These studies show the importance of confronting feared stimuli for extinguishing anxiety. However, at the same time, other research has found that the cognitive methodology has had equal results to the ERP in OCD treatment. Hackman and McLean report that they have as positive results with thought-stopping as those found with ERP. Once again, however, the number of studies has been very small (Abromowitz). In order to choose a plan of treatment, the physician and the patient must work together to determine the personal ability to comply with pharmacotherapy and/or psychotherapy. The two also need to discuss whether medicine and therapy will be used, based on the degree of symptoms, symptoms, medicines already taking, the severity of the illness, and treatment up until this time. A combined plan of treatment is recommended for those patients who have not responded to only one form of therapy, have other psychiatric conditions that respond to medication or who want to limit the duration of the pharmaceutical treatment.
It has only been in the past decade that advances have been made in another possible treatment for the future. In the early 1990s, Baxter began looking at changes in cerebral metabolic patterns that occur with obsessive compulsiveness. He was able to specific changes in the cerebral patterns when ODC activity was occurring. These studies are continuing and becoming more refined. Most recently, Baxter joined others in a study that looked at the affect of hording. Compulsive hoarding and saving are common in individuals with OCD, as a part of the symptoms such as inability to make decisions, need for perfectionism, lack of organization, procrastinating and avoidance. Saxena and colleagues, including Baxter, attempted to identify cerebral metabolic patterns that were especially associated with this compulsive hoarding by using the positron emission tomography (PET). They took PET scans from 45 adults with DSM-IV criteria for OMD, 12 of whom had The authors compared the regional cerebral glucose metabolism between the groups and found that the individuals with compulsive hoarding syndrome had considerably reduce glucose metabolism in the posterior cingulate gyrus and cuneus when compared relative to the comparison subjects.
On the other hand, Saxena et al. found that the nonhoarding OCD individuals had much higher glucose metabolism in bilateral thalamus and caudate. When compared to nonhoarding OCD patients, compulsive hoarders had much lower metabolism in the dorsal anterior cingulate gyrus. Among all of the OCD patients, high levels of hoarding were negatively correlated with glucose metabolism in the dorsal anterior cingulate gyrus. It was the authors' conclusion that patients with the compulsive hoarding syndrome have a different pattern of cerebral glucose metabolism than nonhoarding OCD patients and comparison subjects. Therefore, obsessive-compulsive hoarding may be a neurobiologically distinct subgroup or variant of OCD with symptoms and poor response to anti-obsessional treatment are mediated by lower activity in the cingulate cortex. The positive aspect of such studies is that the researchers are getting closer to narrowing down the impact of the OCD. In the future, these technologies may guide clinical diagnosis of psychiatric conditions and the choice of appropriate treatment.
Neurology, in fact, is showing promise of taking control of even the most difficult brain disorders. Electrical deep-brain stimulation (DBS) is now being used to treat OCD. Psychopharmacology can treat cognitive and affective disorders as well as greatly improve normal cognitive capacities. The other side of the coin, however, is whether such treatment as deep-brain stimulation should be done on a regular basis given the possible risk and also the patient's personal analysis of his or her quality of life. Two patients who received DBS for severe OCD explained if this treatment had not been available, they would have committed suicide (Glannon). After the DBS they could live their lives with enjoyment as once before. They saw no ethical consideration, since their symptoms were so bad that they were willing to accept the risk of other side effects. Yet sometimes one has to be more alert to minor changes in personality than anything radical. Most people are more concerned about the major risks, which rarely occur, such as the Parkinson's patient who becomes manic when the DBS stimulator is on. Last year, the American Psychiatric Association published recommendations regarding treatment for OCD. Because the symptoms of OCD increase or decrease over time, it is necessary to seek are as soon the symptoms interfere with functioning or cause considerable stress. The APA also recognizes that there are a number of different therapeutic approaches to being able to manage one's OCD, based on the needs, abilities and interests of each individual. It is also suggested that an individual coordinate his or her care with both physicians and social...
As can be seen in these studies regarding OCD and its treatment, significant amounts of research has only been conducted over the past couple of decades on this condition. Because of this, results to date give physicians, psychologists and other therapists general directions to take to help their patients. However, these healthcare providers may have to try a couple of different approaches before finding the one that best meets their patient's specific needs. The side effects and amount of therapy or pharmaceuticals needed for each patient will differ considerably depending on such factors as the severity of OCD symptoms, other illness/conditions that the patient may have in tandem with OCD, the patient's motivation, the patient's susceptibility to medicine, and the relationship between the therapist and the patient. It is highly recommended that more therapists write up the results they have with their particular patients in regard to treatment. The more information available, the better the chances will be for improved lives for those suffering from OCD.
Continual research also has to be conducted regarding the work that is being done with the brain scan studies. Over time, as brain neurology is known better, it may be that neurological changes rather than other forms of therapy will be most productive. Or, perhaps a combination of these different approaches will be best. As is noted, the side effects for some of the current neurological therapies are still in the experimental stages, and individuals request such help only as a last resort instead of such drastic measures as committing suicide.
As noted in the literature review, there are three main areas of treatment for OCD.
The aims of behavior therapy are desensitization and relearning. This form of therapy is based on exposure and response prevention. It exposes the patients to the objects or situations that act as trigger points for obsessions, fears, and anxieties, but then keeps them from engaging in the usual compulsive response. The psychologist works with the individuals to define their unreasonable obsessions and assist them to recognize that the responses to their thoughts are not calamitous. The goal is to help people learn how to take control of their anxieties without turning to ritualized behavior. As a result, the patients will often feel at first a great deal of anxiety, which they eventually learn to manage until they subside. For instance, a person who has a great deal of anxiety over germs will be prohibited to wash his or her hands immediately after shaking another person's hands or touching items in public areas In addition, this person recognizes that these obsessions if responded to will eventually disappear along with the anxiety. The degree of success depends on a range of factors, such as motivation and time. It normally takes at least 10 to 20 hours of therapist-controlled practice before any results are seen.
There have, as noted above, been a number of different studies that have found positive results from exposure and response prevention therapy. It is believed to be effective in over 80% of people. Recently, in fact, therapists have found that this form of treatment does not have to be done in person, but can rather be handled over the phone if necessary. This is very helpful for individuals who are too anxious to leave their homes to get assistance.
The second major form of therapy is relaxation techniques or a cognitive approach to relieve or eliminate OCD symptoms. Cognitive therapy is based on the fact that OCD results when people believe that intrusive thoughts or urges are a sign that harm may occur, and that they may be responsible for it they do or do not do. Therapists work with the patients to help them understand that their problem is anxiety-related instead of dangerous and to respond accordingly. OCD individuals are thus doing too much to prevent harm. In other words, the solution becomes the problem.
For instance, a parent may attempt to repress or neutralize intrusive thoughts about harming a child. This increases rather than decreases the frequency of such negative thoughts. The issue is therefore not the intrusive thoughts but instead the meaning an individual attaches to them. For example "because I have…
In order to choose a plan of treatment, the physician and the patient must work together to determine the personal ability to comply with pharmacotherapy and/or psychotherapy. The two also need to discuss whether medicine and therapy will be used, based on the degree of symptoms, symptoms, medicines already taking, the severity of the illness, and treatment up until this time. A combined plan of treatment is recommended for those patients who have not responded to only one form of therapy, have other psychiatric conditions that respond to medication or who want to limit the duration of the pharmaceutical treatment.
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