Tag: obsessive compulsive disorders (OCD).

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Patients with obsessive-compulsive disorder (OCD) frequently experience problems with disturbing, intrusive thoughts, as well as overwhelming impulses to perform ritualistic behaviors that reduce the anxiety associated with such thoughts. Traditional psychotherapy has not been found to be helpful for most individuals with OCD.  However, one modern form of treatment is particularly successful in overcoming symptoms of the disorder.

The nature of cognitive-behavioral therapy

OCD patients typically become distressed about negative thoughts or obsessions, because they see them as warnings of potentially dangerous events. Cognitive –behavioral therapy (CBT) helps patients identify such unrealistic thoughts and reinterpret them, thereby reducing anxiety.  Fewer anxious thoughts lead to decreased compulsive behavior.

How does CBT work?  Treatment focuses on helping patients examine the relationship between their feelings, thoughts, and behaviors. Using a collaborative and structured approach, therapists guide patients to explore and expose themselves to their fears and anxieties in a controlled and safe environment.  The beliefs surrounding those fears are also identified, challenged, and ultimately changed.

Patients learn to recognize their worries as being obsessions and to see their rituals as compulsions. Treatment includes a variety of structured techniques and strategies.

Homework

Working on assignments between therapy sessions is an important part of the treatment process.  Patients are usually asked to keep a journal or “thought record” of their obsessions, in which they write down each one when it occurs, as well as their interpretation of its meaning.  The therapist reviews the journal with the patient and helps challenge any unrealistic beliefs or “magical thinking” that surrounds the obsessive thoughts.

Behavioral Experiments

Once a patient understands the relationships between thoughts and behaviors, therapy may progress to the use of behavioral “experiments,” in which the patient practices what has been learned.  An individual who believes that touching a doorknob three times will prevent her house from burning down may be asked by her therapist to touch it only once, then leave the house.  She will then see that nothing catastrophic happens.

One effective type of behavioral experiment is the use of exposure and ritual prevention.  This technique involves a patient’s prolonged exposure to a distressing situation or object, along with strict prevention of any associated ritualistic behavior.

First the patient is exposed to a situation or cue that stimulates obsessive thoughts. For example, a patient with a germ obsession may find that touching a faucet in a public restroom triggers thoughts of contracting a fatal disease. These thoughts, in turn, lead to compulsive hand washing. During exposure, the patient may actually touch the restroom faucet, while imagining the possible horrible consequences associated with this action.

Following exposure to the triggering obsessive thought, the patient is asked to abstain from performing the behavior believed to prevent the feared consequence; e.g., ritual hand washing. After several exposures, followed by no performance of the compulsive act, the patient realizes that the feared consequence does not occur if the compulsive act is not performed.  More importantly, the patient realizes that distress and anxiety can lesson even without performance of the ritualized behaviors.

Finally, the patient and therapist process the patient’s experience during or after the experiment and discuss how the experience affects the patient’s beliefs and fears.

CBT is generally successful as a short-term therapy, and it has achieved very positive results with a variety of patients.

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Compulsive hoarding is by no means a new phenomenon. However, it has recently moved into the spotlight courtesy of several documentaries and television shows such as A&E’s “Hoarders” and TLC’s “Hoarding: Buried Alive.”

The exposure compulsive hoarding has gained as a result has been an eye-opener to many hoarders as well as to those around them. It has brought awareness to the fact that treatment is available to help people begin to unclutter their lives.

The Characteristics of a Hoarder

Compulsive hoarding affects roughly two million Americans, according to Psychology Today Magazine. Although it is argued in some circles that hoarding is a stand-alone disorder, it is most often placed within the category of obsessive compulsive disorders (OCD).

Generally, hoarders fear that throwing anything away will have negative repercussions on their lives. As a result, they collect and accumulate things that might have little or no real use.

Although the scene inside their dwelling might appear chaotic to others, many hoarders feel hanging onto items provides them with a certain amount of control and sense of organization. Hoarders feel a personal responsibility and connection to their possessions. If an item is lost or discarded, the fragile balance in their lives can be disrupted.

Getting Help

In treating compulsive hoarding, mental health professionals use an approach similar to that of OCD treatment. The foundation of treatment focuses on a combination of medication and psychotherapy. Specifically, behavioral therapies such as cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) are employed.

Some of the goals within behavioral therapy include diminishing the hoarder’s urge to save, and redirecting the distorted view of the importance they place on the items in question. Therapy also helps at decreasing a hoarder’s anxiety over discarding items and improving their judgment and decision-making capabilities.

Mental health centers across the country are home to experienced professionals who have successfully treated compulsive hoarders. Though treatment can be lengthy and at times difficult, it can provide a new lease on life for those struggling with this all-consuming disorder.