The Best Treatment For OCDby Dr Emma Gray - 17th December, 2018
In this blog I am going to explain the best treatment for adults suffering with Obsessive Compulsive Disorder (OCD). This information is up to date at the time of publishing this article and is based on the recommendations made by the National Institute for Health and Care Excellence (NICE), an executive non-departmental public body of the Department of Health in the United Kingdom. For more information about OCD see the video below:
There are 2 types of treatment that have been proven to be effective for OCD: medication and talking therapy. I will start by explaining a little about each of these and then go through what type of treatment you can expect to be offered depending on the severity of your symptoms.
The biological origins of OCD remain unclear, this makes it difficult to develop a medication that works for everyone. So if you are offered medication, prescribing will involve a bit of trial and error to get the type and dose of the medication right. Medication usually takes between 4-6 weeks to have its full effect so you will be reviewed after this period to assess how your symptoms are responding.
The first type of medication that you are likely to be offered is an antidepressant called a Selective Serotonin Reuptake Inhibitor (SSRIs) e.g. Fluoxetine, Fluvoxamine, Paroxetine, Sertraline or Citalopram. If your symptoms are severe and do not respond to a full course of one of these medications, you may be prescribed a different type of anti-depressant called a tricyclic e.g. Clomipramine. If your symptoms still do not improve this may be combined with Citalopram and then with an antipsychotic if necessary.
SSRIs can lead to an increase risk of self-harm and suicide, particularly in adults under 30, so you should be monitored closely, especially in the first few months of treatment.
2. Talking Therapy
The psychological origins of OCD are better understood so developing an effective therapy has been easier. Currently the most effective talking therapy for OCD is Cognitive Behavioural Therapy (CBT). This involves a combination of learning and practicing:
(a) Strategies to evaluate the accuracy and helpfulness of thoughts underlying and maintaining OCD symptoms and exchanging them for more accurate, helpful alternatives that support a calmer, more confidence and productive life.
(b) Strategies to help you to resist engaging in compulsive behaviours and rituals and to build your confidence in tolerating anxiety.
What you will be offered
If your symptoms are mild your will be offered a course of CBT either 1-1 with a therapist or in a group. You should also be provided with some self-help material to help you to learn and practice techniques effectively.
If your symptoms do not improve or if your symptoms were assessed as moderate at the outset you will be offered an SSRI or a more intensive course of CBT (usually more than 10 hours of 1-1 time with a therapist).
If after 12 weeks your symptoms are not responding you may be offered a combined course of an SSRI and intensive 1-1 CBT. Additional medication (as mentioned above) may be added into your treatment if improvement is still not seen. For sufferers who are housebound, treatments are sometimes offered by phone or in the home.
Relevant family members should be involved in treatment in order to ensure that they are able to provide appropriate support for the sufferer and to help them to not become involved in OCD rituals and routines, which will, over the longer term, prevent recovery.