A Comprehensive Guide to OCD Treatments
Although there are some more commonly advised OCD treatments, there are in fact a wide range of options to treat OCD. When making a choice about your treatment it’s important to be self-informed as well as taking guidance from your doctor or mental health professional. This guide will take you through all of your treatment options and the science behind them.
A range of medications are available to treat OCD. Finding the right medication is very much trial and error to figure out which type of medication and which dosage brings you the most benefits, and the least side effects. This can be a difficult process, but can also be very worthwhile as finding the right medication can bring significant relief from OCD symptoms.
OCD medication is usually combined with a form of psychological therapy as standard to produce optimum results for OCD patients. The right combination truly can help you to control and overcome your OCD.
Selective Serotonin Reuptake Inhibitors (SSRIs)
The first line of treatment is Selective Serotonin Reuptake Inhibitors (SSRIs). You might also hear SSRIs referred to as antidepressants. While they are traditionally used to treat depression, they can also be very useful in treating other illnesses such as OCD. SSRIs are taken in tablet form everyday.
SSRIs work by inhibiting the uptake (meaning reabsorption) of serotonin, a chemical in your brain which helps to regulate your mood and control your emotions. This means that SSRIs make more serotonin available, effectively trying to correct any chemical imbalances contributing to mental illness.
There are a number of SSRIs recommended for the treatment of OCD. You’ll typically be started on a small dose of one type of SSRI and be given a few weeks to see if you experience any benefits or side effects.
Potential side effects of SSRIs include nausea, drowsiness, dry mouth, sweating and many more. Each individual medication will have specific side effects which you can find details about from your doctor, online, or in the patient leaflet which comes with prescribed medications. Each individual patient might experience the same side effects very differently and to varying degrees.
It’s important to take these side effects into account when making an informed choice about taking medication. Although side effects can sound scary, often the benefits of taking medication can outweigh the side effects. Many side effects pass after the first couple of weeks of taking the medication once your body adjusts to the tablets.
Tricyclic Antidepressants (TCA)
If SSRIs don’t work, you may be offered a Tricyclic Antidepressant (TCA). TCAs are an older form of antidepressants which tend to have more side effects. Only one TCA is approved for the treatment of OCD: Clomipramine (you may hear it referred to as Anafranil). Clomipramine is taken in tablet form each day.
Clomipramine works in a similar way to SSRI’s, trying to correct chemical imbalances in the brain. Similarly to SSRIs, there are a range of potential side effects which you should take into account when considering taking Clomipramine.
Antipsychotics are typically prescribed to treat mental illnesses with psychosis based symptoms. They are not prescribed on their own to treat OCD. Antipsychotics will only be prescribed when antidepressants have not worked on their own, to help the antidepressants work more effectively. You might hear this referred to as augmentation therapy.
There are a few types of antipsychotics which may be used during augmentation therapy. They are taken everyday in tablet form as standard. Just like the antidepressants we’ve discussed, antipsychotics can have side effects which should be taken into account before starting the medication.
Benzodiazepines are sedatives which work by calming you down. Unlike the other medications we’ve mentioned, they aren’t designed to be taken everyday. They’re a short term solution, only to be taken when they’re really needed. They are often used to calm anxiety and help with sleep.
Benzodiazepines can be addictive if taken in the long term and their treatment value is lessened over time. They tend to have more side effects than other medications, and so are only used to treat OCD when all other medications have failed.
Psychological therapies are essentially talking therapies which deal with core issues, or help you to change behaviours and regain your quality of life. There are a wide range of psychological therapies which can be used to treat OCD.
Cognitive Behaviour Therapy (CBT)
The most commonly used treatment method for OCD is CBT. Rather than dealing with the root causes of your OCD, CBT focuses on the present. Through CBT you can learn to break the cycle of OCD, regain control over your emotions and replace negative thoughts and behaviours with positive ones. Often CBT will be combined with medication as the first line of treatment for OCD patients.
Exposure and Response Prevention (ERP)
ERP is the primary type of CBT treatment recommended for those with OCD. ‘Exposure’ refers to the patient facing their fears in a safe space with the guidance of the therapist. ‘Response prevention’ refers to not engaging in compulsive behaviour in reaction to the trigger.
The patient will develop a hierarchy of their obsessions and starting out with the least troublesome, will be taken through facing these obsessions without responding with a compulsion. This may involve talking and thinking about an obsession or facing obsessions in the outside world. The patient learns over time that even though they didn’t carry out a compulsion in reaction to facing an obsession, nothing bad happened. This retrains the brain to break the cycle of needing to ‘deal with’ obsessions by carrying out compulsions.
This can sound like a really worrisome concept to someone with OCD, but it’s important to remember that you will have support and will start small and build up from there at your own pace. As you start to feel your anxiety reduce, your confidence will grow. The International OCD Foundation states that, “About 70% of people will benefit from ERP and/or medication for their OCD.”
Imaginal Exposure (IE)
For patients who struggle with the idea of exposure to triggers in ‘real world’ situations, IE may be used. This is a form of visualisation which takes the patient through imagining facing a triggering situation, rather than actually doing it physically. The aim of IE is to help the patient build up to carrying out ERP as their anxiety reduces.
Acceptance and Commitment Therapy (ACT)
Rather than trying to change negative thoughts as with CBT, ACT focuses on accepting all of your thoughts, both negative and positive. The therapy guides you through understanding how your thoughts are influencing your behaviours and committing to change for the better, while letting go of what you cannot control.
ACT for OCD is focused on helping patients, “get to a place where they can openly experience thoughts, feelings, or bodily sensations, not be overly impacted by them, and continue to move in directions in life that are meaningful.”
Research into ACT as an OCD treatment is limited although findings suggest promising outcomes. ACT might be suggested if CBT hasn’t been effective. For some people, ACT may work with their individual personalities more effectively than CBT. For others, ACT may not be suited to their circumstances.
Dialectical Behaviour Therapy (DBT)
DBT is similar to CBT, aiming to help you deal with intense emotions and change your thought processes and behaviour for the better. The mental health charity Mind explains that, “‘Dialectical’ means trying to understand how two things that seem opposite could both be true.”
A big part of DBT is acceptance, so referring back to the dialectical aspect, you may learn to accept who you are as a person while also learning how to change your thought processes and behaviour. These two things (which may seem contractitary) can actually both be done at the same time through DBT.
There is more evidence for CBT as a treatment of OCD. However since DBT is similar to CBT, it’s thought that it can be effective in treating OCD. This study on DBT for OCD patients discovered that, “DBT alleviated OCD by modifying emotional responses of patients and that DBT could prove a highly effective treatment in this regard.”
General counselling involves talking to a counsellor about your life, your past and present and what’s on your mind. Counselling doesn’t focus on changing thought processes or behaviours, or giving patients coping strategies. Rather counselling is about getting things off your chest, having someone to talk to, and being guided through coming to realisations and solutions of your own accord.
Counselling for OCD will typically lead to, or be integrated with, other types of psychological treatments such as CBT. Talking about your problems can help you to deal with them and feel supported, which can be useful for anyone. However this type of general counselling won’t directly address OCD symptoms.
Mindfulness is all about being in the moment rather than worrying about the past or the future. Through mindfulness we can learn to truly relax and ground ourselves in the present. This often involves guided meditations, visualization or mindful movement (such as yoga). There is a great deal of research detailing how effective mindfulness can be at reducing anxiety and stress.
Mindfulness can help OCD patients to calm and control their anxiety; to regulate their emotions; to think more clearly; to sleep more restfully and more! However mindfulness doesn’t actually change the thought patterns which cause OCD, so isn’t typically used on it’s own to treat OCD. Mindfulness may be used as part of other therapies, such as CBT, to get the best results for OCD patients. This article from an expert in OCD treatment states that, “many who specialize in treating OCD are finding that mindfulness may be useful at improving the effectiveness of cognitive behavioral therapy (CBT).”
You may hear of mindfulness approaches like Mindfulness Based Stress Reduction (MBSR), which is an intensive mindfulness programme to reduce stress and teach patients the key tools of mindfulness. MBSR has proven results in helping patients with OCD.
Another positive of mindfulness is that just like CBT, you can learn techniques which allow you to practice mindfulness in your daily life. You can even make daily tasks mindful! This means that the results of mindfulness can be long lasting. Anytime you’re feeling anxious, you can use mindfulness to help you alleviate your anxiety.
Interpersonal therapy (IPT)
IPT is all about the connections in your life, focusing on how your relationships with other people affect your mental health and visa versa. IPT helps you to communicate with loved ones more effectively, allowing you to address problems within relationships.
IPT may help to deal with stress within the family unit which is caused by OCD or which is perpetuating symptoms. Some evidence suggests promising results in reducing anxiety in general. IPT can also be very effective at addressing depression which often accompanies OCD. However, evidence of IPT directly treating OCD symptoms is limited at best.
Eye Movement Desensitisation and Reprocessing (EMDR)
During EMDR the therapist will talk you through triggers, for example traumatic memories or situations which usually cause a lot of anxiety. This may be related to your OCD obsessions. As they talk you through these experiences, they will direct your eye movements in various directions. This will often involve following the therapist’s finger with your eyes as you talk or think about these triggers. Sometimes other techniques like tapping your leg or the table in front of you, or playing audio while you address triggers is used.
The EMDR Institute explains that during an EMDR session the patient, “attends to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus.” Since you are unable to focus solely on the distressing memories or triggers, it can make them easier to talk about and deal with. EMDR is thought to retrain the brain by ‘teaching’ it that these triggers don’t need to evoke such a strong emotional response.
EMDR has minimal research and evidence in treating OCD but may be tried when other standard treatments, such as CBT and medication, have failed. EMDR does have proven results in treating trauma, depression, anxiety and panic disorder among other mental illnesses. Therefore EMDR does have the potential to help patients overcome anxiety and deal with past trauma which could have led to their OCD.
The treatment is known to be safe overall. However, this is a more recent treatment which doesn’t have as much research and can be controversial in the scientific community. The exact mechanisms behind how EMDR works are not fully understood yet. This 2018 study on EMDR concluded that, “Studies in well-defined clinical and non-clinical populations, larger sample sizes and tighter methodological control are further needed in order to establish firm conclusions.”
Other cons to EMDR include it being stressful to address traumatic memories. There is a risk of heightened awareness lasting beyond your sessions which can cause a feeling of lightheadedness, stimulus sensitivity and vivid dreams.
Psychodynamic / Psychoanalysis therapy
Psychodynamic therapy focuses on talking about both the present and the past, with the intention of getting to the root of issues which are affecting your mental health and influencing your present behaviour. The British Psychoanalytic Council state that this type of therapy helps patients to “understand and change complex, deep-seated and often unconsciously based emotional and relationship problems thereby reducing symptoms and alleviating distress.”
While psychodynamic therapy may be used to address other mental illnesses which accompany an individual’s OCD, the evidence suggests that on the whole it is not effective in treating OCD symptoms. Some professionals believe that this type of talking therapy can actually be detrimental for OCD patients as it leaves room for uncertainty, wandering thoughts and increased anxiety. The International OCD Foundation states that, “this form of treatment fosters doubt, which is a root problem in OCD”.
Due to the cons of this type of therapy, it’s typically only used to treat someone with OCD if they are also trying to deal with additional mental health issues, and if other forms of therapy have not been successful.
Habit reversal therapy/training
Habit reversal therapy helps patients to become aware of compulsive actions and learn to control them. This is often used for types of OCD which involve impulse control such as trichotillomania (hair pulling) and dermatillomania (skin picking). These compulsive behaviours often become ‘unconscious’, so habit reversal works to bring self-awareness back to these behaviours so that patients can regain the control they’ve lost.
Habit reversal therapy may be used in conjunction with CBT or other therapies to bring the best results for the patient. Unfortunately research is still lacking in the effectiveness of habit reversal for OCD, but initial results seem promising.
Animal assisted therapy
Animal assisted therapy involves sessions of petting, grooming and working with animals, from small animals and dogs to larger animals like horses. Animals can be incredibly soothing and calming. While this type of therapy can bring joy into an OCD patient’s life, reduce their anxiety and give them a positive focus, it won’t treat the core symptoms of OCD.
Creative therapies involve letting out your creative side through dance, art, music and other creative outlets. These sessions are led by a trained professional just as other therapies are. They can be great tools to learn to express your feelings, to feel connected with others, to provide distraction and to allow you to focus on the present. As with animal assisted therapy, they can be very useful for OCD patients but won’t treat the core symptoms of OCD.
Since OCD can have a significant effect on family relationships and many OCD patients need family support to overcome their symptoms, often families attend therapy together. Family therapy can range from general counselling to discuss issues and gain a great understanding, to family CBT to help loved ones form positive coping and support strategies.
Hypnotherapy involves being guided into a state of hypnosis: this is a very calm, deeply relaxed state of consciousness. During hypnosis you are still in control of your own body and mind. The therapist cannot ‘make’ you do anything you don’t want to do. When you’re in this state you’re typically more open to addressing difficult topics and memories. It’s also much easier to work on changing thought patterns and the associated behaviours.
Before the hypnotherapist guides you into a state of hypnosis, they will discuss your goals for the sessions with you and you’ll figure out a treatment plan together. This enables to get the most out of your sessions.
Using hypnotherapy in general can be a controversial topic. Using hypnotherapy for OCD has mixed results: some professionals feel that hypnotherapy is of no benefit in treating OCD symptoms, but can help with general anxiety reduction. Other results suggest that hypnotherapy can be useful for OCD patients, particularly when combined with other treatments such as ERP. One article from a mental health charity explains that, “When you are in a state of deep hypnotic relaxation, your imagination becomes a powerful way to calm and take the sting out of the anxiety created by obsessive thought, as powerful as looking at an actual picture.”
In some severe cases of OCD where other treatments have not proved helpful, brain surgery can be an option. There are two kinds of brain surgery used for OCD: cingulotomy and capsulotomy.
Cingulotomy targets two areas of the brain in the anterior cingulate cortex: these are the areas of the brain which control our emotions, impulse control, sense of reasoning, memory formation and habit formation among other functions. It’s thought that by ‘interrupting’ the pathways in the brain which make a connection between negative emotions and habits, OCD symptoms can be reduced. This is done by drilling into the skull and using an electrode to cut or burn the brain circuits involved in these brain processes.
A capsulotomy follows similar principles and techniques to a cingulotomy, except in a different area of the brain: the anterior limb of the internal capsule. This area of the brain has been shown on brain scans to be ‘overactive’ at specific points in patients with OCD. As with a cingulotomy, the brain circuitry is interrupted to try to restore balance and ease symptoms.
Needless to say brain surgery is a serious decision and not one taken lightly by professionals. This type of surgery is typically only used when all other options have been exhausted and the patient is unable to have a quality of life because of severe OCD symptoms. Brain surgery comes with risks and side effects, such as memory loss, cognitive impairment and seizures, and is not a complete fix for OCD. The recovery can take a number of days depending on the patient. Between 50% and 60% of patients who didn’t respond to more standard treatment experience some relief from symptoms as a result of brain surgery.
Gamma Knife Treatment
During gamma knife treatment, gamma rays are used to target a specific area of the brain called the anterior capsule. Gamma rays can pass through the skull without any incision, meaning no open surgery. When multiple gamma rays meet at the targeted point of the brain, the energy created between them can eliminate the targeted brain tissue.
Similarly to the brain surgery we discussed earlier, the aim of gamma knife treatment is to reduce over-activity in the circuits of the brain which are thought to perpetuate OCD symptoms.
As with brain surgery, gamma knife treatment will only be used when other traditional treatments have failed. Even though the procedure is non-invasive, any procedure which alters the brain has risks and potential side effects. Results so far are mixed and more research needs to be carried out: some patients gain partial relief from symptoms while others have experienced no relief.
Deep Brain Stimulation (DBS)
DBS involves opening the skull, however unlike the other brain surgeries we have mentioned, DBS doesn’t involve destroying any brain tissue. Instead during DBS surgery, electrodes will be placed into specific areas of the brain known as the ventral capsule/ventral striatum (VC/VS).
Once the electrodes are placed, they are connected by wires under the skin to ‘pulse generators’ which are typically placed on the chest, usually just underneath your collar bone. The pulse generators have batteries to power them and can be controlled by your doctor via a small, external, computer based device.
Similarly to pacemakers, the electrodes, wires and pulse generators remain in place as you go about your day to day life. They will remain a long term treatment, which means you will need ongoing care and monitoring under a psychiatrist who will control your ‘pulse generators’. The psychiatrist will be able to alter the charges sent to the electrodes depending on your needs. These charges are thought to modulate neural pathways which contribute to OCD, giving patients relief from their obsessions. The charges also stimulate certain areas of the brain improving mood and cognitive flexibility as this 2019 article explains.
DBS was originally used to treat Parkinson’s disease, but its use has been expanded as the understanding of how our brain works has developed. As with the other brain surgery options, this is a serious decision and will only be offered if other treatment methods have failed. There are significant risks associated with open brain surgery and some adverse effects have been noted. Results on the success of DBS are limited due to the small sample size, but the benefits are thought to be promising.
Transcranial Magnetic Stimulation (TMS)
TMS is noninvasive, meaning it doesn’t require any incisions to be made. During the procedure an electromagnetic device is placed against your forehead. The device sends out magnetic pulses which pass through your brain and stimulate nerve cells within specific areas of the brain to try to reduce OCD symptoms.
This article from Joan A. Camprodon-Gimenez, MD, MPH, PhD, the director of the Transcranial Magnetic Stimulation (TMS) clinical service explains that, “When magnetic pulses reach the targeted brain region, they turn into electricity and force neurons (brain cells) to fire, which then affects the interconnected brain networks.”
As with the other procedures on the brain we’ve mentioned, TMS will only be used if traditional treatments haven’t worked or if the patient’s OCD is particularly severe. While research is fairly limited for TMS for OCD and there are risks, the outcomes appear to be promising.
Electroconvulsive therapy (ECT)
ECT is done under anesthesia, meaning you wouldn’t be awake during the procedure. Small electrical currents are passed through the brain inducing a small seizure. This is thought to bring relief from symptoms of some mental illnesses.
ECT is controversial and has a stigma-fuelled history. You’ll no doubt have seen it in films and on TV in the past. While the procedure is much safer now, there are still significant risks and not a great deal of research into how exactly ECT helps and what the long term effects may be.
Side effects and risks of ECT include memory loss, confusion, headaches, nausea and muscle aches. As with the other brain procedures we’ve talked about, ECT is only used when traditional treatment routes have not worked.
Antibodies: a potential future treatment
Research is always ongoing and the potential for new treatments is being found all the time for a range of mental illnesses, including OCD. Recently scientists have discovered that those with OCD have higher levels of a type of immune cell called Immuno-moodulin (Imood).
Animals with the same heightened levels of this immune cell also display compulsive behaviours and high anxiety. When these animals were given an antibody to counteract the high levels, their anxiety symptoms reduced. This suggests that antibodies could be a potential future treatment for patients with OCD. Professor Fulvio D’Acquisto, a professor of immunology who is leading the research, states that, “it could take up to five years before a treatment can be taken to clinical trials”.
Other available help
Living with OCD can be isolating. It can be all too easy to feel as though no one understands you and you’re alone, even if you have very understanding loved ones. Support groups allow you to connect with other OCD patients. This can be uplifting and let you know that you are not alone! In support groups you’ll be able to discuss your feelings, talk about treatment, voice concerns about any challenges you’re facing, seek guidance from your peers and share your own insight with others.
Support groups can be run by local mental health charities, by the local health service, by someone who has recovered from OCD or by a mental health professional who wants to provide extra support.
Social care services are typically offered by your local council or health service, depending on the country you live in. Social care offers practical help and support with daily life for those who are struggling to function because of their mental illness. This might include helping with daily tasks, like shopping, cleaning and getting ready; guiding you towards the right help with finances; aiding you in getting regular carers who come to your home, and more.
Social care can be particularly helpful for those who experience severe OCD which disrupts their ability to carry out daily tasks and to function. It may also be helpful for those who have moderate OCD and don’t have much support from loved ones. The eligibility criteria for social care will vary depending on your local area.
Occupational therapists help patients with a wide range of physical and mental challenges to get the most out of their life. They will typically come into your environment and ask you to tell them about your life. They’ll help you to find ways to carry out daily tasks and hobbies in an easier way for your own individual circumstances. This can involve helping you to develop new skills, providing adaptations to the home and teaching you how to modify tasks to make them more effective.
When it comes to occupational therapy for OCD, the therapist will ensure that any modifications and advice given don’t feed into OCD behaviours and instead, help you to fight them. Their aim is to help you improve your quality of life and enable you to do what makes you happy!
You may also hear about occupational health services. This is similar to occupational therapy, but is a different service. Occupational health services come into the workplace to assess and provide guidance to both your employer and you. They’ll help you to stand up for your rights at work if needed, and guide you through being able to optimise your success in the workplace.
Depending on where you live, a range of community support options may be offered by local charities, health organizations and volunteer groups. This type of support helps you to get involved in the community and to make friends. They also help with benefits and financial advice, housing, shopping and food, and other day to day tasks. They might be able to help you advocate for the treatment and support you deserve for your OCD, if you are struggling to access help.
How treatment is delivered
There are a few ways therapy is delivered depending on the severity of symptoms, the recommendations and resources of the healthcare system and the individual’s circumstances. In general, patients will start with outpatient or telehealth treatment. The American Psychiatric Association’s (APA’s) practice guidelines state that, “patients should be cared for in the least restrictive setting that is likely to be safe and to allow for effective treatment.”
Outpatient treatment simply means that you will attend a clinic or therapists office for your therapy sessions and then return home. Typically outpatient treatment will involve individual or group sessions once or twice a week. The length of each session can vary depending on the therapist and the individual, but they typically range from 45 minutes to an hour long. Similarly how long you utilize outpatient treatment varies: it may be for a few weeks or more long term.
The guidelines for treating OCD by the National Institute for Health and Clinical Excellence state that, “Variation in therapist time for treating OCD is considerable, ranging from fewer than 10 hours to over 50 hours over 10–20 sessions.”
For some patients with more severe symptoms, a more intensive approach to outpatient treatment will be used. This involves attending therapy sessions several times a week and often each session will be longer than typical outpatient sessions.
Outpatient treatments tend to be preferred over other in-person treatment options because they enable patients to return to their home environment between sessions, and are less disruptive to the rest of their lives. This is also more cost effective for the health system.
Telehealth refers to therapy sessions provided remotely. Telehealth may involve taking part in video calls or phone calls with a therapist. Some therapists offer texting and messaging services. Telehealth can also include using resources through the internet such as videos and written worksheets, as well as therapy apps. Therapy websites are another telehealth option which tend to provide a range of therapy methods, for example CBT and mindfulness, to help the patients reach their goals.
Often attending medical appointments can be quite stressful and anxiety-inducing for those with OCD. Using telehealth can be really beneficial for patients because it allows them to carry out their sessions in their own home where they feel comfortable. There’s no need to travel to an appointment, so you can do your sessions anywhere at any time. It also allows you to fit therapy in around your own schedule.
Often telehealth can be more accessible for patients than in person therapy, because you don’t need to wait for a referral or be on a waiting list for treatment. However, some patients may prefer, or benefit more from, in person guidance depending on their situation.
If you are referred to a day programme this means you will attend treatment for the whole day, doing various types of therapy sessions. The International OCD Foundation explains that during day programmes patients, “attend treatment during the day (typically group and individual therapy) at a mental health treatment center usually from 9am – 5pm up to five days a week”. How many weeks day programme treatment continues for depends on the individual’s progress and the resources offered by the local health service.
For patients with more severe OCD who are not finding outpatient based treatment helpful, they may attend a more intensive day programme at a mental health hospital. They’ll still return home at the end of the day, but will take part in intensive therapy sessions throughout the day for a number of weeks.
During residential treatment patients will live in a mental health hospital, treatment centre or housing unit. This will typically be voluntarily, agreed between the patient and their mental health team. Residential treatment is open, meaning patients aren’t locked in and can come and go. Staff will be on hand at all times to help patients cope and to aid them with any struggles they’re having. Patients will have intensive therapy throughout each day. How long a patient stays in residential treatment depends on an individual’s situation.
The highest level of treatment is inpatient therapy, meaning patients stay in a mental health hospital. This type of treatment can be voluntary or sometimes involuntary, meaning the patient will be sectioned for their own safety. Inpatient therapy means that a patient is in a locked ward and they are not free to come and go. This sounds scary but is in the patient’s best interest if they are experiencing severe mental illness symptoms. The International OCD Foundation explains that inpatient therapy is only used when patients, “are unable to care for themselves or are a danger to themselves or others.”
Inpatient therapy is a short term solution: patient’s will only stay in an inpatient setting for as long as it takes to stabilize their mental health to a safe level. They will then be directed to a lower level of ongoing therapy to treat their OCD and any comorbid mental illness.
Where to access OCD treatment
There are a few different ways you can access the treatments we’ve discussed, depending on the type of treatment you’re seeking, your resources and your needs.
A referral through your doctor or therapist
Medications can be prescribed directly from your doctor or mental health professional. Psychological therapies, physical based therapies (such as brain surgeries) and other types of support can be accessed through your doctor, therapist or mental health specialist via a referral. Depending on where you live this often involves being put on a waiting list for treatment. How long you need to wait varies depending on the resources available.
You will typically get a letter to let you know when and where to attend your therapy. In the UK, these treatments will usually be available for free via the National Health Service. In other countries your insurance may cover treatment or you may need to pay out of pocket.
If your resources allow you will be able to access medication, psychological therapies, physical based therapies and other support privately. This means that you will pay (usually fairly high fees) to access treatment privately. Private treatment bypasses waiting lists and allows you to get what you need more quickly. It can also allow you to have more choice and control over which doctors and therapists you see, but can be very costly especially over a long period of time.
The telehealth we mentioned earlier often means that you can access psychological treatments online or through an app. Online platforms and apps allow you to be guided through treatment in your own time, on your terms and in an environment where you feel safe. They are often much more cost effective for patients as well as time saving.
The Impulse platform is a therapy website specifically developed to treat OCD. The platform is developed by OCD patients meaning that we truly understand the struggles of living with OCD and how to overcome symptoms. Jamal, our founder, struggled with years of OCD before he was able to access the treatment he needed to reclaim his life. Now he wants to help others do the same!
The Impulse platform tailors a course of treatment specifically for your type of OCD and your individual needs. Using cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), exposure and response prevention (ERP) and mindfulness, the website helps OCD patients to break the cycle of OCD and get relief from their symptoms.
How to advocate for the treatment you deserve
Unfortunately in some cases stigma and lack of education among medical professionals about OCD may mean that you need to advocate for your own treatment. Some tips for advocating for the treatment you deserve for your OCD are shown below.
- Getting informed about the treatments available, their side effects and how they work so you can make an informed choice.
- Keeping notes of every appointment you attend and what happened during the appointment for future use.
- Writing down any questions or concerns you want to address before an appointment to help keep you on track if you get flustered.
- Speaking up if you have concerns: you are not a burden.
- Regularly asking for updated copies of your medical records so you know what is on file about your OCD.
- Being calm, persistent and clear when seeking treatment and asking questions.
- Asking a friend, family member or care worker to help you advocate for yourself, or to advocate for you.
- Asking for another doctor if you feel you are not getting what you need.
- Making a complaint if you feel you have been treated unfairly.
The charity OCD Action has a really great resource: a self-advocacy toolkit which can help you to organise your advocacy actions.
How to choose the right treatment for you
Your doctor or mental health professional will guide you towards the right treatment for you, but it’s important to remember that you have choices and are fundamentally in control of which treatments you agree to. The following tips can be useful when making a choice:
- Ensure you do your research: knowledge is power when making an informed choice.
- Consider the side effects and potential risks, weighed up against the potential benefits.
- Consider your resources when choosing a treatment method: figure out what will suit your individual needs, preferences and financial resources.
- Ask someone you trust for a second opinion; often this can be very reassuring.
- Ensure you trust the medical professional recommending treatment: if not, don’t be afraid to ask for a second opinion.
- If you have concerns or questions about a treatment, write them down and ensure they are addressed clearly and fully by a medical professional before you agree to move forward.
Remember that whatever treatment you choose and however you access it, this is your recovery journey and you can take control. You’re a warrior fighting your OCD, and with the right treatment and support, you can win your battle!
International OCD Foundation, (2020), “How is OCD Treated?”
Anxiety and Depression Association of America, (2018), “Treatments for OCD”.
Michael Twohig, PhD, (2010), “What is ACT?”. International OCD Foundation.
Mind, (2017), “Dialectical behaviour therapy (DBT)”.
Masood Ahovan, Saeede Balali, Najmeh Abedi Shargh, Younes Doostian, (2016), “Efficacy of Dialectical Behavior Therapy on Clinical Signs and Emotion Regulation in Patients with Obsessive-Compulsive Disorder”. Mediterranean Journal of Social Sciences, Vol 7 No 4.
Jon Hershfield, MFT, Tom Corboy, MFT, (2014), “Mindfulness and Cognitive Behavioral Therapy for OCD”. International OCD Foundation.
Sapana R.Patela, James Carmody, H. Blair Simpson, (2007), “Adapting Mindfulness-based Stress Reduction for the Treatment of Obsessive-compulsive Disorder: A Case Report”. Cognitive and Behavioral Practice, Volume 14, Issue 4, November 2007, Pages 375-380
Markowitz, J. C., & Weissman, M. M. (2004). “Interpersonal psychotherapy: principles and applications. “World psychiatry : official journal of the World Psychiatric Association (WPA), 3(3), 136–139.
Dean McKay, PhD, Jonathan Abramowitz, PhD, Eric Storch, PhD, (2019), “Ineffective and Potentially Harmful Psychological Interventions for Obsessive-Compulsive Disorder”. International OCD Foundation.
EMDR Institute.Inc, (2020), “What is EMDR?”.
Landin-Romero, R., Moreno-Alcazar, A., Pagani, M., & Amann, B. L. (2018). “How Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systematic Review on Suggested Mechanisms of Action.” Frontiers in psychology, 9, 1395.
Katharina Star, PhD, (2020), “What Is EMDR Therapy?” Very Well Mind.
British Psychoanalytic Council, (2020), “What is psychoanalytic psychotherapy?”
Leichsenring, F., & Steinert, C. (2016). “Psychodynamic therapy of obsessive-compulsive disorder: principles of a manual-guided approach.” World psychiatry : official journal of the World Psychiatric Association (WPA), 15(3), 293–294.
Lee, M. T., Mpavaenda, D. N., & Fineberg, N. A. (2019). “Habit Reversal Therapy in Obsessive Compulsive Related Disorders: A Systematic Review of the Evidence and CONSORT Evaluation of Randomized Controlled Trials.” Frontiers in behavioral neuroscience, 13, 79.
Morteza Abbarin, Mehdi Zemestani, Mehdi Rabiei, Amirhooshang Bagheri, (2018), “Efficacy of Cognitive-Behavioral Hypnotherapy on Body Dysmorphic Disorder: Case Study”. IJPCP 2018, 23(4): 394-407
Ruth Washton, (2020), “Hypnosis: A Tool for Calming the Anxiety of Obsessive Thought”. Made of Millions.
International OCD Foundation, (2020), “Brain Surgery for OCD”.
Giorgio Spatola MD, Roberto Martinez-Alvarez MD, PhD, Nuria Martínez-Moreno MD, PhD, et al, (2019), “Results of Gamma Knife anterior capsulotomy for refractory obsessive-compulsive disorder: results in a series of 10 consecutive patients”. Journal of Neurosurgery, Volume 131: Issue 2 (Aug 2019): Pages 333-656
Elsevier. (2019). “Deep brain stimulation sites for OCD target distinct symptoms: Two DBS sites equally reduced OCD symptoms but improved distinct symptoms.” ScienceDaily.
Joan A. Camprodon-Gimenez, (2015), “Transcranial Magnetic Stimulation (TMS) for Obsessive Compulsive Disorder (OCD)”. International OCD Foundation.
Queen Mary University of London. (2020). “Antibodies could provide new treatment for OCD.” ScienceDaily.
Lorrin M. Koran, M.D., H. Blair Simpson, M.D., Ph.D. “Practice guideline for the treatment of patients with obsessive-compulsive disorder”. APA Practice Guidelines.
National Institute for Health and Clinical Excellence, (2006), “Obsessive compulsive
Disorder: Core interventions in the treatment of obsessive compulsive disorder and body dysmorphic disorder”.
OCD Action, (2020), “Self-Advocacy Toolkit”.