What clinical perspective is most important when appraising obsessive-compulsive disorders

Overview

• Treatment for most OCD patients should involve Exposure and Response Prevention (ERP) and/or medication.
• The majority of people with OCD (about 7 out of 10) will benefit from either medication or ERP.

What Are the Most Effective Treaments for OCD?

The most effective treatments for OCD are Cognitive Behavior Therapy (CBT) and/or medication. [1] 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.

Exposure and Response Prevention is typically done by a licensed mental health professional (such as a psychologist, social worker, or mental health counselor) in an outpatient setting. This means you visit your therapist’s office at a set appointment time once or a few times a week.  Click here for help finding the right therapist for you.

Medications can only be prescribed by a licensed medical professionals (such as your physician or a psychiatrist), who would ideally work together with your therapist to develop a treatment plan. Click here to learn more about medications for OCD.

Taken together, ERP and medication are considered the “first-line” treatments for OCD. In other words, START HERE! About 70% of people will benefit from ERP and/or medication for their OCD.

What if Outpatient ERP Hasn’t Worked? Are There More Intensive Options?

Yes. If you or a loved one has tried traditional outpatient therapy and would like to try a more intensive level of care, there are options. The IOCDF keeps a Resource Directory of intensive treatment centers, specialty outpatient clinics, and therapist who provide these various levels of services for OCD. The following lists therapy options from least intensive to most intensive:

• Traditional Outpatient – Patients see a therapist for individual sessions as often as recommended by their therapist generally one or two times a week for 45-50 minutes. (Most Therapists in the Resource Directory as well as “Specialty Outpatient Clinics” offer this type of treatment).
• Intensive Outpatient – Patients may attend groups and one individual session per day several days per week. Clinics designated as “Intensive Treatment Programs” in the Resource Directory offer this level of treatment.
• Day Program – Patients attend treatment during the day (typically group and individual therapy) at a mental health treatment center usually from 9am – 5pm up to five days a week. Many clinics designated as “Intensive Treatment Programs” in the Resource Directory offer this level of treatment.
• Partial Hospitalization – Same as the Day Program but patients attend the treatment at a mental health hospital. Several clinics designated as “Intensive Treatment Programs” in the Resource Directory offer this level of treatment.
• Residential – Patients are treated while living voluntarily in an unlocked mental health treatment center or hospital. Clinics designated as “Residential” in the Resource Directory offer this level of treatment.
• Inpatient – This is the highest level of care for a mental health condition. Treatment is provided on a locked unit in a mental health hospital on a voluntary or sometimes involuntary basis. Patients are admitted into this level of care if they are unable to care for themselves or are a danger to themselves or others. The goals of inpatient treatment are to stabilize the patient, which generally takes several days to a week, and then transition the patient to a lower level of care.

Additional Treatment Options for OCD

Other recommendations from the APA Practice Guideline,1 cite research showing that ERP delivered in a group format, as well as ERP therapy delivered via videoconferencing (teletherapy), might be effective. Also, there is some promising new research showing that Acceptance and Commitment Therapy may be helpful for OCD. You can search for any of these treatment types in the Resource Directory.

OCD treatment can be difficult, and requires a lot of courage and determination. Having a support network to talk to during treatment can make all the difference.  Consider accessing a support group in your area. Click here to learn more about support groups.

OCD can be a family affair. Read more here about the impact on families and what family members can do.

When severe OCD proves resistant to standard forms of treatment, there are other options available. However, it should be noted that all of the following procedures are still currently being researched. While there is evidence to suggest that they could potentially be helpful in reducing OCD symptoms, they are not concretely proven to do so. These should be utilized as a last resort when all of the evidence-based treatment methods for OCD (outlined above) have already been accessed:

What about PANDAS?

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is a rare type of OCD that occurs in childhood following the immune system’s overreaction to an infection, such as strep throat. PANDAS should be managed with early antibiotic treatment for strep infections. Continued symptoms can be treated with standard OCD treatments such as exposure and response prevention (ERP) therapy and/or SRI medication*. For more information on PANDAS, including diagnosis and treatment, click here.

*Closely watching a child's reaction to SRIs is important as they can cause severe behavioral problems, including suicidal thoughts.

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