What To Do About the Obsessions Part of OCD - Treating OCD

Written by HealthyPlace.com Staff Writer

MYTWOGRLSMOM: My mind goes constantly. I count everything and I am constantly saying prayers, so nothing "bad" will happen. How can I help myself to stop this?

Dr. Jenike: This is one of the typical OCD symptoms. You need to work with a good cognitive behavior therapist to develop a treatment plan. Also, medications may help.

When you say that your mind goes constantly; it is probably generating obsessions. Then, the counting and praying are actually mental rituals that you do to lessen the anxiety caused by the obsessions. You need to have a plan to stop the rituals, and just feel the anxiety produced by the obsessions. Once your brain learns (and I mean learns) that you will not do rituals, it will tire of generating obsessions. As I said, medications can help this process. Some of your mental rituals, are by now almost automatic, so you will have to make a conscious effort to cut them back. The first step is to list all the mental rituals, and then decide which ones to approach first.

Besides the book I mentioned earlier, another good book is "Getting Control". This book gives all kinds of self help advice.

David: I am getting some questions regarding what constitutes a diagnosis of OCD. You can click the link for that.

Here are some audience comments on what's worked for controlling obsessions:

matrix*: Obsessive-Compulsive Disorder, to me, is like an itch on my arm. I must scratch it and it feels better once scratched, but actually it spreads and gets worse in the long run. If I don't scratch the itch, it gets real bad, but in awhile, it fades away.

cwebster: To reduce obsessions, I take medications (Effexor-XR, Serzone) and tell myself to just let the thoughts go, they're not important. If that doesn't work, I take Seroquel and pass out!

Kerri20: I wanted to share that exposure and response therapy, as well as CBT, helps me a lot.

Dr. Jenike: Exposure and response prevention is the BT part of CBT.

Gridrunner: Have you heard of some success using St. John's Wort or 5-htp to lessen OCD?

Dr. Jenike: Yes, there are a few cases where St. John's Wort has helped OCD. In Germany, there are dozens of studies using SJW for mild to moderate depression, but its use for treating OCD is relatively new. I have tried it in quite a few patients, with not much success. But then again, most of the patients I see now, are on the more severe end of the spectrum.

Bea: What kind of dosage of the St. John's Wort is effective for OCD?

Dr. Jenike: It depends on the preparation. It is approximately three tablets per day of the most commonly available preparations. There is quite a bit of information on the internet about dosing. The dosing studies are with depression, but most people use similar doses for OCD.

HealedHeart: I have a severe fear of germs. I don't exactly know what the fear is, as I'm not really afraid of getting sick. However, I can't touch library books or anything like that, without having to wash my hands over and over. Also, I can never wear anything more than once without washing it.

I am entering the working world and will have to take the public bus. I don't know how I will survive sitting and touching seats that so many other people have touched. What can I do about this?

Dr. Jenike: You are CBT deficient in a big way. For advice, go to the OC Foundation web site, join the OCF and learn about OCD and how to treat it. Medication for treating OCD may help.

The people with fear of germs are actually the easiest to treat, and success rates are great if you do the exposures and response prevention. If you contact a support group locally, they can tell you which local doctors know how to treat OCD.

David: CBT, by the way, is Cognitive Behavioral Therapy. You can read more about how to use CBT to treat OCD here.

Brin: I have been taking Klonopin (Clonazepam) for five years. I decided to wean myself off. I have been tapering for about two weeks and now I am completely off, and I am having horrible withdrawal symptoms. Can you give me any idea of how long these withdrawals can possibly last?

Dr. Jenike: If you are on high dosages of a benzodiazepine like Klonopin, sudden stopping can be dangerous. If the dose is low, there is probably no problem. Withdrawal depends on dosing and length of time you have been on the drug. Since I don't know dosage, I cannot comment intelligently. Even if I did know the dose, I can't comment without being familiar with your case.

Also, I don't know what withdrawal symptoms you are having. I would think that by two to three weeks, you should be back at baseline. Keep in mind that the Klonopin may have been helping anxiety and maybe the anxiety is returning so the problems are not actually withdrawal. Also, Klonopin is not a great anti-OCD drug.

sbg1124: Is it possible for some SSRI's to make OCD worse?

Dr. Jenike: Yes. I think that, sometimes, worsening OCD symptoms (not side effects) actually predicts a good response. That is if the patient can stay on the drug long enough. It is a rare OCD patient who continues to have worsening OCD on these drugs, but I have seen it. Sometimes, the drugs help, but other times, they can make things worse.