Prior to the late 1960s, OCD was generally considered unresponsive to a range of conventional therapies. Traditional talk therapy based on psychoanalytic principles was rarely successful in reducing the severity of obsessions or compulsions. Understanding and working through the symbolic meaning of obsessions may have enhanced some patients’ understanding of the workings of their minds, but it proved insufficient in turning the tide of obsessive-compulsive behavior. The success rate with a range of different medications was just as disappointing.
Two developments mark the beginning of the modern era in the treatment for OCD. First, the British psychologist Victor Meyer reported in 1966 that two cases of OCD had responded to a behavior therapy technique later referred to as exposure and response prevention. Behavior therapy attempts to modify maladaptive behaviors by employing strategies that focus on the present.
Second, several European psychiatrists reported in the late 1960s and early 1970s that a medication called clomipramine was effective in a series of cases of OCD. In a number of subsequent studies conducted around the globe, behavior therapy and serotonin reuptake inhibitors (SRIs), of which clomipramine is an early example, have each been established as effective treatments for OCD. The most broadly effective treatment for OCD appears to be a combination of an SRI and behavior therapy.
Since it was first introduced for OCD, exposure and response prevention has undergone considerable refinement by several noted behavior therapists, including the English psychiatrist Isaac Marks, and by the psychologist Edna Foa, now at the University of Pennsylvania.
Exposure consists of confronting the patient with situations that evoke obsessional distress; response prevention consists of instruction to abstain from compulsive rituals, sometimes supervised by significant others or clinical staff. The aim is simple enough: to teach patients with OCD that they can master anxiety provoked by obsessions without performing rituals. They learn through repeated exposure that the obsessions eventually will disappear.
The successful application of these techniques requires the skills of an expert therapist and the full commitment of the patient. At least 10 to 20 hours of treatment and practice are required to achieve a favorable outcome. Success rates as high as 80 percent have been documented. However, behavior therapy may not be suited for everyone. OCD patients with depression, obsessions alone, or who are nearly convinced that their fears are valid, seem to do less well with behavior therapy alone.
Unfortunately, not everyone responds to treatment for OCD. Despite recent advances in behavior and medication treatment, about one-third of people with OCD fail to experience improvement. This underscores the need for ongoing research into the causes of OCD so that new and better treatments can be developed.
There is reason to be optimistic about the future. Interest in OCD has exploded and we seem to learn more about it every day. The first step is to recognize that you or your loved one may have OCD and that help may be just around the corner.