training parents, spouses, or family members about OCD, its treatment, and how to effectively assist with a loved one’s therapy has also been found to be effective and at The Koch Center we may recommend this as part of the treatment plan.
WHAT ARE THE FOUR DBT SKILLSETS?
At The Koch Center, we may incorporate Dialectical Behavior Therapy (DBT) into the treatment plan when someone is struggling with OCD. DBT skills have found to be helpful in terms of improving one’s ability to tolerate distress and to regulate emotions. There are four skill areas in DBT:
- Core Mindfulness: These skills teach patients to retrain their focus to the here and now in order to help them attain attentional and emotional control.
- Distress Tolerance: Tolerating distress is one of the most difficult tasks people need to learn. This skill set teaches individuals how to cope with and distract themselves during moments of overwhelming emotion and/or during a crisis.
- Emotion Regulation: Individuals are taught the basic components of feelings, as well as means to enhance and more fully enjoy positive emotions, while concurrently decreasing and tolerating negative feelings.
- Interpersonal Effectiveness: The aim of these skills is to teach individuals the basics of interpersonal interactions including how to ask for help from others, how to assert one’s needs, and how to express one’s self in a manner that others can readily respond to.