What does cognitive behavioral therapy involve?

There are different types of psychological treatment. OCD is usually treated with cognitive behavioral therapy (CBT). In Germany it is offered by therapists specialized in CBT. This treatment combines two therapeutic approaches: cognitive therapy and behavioral therapy.

Cognitive therapy is about learning to recognize and understand your own thought patterns. The aim is to identify the thoughts that are at the root of the compulsive behavior, and then change them. This may involve asking questions like: Is it helpful to check ten times whether the door is locked? Will my rituals really make me safer?

Behavioral therapy deals specifically with the compulsive behavior itself. One particular type of behavioral therapy that is commonly used for people with OCD is called “exposure and response prevention.” In this treatment, people are gradually confronted with the things that trigger their compulsive behavior (exposure). If, for instance, someone has a compulsion to constantly wash their hands, the therapist could ask the person to touch something that they think is dirty. After that, the person with OCD would try not to immediately wash their hands (response prevention). Over time, the confrontation teaches them that their feeling of fear and restlessness goes away even if they don't carry out their compulsive behavior. Having a therapist for support is very important, especially when starting treatment or when the exercises get harder.

Cognitive behavioral therapy is offered as group or individual therapy. In Germany, it usually involves a series of weekly sessions, each lasting 50 minutes. Some people already feel much better after several sessions, while others may need longer before they notice a clear improvement. In order for the therapy to be successful, it is important that you feel comfortable with your therapist. You can use the trial sessions to find out if the chemistry is right.

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Involving family members in therapy can also help. For example, they can help people with OCD deal with their compulsions at home. This is especially important after the therapy, to help make the positive effects last.

What can I expect from cognitive behavioral therapy?

Cognitive behavioral therapy has been tested in a number of studies with children, teenagers and adults who have OCD. The studies show that this therapy is very effective. It can help people keep their symptoms under control, relieve their anxiety, and cope better in everyday life again.

You need to be committed and patient when doing this kind of therapy: It can take a while to get OCD under control, and it takes a lot of courage to face your urges and fears. The therapy can be very demanding, especially at first. But many people say it was worth it because they were able to deal with their OCD much better afterwards.

Which medications can help?

Medications that are used to treat depression (antidepressants) can also be used for OCD. Selective serotonin re-uptake inhibitors (SSRIs) are commonly used for this purpose. These medications increase the concentration of a neurotransmitter (chemical messenger) in the brain known as serotonin.

A number of studies have shown that SSRIs can relieve OCD symptoms: Because many of these studies only lasted up to three months, further research is needed on the long-term effects of SSRIs. But the few studies that lasted more than twelve months already suggest that SSRIs do help over the long term as well.

They can have a variety of side effects, though. These include nausea, nervousness, and trouble sleeping. And sexual desire may be reduced.

The side effects mainly occur during the first few weeks of use. If a particular SSRI is poorly tolerated, you can try a different one. When stopping treatment with an SSRI, the dosage is gradually reduced over several weeks to prevent side effects.

Various studies suggest that teenagers are more likely to feel suicidal when taking SSRIs, and also actually attempt to take their own lives more often. Teenagers should see their doctor or therapist more regularly at the beginning of treatment so that any risk of suicide can be identified early on.

The tricyclic antidepressant clomipramine can also be used for OCD, but not as the treatment of first choice.

Which is more effective: Cognitive behavioral therapy or medication?

Several studies have looked into how cognitive behavioral therapy compares to medication in the treatment of OCD. They suggest that cognitive behavioral therapy is somewhat more helpful than antidepressants are. For this reason, cognitive behavioral therapy is the treatment of choice for obsessive compulsive disorder.

But there may be good reasons for using medication, like having to wait a while before starting therapy. Also, cognitive behavioral therapy can demand a great deal of commitment and strength. Some people's urges are so strong that they would hardly be able to make it through the therapy without medication. The medication can help relieve the symptoms enough to make it possible to do the therapy. And some people might prefer medication to psychological treatment for personal reasons.

These two treatment approaches can also be combined. This may be particularly suitable for people with OCD who also have depression.

What other options are available?

Some people still have severe symptoms even after trying psychotherapy and medication. They can talk to their doctors about whether repetitive transcranial magnetic stimulation (rTMS) might be suitable. It involves a coil being placed on the person's head to produce magnetic fields that stimulate the nerve cells in their brain. The aim is to relieve the symptoms by changing the brain's activity. Some studies suggest that repetitive transcranial magnetic stimulation can help with OCD and reduce depressive symptoms.

Deep brain stimulation (DBS) also can also be used to treat very severe OCD. In DBS, the ends of electrodes are attached under the scalp and then inserted deep into the brain through the skull. A device regularly sends weak electrical signals to stimulate certain centers in the brain via these electrodes in order to improve the symptoms – which is why this form of treatment is called deep brain stimulation.

Sources

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