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Obsessive Compulsive Disorder (OCD) is a disorder that often starts in childhood and wreaks havoc on a person’s and their families’ life. At Dr. Roseann and Associates, we support children, teens, and adults with OCD disorder every day with brain-based therapies, such as neurofeedback and biofeedback combined with Cognitive Behavioral Therapy (CBT) and Exposure Therapy.
Children and adults with OCD experience unreasonable thoughts and fears (obsessions) leading to compulsive behaviors and rituals (physical and mental). Individuals with OCD engage in compulsive behaviors attempting to end the obsessions, decrease distress and anxiety, or stop perceived bad things from happening. As part of OCD, individuals perform both mental and behavioral rituals to reduce feelings associated with anxiety. These signs of OCD take up a considerable amount of their time every day (one hour or more) and interfere with their daily functioning (home, school, work, relationships, etc.).
Through the use of different therapies, one can learn to manage and sometimes eliminate obsessions and compulsions. It is a process that typically involves working with a psychotherapist. Symptoms can increase during periods of stress, as well as hormone and developmental change. Getting support when symptoms first appear is key to successfully manage obsessions and compulsions before one becomes habituated to the behaviors. One can learn healthy ways to manage anxiety and obsessions and compulsions.
OCD is treated using a variety of traditional and holistic therapies. Some people benefit from medication, and others don’t. The research supports OCD medication as negatively reinforcing the behaviors thus making people treatment resistant. A consistently proven effective treatment for OCD is Cognitive Behavioral Therapy (CBT) and Exposure Therapy (and more specifically Response and Prevention Therapy).
Holistic therapies, such as Neurofeedback, Biofeedback, Reiki, EFT/Tapping, and massage can also be good adjunctive therapies to help align the nervous system. Before a person can fully move forward in clinical therapy, they need to get the Central Nervous System (CNS) regulated.
Exposure therapy is a type of treatment that was developed to help people confront their fears. Exposure therapy has been scientifically demonstrated to be a helpful treatment for a variety of issues, including Phobias, Panic Disorder, Social Anxiety Disorder, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, and Generalized Anxiety Disorder.
Cognitive Behavioral Therapy (CBT) is a type of psychotherapy that works at the conscious level. CBT is combined with Exposure Therapy to help people challenge irrational fears and worries. CBT presumes that how individuals perceive a situation is more connected to their reaction than to the situation itself thus working through those misperceptions brings relief. CBT combines talk and behavioral therapy to reframe negative thinking patterns into positive thoughts. So, in other words, you learn to break that negative internal looping. Research has found CBT to be more effective than medication in reducing symptoms (59.9 % vs. 33.4%) and widely considered to be the first line of treatment in OCD.
Exposure therapy is a type of behavioral therapy where a person is gradually and systematically exposed to their fears. Therapists create a safe environment where an individual can learn to tolerate their fears to reduce avoidance of dreaded situations and reduce anxiety and panic. There are several ways a therapist can expose a client to their fears; types of exposures include:
Exposure therapy incorporates a variety of techniques to help a person confront their fears. As part of the intake and therapeutic process, a therapist determines what are the best techniques to use to assist with the exposure process. Techniques include Systematic Desensitization, graded exposures, flooding, prolonged exposures, and Response and Prevention Therapy (E/RP).
Exposure Response and Prevention Therapy (E/RP or ERP Therapy) is a combination of Exposure Therapy and Cognitive-Behavior Therapy (CBT) that exposes the person to their trigger so they learn how to be uncomfortable to the point where they can ignore their trigger. Before E/RP begins deep psychoeducation about the OCD impacts brain and behavior is essential for both the child or teen and parent. Understanding the neuropsychological mechanisms of anxiety and OCD helps one to move forward in therapy.
With E/RP, first, the person identifies all the triggers. Next, the therapist exposes the person to the situations that trigger his or her obsessions and compulsions (sometimes starting gradually and other times addressing more moderate triggers). The therapy emphasizes learning how to deal with the uncomfortableness rather than avoiding it, as the latter leads to negative reinforcement. Patients learn that with exposure, their anxiety increases, but it also decreases. They safely test the limits of their fears with a therapist guiding them through the awareness that their fears aren’t rational and their exposure experiences are a validation of that.
Over time, through psychoeducation and cognitive behavioral therapy, the person’s response to triggers changes, leading to a decrease in the frequency of compulsions and the intensity of obsessions. OCD treatment and anxiety expert, Kimberly Morrow, LCSW explains “We have to teach clients that they are “feeding the dog” with negative thinking and they have to understand that OCD is a bully that they can overcome”. Therapeutic exposures repeated over time decrease associated anxiety because the individual learns that nothing bad happens when they stop performing rituals. They can learn to stop OCD from bullying them. Cognitive restructuring is part of the process, so they learn to evaluate perceived threats associated with each obsession and then test limits. And when their anxiety does get too high in a session, a therapist is trained to support the client through the exposure.
There is work to be done outside of the session too, as practicing managing exposures transfers from the therapy session to the real world. Review of that practice is part of each session. With children, parents are part of every session, and they learn to support exposures at home, as well as get their child or teen to learn how to tolerate the discomfort.
Upon completion of E/RP therapy, OCD intrusive thoughts and symptoms often diminish or disappear. Ultimately, the person with OCD learns to tolerate the discomfort and not be so triggered. Moreover, as part of the E/RP process, they also learn strategies to cope with the anxiety that breaks the anxiety cycle.
Research has shown that exposure therapy for anxiety has been shown to be an effective short-term and long-term treatment. The primary way exposure therapy works is to break the worry cycle that often hijacks one’s brain. When one is anxious, they often spend a considerable amount of time caught up in their worries and fears. Exposure therapy can be an effective treatment for a variety of anxiety-related conditions, such as generalized anxiety, phobias, social anxiety, and so on.
It isn’t unusual for someone to have a fear of flying and be so fearful that one never flies. That isn’t going to interfere with your functioning unless your job requires you to travel.
Exposure therapy is used for more than OCD and is also often used for the treatment of specific phobias. With phobias, a person avoids specific phobias inducing stimuli or situation. They negatively reinforce their phobia by continually avoiding it. Exposure therapy is about breaking that behavioral cycle.
Depending on the type of phobia, exposure may be a real (in vivo) or simulated (imaginal), including virtual reality exposures. Typically the exposures are gradual but may involve flooding at some point. While phobias are common, it becomes a clinical issue when it interferes with your daily functioning.
The best thing you can do is to get your child or teen help from a licensed and highly trained mental health professional. Obsessions and compulsions often appear between at a young age and shouldn’t be ignored. The longer they occur, the more behaviorally ingrained they become and therefore harder to break the “habit.” Children and teens can become habituated toward obsessive and compulsive behaviors as a way to cope with stress. Breaking those behaviors before they become ingrained can lessen the severity and, in some cases, stop the progression of OCD.
Even when obsessions and compulsions have already become more ingrained and are debilitating, forms of treatments, including Exposure Therapy- Response and Prevention (E/RP) and neurofeedback can help.
Parent psychoeducation and participation in the E/RP therapy sessions and the process is critical for supporting a child or teen with OCD or another anxiety-related condition. Both the child and parent need psychoeducation about how OCD, anxiety, phobias, social anxiety, and so on the impact the brain and body. Parents need to help with the exposure process by not allowing a child to suppress the obsessions and compulsions and instead learn to tolerate them. This process helps to lessen, if not extinguish, obsessions and compulsions and restore functionality and wellness.
We offer ERP therapy for OCD at our Ridgefield, CT center. We offer both traditional ERP therapy and ERP intensives and are members of The International OCD Foundation (IOCDF). To make an appointment with Dr. Roseann for a QEEG Brain Map, schedule an intake for our 360° Reboot® Program, or to meet with one of our E/RP clinicians 203.438.4848 or email info@drroseann.com.
Dr. Roseann is a Psychologist who works with children, adults, and families from all over the US, supporting them with research-based and holistic therapies that are bridged with neuroscience. Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, Certified Integrative Medicine Mental Health Provider (CMHIMP) and is a Board Member of the Northeast Region Biofeedback Society (NRBS) and Epidemic Answers. She is also a member of the American Psychological Association (APA), National Association of School Psychologists (NASP), Connecticut Counseling Association (CCA), International OCD Foundation (IOCDF) International Society for Neurofeedback and Research (ISNR) and The Association of Applied Psychophysiology and Biofeedback (AAPB).
©Roseann-Capanna-Hodge, LLC 2019