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Clinical and animal research sponsored by NIMH and other scientific organizations has provided information leading to both pharmacological and behavioral treatments that can benefit the person with OCD. While some benefit significantly from behavior therapy and others are helped by pharmacotherapy, research indicates that a robust treatment of OCD includes both medication and therapy. Patients may begin with medication to gain control over their symptoms and then continue with behavior therapy. Which therapy to use should be decided by the individual patient in consultation with his or her therapist.
Clinical trials in recent years have shown that drugs that affect the neurotransmitter serotonin can significantly decrease the symptoms of OCD. The first of these serotonin re-uptake inhibitors (SRIs) specifically approved for the use in the treatment of OCD was the tricyclic antidepressant clomipramine (Anafranil). It was followed by "selective" serotonin re-uptake inhibitors (SSRIs). Those that have been approved by the Food and Drug Administration for the treatment of OCD are citalopram (Celexa), flouxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft).
Large studies have shown that more than three-quarters of patients are helped by these medications at least a little. And in more than half of patients, medications relieve symptoms of OCD by diminishing the frequency and intensity of the obsessions and compulsions. Improvement usually takes at least three weeks or longer. If a patient does not respond well to one of these medications, or has unacceptable side effects, another SRI may give a better response. For patients who are only partially responsive to these medications, research is being conducted on the use of an SRI as the primary medication and one of a variety of medications as an additional drug (an augmenter). Medications are of help in controlling the symptoms of OCD, but often, if the medication is discontinued, relapse will follow.
Cognitive behavior therapy (CBT) has been shown to be the most effective type of psychotherapy for this disorder. CBT aims to diminish thoughts and beliefs in order to help modify behaviors and vice versa. Medication and CBT together are considered to be better than either treatment alone at reducing symptoms.
A specific behavior therapy approach called "exposure and response prevention" is effective for many people with OCD. In this approach, the patient deliberately and voluntarily confronts the feared object or idea, either directly or by imagination. At the same time, the therapist, and possibly others the patient has recruited for assistance, offer support and structure, strongly encouraging the patient to refrain from using rituals or avoidance. For example, a compulsive hand washer may be encouraged to touch an object believed to be contaminated and then urged to avoid washing for several hours, until the anxiety provoked has greatly decreased. Treatment then proceeds on a step-by-step basis, guided by the patient's ability to tolerate the anxiety and control the rituals. As treatment progresses, most patients gradually experience less anxiety from the obsessive thoughts and are able to resist the compulsive urges.
Other forms of therapy can also provide effective ways of reducing stress or anxiety by helping the patient become aware of and resolve inner conflicts.
Ways to Make Treatment More Effective
Many people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms can also be useful in this regard, but any advice received over the Internet should be used with caution as Internet acquaintances have usually never seen each other and false identities are common. Talking with a trusted friend or member of the clergy can also provide support but is not a substitute for care from a mental health professional.
Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. There is preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided. Check with your physician or pharmacist before taking any additional medications.
The family is very important in the recovery of a person with an anxiety disorder. Ideally, the family should be supportive and avoid perpetuating their loved one's symptoms. Relatives should not trivialize the disorder or demand improvement without treatment. When a family member suffers from obsessive-compulsive disorder, it's helpful to be patient about any progress and acknowledge successes, no matter how small.