Obsessive-compulsive disorder (OCD) is a complex mental illness that can be challenging to treat due to its life-long prognosis and unique symptoms. Being equipped with the most up-to-date treatment methods for OCD can prepare mental health professionals to offer the most comprehensive and effective support for long-term symptom remission in clients. Continue reading to learn more about OCD, including diagnostic criteria, best treatment practices, and getting certified as an OCD specialist.
What Is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as an “obsessive and compulsive-related disorder,” alongside conditions like trichotillomania, hoarding disorder, skin picking disorder, and body dysmorphic disorder. It involves unique obsessive thought patterns, intrusive thoughts, and compulsive behaviors.
People with OCD experience moderate to severe functioning impairments in multiple areas of life which could include school, work, and at home. An individual with this condition may have an extreme preoccupation with fears, thoughts, and beliefs that lead to ritualistic compulsions, which can differ their theme based on an individual’s morals, values, life experiences, and unique fears.
The DSM-5-TR Criteria For OCD
Obsessive-compulsive disorder was listed under the “anxiety disorders” category in the DSM-4 but was reclassified in the DSM-5 and the revised version of the DSM-5, the DSM-5-TR. Below are the most recent criteria and obsessive-compulsive symptoms required for diagnosis:
- The presence of obsessions, compulsions, or both
- Persistent and repeated thoughts that are unwanted and intrusive and cause significant anxiety or distress
- An attempt to avoid distressing thoughts, urges, or images with another thought or action, often in the form of a compulsion
- Time-consuming compulsions or obsessions that take up over an hour a day or cause significant distress and functional impairment
- Repetitive behaviors or mental acts that a person feels they must complete or perform to respond to or avoid an obsession or fear
- The intent to reduce distress by performing a repetitive behavior
- Compulsions that may not be realistic in reducing the perceived threat posed by one’s obsessions
To diagnose OCD, a client’s disturbances and symptoms must not be better explained by another mental illness or physical condition. Skin picking, hair pulling, body dysmorphia, ritualized eating behavior, and hoarding are not forms of OCD but are separate obsessive and compulsive-related disorders listed in the DSM-5-TR. In addition, providers can specify if the individual is also experiencing a tic disorder, which is a separate category in the DSM and may occur alongside OCD.
Providers can further specify if the client has insight into whether their OCD-related beliefs are true. Clients can be labeled as having good or fair insight, poor insight, or delusional beliefs. In some cases, entirely delusional beliefs may signify a different mental health condition or comorbid conditions with OCD.
A Note On Intrusive Thoughts
The term “intrusive thoughts” is sometimes misused by pop culture and professionals. However, its definition in the context of OCD is severely distressing obsessive mental imagery and thoughts that go against an individual’s moral beliefs or desires. For example, an individual with OCD may experience intrusive thoughts about wanting to harm their best friend, related to a theme of harm OCD. They may have compulsions like checking whether they’ve locked all their kitchen knives away or changing the password on a gun case to reassure themselves they won’t accidentally harm someone.
Intrusive thoughts are not random impulses or urges that might be seen as quirky, funny, or cute. They are scary and often involve severe subject matter, including illegal and controversial topics. Individuals with OCD do not want to act on their intrusive thoughts and may fear that having these thoughts makes them “impure,” “bad,” or “dangerous.” A therapist can support a client with intrusive thoughts by not judging the images or concepts the client is struggling with. Facing fears is often a core concept of OCD treatment, so talking about intrusive thoughts may be part of taking away the power that thought has over a client.
What Are The Most Effective Therapeutic Modalities For OCD?
There are several recommended therapeutic modalities for OCD, including the following, which have been extensively studied as effective treatment options.
Exposure And Response Prevention (ERP)
ERP is a behaviorally focused offset of cognitive-behavioral therapy (CBT). Clients are asked to face their obsessions and fears while refusing to allow themselves to perform compulsions. For example, a client that believes they will get sick if they touch a door handle in public might perform graded exposures in the following steps:
- Touching a door handle at a clean building with a thinner cloth than normal
- Touching a door handle with gloves instead of a cloth
- Touching a door handle with one finger and no gloves or cloth
- Touching the door handle with all fingers
- Wrapping one’s hand around the door handle entirely and staying there for five to ten seconds
- Holding the door handle and then touching one’s face
- Holding the door handle and then licking one’s hand
- Holding the door handle of a dirty building with rust or grime and repeating the above exposures
Exposure practices can be personalized for each client but increase in severity as they work on their fear. For the above exposure to work, the client must also not partake in any compulsions, such as washing their hands, using hand sanitizer, tapping their leg, etc. As the client performs the exposure and avoids partaking in a compulsion, the therapist can ask them to rank their anxiety on a scale of one to 100, offering a number every five seconds. Once anxiety peaks and begins to reduce, exposure practice can stop, and the client can take a break.
Exposure often starts with minor fears or obsessions and builds up to severe intrusive thoughts and constant compulsions. However, with all exposure practice, a willingness to participate in therapy may be a significant ingredient for success. Being unwilling to try the exposure or stopping in the middle may cause the technique not to be as effective. For this reason, therapists often get certified in exposure therapy before practicing this technique.
According to studies, up to 50% of people who attend exposure and response prevention therapy (ERP) achieve reduced symptom severity or symptom remission after treatment. However, studies are still needed to understand why ERP is effective and why it may not work for some clients.
Cognitive-Behavioral Therapy (CBT)
Cognitive-behavioral therapy for OCD involves guiding clients through restructuring beliefs and thought patterns that may contribute to compulsive urges. For example, a client with obsessions about having their mind read might work with the therapist to explore why these thoughts arise and why the client believes they are related to a compulsion to tap their leg 100 times. As compulsions and obsessions often seem unrelated to onlookers, a client is the expert in their own treatment and may be able to offer insight to the therapist about why these patterns and behaviors developed.
Some people with OCD may experience symptoms due to a past traumatic event or difficult upbringing. CBT allows these clients to work through the initial causes of their symptoms and start replacing unwanted thoughts with positive, factual, and effective beliefs.
Acceptance And Commitment Therapy (ACT)
Acceptance and commitment therapy (ACT) for OCD is another offset of CBT. This therapeutic modality involves elements of validation, acceptance, and a self-growth mindset. Clients are taught that behaviors can be changed and are not set in stone. In addition, clients learn to focus on how they react to events, thoughts, and feelings instead of what they believe the event means.
Unlike ERP, ACT focuses on reducing the emphasis on getting rid of obsessions. Individuals learn how to accept their obsessions and thoughts as reality without allowing them to change their behaviors (compulsions). Therapists can help clients reduce bias and stereotypes by teaching them that it can be normal and part of the human experience to have fears and obsessions and that these obsessions do not mean there is something flawed, abnormal, or wrong with them.
How To Learn More About Treating OCD
If you’re a provider interested in learning more about treating patients with OCD, there are several steps you can take to become more experienced in this area of mental healthcare. Consider the following.
Get Certified As A Specialist In An OCD Modality
There are several ways you can get certified in modalities to treat OCD. According to the International OCD Foundation (IOCDF) Training Institute, it can take up to 17 years after the onset of OCD symptoms for some clients to get a diagnosis and receive treatment, often due to shame and stigma. For this reason, becoming a specialist in OCD can provide more opportunities for clients with symptoms to receive support.
The IOCDF Training Institute offers a program for mental health professionals to study OCD and support clients with this condition. They also offer continuing education credits to those who qualify. Through the program, you can complete 100-level- to 400-level training and receive a certificate. For those with prior experience in OCD treatment, the IOCDF offers a master clinician series exploring the latest research and cutting-edge treatments.
If you’re unsure which program might be right for you, you can take the Training Institute Self-Assessment Test to get a placement recommendation. IOCDF also offers a virtual training opportunity for those who want to receive more information from their home.
If you are interested in certification in a therapeutic modality like exposure therapy or group consultation sessions, other options may also exist. For example, the Perelman School of Medicine exposure and response prevention therapy workshop for OCD takes place once or twice a year and is open to licensed mental health professionals or those working under a licensed mental health professional.
Take A Class
One-time classes or lectures can also allow clinicians to learn more about OCD. Researchers, psychologists, and other professionals dedicating their careers to OCD treatment and research may hold seminars for professionals to learn more about up-and-coming studies and treatment options. These classes may also be beneficial if you want to fulfill your licensure requirements for continued education credits.
Practice Integrative Therapy
Some therapists choose one or two modalities to specialize in, with cognitive-behavioral therapy (CBT) often being one of the most effective. However, clients are often complex and may benefit from integrative approaches. If you’re not entirely comfortable with a new treatment for OCD, you might start using aspects of that treatment in conjunction with a client’s current treatment to build experience in that new skill. You can ask your client how they feel about trying an integrative approach and new techniques and use their feedback to expand your knowledge and practice.
Online Therapy For Obsessive-Compulsive Disorder
Like many other mental health disorders, OCD can be difficult to treat successfully. However, with the right training and tools, it is possible to lead clients toward growth and healing. If you’re wanting to learn more about OCD, including treatment approaches, consider connecting with an online therapist through the BetterHelp platform. By connecting with an online therapist, you can discover more about OCD and consider various treatment methods to incorporate into your practice. Additionally, if you’re facing mental health concerns of your own, you can speak about these with your provider using video chats, phone calls, or in-app messaging.
The Efficacy Of Online Therapy For OCD
Research has shown that children and adults living with OCD could benefit from participating in online therapy. In a comprehensive review of six different studies, researchers found that online cognitive behavioral therapy (CBT) was highly effective in treating OCD symptoms for pediatric patients. CBT is a type of therapy that teaches individuals how to shift their negative thoughts to those that are more helpful, thereby allowing them to change their behaviors.
Results from another study showed that an online-based therapy intervention reduced symptoms of OCD, depression, and anxiety. Ultimately, researchers concluded that there were “no significant differences in efficacy between remotely-delivered CBT and face-to-face CBT for OCD symptoms.”
OCD is a serious mental disorder that can impact many aspects of daily functioning for those it affects. Providers can learn more about this condition and its approved treatments in many ways, including webinars, classes, workshops, and official certification courses. Training in a mental illness can involve putting yourself out there to new ideas and modalities and taking an integrative approach to mental healthcare. Consider signing up for continued education units in OCD treatment to get started. You can also speak with an online professional through the BetterHelp platform to gain more knowledge and get started down a new, helpful path.