Psychological Treatment of Obsessive–Compulsive Disorder: Fundamentals and Beyond

Fourthly, there are several different psychological paradigms in terms of explaining and giving treatment for OCD which are beyond the genetic, neuroscience and social paradigms. The origin of the illness lay in the regular conflict between Ego and Superego and also sexual and aggressive impulsions. By using the regular techniques of free association and therapist interpretation, psychoanalysts try to help patients discover and overcome their underlying conflicts and defenses. The traditional psychodynamic psychotherapy could not bring any significant change in the OCD patients during different trials [11].

Moreover, there are so far no verified data is found that shows improvement of using this therapy in the treatment of OCD [12].

Cognitive Therapy of Obsessive Compulsive Disorder with Chronic Tic Disorder

Finally, the cognitive behavioral paradigm provides a clearer description of the processes and content of the disorder; the major clinical characteristics and their origin, and also the effective treatment which does not only help people but also ensure safety. Modern cognitive-behavioral paradigm is classified into two sections, general deficit paradigms and belief and appraisal paradigms. According to general deficit paradigms research says that OCD afflicted people have more deficits or abnormalities in tasks which seems not related to threats or obsessions.

OCD patients, compared with the control group, show less ability which inhibits the responses even if there are emotive neural responses.

Psychological Treatment of Obsessive-compulsive Disorder: Fundamentals and Beyond

Studies prove that all OCD patients do not have neuropsychological deficits. However, it shows that OCD symptoms begin from the abnormality in general information processing systems [13]. Besides, beliefs and appraisal paradigms say that unwanted thought and repetitive behavior grow from specific type of dysfunctional beliefs.

To illustrate, researchers suggested that assumption about responsibility, blame or organization play an important role in OCD. Researchers thought that these assumptions develop from harsh religious or moral fostering or from the experiences of strict codes of conduct and responsibility. The strength of these paradigms is that they are clearly verifiable and also have provided a large number of empirical predictions which lead to the greater field of research.

Unlike other paradigms, this paradigm tries to understand the specific underlying facts such as thoughts, feelings, and emotions of action of an individual. Scientists may or may not find out some more genes which are involved causing OCD or neuroscientist may or may not discover some new transmitters which have more chances to cause OCD and socio-cultural facts are wide which is almost impossible to specify.

Considering these all facts the best paradigm is the cognitive behavior paradigm which not only explains the fundamental causes of the symptoms of OCD but also gives the most effective and prominent treatment Cognitive Behavior Therapy [16]. Cognitive behavior therapy CBT is the most successful treatment for OCD, because it mainly focuses on the relationship between thoughts, feelings and behaviors. It explores the patterns of thinking of a patient. The therapy practices are sat up as behavioral experiments to test appraisals and beliefs.

Through the technique exposure and response prevention therapy ERP the patient is exposed to the challenges of their irrational beliefs. In response this therapy teaches them to endure those anxious experiences rather than avoiding them.

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The ERP is very important in the treatment because it helps patients reduce their anxiety and make them understand that these situations are not dangerous. It is scientifically confirmed that CBT essentially changes the brain activity improving its functioning which is the result of broad engagement of the patient in the therapy [17]. Also, in case of ERP the rate of relapse is lower, the cost is lower than medications, and in terms of efficiency it is higher- ranking [18].

Moreover, studies have constantly exposed that the positive achievements related with CBT are longer-lasting than different kinds of medication. OCD symptoms do not get reduced immediately in most of the medication. Most of the cases medication takes weeks to start working and also theses doses have shown side effects in OCD patient whereas, for ERP it might take 8 weeks or less than that to get the positive result.

Apart from the positive sides, cognitive behavior paradigm and CBT have some negative aspects as well. For example, the Cognitive behavioral paradigm does not consider the facts of neurobiological and genetic factors which have really good contribution to understand the onset of OCD. Beside CBT mainly looks for the current specific issues and ignore the past history of a patient. For some patients with hording, religious or sexual symptoms, it shows low efficiency.

Furthermore, the number of CBT practitioners is less in number because of lack of training [19]. He had intermittent concerns over balding, shape of his chin, having gynecomastia, getting swine flu or scrotal cancer over a period of few months. He had anankastic and borderline personality traits. A diagnosis of OCD with chronic tic disorder with anankastic and borderline traits was made.

Fluvoxamine and clomipramine were titrated to mg and mg respectively and talking to self-tics and body tensing were improved.

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Addition of risperidone did not benefit him. His residual symptoms were preoccupation with gynecomastia, complex tics, several obsessions, mental compulsions and ruminations but without talking to self. He was referred to a qualified psychologist to undergo cognitive behavior therapy CBT and in 20 sessions preoccupations with breast shape and tics improved but obsessions persisted.

Perusal of his past CBT treatment notes revealed that therapy had focused on preoccupation on gynecomastia and tics habit reversal but obsessions remained untouched. During follow-up, after 2 years, author offered him cognitive therapy CT for his persisting obsessions and patient consented. Main schematic beliefs were need to control and over importance of thoughts moral thought action fusion. He believed that just presence of sexual thought made him a bad person and failure to control his mind might lead to overt sexual womanizer behavior.

He aspired for mental purity. Unless he recalled information perfectly, he thought, he will not retain information usefully low cognitive confidence. Initially patient was reluctant to allow the bad thoughts in the mind without responding them. He was motivated to do this by advantage and disadvantage analyses. Normalization of intrusive sexual thoughts was achieved by self-disclosure and internet search. Futility of thought suppression was demonstrated by suppression of an image of elephant for 1 minute. He was told that non-acceptance and resistance offered to mental events and avoidances results in excessive unwanted intrusions.

Thought action fusion was corrected with behavioral experiments. He was told to allow sexual thoughts freely for 1 day and observe for any change in his behavior. Gradually he was more confident and stopped mental compulsions in response to sexual thoughts. He was told to look at ladies he was avoiding or imagine and masturbate as much as he wanted lead to reduction in avoidance of sexual issues.

He was told to stop doing repeated recall of information for 1 day and see any deterioration in his memory or functioning. He learnt that there was no need to take care of his memory and those compulsions improved. He wanted an ideal friendship in every friend in every occasion. This splitting or polarized thinking was corrected. At the end of therapy he told that friendship pricks him only once in ten times compared to past.

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