Treatment of OCD with ABA

Applied behavior analysis (ABA) offers a variety of evidence-based strategies to assist in the treatment of OCD (obsessive-compulsive disorder). OCD may co-occur with other diagnoses, including conditions on the autism spectrum.

Obsessive-Compulsive Disorder (OCD) and Autism

According to Autism Speaks, OCD may occur more frequently among people with ASD than among others in the general population. About 2 percent of people in the general population have been diagnosed with OCD. Various studies have identified between 8 and 33 percent of people on the autism spectrum as being affected by OCD.

One important distinction between an OCD diagnosis and repetitive behaviors that are a feature of autism is how the person feels about their behaviors. Many people with ASD perform repetitive behaviors, but they are not bothered by them. In some cases, the behaviors may be comforting and enjoyable. An OCD diagnosis is related to compulsive behaviors which are considered undesirable and uncomfortable, like repetitive handwashing which causes raw, bleeding skin.

Some treatment plans for teens and adults with ASD who have symptoms of OCD may include treatments with anti-depressants. Clinical studies reported in the Journal of Depression and Anxiety in 2013 showed that some benefits from cognitive behavioral therapy (CBT) did reduce the severity of OCD symptoms in adults and young people on the autism spectrum.

Which Types of OCD Behaviors Can ABA Help to Moderate?

According to Melinda Smith, M.A., and Jeanne Segal, Ph.D. writing for Harvard Medical School’s Helpguide, people with OCD can fall into five primary categories: washers, checkers, doubters and sinners, counters and arrangers, and hoarders. Different behaviors do show varying rates of success in treatment. Success rates with ABA techniques or cognitive-behavioral therapy (CBT) vary depending upon the type of behavior and co-occurring diagnoses, including autism, depression, or tics.

Is Hoarding a More Challenging OCD Behavior for Applied Behavioral Analysis?

Hoarding has been found to be more challenging to treat than other OCD categories. Behavioral analysis can be used to help identify what objects the person acquires, assist the person to practice sorting unnecessary items, and finally, develop methods to reward the hoarder when they can discard hoarded items.

Cognitive behavioral therapy (CBT) may be used to assist the hoarder to rethink their belief systems and deep attachment to unnecessary and sometimes dangerous or unhealthy things.

What do Applied Behavioral Analysts Need to Know About Obsessions and Compulsions?

Obsessive-compulsive disorder (OCD) is characterized by obsessions (thoughts) and compulsions (actions or behaviors).

Obsessions are considered to be more difficult to moderate using ABA techniques. Examples of obsessions include irrational fears such as germ-contaminated clothing or common items like faucets and doorknobs. Others with OCD may see the doctor and have a clear checkup, but leave the office thinking “the doctor must be wrong — I’m sure I have cancer.”

Obsessions lead to anxiety and almost uncontrollable fears, such as making a mistake and work and being convinced you will be fired. People with OCD-related religious beliefs may become certain they will receive Divine punishment for any mistake. Because Applied Behavioral Analysis focuses on behaviors, working with obsessions can be more challenging than with compulsions, which are behaviors that are acted upon.

How Can Applied Behavioral Analysis Work With OCD

Focusing on OCD compulsive behaviors, ABAs can identify an antecedent stimulus, a behavior, and a consequence (ABC) to develop a treatment plan for specific compulsive behaviors. Using behavioral activation (BA), applied behavioral analysts can assist people with OCD to set goals to moderate their compulsive behaviors.

ABAs can assist the patient to recognize a trigger that could be the stimulus for the undesirable compulsive behavior. They can also intervene and assist in replacing the compulsive behavior with an alternative, less-stressful and harmful response.

Functional Analysis and OCD Behavioral Interventions

ABAs can develop interventions for OCD behaviors using functional analysis of the reasons why the patient is engaging in the behavior. Functional analysis can help the ABA to devise alternative interventions that will help the person with OCD to obtain the same or an improved social or internal result from a non-compulsive behavior. Functional analysis can also assist ABAs to change or disrupt conditions that lead to the performance of the compulsive behavior. A functional analysis will support a consequence-based or antecedent-based intervention.

Functional Communication Training and OCD Self-Harm

When a patient with OCD is causing harm to themselves, whether through excessive hand-washing or other similar behaviors, Functional Communication Training (FCT) has shown the ability to reduce harm and introduce more positive behaviors. FCT involves several approaches that help to teach the patient more appropriate responses to achieve a similar result to the harmful behavior. The FCT strategy also withdraws any potential reinforcements of self-harming behaviors.

Preparing for a Career Working With OCD as an Applied Behavioral Analyst

Most people who use applied behavioral analysis (ABA) to work with people with obsessive-compulsive disorder (OCD) are licensed therapists who possess at least a Master’s Degree and who have also completed requirements for state licensing as behavioral therapists. ABA is an important tool for clinical psychologists, who possess a Ph.D. and have completed supervised internships in their field, including assisting in the treatment of patients with OCD.

Because there are a variety of approaches in treatment for OCD and co-occurring diagnoses such as autism spectrum disorders (ASD), preparation for a career should involve working with experienced professionals and treatment teams who are already in the field. An internship or supervised practicum working in a program that specializes in treating patients with OCD can assist in preparation before you incorporate ABA into your clinical practice.

Following completion of your education and licensing, you may apply to become a board-certified Behavioral Analyst (BCAB) from the Behavior Analyst Certification Board.

Further Reading on Applied Behavioral Analysis and OCD

National Institutes of Health’s Clinical literature overview – Thorough examination and list of evidence-based behavioral interventions for repetitive behaviors among patients with autism.

HelpGuide for Obsessive-Compulsive Disorder (OCD) – Symptoms, behaviors, and treatment.

Child Mind Institute’s behavioral therapy interventions – Benefits of OCD treatment in children from the Child Mind Institute.

Behavior Therapy Training Institute – Three-day and longer training courses for applied behavior analysts in working with OCD patients.

Another excellent resource:

Top 20 ABA Online Bachelor’s Degree Programs

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