Obsessive-compulsive disorder (OCD) is a leading chronic anxiety disorder that affects about 1.0% of men and 1.5 % of women globally. However, early diagnosis and treatment may improve patients' health outcomes in addition to enhancing the quality of life. The fact that OCD is not curable means that patients have to opt for medication and treatment regimens to reduce or eliminate symptoms. The available treatment options are categorized as anatomically-targeted treatments, pharmacotherapy, psychotherapy, or their combinations depending on the severity of symptoms. The essay will focus on reuptake inhibitors, cognitive behavioral therapy, and exposure therapy since they are considered as first-line treatments.
Reuptake Inhibitors
Reuptake inhibitors are a preferred pharmacological treatment option since they are associated with mild adverse effects on OCD patients. There are various categories of reuptake inhibitors depending on the neurotransmitters that they target. These inhibitors include selective serotonin reuptake inhibitors (SSRIs), norepinephrine and dopamine reuptake inhibitors (NDRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs) (Mallaziti et al., 2020). SSRIs, the most commonly prescribed antidepressants, work by increasing the brain's serotonin levels to enhance communication between nerve cells, thus improving mood. SNRIs block the reuptake of norepinephrine and serotonin to ensure that the brain does not absorb transmitters rapidly, thus allowing for positive emotions. NDRIs, on the other hand, block the transmission of dopamine and norepinephrine back to the brain cells meaning that there is an increase of active transmitters, which in turn help in relieving depression (Reddy et al., 2017). It is important to understand that there are various reuptake inhibitors in the market, and their effectiveness is assessed by the ability to reduce symptoms. One of these inhibitors in the SSRIs category is citalopram (Celexa), which works by inhibiting serotonin's reuptake. Mallaziti et al. (2020) assert that there have been various studies that support the effectiveness of citalopram and other SSRIs in reducing OCD symptoms. While all SSRIs are equally effective in managing OCD symptoms individual patient’s reaction to each of them varies. In this case, patients and physicians may require to engage in trial and error to determine which of the SSRIs will produce optimum clinical outcomes. Nonetheless, research indicates that up to 60 % of patients suffering from OCD experience a partial reduction in symptoms after SSRI pharmacotherapy (Reddy et al.,2017). These statistics imply that SSRIs are a reliable treatment regimen, especially if the patients find an option that helps in diminishing adverse effects.
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Psychotherapy Treatment Options
Obsessive-compulsive disorder patients have the option of using psychotherapy-related options to alleviate symptoms and thus improve the quality of their lives. There are various psychotherapy treatment options which include cognitive behavior therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), and exposure and response prevention (ERP) therapy.
Cognitive Behavioral Therapy
Cognitive-behavioral therapy (CBT) is one of the most common and preferred approaches for managing symptoms in OCD patients. CBT helps individuals to cope with problematic behaviors, thoughts, and emotions through associations. Marazitti et al. (2020) establish that CBT follows various steps to establish if the patients will benefit from the intervention or not. At the beginning of the therapeutic intervention, the therapist assesses the patient to establish counter-indications and motivation for CBT. From here, the patients receive psycho-education on the level of discomfort with exercises, cognitive techniques that will be used. During this stage, patients are taught to associate sensations of distress with the situations and objects that produce them. Moreover, patients learn to associate ritualistic behaviors they engage in during depressive episodes with the level of distress they produce. Patients who understand these associations are usually in a better position of breaking the bond between being anxious and engaging in rituals to combat the anxiety.
Cognitive-behavioral therapy is highly effective in training OCD patients to deal with their symptoms to have improved interpersonal relationships. Numerous studies have been conducted to establish the extent to which CBT can improve clinical outcomes for OCD patients. According to Moody et al. (2017), CBT is associated with hyperactivity in cortical-striatal-thalamocortical (CSTC) regions that include the thalamus, orbitofrontal cortex, putamen, caudate anterior cingulate cortex. The activation of these regions in the brain strengthens the connections with frontal cortices, which improves cognitive control of emotions. Moreover, the activation enhances cerebellar and prefrontal connectivity, which allows patients to resist compulsions as well as acquire new, non-compulsive, and goal-directed thought and behavior patterns. In this case, OCD patients are in a position to handle their emotions in a better manner, meaning that they are capable of resisting obsessions and compulsions.
Exposure Therapy
Exposure therapy is a common psychotherapy approach that helps in reducing the severity of symptoms in OCD patients. This treatment option requires patients to be exposed to situations or objects that elicit anxiety so that they may learn to refrain from engaging in obsessive behaviors. The goal of exposure therapy, in this case, is to teach people to tolerate distress without opting for compulsions that they normally consider as a reprieve. Hezel & Simpson (2019) note that exposure therapy has three components: imaginal exposure, in vivo exposure, and ritual prevention, all of which help reduce depressive episodes. Imaginal exposure allows patients to visualize themselves in fearful situations such as hitting pedestrians and imagining the consequences of these situations. In vivo exposure is an approach that requires patients to stay in the presence of feared situations or objects for extended periods to evoke anxiety.
On the other hand, Ritual prevention is a technique that psychotherapists use to help patients refrain from engaging in ritualistic behaviors. These components make exposure therapy an intervention technique aligned to classical conditioning, which establishes that avoidance of feared stimuli alleviates anxiety. According to Hezel & Simpson (2019), subsequent avoidance of adverse situations or objects is associated with compulsions, which, in turn, reinforce fears. Exposure therapy thus helps patients to tolerate distress without opting for counterproductive strategies, thus breaking this cycle. Hezel & Simpson (2019) confirm that exposure therapy is efficacious, considering that 50% of patients will have minimal symptoms after the process. These statistics affirm that patients who opt for exposure therapy have improved chances of dealing with their emotions and, in this way, improve their quality of life.
Conclusion
Treatment options are classified into two broad categories: pharmacological and psychotherapy, both of which reduce symptoms. Cognitive-behavioral therapy and exposure therapy are effective, yet costly meaning that only a few patients with financial capability will benefit from the process. Patients who cannot afford rehabilitative therapy have the option of using SSRIs. Fineberg et al. (2018) assert that SSRIs are an effective pharmacological treatment option since adherence to the regimen protects against relapse. However, if patients are to experience SSRIs' benefits, they cannot discontinue the treatment plan since doing so occasions relapse. This assertion means that SSRIs' effectiveness in dealing with symptoms is dependent on the willingness of patients to follow treatment guidelines. Clomipramine, one of the most effective SSRIs, cannot be used as a first-line option for children and adolescents. Khan et al. (2018) establish that clomipramine use in this population could cause urinary retention, constipation, ventricular fibrillation, seizures, xerostomia, and orthostatic hypotension, in worst cases, cardiac death. The limitations associated with various treatment options means that individuals need to seek alternatives that could improve outcomes. Lissermore et al. (2018) propose that patients use both medications and psychotherapy to gain the benefits they offer cumulatively. The authors establish that combining CBT with sertraline has proven to reduce obsessive-compulsive symptoms significantly.
References
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