Medication
The two main types of psychological therapy for OCD are cognitive-behavioral therapy (CBT) and a type of behavioral treatment called exposure and response prevention (ERP) therapy.
Therapy
The psychological treatment of choice for OCD, in both adults and children and backed by numerous clinical trials, is cognitive-behavioral therapy (CBT), particularly exposure with response prevention (EX/RP)[45]. It is superior to medications alone, with effect sizes ranging from 1.16-1.72[46,47].
Self-care
Introduction A comprehensive evidence-based assessment is a critical step in accurately identifying the presence and severity of obsessive–compulsive disorder (OCD) in both clinical and research practice.
Nutrition
Although these medications are called antidepressants, they are effective in treating anxiety disorders such as OCD too. These drugs are thought to work by increasing the amount of serotonin that is available within the brain.
What are the different types of psychological therapy for OCD?
How is obsessive-compulsive disorder (OCD) treated?
What is an evidence-based assessment of obsessive–compulsive disorder?
How do medications treat anxiety disorders such as OCD?
What is evidence based treatment for OCD?
More specifically, the most effective treatments are a type of CBT called Exposure and Response Prevention (ERP), which has the strongest evidence supporting its use in the treatment of OCD, and/or a class of medications called serotonin reuptake inhibitors, or SRIs.
Which of the following are the most effective treatments for OCD?
The two most commonly prescribed and effective treatments for OCD are medications and cognitive-behavioral therapy (CBT). A combination of the two sometimes creates the best results.
What are 3 treatments for OCD?
Treatments for OCDExposure Therapy. The psychotherapy of choice for the treatment of OCD is exposure and response prevention (ERP), which is a form of CBT. ... Imaginal Exposure. ... Habit Reversal Training. ... Cognitive Therapy.
What therapies are used for OCD?
The two main types of psychological therapy for OCD are cognitive-behavioral therapy (CBT) and a type of behavioral treatment called exposure and response prevention (ERP) therapy.
What is the first line of treatment for OCD?
Serotonergic antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and clomipramine, are the established pharmacologic first-line treatment of OCD. Medium to large dosages and acute treatment for at least 3 months are recommended until efficacy is assessed.
Is CBT effective for OCD?
CBT has been found to result in long-lasting benefits in OCD patients, and also aims to provide you with a more effective way of managing unwanted thoughts and feelings that doesn't impair your functioning in the long term.
Are SSRIs effective for OCD?
SSRIs are effective for the treatment of OCD. If it is assumed that 10 percent of persons with OCD will recover without treatment, then 12 persons with OCD need to be treated for one additional person to have a response within six to 13 weeks.
How do psychologists treat OCD?
Psychological therapy Therapy for OCD is usually a type of cognitive behavioural therapy (CBT) with exposure and response prevention (ERP). This involves: working with your therapist to break down your problems into their separate parts, such as your thoughts, physical feelings and actions.
What is the best treatment for OCD?
The psychological treatment of choice for OCD, in both adults and children and backed by numerous clinical trials, is cognitive-behavioral therapy (CBT), particularly exposure with response prevention (EX/RP)[45]. It is superior to medications alone, with effect sizes ranging from 1.16-1.72[46,47]. While there is a lower relapse rate than in medications (12% vs24%-89%), it is important to note that up to 25% of patients will drop out prior to completion of treatment due to the nature of treatment[48]. The course of therapy generally lasts between 12-16 sessions, beginning with a thorough assessment of the triggers of the obsession, the resultant compulsions, and ratings of the distress caused by both the obsession and if they are prevented from performing the compulsion. A series of exposures are then carefully planned through collaboration between the therapist and client and implemented both in session and as homework between sessions[49-52].
How prevalent is OCD?
In the United States, the lifetime prevalence rate of OCD is estimated at 2.3% in adults[8] and around 1%-2.3% in children and adolescents under 18[9]. There are also a fairly substantial number of “sub-clinical” cases of OCD (around 5% of the population[10]), where symptoms are either not disturbing or not disruptive enough to meet full criteria and yet are still impairing to some degree. There is strong evidence that cultural differences do not play a prominent role in presence of OCD[11,12], with research showing few epidemiological differences across different countries[13-15] and even between European and Asian populations[16]. There are, however, cultural influences on symptom expression. In Bali, for example, heavy emphasis on somatic symptoms and need to know about members of their social network is found[17], while type of religious upbringing has been related to different types of primary obsessions, such as emphasis on cleanliness and order in Judaism, religious obsessions in Muslim communities, aggressive aggressions in South American samples, and dirt and contamination worries in the United States[13,18-20].
What is the most common disorder in OCD?
Up to 75% of persons with OCD also present with comorbid disorders[8]. The most common in pediatric cases are ADHD, disruptive behavior disorders, major depression, and other anxiety disorders[27]. In adults, the most prevalent comorbids are social anxiety, major depression, and alcohol abuse[10].
What are the effects of OCD on children?
Almost all adults and children with OCD report that their obsessions cause them significant distress and anxiety and that they are more frequent as opposed to similar, intrusive thoughts in persons without OCD[31]. In terms of QoL, persons with OCD report a pervasive decrease compared to controls[28]. Youth show problematic peer relations, academic difficulties, sleep problems, and participate in fewer recreational activities than matched peers[32,33]. Overall, there is a lower QoL in pediatric females than males[28], but in adults similar disruptions are reported[29]. When compared to other anxiety disorders and unipolar mood disorders, a person with OCD is less likely to be married, more likely to be unemployed, and more likely to report impaired social and occupational functioning[34].
What are the compulsions of OCD?
Subsequent compulsions serve to reduce this associated anxiety/distress. Common obsessions include contamination fears, worries about harm to self or others, the need for symmetry, exactness and order, religious/moralistic concerns, forbidden thoughts (e.g., sexual or aggressive), or a need to seek reassurance or confess[5]. Common compulsions include: cleaning/washing, checking, counting, repeating, straightening, routinized behaviors, confessing, praying, seeking reassurance, touching, tapping or rubbing, and avoidance [6]. Unlike in adults, children need not view their symptoms as nonsensical to meet diagnostic criteria[7].
How long does a therapist have to do a compulsion?
The course of therapy generally lasts between 12-16 sessions, beginning with a thorough assessment of the triggers of the obsession, the resultant compulsions, and ratings of the distress caused by both the obsession and if they are prevented from performing the compulsion.
Is there a treatment for OCD?
There are both pharmacological and psychological treatments for OCD that are supported by research evidence[35-38]. Overall, pharmacology with serotonin reuptake inhibitors (SRIs) shows large effect sizes in adults (0.91[39]), but only moderate effect sizes in youth (0.46[40]).Unfortunately, even with effective medication, most treatment responders show residual symptoms and impairments. There is also a very high relapse rate seen across numerous studies (between 24%-89%[41]). SRIs can be successfully supplemented with adjunctive antipsychotics, but even then only a third of patients will show improvements and there are serious health concerns with their long-term usage[42]. Metanalyses and reviews have not shown that the five selective SRIs (including fluoxetine,, paroxetine, fluvoxamine, sertraline, and citalopram) or the non-selective SRI clomipramine differ among each other in terms of effectiveness in either adults or pediatric patients[39,40]. Across subtypes of OCD, however, there are medication differences seen (for a review see[43]). For example, the presence of tics appears to decrease selective SRI effects in children[44], but it is unclear if it has the same effect in adults. Another known difference is that patients who have OCD with comorbid tics respond better to neuroleptic drugs than those who have OCD without tics[43].
What is the class of medication for OCD?
Most of these drugs belong to a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs); however, one of these drugs, Anafranil, belongs to a class of drugs called the tricyclic antidepressants (TCAs).
What is the best treatment for OCD?
Psychological Therapy. Psychological therapy for obsessive-compulsive disorder is effective for reducing the frequency and intensity of OCD symptoms. The two main types of psychological therapy for OCD are cognitive-behavioral therapy (CBT) and a type of behavioral treatment called exposure and response prevention (ERP) therapy.
How many people do not respond to OCD treatment?
It has been estimated that between 25 and 40% of people will not respond to treatment options described above. There are also other potential treatment options for OCD that are less common. Some of these options include electroconvulsive therapy (ECT), deep brain stimulation, and repetitive transcranial magnetic stimulation.
How many people with OCD are in remission?
Long-term studies suggest that 32—70% of people with OCD experience symptom remission which suggests that recovery is a realistic, achievable goal for some people with the condition. 1 There are a number of different approaches used in the treatment of OCD including:
How do antidepressants help with OCD?
Although these medications are called antidepressants, they are effective in treating anxiety disorders such as OCD too. These drugs are thought to work by increasing the amount of serotonin that is available within the brain. Problems with serotonin may be a significant cause of OCD.
What is act therapy?
ACT is a relatively new psychological therapy for obsessive-compulsive disorder that has shown promise in the treatment of anxiety disorders, including OCD. The central philosophy of ACT is that anxiety is part of life and so it is our reaction to the experience of anxiety that can be the real problem. The 9 Best Online Therapy Programs We've ...
Is deep brain stimulation good for OCD?
Repetitive transcranial magnetic stimulation, or rTMS, has also received considerable attention as a possible alternative treatment to reduce OCD symptoms. However, to date, the evidence has been mixed with respect to whether rTMS is an effective treatment.
Is obsessive compulsive disorder a lifelong disorder?
Over the past three decades, obsessive-compulsive disorder (OCD) has moved from an almost untreatable, life- long psychiatric disorder to a highly manageable one. This is a very welcome change to the 1%-3% of children and adults with this disorder as, thanks to advances in both pharmacological and ps …
Is OCD a lifelong disorder?
Over the past three decades, obsessive-compulsive disorder (OCD) has moved from an almost untreatable, life-long psychiatric disorder to a highly manageable one. This is a very welcome change to the 1%-3% of children and adults with this disorder as, thanks to advances in both pharmacological and psychological therapies, prognosis for those afflicted with OCD is quite good in the long term, even though most have comorbid disorders that are also problematic. We still have far to go, however, until OCD can be described as either easily treatable or the effective treatments are widely known about among clinicians. This review focuses on the current state of the art in treatment for OCD and where we still are coming up short in our work as a scientific community. For example, while the impact of medications is quite strong for adults in reducing OCD symptoms, current drugs are only somewhat effective for children. In addition, there are unacceptably high relapse rates across both populations when treated with pharmacological alone. Even in the cognitive-behavioral treatments, which show higher effect sizes and lower relapse rates than drug therapies, drop-out rates are at a quarter of those who begin treatment. This means a sizable portion of the OCD population who do obtain effective treatments (which appears to be only a portion of the overall population) are not effectively treated. Suggestions for future avenues of research are also presented. These are primarily focused on (1) increased dissemination of effective therapies; (2) augmentation of treatments for those with residual symptoms, both for psychotherapy and pharmacotherapy; and (3) the impact of comorbid disorders on treatment outcome.
What is OCD assessment?
Obsessive–compulsive disorder ( OCD) is a neuropsychiatric illness that often develops in childhood, affects 1%–2% of the population , and causes significant impairment across the lifespan. The first step in identifying and treating OCD is a thorough evidence-based assessment. This paper reviews the administration pragmatics, psychometric properties, and limitations of commonly used assessment measures for adults and youths with OCD. This includes diagnostic interviews, clinician-administered symptom severity scales, self-report measures, and parent/child measures. Additionally, adjunctive measures that assess important related factors (ie, impairment, family accommodation, and insight) are also discussed. This paper concludes with recommendations for an evidence-based assessment based on individualized assessment goals that include generating an OCD diagnosis, determining symptom severity, and monitoring treatment progress.
How to determine if a patient has OCD?
In order to determine if a patient meets DSM-5 diagnostic criteria for OCD, the patient must experience the presence of recurrent, unwanted, and intrusive thoughts (ie, obsessions) and/or repetitive behaviors or rituals (ie, compulsions) intended to relieve the fear, anxiety, and/or distress associated with obsessions.5Additionally, obsessions and compulsions must cause significant distress and impairment in social, academic, and/or family functioning.5While diagnostic assessments are often conducted as free-form unstructured clinical interview, there are several standardized structured or semi-structured interviews that have several advantages. Standardized interviews show psychometric superiority, higher validity, and less subjectivity and are more comprehensive compared to unstructured interviews.6–10Also, when differential diagnoses are a concern, the administration of relevant diagnostic modules from standardized interviews can assist with diagnostic clarification. However, these interviews typically increase patient and clinician burden as they can require one to three hours to administer, depending on the diagnostic categories in question. While free-form clinical interviews are the most common method for determining an OCD diagnosis in clinical practice, standardized interviews are generally used in research. When an individual’s presentation is complex and differential diagnoses are a concern, there is benefit to using standardized interviews in clinical practice as well. Most extant diagnostic interviews are derived from DSM-IV criteria, including the Anxiety Disorders Interview Schedule for DSM-IV (ADIS), Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions (ADIS-C/P), and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), although more recently, updated versions of these measures have been published to reflect changes in the DSM-V (eg, ADIS-V and SCID-V – Clinician Version).11–15The ADIS possesses strong psychometric properties, shows excellent discrimination among anxiety disorders, and can reliably produce an OCD diagnosis.11,12,16,17Shortcomings of the measure include limited focus on other nonanxiety disorders (eg, psychosis), which may be considered as a differential diagnosis. The SCID-I also shows good psychometric properties; however, some research has criticized the measure’s ability to produce clinically meaningful information specific to OCD.13,18–21A third structured interview, the Mini International Neuropsychiatric Interview (MINI) for DSM-IV, has also been validated in adult and youth samples, and a version revised in accordance with DSM-V is available for use with adults.22,23
What is the Yale Brown Obsessive Compulsive Scale?
The Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) comprises a Symptom Checklist and Severity Scale to consecutively rate obsessions and compulsions (see Table 1).24,25The Symptom Checklist includes 54 common obsessions and compulsive behaviors, which are grouped according to thematic content (eg, contamination and aggression) or behavioral expression (eg, checking and washing). Symptoms that are endorsed over the past week are then globally rated by the clinician using a five-point scale ranging from 0 (none) to 4 (extreme) across five dimensions: (1) time/frequency, (2) interference, (3) distress, (4) resistance, and (5) degree of control (see Table 1). Obsessive and compulsive symptom severity are rated separately (scores range from 0 to 25) with these scores summed to create a total OCD severity score (range, 0–50). The Y-BOCS also includes single-item ratings of insight, avoidance, indecisiveness, responsibility, pervasive slowness, and doubting on the 0–4 point scale, but these ratings are not included in severity scores and are less often used. The following score clusters approximately map onto symptom severity: mild symptoms (0–13), moderate symptoms (14–25), moderate–severe symptoms (26–34), and severe symptoms (35–40).26
What is the symptom checklist for OCD?
First, the Symptom Checklist includes the consecutive assessment of obsessions and compulsions, as well as a more inclusive range of obsessive–compulsive symptoms with examples. Specifically, revisions have been made to: (1) better capture discomfort that some individuals experience unless rituals are completed just right, (2) provide enhanced explanations and examples of anchors, and (3) remove a priori symptom headings.45,46Second, active avoidance behaviors that are commonly seen in adults with OCD are also included in the Symptom Checklist. The Y-BOCS-II considers active avoidance behaviors as compulsions and, in doing so, accounts for minimization of overt compulsions that may result from lack of contact with triggering stimuli. Last, ancillary items from the original Y-BOCS were removed or incorporated in the Symptom Checklist.
What is evidence based assessment?
A comprehensive evidence-based assessment is a critical step in accurately identifying the presence and severity of obsessive–compulsive disorder (OCD) in both clinical and research practice. Obsessive–compulsive symptoms can be difficult to assess, given that they are often manifested internally, and individuals with OCD may not be inclined to recognize and report symptoms (ie, limited insight). In response to these challenges, this paper reviews commonly used OCD measures that have been examined in research studies to enhance clinicians’ abilities to detect and monitor OCD symptom severity during assessment and treatment. First, the pragmatics of measure administration and psychometric properties are reviewed. Clinician-rated measures are discussed initially, followed by adult self-report measures, and finally parent/child measures. Second, the incorporation of additional important factors in an evidence-based OCD assessment is discussed (ie, impairment, family accommodation, and insight). Finally, this paper concludes with recommendations for an evidence-based assessment based on individualized assessment goals and empirical support.
What scale is used to measure obsessive compulsive disorder?
Clinicians review items endorsed by the patient across six obsessive-compulsive symptom dimensions. Severity, distress, and interference for each dimension is rated on a scale from 0–5. Global frequency, distress, and interference scores are derived using using a scale from 0–5 (maximum score: 15). Global ratings are combined with a global rating of impairment, which is measured using a scale from none (0) to severe (15), to yield a global severity score (maximum score: 30).53
Is the Y-BOCS-SR a good test?
The Y-BOCS-SR shows good to fair internal consistency and good short-term test–retest reliability in nonclinical samples (see Table 2).67–69It shows good correspondence with clinician-rated measures of OCD severity and possesses a good ability to differentiate between individuals with OCD, anxiety disorders, and healthy controls.67–70The Y-BOCS-SR Total Severity score shows fair discriminant validity with measures of worry in a college sample, with no extant data in a clinical sample.71There has been no systematic evaluation of the Y-BOCS-SR’s treatment sensitivity. However, it does appear to have utility as a diagnostic screening measure, with research suggesting that a score of 16 or greater may predict OCD diagnosis.67,69,70
