Prevention and care
Panic disorder, social phobia and depression may also accompany OCD. In such cases, the treatment suggested will first target the most severe and the most incapacitating problem. In cases where depression is associated with OCD, the same medication may sometimes reduce the symptoms of the two disorders at the same time. The optimal treatment will thus be chosen based on an overall evaluation of OCD and may call for a concerted approach involving several health professionals.
Overcoming OCD requires courage, a lot of work, and a structured approach. There are two forms of treatment that have proven effective in cases of obsessive compulsive disorder:
• cognitive-behavioural therapy
• specific and controlled medication
These two treatments can be undertaken simultaneously. Ideally, the therapy is given by a psychologist who is a member of a professional order such as the Ordre des Psychologues du Québec, recognized for his expertise in OCD. OCD medications can only be prescribed by a doctor, preferably a specialized psychiatrist. A concerted approach by health professionals helps structure the treatment by having a complete understanding of the problem, of the future steps in the treatment and of the methods to be used and encouraged.
It may also be useful for the patient to participate in support groups where others and their families get together to encourage each other, share their experiences and exchange advice.
Family or individual therapy may be beneficial for family members since the therapeutic setting helps them to talk about everyday problems, eliminate them or to find ways to resolve them, while being supported and understood.
Specialized therapy
A consensus of experts recommends cognitive-behavioural therapy to treat OCD. As the name implies, this type of therapy treats both cognitions (thoughts) and behaviours. In other words, the therapist works to modify how situations are interpreted and how to act in such situations. Thoughts and behaviours play an important role in explaining OCD.
People suffering from OCD regularly experience problems separating their behaviours and obsessive thoughts from the rest of their personality. For them, everything they are (their values, desires, skills and shortcomings) and everything they do (reflect and act) are influenced by the OCD. However, it has been clearly demonstrated that OCD is a behaviour (or habit) problem and not a personality problem.
Obsessions thus keep the person in a state of alertness (activation of the emergency system). He performs the compulsions with the goal of reducing anxiety; however, it has been shown that they only maintain the anxiety and the problem.
In the cognitive-behavioural approach, the therapist teaches the person to recognize and control his compulsions and works to modify the patient’s behaviour and way of seeing and interpreting things through self-observation exercises and cognitive restructuring. Practising the exercises, as well as the gradual acquisition of new techniques, helps reduce the anxiety. This approach sees the therapeutic process as a kind of apprenticeship, learning to develop new behaviours by practising them.
Medications, such as antidepressants, which increase the concentration of a chemical substance produced by the brain, have proven effective in many cases.
Some antidepressants work on the serotoninergic system in the brain. Current research shows that selective serotonin re-uptake inhibitors (SSRIs) are especially effective in reducing obsessive symptoms.
Following an evaluation, the doctor or psychiatrist determines if there is a need to prescribe medication and establishes the dosage and length of treatment. The doctor may prescribe different types of medication, or a combination of medications. Each person is unique and responds differently to medications. That is why it is important for the patient to go to the follow-up meetings scheduled so the attending physician can establish the optimal dosage based on the patient’s comments, observations and reactions.
It is important that the medications be taken as prescribed – the right dose at the right time. It may take 8-10 weeks to judge the effectiveness of the medication. The dosage will be adjusted until the person regains optimal functioning, along with a minimum of undesirable side effects. Before deciding that a treatment is not working, the patient should consult his doctor or psychologist.
Some people do not like taking medications or are anxious because they do not know what effect the medications may have. Such people should not hesitate to ask their doctor precise questions about the medication, such as:
- How does it work?
- How long will it take for it to work?
- When should I take it?
- Should I take it with meals or between meals?
- Can I take it with other medications?
- Are there any side effects?
Family members can play a crucial support role, first by accepting that a loved one is suffering from a psychological problem and then by supporting him throughout the treatment. Family members often become involved in the rituals, albeit against their will. Planning their schedules based on their loved one’s need to perform his compulsions, doing them for him, or constantly reassuring him at his request may become burdensome and lead to tension. A person suffering from OCD never performs the compulsions voluntarily. On the contrary, he considers the compulsions to be embarrassing and puts a lot of effort into suppressing the need to perform them.
Helping a loved one does not mean taking part in the rituals. However, putting pressure on him while he is performing them should be avoided. In OCD therapy, patients will learn for themselves and at their own pace how to develop better control of their compulsions. They can then be encouraged to reward themselves for the progress made.
An excellent way of encouraging a loved one is to reinforce his strong points and to emphasize those times when there are no compulsions. The OCD is the problem, not the person! It is helpful to remind him that he has personal qualities that are not affected by the OCD.
The family can help their loved one get informed about OCD and negotiate with him so he continues to contribute to the smooth functioning of the family and thus to their quality of life.
Are support groups useful?
Il peut être bienfaisant de se joindre à un groupe de soutien pour partager son expérience et s’enrichir de celles des autres. Il est aussi possible de suivre des cours d’éducation sur le TOC pour apprendre comment réagir face au TOC.
De nombreuses personnes ont constaté que le fait d’adhérer à un groupe de soutien est un élément important de leur démarche. Rencontrer d’autres gens qui ont le même problème, comprendre davantage la problématique et recevoir appui et encouragement peut être très salutaire. Les membres des groupes de soutien participent activement à leur guérison et connaissent souvent les meilleurs programmes thérapeutiques et centres de documentation au sein de leur communauté.
It may be helpful to join a support group to share experiences and to benefit from those of others. There are also OCD training courses to learn how to cope with OCD.
Several people have said that simply joining a support group is an important step forward. Meeting other people who have the same problem, understanding the problem better and getting support and encouragement can be very beneficial. Support group members actively participate in their recovery and often know the best therapeutic programs and documentation centres in their community.
There are support groups for adults, children, and family members. The individual needs to find a group where he feels completely at ease. To learn about when and where support groups meet in the Montréal area, contact the Quebec Obsessive Compulsive Disorder Foundation or visit their Web site: http://fqtoc.mtl.rtss.qc.ca