What strategies are used to treat OCD in psychotherapy?

These are the different types of effective psychological intervention used for OCD.

Obsessive-Compulsive Disorder is a very complex psychiatric condition, in which there are obsessive ideas of all kinds whose anxiety is calmed by all kinds of compulsions and ritualistic behaviors.

Focused on treating anxiety and avoiding compulsive behavior in patients with this disorder, there are several strategies used to treat OCD in psychotherapy; let's go deeper into them..

Characteristics of OCD

The Obsessive Compulsive Disorder (OCD) is a mental disorder that is characterized by the patient having intrusive ideas in the form of obsessions that provoke anxiety, and that to reduce the associated symptomatology he/she needs to perform certain rituals or compulsions.. These compulsions serve to reduce anxiety and to acquire the feeling of security that nothing bad is going to happen.

For example, we have a patient with the obsessive idea that he may choke to death while eating. When he has to eat he feels very anxious and cannot stop thinking at any time about the possibility of choking (obsession). To make sure that he is not going to choke, he does not eat any solid food and makes sure that everything he eats is well crushed, checking it before putting it in his mouth and, once there, he chews it ten times (compulsion).

OCD is a fairly complex disorder, with many different types of obsessive ideas, ritualistic behaviors and compulsions, with varying degrees of anxiety and fear.

Fortunately, there are different therapeutic strategies, both psychological and pharmacological, that serve to improve the quality of life of patients and even eliminate their symptoms. that serve to improve the quality of life of patients and even eliminate their symptomatology. However, the effectiveness of the treatment depends on how quickly and early the disorder is diagnosed. Without a diagnosis of the disorder, there can be no good treatment.

It is considered that the most appropriate tool for treating OCD is psychotherapy, there being some consensus that it offers an effective treatment.There is some consensus that it offers greater short-term benefit and has longer-lasting positive results than pharmacology. It is for this reason that, as a general rule, in mild to moderate cases it is recommended to start with psychotherapy and, depending on how the patient responds to treatment, it would be decided whether or not to combine it with medication. The combination of psychotherapy with psychotropic drugs is usually used in severe cases of OCD.

Throughout the following points, we will find out what strategies are used to treat OCD in psychotherapy, as well as give some insight into what psychopharmacological treatments exist, along with brain stimulation and the importance of psychoeducation.

Psychotherapy

The psychotherapeutic approach to OCD focuses on intervening on the rituals and avoidance behaviors (compulsions) carried out by the patient to reduce the anxiety associated with the presentation of a stimulus or the intrusion of an unpleasant idea (obsessions).

In most situations, the goal is to get the patient not to to ensure that the patient does not perform rituals associated with obsessive ideas and that he/she gradually habituates to them or controls them so that they do not cause too much disruption in his or her life.

We are now going to look at a few strategies used to treat OCD in psychotherapy, some of them specific to strategic psychological therapy, one of the psychotherapeutic approaches considered effective for the management of this disorder.

1. Exposure with response prevention

This therapy is based on the idea that, when we expose a person to that which produces anxiety or phobia, in a progressive and controlled manner, he/she will become accustomed to it and, as time goes by, the levels of anxiety that such stimulus may produce will be lower and lower.

In the specific case of OCD, the exposure and response prevention involves having the patient expose him/herself to the object that he/she fears or that every time he/she thinks about an obsessive ideaThe person is exposed to them, such as dirt, order, pollution, but resists the urge to do his compulsive rituals, the ones he did to make sure he was in control of the situation or to calm himself down.

Exposure and response prevention involves a lot of effort and practicebut it is possible for the patient to achieve a better quality of life once he or she learns to manage his or her obsessions and compulsions.

2. Counter-rituals

Let's imagine an OCD patient who always, before leaving the house, has to check that absolutely everything is locked or in a certain way. Check the gas, make sure all the lights are off, the door is properly closed, the faucet is not dripping.... but, in spite of having done so, just when he is out on the street he has doubts and has to go back home to check everything again.

One of the strategies used to cope with this behavior is what psychologists call "counter-ritual", making your compulsive ritual more tedious and time-consuming, something that, over time, can be a very difficult and time-consuming task.something that over time becomes unsustainable to maintain.

For this particular case, the patient could be asked that, every time he feels the urge to have to check again what he has done and does it, he should check it not once, but five times. He will do everything five times, going out and coming in and out of his house each time he has done it, but only if he has had to check it again after having checked everything the first time.

By having to apply this new ritual, the patient is much more likely to dispense with double-checking everything the first time.The simple reason is that you don't want to waste any more time and you know that a new review would mean going over everything five more times.

3. Ritual violation

There are cases of OCD patients who have many rituals, so many and so varied that it is difficult to classify them. In these cases, the strategy of ritual violation can be applied, asking the patient to choose one of his many rituals each day and to make an effort not to perform it, while he is free to follow it.while he/she is free to continue doing the others.

This strategy is based on the idea that, first, the patient manages to violate his own routine, even if he does it in a different way each day. The simple fact of having to deprive himself of doing a compulsion when he has an obsessive idea or a stimulus that generates fear is already an advance, which can help him to understand that compulsions are not necessary to reduce his anxiety if he habituates himself to that which provokes it.

As the months go by, the patient will dare to dispense with more rituals.The time will come when he will completely violate his initial ritualistic pattern. That is to say, it is passed from a progressive violation to a total violation of the whole list of rituals and compulsions that he/she did to calm down.

4. Delaying the compulsion

Another strategy used to treat OCD in the context of strategic psychological therapy is to delay the compulsion. For example, the patient can be asked each day to try to avoid what the obsession is asking him to do and to delay the compulsion..

If it is a patient who needs to wash his hands every time he touches a wooden table, he can be asked to wash his hands after about five minutes. The idea behind this technique is that sooner or later, as time goes by, putting off the ritual will turn into doing without it, perhaps even without realizing it.

5. Ritualizing the compulsion

This technique is used in cases where, for example, the patient repeats formulas, lists of words and numbers or pulls out hair throughout the day after performing a certain action or coming to mind a certain idea. Ritualizing the compulsion involves turning it into something more orderly, making it have to be done at a certain time and following a much more complex ritual..

For example, a patient who repeats the multiplication tables every few minutes while thinking about how bad she was at mathematics as a child (intrusive thinking) can be asked to do just this, to repeat the multiplication tables, but only when the clock strikes an even numbered hour (10, 12, 14...). When this condition occurs, the patient should go to the nearest bathroom, look at herself in the mirror and, for 3 minutes, repeat the multiplication tables without a break.

This strategy means that the patient, although still carrying out the compulsion, now has control over it. Before, he used to do it at any time of the day, and it could intrude on his work schedule or while he was doing a leisure activity. Now, by having a schedule where he specifies when he allows the compulsion to take place, he is turning it into a controlled habit and, over time, he has a better control over it. and, with the passage of time, he will be able to dispense with its use.

Psychopharmacology

The first psychopharmacological drug to show great utility in the treatment of OCD was marketed in Switzerland in 1966: clomipramine.

Since then, no pharmacological treatment has been discovered that has been more effective than this tricyclic antidepressant, but safer drugs have been discovered, with fewer side effects and less risk of interaction with other drugs. The most widely used are the SSRIs which, together with clomipramine, constitute a group of antidepressants with anti-obsessive properties.

The drugs approved for treatment of OCD are:

• Citalopram (Prisdal ®).
• Clomipramine (Anafranil ®)
• Escitalopram (Esertia ®)
• Fluoxetine (Prozac ®)
• Fluvoxamine (Dumirox ®)
• Paroxetine (Seroxat ®)
• Sertraline (Besitran ®)

There are other drugs that, despite not having been approved by governmental agencies, contain active ingredients that could be useful for the treatment of OCD, one of them being Venlafaxine (Vandral ® or Dubupal ®).

Brain stimulation

There are two techniques used as treatment for OCD that cannot be included in either psychotherapy or psychopharmacology: two forms of brain stimulation. These techniques are unorthodox methods, used as alternative therapy when drugs and psychotherapy have not been shown to be helpful, especially in the most severe cases.

1. Deep brain stimulation

Deep brain stimulation is a therapeutic strategy approved in the United States by the FDA (Food and Drug Administration) to treat OCD in adults 18 years of age or older who have not responded to more traditional treatments. This procedure involves implanting electrodes in certain areas of the brain, which produce electrical impulseswhich produce electrical impulses that can help regulate obsessions and, especially, compulsions.

2. Transcranial magnetic stimulation

Also approved in the United States by the FDA, transcranial magnetic stimulation is used in adults with OCD between the ages of 22 and 68. This procedure is noninvasive, and involves using magnetic fields to stimulate brain nerve cells and improve associated symptomatology. and improve the symptomatology associated with the disorder. During a transcranial magnetic stimulation session, an electromagnetic coil is placed on the scalp near the forehead. This electromagnet produces a magnetic pulse that stimulates nerve cells in the brain.

Psychoeducation

As a final point, we would like to emphasize the importance of psychoeducation before applying psychotherapeutic and psychopharmacological tools to the patient. It is essential that the patient has a correct understanding of his disorder before starting treatment and beginning the road to recovery..

It is preferable that the information the patient receives about OCD comes directly from his or her psychotherapist, but in practice this is complicated given that we live in a world where ICTs have conquered all aspects of people's lives. It is very likely that the patient has already documented previously, and it is possible that he/she has done so finding information that does not correspond to reality and is not reliable.

For this reason, one of the tasks of the psychologist during the psychoeducation phase and before starting therapy is to see what misconceptions or myths the patient may believe, try to counteract them with real and truthful information and explain to the patient what the fundamental features of his or her psychopathology are. This part can help a lot in his or her recovery, since the patient can understand that this problem does not only happen to him or her, and that there are proven therapies to improve his or her state of health.