As late as the 1970's, most mental health experts described the prospect of
recovery from OCD as poor. However, in the last 30 years with the development of
cognitive behavior therapy the prognosis for recovery has improved. With
cognitive behavior therapy, sufferers are taught specific techniques to rid
themselves of unwanted images, thoughts, beliefs, compulsions, and the anxiety
associated with them. Behavioral treatments are successful with patients
undergoing medication treatment from OCD and lowers the risk of relapse. It is
also effective with patients who do not take medication.
At Wartel Behavioral Services we use the latest behavioral techniques for
treating OCD. One method taught is exposure and response prevention (ERP).
During ERP, people are exposed to a feared situation and refrain from doing the
ritual/compulsive behavior. An example of ERP is someone who is afraid of touching doorknobs due to
a fear they will be contaminated by germs and get sick, then doing it and refraining from washing their hands. Repeated exposure results in diminishing and eliminating anxious and
obsessive thoughts, because the feared consequences do not happen.
In order to maximize the likelihood of success and minimize the anxiety
produced with exposures, a fear/exposure hierarchy is developed with the patient.
This hierarchy is simply a list of all the obsessions/compulsions that cause
anxiety for the patient, including the ones that just cause a little. Exposure
starts with obsessions and compulsions that are the lowest and cause the least
distress. Decreases in anxiety from an exposure also generalize
(a principal called generalization) to other fears on the exposure hierarchy and
bring them down a little. Subsequently, exposure begins with the item next
highest on the hierarchy. Due to generalization, the next item on the list is not as hard as it
was initially, and is just a little more difficult than the exposure that was just
finished,and is no longer a problem.
Imaginal exposure is done to reduce
obsessional thinking. With imaginal exposure, the client is assisted in writing a story about his obsession. The story is written in the present tense, first person, and is based on the client's actual obsession. What the client obsesses is going to happen, occurs in the story. A hierarchy is also produced for doing imaginal exposure. Imaginal exposure starts with obsession lowest on the hierarchy and progresses up the hierarchy as the client's anxiety decreases.
Postponing doing rituals and doing rituals differently helps weaken
compulsions. Cognitive therapy is helpful for helping patients challenge
obsessional thinking.
Sometimes families and others with the best of intentions may inadvertently
reinforce compulsions. We work with family members to help them better
understand how they can help.
When necessary for improvement, we provide training therapy in the
patient's home or other settings.
Wartel Behavioral Services, P. C. 6346 Orchard Lake Rd., Suite 107 West Bloomfield, Michigan 48322 Phone: (248) 626-1330 Fax: (248) 626-9170 E-mail: drwartel@gmail.com
