Treatment & Causes of Obsessive Compulsive Disorder

What Is Obsessive Compulsive Disorder

People with obsessive-compulsive disorder, or OCD, have recurrent thoughts and behaviors that can be crippling.  What follows is a discussion of the biology of the disorder and several aspects of treatment.

Obsessive compulsive disorder is not a single disorder; rather, it’s of a cluster of conditions. In OCD, sufferers might obsess and be anxious and compulsive about hoarding, cleaning, ordering and checking. Patients can also exhibit body dysmorphic disorder (BDD), where they imagine possessing a defect in physical appearance.  Other diseases that overlap with OCD include Tourette’s syndrome and hypochondria. OCD also has a genetic component and runs in families; relatives of someone with OCD are 8 times more likely to present symptoms.

The areas of the brain that appears involved with OCD are the orbito-frontal cortex (OFC), a center for decision-making, and the thalamus, which filters and relays information. In these brain regions, the neurotransmitter glutamate is responsible for neuronal signaling. It’s thought that the deficit of glutamate production and function might contribute to the condition of OCD and other counter-productive behavior, including making decisions based on inappropriately perceived danger.

Obsessive Compulsive Disorder Treatment

The neurotransmitter serotonin may play an important role in whether someone gets obsessive compulsive disorder. Researchers have found a defect in the gene that makes a protein that “mops up” serotonin from between neurons. When there’s too much of this protein there is not enough serotonin, and that’s what is found in some with OCD. This is why Serotonin Re-uptake Inhibitors (SRIs) such as Prozac, which makes serotonin more available to the brain, are perhaps the most popular OCD treatment.

Another commonly used OCD treatment is exposure and response prevention (ERP), where the patient is exposed to stimuli that trigger the repetitive behavior but do not allow the patient to actually perform the compulsive behavior. Eventually the patient can learn that nothing bad happens when they don’t act out their compulsion.

Unfortunately, ERP is a stressful treatment for patients to endure. And significant numbers of patients drop out of treatment. Various drugs, such as the SRIs, are now being used in conjunction with ERP.

Anxiety usually is significant part of obsessive compulsive disorder. While anxiety does not appear to be the actual cause of OCD, anxiety can drive persistent thoughts and behaviors. A reduction in anxiety can be important in the treatment of OCD.  Various modalities for treating anxiety include medication, neurofeedback (both traditional and LENS Neurofeedback), and/or behavioral approaches.

When anxiety is successfully brought under control, there are not only fewer obsessive thoughts, but those obsessive thoughts that do persist become less prominent.  Instead being the dominant focus, compulsive become background music as opposed to a loud concert. These thoughts demand less attention and this makes it easier to control compulsive behavior.

Non-drug Approaches To Treating PTSD

Part II—PTSD And Painful Memories

There are many approaches to the treatment of the anxiety, fear, depression and other symptoms of PTSD that do not involve medication. The most common non-pharmacological treatment is trauma-focused cognitive-behavioral therapy (CBT).  Cognitive restructuring helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about what is not their fault. The therapist helps people with PTSD look at what happened in a more realistic way. Other than in the initial stages, psychodynamic talk therapy alone has a limited role in treating PTSD.

“Exposure Therapy” involves gradually “exposing” a client to thoughts, feelings, and situations that bring back the memory of the trauma in order to wear out or “extinguish” their impact. This helps people with PTSD cope with their extreme anxiety and fear. A major drawback of exposure therapy is a greater than 50% dropout rate. Because the client has to revisit the traumatic events, however gradually, many find this too painful to continue.

Another modality that is increasingly being for PTSD is Eye Movement Desensitization and Reprocessing, more commonly known as EMDR.  The premise of EMDR is that when a traumatic experience occurs, it overwhelms our usual cognitive and neurological coping mechanisms. The memory and associated stimuli of the event aren’t properly processed, and are dysfunctionally stored in an isolated memory network. EMDR therapy supposedly helps the client process these traumatic memories, reducing their influence and allowing him to develop more adaptive coping mechanisms.

In EMDR treatment, the patient recalls a trauma while at the same time receiving “bilateral stimulation” such as rapidly moving his eyes from side to side. Tapping movements on different sides of the body or other modalities such as light and sound are used. Despite it’s name, eye movement is not essential in EMDR.

There are a number of other approaches associated with “complementary medicine”, that show promise for treating PTSD. One study demonstrated that acupuncture was as successful as CBT for treating PTSD. The improvements persisted at 3-month follow-up.

Other studies have found yoga to be helpful, particularly with veterans, where it reduced hyper-arousal and helped them sleep.

One of the most promising techniques for PTSD is mindfulness meditation, inspired by Buddhist teaching, which focuses awareness on the present moment. Mindfulness-based training for PTSD has been looked at in a number small studies, most showing about 80 percent of subjects showed clinically significant decrease in PTSD symptoms.

Mindfulness meditation medicine groups have a dropout rate of virtually zero. Members can talk about their past trauma if they wish, but there is no pressure to do so. Instead, the groups are centered on the present, helping members to cultivate present moment awareness and other practical skills they can employ immediately. Another advantage of mindfulness meditation is that it is “broad-spectrum”, showing success not only with PTSD but depression, anxiety, panic attacks, pain, insomnia, and substance abuse.

Along the lines of meditation, there is even a group in the Puget Sound V.A. Hospital in Seattle that treats PTSD - including among Navy Seals - using the Buddhist practice of "loving kindness meditation." (They had a bit of debate about changing the name but decided to keep it. According to the director of the study, it worked out just fine.)

Two additional therapies with clinical evidence are traditional neurofeedback and LENS neurofeedback. The traditional neurofeedback method, commonly call Alpha-Theta (A-T) Neurofeedback, employs low frequency signals that bring the brain to a "twilight" state half-way between awake and asleep. This state that appears conducive to processing emotions.

An example of this treatment is to have the client relax in a darkened room. He or she is connected to EEG sensors and wears earphones. The client receives soothing sounds (like a river or ocean), which subtly change based on changes in brainwaves. These sounds both relax a client and at the same time help prevent the client from falling asleep.

An A-T session typically lasts about 30 minutes. Various guided visualizations can be used, but the basic instruction is to let the mind wander. Because the client is in an altered and profoundly relaxed state, her usual defenses are not as vigilant, and when something traumatic arises, instead of being re-traumatized, the brain can process these intense emotions. Initial changes with A-T can often be seen after one to three sessions. Typically, 10 - 20 sessions are required. Alpha theta is often in conjunction with talk therapy.

Lens Neurofeedback PTSD Treatment

Another form of neurofeedback, LENS (Low Energy Neurofeedback System) has shown in clinical reports to be an effective modality for the treatment of PTSD. Clinical reports indicate that it reduces the flight or fight response and clients feel more relaxed and emotionally “lighter” and more resilient.

In a LENS treatment, the client receives a series of unobtrusive, brief (1/100th sec), extremely weak brain signals, hundreds of times less than a cell phone. These minute feedback signals constantly change, responding to the client’s brain function. The introduction of these signals is thought to cause a slight fluctuation in brain waves that “shifts” the brain out of frozen, stuck patterns, such as the traumatic memories that give rise to PTSD. This is analogous to rebooting a frozen computer and allowing it to return to its previously functional state.

Read Part 1—PTSD & Painful Memories