According to the National Comorbidity Survey Replication (NCS-R), Obsessive-Compulsive Disorder (OCD) impacts about 1.2% of adults aged 18 years or older. Despite the recent media attention and OCD entering household vocabulary, most people are unaware of the symptoms of OCD and the currently recommended treatments. Along with medication, behavior therapy is considered to be one of the safest and most effective treatments for OCD.
What OCD symptoms can be addressed with behavior therapy?
The symptoms of OCD described in the Diagnostic and Statistical Manual (DSM-5) can present differently for different individuals. OCD involves engaging in both obsession and compulsion behaviors. Obsession behaviors include unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings and engaging in compulsions behaviors.
Compulsions are behaviors that an individual engages in to attempt to get rid of the obsession behaviors or decrease the distress and anxiety related to obsession behaviors.
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Even though most individuals engage in cleanliness activities and occasional anxiety about thoughts and feelings, individuals with OCD experience substantial decreases in quality of life. Individuals with OCD cannot control these thoughts or behaviors and frequently spend an hour or more per day engaging in obsession and compulsion behaviors. Also, individuals with OCD do not achieve a sense of control or satisfaction from obsession or compulsion behaviors. They are extremely distressing and cause significant problems in daily life.
Behavior therapy can be used to address both the obsession and compulsion components of OCD symptoms. Some common obsessions treated with behavior therapy include fears of germs and disease, aggressive thoughts towards one’s self or others, or object-related behaviors like hoarding or having things in a symmetrical or specific order. Some compulsion related behaviors treated by behavior therapy include ordering and arranging things, excessive hand washing or cleaning, or repeatedly checking on things.
How successful is behavior therapy in treating OCD symptoms?
It’s reported that 70% (7 out of 10) individuals respond positively to either behavior therapy, medication, or a combination of both to remedy symptoms of OCD.
These findings have been replicated in different behaviors and with children and adults both. Some studies even note that behavior therapy techniques can be as effective or more effective than medication alone.
OCD Therapy Techniques
The OCD symptoms listed above and how they are expressed in daily life can vary substantially among individuals. Different behavioral psychologists and medical professionals may recommend different forms of Cognitive Behavioral Therapy treatments based on the type and severity of OCD symptoms. Although this is not an exhaustive list of behavioral treatments, here are several common OCD therapy techniques that can address the symptoms of OCD without medication:
● Functional Analysis – Functional Analysis is a methodology used in Applied Behavior Analysis to identify and describe the relationship between environmental stimuli and OCD behaviors. Functional analyses help identify why a behavior occurs and then create a corresponding intervention. Studies have shown that functional analysis procedures can help address OCD behaviors like hoarding and excessive washing.
● Parent Training – The Centers for Disease Control lists parent training as one beneficial component of OCD therapy for children. Parent training allows parents to work alongside the therapist and child to learn helpful strategies and techniques to support success. Parents are then encouraged to implement these techniques outside of the therapy environment to reduce engagement in obsessive and compulsive behaviors.
● Functional Communication Training – For individuals with OCD behaviors who may also struggle with communication or may engage in challenging behaviors when OCD rituals are interrupted, Functional Communication Training is effective. Functional Communication Training (FCT) involves teaching an alternative communicative response (sign language, vocalization, picture exchange, etc.) to avoid the individual using problem behavior or dangerous behavior to engage in OCD-related behaviors.
● Exposure and Response Prevention – The International OCD Foundation lists Exposure and Response Prevention (ERP) as one of the most effective forms of Cognitive Behavior Therapy for treating OCD symptoms. ERP involves systematically exposing an individual to environmental triggers likely to cause obsessive and compulsive behaviors. Then, following exposure, the OCD responses are prevented from occurring. ERP occurs in safe, controlled settings with therapy professionals on hand to help the individual progress slowly and successfully through repeated exposures and response prevention sequences.
OCD and Co-Morbidity
OCD has a high rate of co-morbidity with other medical and psychiatric diagnoses, including Autism Spectrum Disorder. Studies indicate that between 8 and 33 percent of individuals with ASD also are impacted by OCD. It’s not uncommon for individuals with autism to engage in OCD-related behaviors, including hoarding and excessive collecting as well as repetitive routines.
What to Expect When Consulting with a Behavioral Professional About OCD
If you or a loved one are seeking behavior therapy for OCD, there are several things you can expect from the services. First, spend some time determining the best setting for the behavioral consultation you’re interested in. Behavior therapy for OCD can be conducted in a variety of settings including intensive and residential programs, outpatient clinical settings, support groups, or a combination of strategies. Ask questions about the practitioner and programming so you can weigh the options that are likely to fit best with your lifestyle and needs.
Once behavioral therapy begins, anticipate that it may take some time for results.
Most behavior analysts will begin with some assessments to help evaluate the types and functions of OCD behaviors.
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It can take time to determine the course of treatment. Expecting treatment strategies to show immediate improvement can create further setbacks.
Finally, work to include family members and your immediate support network. Research shows that including others in treatment can promote success for some individuals with OCD.
References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.
5th ed. Washington, DC: American Psychiatric Association; 2013:237.
Franklin, M. E., Sapyta, J., Freeman, J. B., Khanna, M., Compton, S., Almirall, D., … & Foa, E. B. (2011). Cognitive behavior therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder: the Pediatric OCD Treatment Study II (POTS II) randomized controlled trial. Jama, 306(11), 1224-1232.
Hanley, G. P., Iwata, B. A., & McCord, B. E. (2003). Functional analysis of problem behavior: a review. Journal of applied behavior analysis, 36(2), 147–185.
Harvard Medical School, 2007. National Comorbidity Survey (NCSSC). (2017, August 21). 12-month prevalence DSM-IV/WMH-CIDI disorders by sex and cohort.
Sheen, H. (2012). Functional analysis and treatment of OCD-related behaviour in a child with Autism Spectrum Disorder.
Vermes, J. S., & Banaco, R. A. (2013). The study of some functional relations involved in obsessive-compulsive behaviors. Revista Brasileira de Terapia Comportamental e Cognitiva, 15(2), 18-34.
Amy Sippl
Applied Behavior Analysis | Saint Cloud State University
Bachelor of Arts (B.A.), Psychology | University of Minnesota
May 2020
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