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home : columns : dr. k May 25, 2016

   
6/16/2014 2:10:00 PM
Medication and psychotherapy work together to treat O.C.D.

DEAR DOCTOR K: I've been struggling with obsessive- compulsive disorder for years. Is there any effective treatment for it?

DEAR READER: There are better treatments today than there were when I went to medical school. As you know, in obsessive-compulsive disorder (OCD), a person is troubled by persistent, intrusive, anxiety-provoking or distressing thoughts (obsessions). He or she feels pressure to carry out excessive, repetitive behaviors (compulsions).

A person with OCD tries to relieve his or her obsessions by performing a compulsion. The goal of the compulsion is to reduce the anxiety caused by obsessive thoughts. For example, a woman who has the obsession that her hands are dirty may develop the compulsion to wash them 50 times a day.

OCD can affect anyone from any walk of life. A person can be extremely accomplished at what he does, but just spend a few hours a day (usually alone) performing his compulsive act. I know of a famous and brilliant scientist who was at the top of his field. However, he spent several hours each night on his knees, scrubbing the grout between the tiles on his laboratory floor. He had to keep the grout completely free of dirt.

The type of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) can help control OCD symptoms. If one SSRI isn't effective, another may work better. But even with the most effective SSRI, symptoms usually don't disappear completely. You may need to combine an SSRI with another drug, such as a tricyclic antidepressant. These drugs can be effective, but they are more likely to have unpleasant side effects.

Patients often get the best results when they combine SSRIs with some type of psychotherapy. The two together are often more effective than either used alone.

A number of psychotherapy techniques may help. One technique is cognitive behavioral therapy (CBT). CBT helps a person with OCD recognize that his fearful, obsessive thinking is unreasonable. The therapist may teach specialized techniques that can help extinguish the compulsions. For example:

-- Exposure and response prevention (ERP). A person is exposed to situations that provoke obsessive thoughts. He or she is then prevented from performing the usual compulsive ritual, for gradually increasing amounts of time -- and sees that nothing bad happens as a result.

-- Habit reversal. A person is asked to substitute a different response, such as deep breathing, for the usual compulsive ritual.

-- Thought stopping. The person uses some form of distraction whenever an obsessive thought occurs, such as thinking about a favorite vacation spot, or the ninth inning of the last game of their favorite World Series.

-- Saturation. The person concentrates intensely on the obsessive thought until the thought loses its impact and becomes meaningless.

You may need to try more than one approach, or combination of approaches, before you find the one that is right for you. But most of my patients with OCD have been successfully treated -- so keep trying and don't give up.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)


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