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 often is an effective method of treatment.
Medications
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 to develop insight into his or her problem, generally is not helpful for OCD. However, a specific behavior therapy approach called “exposure and response prevention” is effective.
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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