Treatment
Clinical and animal research sponsored by NIMH and other scientific organizations
has provided information leading to both pharmacologic and behavioral treatments
that can benefit the person with OCD. A combination of the two therapies
is often an effective method of treatment for most patients. Some individuals
respond best to one therapy, some to another.
Pharmacotherapy
Clinical trials in recent years have shown that drugs that affect the
neurotransmitter serotonin can significantly decrease the symptoms of OCD.
These drugs include fluvoxamine, paroxetine, sertraline, clomipramine and
fluoxetine. All these serotonin reuptake inhibitors (SRIs) have proved
effective in treatment of OCD. If a patient does not respond well to one
SRI, another SRI may give a better response. For patients who are only
partially responsive to these medications, research is being conducted
on the use of an SRI as the primary medication and one of a variety of
medications as an additional drug (an augmenter). Medications are of great
help in controlling the symptoms of OCD, but often, if the medication is
discontinued, relapse will follow. Most patients can benefit from a combination
of medication and behavioral therapy.
Behavior Therapy
Traditional psychotherapy, aimed at helping the patient develop insight
into his or her problem, is generally not helpful for OCD. However, a specific
behavior therapy approach called "exposure and response prevention" is
effective for many people with OCD. In this approach, the patient is deliberately
and voluntarily exposed to the feared object or idea, either directly or
by imagination, and then is discouraged or prevented from carrying out
the usual compulsive response. For example, a compulsive hand washer may
be urged to touch an object believed to be contaminated, and then may be
denied the opportunity to wash for several hours. When the treatment works
well, the patient gradually experiences less anxiety from the obsessive
thoughts and becomes able to do without the compulsive actions for extended
periods of time.
Studies of behavior therapy for OCD have found it to produce long-lasting
benefits. To achieve the best results, a combination of factors is necessary:
The therapist should be well trained in the specific method developed;
the patient must be highly motivated; and the patient's family must be
cooperative. In addition to visits to the therapist, the patient must be
faithful in fulfilling "homework assignments." For those patients who complete
the course of treatment, the improvements can be significant.
With a combination of pharmacotherapy and behavioral therapy, the majority
of OCD patients will be able to function well in both their work and social
lives. The ongoing search for causes, together with research on treatment,
promises to yield even more hope for people with OCD and their families.
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