Obsessive-compulsive disorder (OCD) is a condition that is characterized by unwanted, recurrent, and intrusive obsession together with the desire to complete certain repetitive and ritualistic behaviors. Those who suffer from OCD engage in the compulsions as a way of reducing the level of distress that is linked with the obsessive thoughts. The obsessional fears are usually linked to the uncertainties about personal safety and the wellbeing of other people. The compulsions are performed deliberately as a way of reducing the uncertainty levels. It is also imperative to state that people with OCD may experience a wide range of obsessions that will affect the way they live and interact with other people. The obsessions may be related to decontamination rituals, reassurance seeking rituals, and reassurance rituals. In other cases, the patients are obsessed with repugnant, aggressive, and blasphemous rituals. Others develop excessive concerns about the struggles that they may have regarding their health and wellbeing. The rituals that they perform are done to help deal with the uncertainties linked with disastrous consequences. The lifetime prevalence of the condition is approximated to be about 2-3 percent in the general population. This paper aims to review the literature on the psychological treatments that have been used in managing OCD.
Literature Review
OCD is considered to be a severe anxiety disorder that can adversely affect the health and wellbeing of patients. The disorder is linked with significant disability in the general population. According to the World Health Organization, OCD is ranked as one of the top ten chronic problems with high rates of relapse and re-occurrence. If the disorder is not treated well, OCD can become a chronic problem that can cause disability among patients. In most instances, people who suffer from OCD may significantly delay professional help-seeking because of a wide range of factors such as the lack of awareness and the fear of being stigmatized. In such cases, the patients will suffer for a long time and struggle to deal with the symptoms of OCD.
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Exposure and Response Prevention (ERP)
One of the psychological methods that have been used to manage and treat OCD is Exposure and Response Prevention (ERP) therapy. According to Rees and Anderson (2013), ERB is widely regarded as the gold standard treatment for the management of OCD. Furthermore, it is an intervention that has been supported by evidence from previous studies. Rees and Anderson (2013) opined that available evidence shows that more than 50 percent of people who receive ERP therapy usually recover from the condition. Furthermore, the therapy has proved to be effective when it comes to reducing the adverse symptoms of OCD among patients. Therefore, it remains one of the psychological interventions that caregivers can use to help patients with OCD recover from the disorder and live a normal life.
Some studies have been done to explore the efficacy and importance of ERP when it comes to the management of OCD. For instance, Jones, Wootton, and Vaccaro (2012) conducted a case study to investigate the effectiveness of ERP in helping 65-year-old and 80-year-old patients to recover from OCD. The author stated that ERP is considered to be the most effective intervention for treating OCD among children and adults. However, its clinical efficacy among older adults needs to be explored further. Using the case study of the two patients, the authors found out that ERP treatment could reduce the BOCS score by about 65 percent. Besides, the intervention reduces the total OCI-R score by about 45%. The results supported the efficacy of the approach when used in the treatment of OCD. Kircanski and Peris (2015) also conducted empirical research to examine how ERP intervention could be used in managing OCD and improving clinical outcomes among patients. The researchers selected a sample population of 35 youths who had been diagnosed with OCD. The key exposure variables in the randomized controlled trial included youth reported distress and the symptoms of OCD. The results showed that the completion of the ERP program was an excellent indicator of better OCD outcomes among patients. Also, the youths who undertook the program reported a low level of distress caused by OCD. Based on the results, the authors concluded that ERP is a critical psychological therapy that caregivers can use to manage the adverse symptoms of OCD and assist patients to live a normal and healthy life.
More recent empirical research and reviews have also highlighted the efficacy and safety of ERP in the management of OCD. Law and Boisseau (2019) conducted a review to examine how patients respond to ERP treatment. According to the author, numerous clinical trials have shown that ERP is an effective and safe treatment method for ODC. In addition, it is recognized as the first line of treatment for those suffering from the disease. Consequently, it is important to examine the theoretical underpinnings of the intervention and assess how it affects clinical outcomes. The data that the researchers obtained from previous clinical trials reviled that the feasibility, safety, and reliability of ERP are grounded in research evidence. Besides, it is a therapy that can be used when dealing with both children and adults who have been diagnosed with OCD. The findings are further supported by the result of another recent study done by Hezel and Simpson (2019). According to Hezel and Simpson (2019), ERP is first-line psychotherapy that has been used in the management of the symptoms of OCD. The authors further stated that ERP has proved that OCD is no longer untreatable. Furthermore, it has been used as the basis for reducing the severity of the symptoms that patients experience when diagnosed with OCD.
Cognitive Behavioral Therapy (CBT)
Another psychological intervention that has been used in treating OCD is CBT. CBT is an empirically supported intervention for the psychological management of conditions that affect the everyday life of patients. The intervention is based on the idea of teaching and helping patients to learn about coping skills. The skills are aimed at modifying and discouraging maladaptive psychological responses, behaviors, and cognitions. CBT is an internet that is problem-specific in nature and goal-oriented. Moreover, the program is meant to assist the patients to take action-oriented steps that will enable them to cope with the adverse effects of the disease. The actual mechanism through which CBT enhances the well-being of patients with OCD is unclear. However, researchers believe that the intervention revolves around three particular pathways. The first one is the cognitive mechanism that relates to the process of increasing adaptive cognitions through restructured thinking patterns, development of coping toughs, and changes in attentional focus. The second pathway is the behavioral mechanism that is aimed at increasing adaptive behavioral changes in the patient through associative learning, reinforcement of positive responses, and behavioral activation. Finally, there is a physiological mechanism that entails normalizing positive physiological arousal in the patient. The changes that the patient experience during the sessions are aimed at reducing the symptoms of the disease and helping the patient to overcome the adverse effects of the disorder.
Researchers have explored the efficacy and effectiveness of CBT in the management of OCD. O'Neill and Feusner (2015), for example, reviewed previous studies to examine the main issues related to CBT treatment among patients with OCD. The author stated that CBT is considered to be a reliable and effective strategy that can be used to manage OCD. In addition, patients who have access to CBT interventions can learn cognitive and behavioral skills that will allow them to cope with the adverse symptoms of the disease. O'Neill and Feusner (2015) stated that in comparison to other interventions such as serotonin-reuptake inhibitors (SRIs) administration, CBT is linked to faster initial response. The positive outcomes can influence the overall life and wellbeing of the patient in the long term. Tundo and Necci (2016) also conducted a review to explore the use of CBT in the management of psychosis in patients with OCD. The researchers conducted a systematic search of MEDLINE/PubMed to identify studies that had been done on the use of CBT in OCD treatment. The researchers made four main findings based on the data collected. First, they reported that CBT is a safe intervention that does not worsen psychotic symptoms in patients with OCD. Secondly, it is a well-accepted intervention among researchers, practitioners, and experts. Third, the use of CBT was associated with reduced symptoms of psychosis in patients who are diagnosed with OCD. Finally, the therapy could be used to reduce cases of relapse among the patients. Based on the findings, the authors concluded that CBT could be used to improve the well-being of patients with OCD.
In the last decade, there has been a significant shift in the way OCD is treated throughout the world. The trend is associated with the desire to identify and develop new interventions that can be used in managing the disease. AA review of the existing body of research evidence shows that there is a consensus among researchers that CBT remains one of the reliable and effective interventions that caregivers can use to improve the health and wellbeing of patients. Fao (2010) remarked that in the 1960s, OCD was regarded to be a treatment-resistant disorder. In addition, researchers believed that it could not be managed through medication or psychological methods. However, the introduction of therapies such as CBT has shown that patients can recover from the disease and live a normal life. The intervention works for different categories of patients and enables them to acquire skills that will result in positive behavioral change. Wu, Lang, and Zhang (2016) concur by stating that even though OCD was traditionally considered to be a debilitating and untreatable psychological disorder, available research evidence shows that it can be managed through CBT. The authors stated that the use of CBT could result in the reduction of the Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) and Weighted mean difference (WMD) score in patients with OCD. The changes are an indication of the dramatic relief of the symptoms of OCD after the CBT intervention. Moody et al. (2017) added to the debate by stating that CBT has proved to be an intervention that can reduce the symptoms of OCD by altering the functions of the brain. The authors stated that the intervention can change the connectivity between the cerebellum and putamen. In the long run, it ensures that patients can deal with the symptoms and live a normal life.
Within the context of OCD, the expansion of CBT has been a major clinical challenge. O'Neill and Feusner (2015) examined so of the factors that have prevented access to the therapy and how they can be managed. The author noted that CBT is highly effective in the management of OCD when used in the right way. Besides, the intervention has been linked with a response rate of about 50-70% in previous studies. Therefore, it offers a suitable method for improving symptoms of OCD and reducing cases of relapse compared to other time-limited pharmacotherapies. Although CBT has proved to be an effective therapy, it is a highly underutilized intervention in the healthcare sector. In addition, only a few patients who have been diagnosed with OCD often receive CBT treatment. O'Neill and Feusner (2015) remarked that one of the main factors that are affecting access to the intervention is the fact that most OCD patients are not aware of the treatment while others are not ready to get professional help. In other instances, the stigma associated with OCD prevents the patients from undertaking the CBT sessions. In the long run, the trend has resulted in a situation where may patients with OCD fail to get the appropriate services that will enable them to live a healthy life.
Metacognitive Therapy
Another therapy that has been explored in previous studies related to OCD treatment is metacognitive therapy. Rees and Anderson (2013) noted that metacognition therapy encompasses and strategies that help in controlling and regulating how people think. The author added that three primary types of metacognition are relevant to the understanding of OCD. They include fusion beliefs, signal ritual criteria, and action fusion. In the metacognitive therapy intervention, the objective is to assist OCD patients to know how metacognitive processing occurs and assist them to learn how to change their beliefs and thoughts. It is also imperative to state that metacognitive therapy differs from CBT since it does not entail promoting habituation through exposure exercises.
Available research evidence has shown that metacognitive therapy is one of the interventions that can be used to successfully manage the symptoms of OCD. Fisher and Wells (2008) noted that CBT and ERP are the most effective psychological methods for treating OCD. However, the interventions also produce variable results with some patients who receive the therapies remaining symptomatic. Therefore, there is a need to explore other psychological interventions that can be used to manage the disease. It is against this background that Fisher and Wells (2008) conducted a study to assess the efficacy of the Wells' metacognitive model when used in managing OCD. The researchers used the case study approach involving four individuals and found that the intervention was effective in reducing the symptoms of the intervention. The positive changes in terms of symptom reduction were maintained through the six months follow-up period. Melchior, Franken, and van der Heiden (2018) also used a case study method to evaluate the efficacy of metacognitive therapy. The author stated that the use of the therapy could help in changing the patient’s beliefs, obsessions, and compulsions. However, there is a need for further empirical investigations to determine its effectiveness. Similar sentiments were raised by Miegel, Demiralay, and Moritz (2020) who argued that even though Metacognitive Training is a promising intervention, there is a need to carry out further research to understand how it changes cognitive biases and beliefs. In addition, it is important to carefully assess the efficacy and safety of the intervention to determine the best administration model that will result in optimal outcomes.
Acceptance and Commitment Therapy
Finally, some studies have been done to explore the subject of Acceptance and Commitment Therapy (ACT) in the management of OCD. Rees and Anderson (2013) stated that ACT is an intervention that is based on the rational frame theory and the concept of functional contextualism. The fundamental premise is that people can learn and understand the link between responses and stimuli. The therapy is usually implemented in six main stages. They include acceptance, diffusion phase, understanding the self as context, experiencing the present moment, value development, and committed action. Unlike the CBT approach, the ACT model does not concentrate on addressing a behavior or cognition context. Instead, it is a therapy that is aimed at changing the actual processes of behavior formation and cognition. In other words, the OCD patients are helped to learn how previous trials to change and control their obsessions failed and that the objective of the ACT therapy will be to help them accept the obsessional thoughts first. The therapist will work with the patient to realign quality of life goals and explore ways through which they can commit to exercises that will lead to positive behavioral changes.
There is a fair amount of research evidence showing that ACT can help in addressing the adverse symptoms of OCD. According to Twohig et al. (2010) reported that ACT could produce significant changes in patients with OCD compared to Progressive Relaxation Training (PRT). The authors concluded that further investigations are required to assess the efficacy of the treatment. Bluett et al. (2014) also stated that although ACT is a rarely used method when it comes to treating OCD, it is an intervention that can help reduces the distress and frequency of compulsions and obsession. Therefore, there is a need for further investigations into the efficacy and safety of the therapy when used among patients who have been diagnosed with OCD.
Summary and Future Research
Evidence from epidemiological studies has shown consistency with regard to the rate of OCD prevalence across various cultures, countries, and regions around the world. Although the signs of OCD may reduce as time goes by, the patients require support to be able to live a normal life. Besides, the symptoms may make it difficult for people to function normally in different areas of life including social. Leisure, academic, and work-related activities. One of the methods that have been used to address the adverse symptoms of the disease is psychological treatment. Available evidence shows that psychological interventions can help reduce the obsessions and compulsions linked to OCD. There is sufficient evidence supporting the use of CBT and ERP as first-line psychological treatments for OCD. However, further studies are required to explore the efficacy of other psychological interventions like the ACT and metacognitive therapy.
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