OCD, or Obsessive Compulsive Disorder, is defined as obsessional thoughts that create distress and anxiety, which is then relieved by a compulsion. The person must do the compulsion in order to relieve the stress from the obsession. Obsessive thoughts and their accompanying compulsions vary. Common obsessions are fear of germs, but people also suffer from obsessional thoughts about hurting people, or about following religious edicts.
For example, someone might feel compelled (the obsessional thought) to search for all sharp objects in a road (the compulsion) to prevent harm to people because they feel it is their moral obligation to do so (religious edict). Regardless of the type of obsession or compulsion, OCD is best treated by exposure therapy.
The concept of exposure therapy is really quite simple. First, the fear is identified. Then, a hierarchy of related feared activities is created, based on how the person subjectively rates the fear level of the activity. The fancy name for this rating is SUDS (Subjective Unit of Disturbance Scale). The hierarchy would start with 1s or 2s and end with a 10. For example, if someone were afraid of dirt and bugs, the highest activity in the hierarchy might be a cockroach in their kitchen sink, and the lowest might be a pinch of dirt in the foyer.
What happens is that the person is instructed, preferably in vivo (with the counselor present) to experience these situations, starting with the one with the lowest SUDS rating. If it is not possible for the counselor to be present, the client can “experience” the activity via their imagination during the therapy session. Once they were able to tolerate the activity (their SUDS goes down to a 0 or 1), then the next activity is attempted. This is repeated until the person is able to tolerate the most intolerable activity. The concept behind this is that anxiety is learned, and can be unlearned. Once the person is able to relax (and they will due to the body’s natural reaction to aversive stimuli) they will no longer fear the stimulus. And that is how exposure therapy works to treat OCD.
Relaxation exercises such as breathing may be incorporated to help the person calm down, however that practice is a bit controversial. Some therapists incorporate relaxation exercises, and some don’t. Some practitioners think that incorporating a relaxation technique is problematic because then the person becomes dependent on the technique, rather than their own internal coping mechanisms to reduce the anxiety. Other therapists think that isn’t relevant; rather, the person will naturally begin to associate what the previously feared with a relaxed state, eventually making the relaxation technique moot.
Yours in the Joy of Knowledge,
Barb LoFrisco
