Tuesday, April 28, 2009

Treating OCD...what works and wat doesn't

The anxiety disorder known as obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by uncontrollable, unwanted thoughts and repetitive, neurotic behaviors that one is compelled to perform without reason. OCD causes the brain to focus on a particular thought or urge, such as hand washing, or checking the front door lock at night exactly 13 times.
The most effective treatment for obsessive-compulsive disorder would most narrowly be two-pronged; a combination of behavioral and cognitive therapy.
On the behavioral side, exposure and response prevention would involve the repeated exposure to the source of obsession, (the front door lock at night). Then, the afflicted would be asked to refrain from the compulsive behavior that would usually be performed. For example, as the patient sits next to their front door, anxiety-ridden, the urge to check the lock should theoretically go down. This shows the patient that they have control over their anxiety and can turn it off and on. Traditionally, behavioral therapy attempts to eliminate unwanted behaviors through classical conditioning, systematic desensitization, progressive relaxation, exposure therapy, flooding, aversive conditioning and/or operant conditioning.
The other prong of the therapy for OCD would come in the form of cognitive therapy. This therapy would attempt to eliminate irrational thoughts and create an awareness of negative thinking and words. It would assume that OCD focuses on scary thoughts of exaggerated situations, (for example, the idea that if the front door lock is not checked 13 times, a rapist/murderer will break into my home and slowly kill everyone that I love). A larger part of this therapy, however, focuses on teaching healthy and effective ways of responding to obsessive thoughts, without resorting to compulsive behavior. This comes about primarily from gentle questioning, which helps patients discover their irrational and maladaptive thoughts and change their views.
These two forms of therapy are clearly a superior combination, over their three counterparts of psychoanalytic therapy, humanistic therapy or family/group therapy.
Psychoanalytic therapy would not work because it states that the unconscious holds the key to everything and that childhood memories hold the key to everything. It uses free association, dream analysis and transference. However, none of these offer real solutions to fix the problem, nor are they scientifically-backed.
Humanistic therapy uses introspection and active listening to promote personal growth, genuineness, acceptance and empathy. However, that is not what an OCD patient needs¾ they are not having problems with their inner being, they just have something wrong with their brain. They are like a CD stuck on repeat, not a tortured soul that needs to be tamed.
Finally, family/group therapy would presumably be ineffective for people with OCD as well. This form of therapy aims demonstrate that patients are not alone in their problems and to share helpful hints with one another. However, this is still not what an OCD patient needs. Rather than hearing that ‘no person is an island,’ OCD patients need to be conditioned to not obsess on one minute thing.
Thus, the cocktail of the behavioral and cognitive therapies would be the most effective, because it tackles the issue of contorted thoughts and maladaptive behaviors.

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