The Anxiety and OCD Treatment Center of Florida strives to provide only evidence based treatment options for individuals. Therapy and treatment methods vary depending on many factors. A review of current treatment methods and services are below:
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is a highly effective, extremely common evidenced based type of therapy often used to treat anxiety disorders, OCD, depression, and other related conditions. CBT is an integration of two originally separate theoretical approaches; the behavioral approach, and the cognitive approach. Overall, the focus is on helping individuals understand their thoughts and thought patterns, how this impacts their mood, affect, and behaviors. But breaking CBT down further, the cognitive approach emphasizes the role of your mind and cognitions (thoughts). People with OCD and anxiety will often overestimate a negative outcome, that they are in a dangerous situation, or jump to a conclusion with no evidence to support the thought. A key to treatment is learning to identify, correct, and restructure these misconceived irrational thinking patterns and fears. The behavioral approach emphasizes individuals actively changing their responses to situations and being able to be present. One such form of behavioral therapy is called Exposure and Response Prevention (ERP), which will be discussed below in detail. Finally, CBT teaches individuals about cognitive distortions and ways that we automatically think in an incorrect fashion. Learning about your own cognitive distortions and how to respond to them can significantly improve the outcome of your treatment goals.
Exposure Response Prevention (ERP)
A core treatment for OCD and other related conditions, is called Exposure and Response Prevention (ERP). Similar to CBT, methods of ERP attempt to change thoughts and behaviors, but ERP relies on an exposure to the feared stimulus with a choice of not letting yourself engage in a compulsion, avoidance behavior, or related ritual. Over time and practice, exposure to the feared stimuli will not have the same heightened anxiety response and eventually diminish anxiety. This process of habituation (becoming accustom to) is a core aspect to treatment success and can train your brain to respond to many situations in a healthy
manner. Individuals with OCD often develop a strong connection with obsessive thoughts and ritualistic behaviors and ERP works to disrupt this connection and decrease compulsions and rituals.
Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy (ACT) is a form of treatment that stems from Cognitive Behavioral Therapy (CBT) and is known as the “fourth wave” of treatment. ACT helps people focus on the present, process difficult emotions, diffuse the impact of negative emotions and reshape thinking to treat depression, anxiety, and other related conditions. Core concepts of ACT include acceptance, mindfulness, cognitive defusion, being present, self as context, values, and committed actions as the focus of treatment. ACT’s biggest difference from CBT is that it does not rely solely on one’s thoughts, but highlights the importance of altering one’s relationship to one’s private experiences to become “disentangled” from them. The goal of ACT is to help individuals practice values based behaviors while experiencing disruptive internal processes.
Mindfulness Based Cognitive Therapy (MBCT)
Developed originally from Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction program, Mindfulness Based Cognitive Therapy (MBCT) incorporates concepts of cognitive therapy, meditative practices, and mindfulness training. Informal mindfulness training along with exposure and response prevention is often practiced with OCD treatment. Goals of MBCT would be to recognize repetitive depression patterns, become aware of the different ways of thinking often associated with mood dysregulation, and learn how to develop a new relationship with them while avoiding being stuck at the bottom of the spiral.
Habit Reversal Training (HRT) and Comprehensive Behavioral Intervention for Tics (CBIT)
There are a few evidenced based treatments for individuals who struggle with tics associated with Tic Disorders or Tourette’s Disorder, hair pulling associated with Trichotillomania, nail biting, thumb sucking, or skin picking. Habit Reversal Training (HRT) is a form of treatment that incorporates increasing awareness and then practicing a competing behavior for a related urge. Similarly, Comprehensive Behavioral Intervention for Tics (CBIT) is a formal non-medicated step by step treatment process of training an individual to be more aware of his or her tics and the urge to tic; training the individual to do competing behavior when they feel the urge to tic, and developing changes to an individual’s day to day activities in ways that can be helpful in reducing tics. It is important for a parent to align with a child to work together on tics, rather than to police the child on each tic they are presenting with. The more motivated and willing a child is to work on their tics, the more likely a successful outcome. CBIT is a successful treatment option with a large, multi-site, National Institutes of Health-funded study showing that more than half of the people who undergo CBIT will have significant reductions in tic severity and improved ability to function, as well as research showing that 87% of recipients showed continued success after 6 months or more (Piacentini et al. 2010).
Dialectical Behavioral Therapy (DBT)
When working with individuals who struggle with emotional regulation, a common form of Cognitive Behavioral Therapy is called Dialectical Behavioral Therapy (DBT). Treatment using DBT is evidence based and works on recognizing negative thinking patterns, changing them, and striving for positive behavioral changes. Overall emphasis in treatment is focused on emotional regulation, being mindful, and learning to accept discomfort and pain. DBT was developed by Marsha Linehan originally for individuals who designed specifically for people who harm themselves, present with self-destructive behaviors, and are diagnosed with borderline personality. Since DBT’s therapeutic inception, it has expanded to help many other diagnostic criteria. The term "dialectical" comes from the idea that bringing together two opposite concepts in therapy, acceptance and change, brings better results than either one independently.
Individuals can patriciate in treatment that incorporates DBT techniques and strategies on a one on one basis in therapy. DBT also offers a comprehensive program of treatment consisting of individual therapy, group therapy, phone coaching between sessions, and a therapist consultation team. In this latter way, DBT is a program of treatment, rather than a single treatment method or skills conducted by a practitioner in isolation. The most critical elements of any DBT program has to do with whether it addresses five key functions of treatment:
- Enhancing capabilities,
- Generalizing capabilities,
- Improving motivation and reducing dysfunctional behaviors,
- Enhancing and maintaining therapist capabilities and motivation and,
- Structuring the environment.
Motivational Interviewing (MI)
Individuals who struggle with shifting or change, are often supported with a Motivational Interviewing (MI) approach. Originally developed over 30 years ago by Miller and Rollnick, Motivational Interviewing works on shifting an individual away from a state of indecision or uncertainty and towards finding motivation towards positive decisions and established goals. MI is used and successful when individuals are stuck, not interested in change or treatment, unwilling to participate, or closed off to conversation. MI does not work to coerce or externally drive individuals to change, rather focusing on supporting change aligned with the individuals own person value driven beliefs and goals. Important aspects of MI are:
- A respectful stance with focusing on building rapport in a conversation about change,
- Resolving ambivalence towards change,
- Engaging in a collaborative and evocative joint process.
Behavioral Therapy Combined With Medication Management
While psychologists do not typically manage medications with an individual, this should be a topic that is considered when engaging in treatment. To date, behavioral therapies are seen as the most effective evidence-based treatment for long term management of OCD and other related conditions. With that said, research indicates that a combination of both Cognitive Behavioral Therapy and medication management may be beneficial for overall success. Certain patients who have severe symptom presentations may first benefit from a trial of medication to loosen their symptoms and prepare them to be in treatment. Common medications that are considered for the treatment of OCD while also participating in CBT treatment are selective serotonin reuptake inhibitors (SSRI’s). While a combination of medication management and CBT has the highest statistical and research based opportunity for treatment success, many individuals are either not ready for a medication option or want to see how first learning new skill sets of CBT will help support their treatment. These and other medications can have side effects and should only be taken under the supervision of a licensed medical provider who has specific experience in treating your condition. A referral for a psychiatrist specific to your symptoms can be provided in the process of therapy.