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June 28, 2012Posted in: Programs & Resources, TS + Tagged:

Is CBT* the Right Treatment for Your OCD?

Obsessive Compulsive Disorder (OCD) is a chronic anxiety condition that is often found in people with Tourette Syndrome. It is so common in fact, that studies indicate that 60% of people with TS also have OCD. This makes OCD the most common co-occurring “+” in TS+ alongside ADHD. OCD symptoms include obsessions, or recurrent thoughts or mental images; and compulsions, acts aimed at reducing anxiety (even if they are not logically connected with the anxiety or fear). Common obsessions include fear of germs, desire for cleanliness, and wanting everything to be “just right.” Common compulsions include repeated hand-washing, repetitive counting, lining up clothes by colour, and constantly checking that you locked the door. There are many other types of obsessions and compulsions, too many to list here. OCD is a medical condition; it is not simply about being fixated on something. For example, checking once or twice that you locked the front door or turned off the curling iron does not mean you have OCD. OCD involves obsessions and compulsions that significantly impair day-to-day functioning. For example, if you can’t get to work on time because you need to wash your dishes over and over, or you can’t sleep until you wash the floor three times daily to the point that you are unable to get a full night’s rest, this may be OCD. If you think you have OCD, do not self-diagnose and/or self-treat, see your doctor and tell them why you think you may have this condition. To date the most effective psychological treatment for OCD is Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention or (E/RP). E/RP involves confronting fears and learning to discontinue your natural escape response that usually follows the confrontation. Cognitive Behavioural Therapy involves learning to replace negative thinking and over-generalizing with positive, effective, and realistic thinking with the end goal being decreased emotional distress and decreased self-defeating behaviour. Several studies find that the use of CBT, even in extremely severe OCD cases, can lead to clinically significant improvements in symptoms. However, some studies also find that many individuals still experience some symptoms rather than a “full recovery” or “remission” after doing CBT. Unfortunately, CBT and E/RP can be costly when they are not covered. They are also extremely time-consuming since they require many months of frequent therapy sessions in order to be successful. It is for these reasons that two Australian doctors examined exactly what factors are associated with successful CBT treatment outcomes in OCD patients. They published their findings in 2011 in the Journal of Counselling and Psychotherapy. What did they discover? First of all, they concluded that: “predicting the CBT outcome in adult OCD is difficult.” Gender, how long a person had OCD, age of onset, and whether or not they had other co-occurring psychological conditions like anxiety or depression, was not related to treatment outcomes. For the most part, treatment success was also unrelated to the type of obsession and/or compulsion, except for sexual obsessions, which they found to be associated with poorer treatment results. Another factor they found to be associated with poorer treatment outcomes was severity of symptoms. Their study showed that if a person began CBT treatment with extremely severe symptoms, they were the more likely to conclude treatment with some severe symptoms. A word of caution: the authors noted that their results are consistent with another study that found that more severe OCD is associated a poorer treatment outcomes. However, they pointed out that a different study found contradictory results. Due to this contradiction they stated, “lack of consistency in the research…makes targeting specific treatments at those most likely to improve a difficult [task]”. As a result, they concluded, “CBT-based treatment for OCD should be recommended for all individuals with the condition.” If you think you or a loved one may have OCD, talk to your family doctor about it. They can help refer you to a practitioner who can administer CBT. You should not receive CBT from someone who is not a licensed professional like a physician or psychologist. If you would like a name and phone number for a licensed CBT professional in your area, call or email the National Office at 1-800-361-3120 or tsfc@tourette.ca. Have you ever had CBT? What was it like? Did it help? Share your stories in the comments. *CBT stands for Cognitive Behavioural Therapy. If you would like more information on CBIT, which stands for Cognitive Behavioural Intervention for Tics, please read about it here or call or email the National Office at tsfc@tourette.ca or call us at 905-673-2255 or toll free at 1-800-361-3120.

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