Obsessive-compulsive disorder. How is as treated?

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Today we will speak about OCD (obsessive-compulsive disorder, obsessive-compulsive disorder), complex subject that I will try to explain simpler. br>
Right to the point. OCD is a disease that is characterized by obsessive thoughts and actions. For example, obsessive thoughts about the infection any infection and frequent long hand washing in consequence. br>
OCD is a fairly common problem, on average, about 1-2% of people suffer from it for life (that is one of your 500 Facebook friends 5-10 people may well be sick). br>
What is the obsession? It is thoughts, images, representations that appear in our heads and don't want to leave it. Or leave, but soon return again. As a rule, they are of unpleasant nature, a painful character, and really spoil the mood. Most likely, you know, because in one form or another obsessive thoughts happen to all people. Stuck you have the song in my head, I think on the eve of an unpleasant meeting about it every 5 minutes, I doubt all day, turned off if the iron in the morning are all examples of obsessions (obsessions). But are you sick? Probably not. There are few signs. The first - the very appearance of these thoughts in the head of the patient is already distasteful to him, that is, it is the very fact that these thoughts are. Second - this problem exists at least for two weeks, and most of the days of man are overwhelmed by obsessive thoughts. The third one tries with these thoughts to fight. For a start, "ward off" them, to escape, to forget. Then there is any action that helps cope with the idea at any time. This is Intrusive action. br>
As you can see from my words above - the actions themselves are not in the full sense of an obsessive or uncontrollable, they are only a reaction to the obsessive thoughts. What is this action? the
hand-Washing for 10 minutes in a certain way after every possible "intrusion" (sometimes dozens of times a day). Three times to return to the apartment and pull the handle exactly 5 times and then get out of the house with the left foot and the apartment will not burn. By the way, if suddenly a man came out of the door with his right foot, the whole cycle of actions will have to be done again. Very inconvenient, isn't it? This is one of the signs of the disease, it really limits a person's life, turning it into an endless series of compulsive actions. The second example is an example of a very pretentious behavior, which is not very likely to be explained by any logic. So obsessive acts are called "rituals". There are also mental rituals - for example, a person obsessed with the idea that his mother will die from cancer. Once she came to such a scenario did not come true, people need details to imagine her living healthy at the age of 150 years. Or to imagine as he stroked her (showing apologies for your thoughts - as we remember, it is often the fact of their existence brings negative emotions). br>
More recently, the treatment of such people was a big problem. However, at the moment, this disease is curable in most cases! the
first, the antidepressants from group SSRI show a good result, at a relatively low level of side effects. Unfortunately, in 94% of cases the result is stored only if you do not finish the medication.
Well, the second option of treatment is cognitive-behavioral therapy, which has proven its effectiveness in the treatment of this disease, as none of the other methods of psychotherapy. The performance in this case is, on average, at the level of 50-60%. Smallish, you say? Yes, the figure is not very encouraging, but the fact that it includes people who have not completed a course of therapy to the end. And a lot of people. Why? Psychotherapy is always work and not always pleasant, and in the case of OCD - and in General, difficult and unpleasant But effective.

How is psychotherapy this disorder? In order to deal with this, you need to understand how to "work" this disease (and for me pre-read the article about cognitive personality theory).

so, take for example a person with obsessive hand washing. Typical for these patients, the situation came to a public place and ran to wash my hands every five minutes. Why? Because start a certain sequence of thoughts, emotions and actions:

  1. a Person touches a door handle, countertop, accidentally touches the other person picks up money from the floor...

2. Appears Intrusive thought (obsession) - handle/floor/human was bacteria, now I can get.

3. This thought causes an increase in anxiety.

4. To lower anxiety, the man decides to wash his hands.

5. Anxiety is reduced. Ready! He is amazing!







Probably, a similar situation was many to lift something from the floor, to touch the handle. And even thought about the dirt and bacteria, but most often to run to wash your hands you don spodvigaet. Why our seeing things differently? Because the idea of bacteria actually consists of two parts — the automatic and the evaluation of thoughts:

  1. automatic thought: "subject bacteria"
  2. — EVALUATES the idea: "I'll catch something terrible"







But, you say, and such a thought may sneak in a healthy person. Yes, it can. Everything happens then, when people still washed his hands: he washed his hands, and — Oh, miracle! — no sick. This closes the cycle:







since man does not receive the corrective experience — experience demonstrating that not washing your hands, you can stay alive, he thought about what to get stronger as confidence in the fact that it saves washing your hands. So wash in this case or any of the other rituals in others, called protective behavior, and, although subjectively they help in the moment, in the context of the disease — only aggravate the situation.

This cycle is reinforced by not only the relationship of "ritual — evaluates the idea."

When a person performs the ritual, his anxiety is reduced — and this is a very nice feeling that is a powerful positive reinforcement (like treats for dogs for the correct execution of commands).







the Following mechanism:

People may not be very sure of the veracity of the evaluation of ideas, but does a ritual (which is often unpleasant — for example, people with obsessive washing of hands often with these hands peel off the skin),to reduce the level of anxiety. Yes, he has thought "This anxiety is unbearable" "I will not stand," etc.







How does this idea of protective behavior? Right, it confirms it, because the person does not receive evidence that it can withstand disturbing.







And finally, another mechanism is what keeps our rating idea. Right, it's intermediate and core beliefs.

for Example, GU — "I'm a loser", and PU — "If it can happen something bad with me that's for sure going to happen." Needless to say that the existence of the disease, which poisons life, only fuels those beliefs?







What to do with all this? How can I break these cycles? Where to hit? Think about it before you jump to the correct answer.

Correct answer:

Work in the treatment of OCD have multiple targets.

  1. Evaluate idea — we investigate its objectivity and realism.
  2. We reject the rituals and other protective behavior. Thus, we no longer evaluates to reinforce the idea
  3. To the rituals, it was easier to give up, we work directly with the anxiety — and this is both the main and the most unpleasant component of treatment is exposure and behavioural experiments. We are especially alarming, and not to do the rituals. Of course, pick up incentives — in this case, dirty objects, will be according to the degree of contamination, from climbing in the toilet with your hands will not. By the way, is all this possible with the participation of the psychotherapist (it will also touch dirty objects, curse at parents, etc.).
  4. these exercises not only will we reduce the level of anxiety, but also beat the idea that anxiety is unbearable (and the rejection of rituals, too, will help us in this — we will experience victory over anxiety)
  5. Finally, working with intermediate and underlying beliefs, which is primarily aimed at preventing recurrence.
  6. it is Worth noting that with a primary Intrusive thought — about that the subject bacteria, or that ever had contact with the subject, the work is not carried out, because it does not make sense. Failed rubidine in these thoughts often lead to the fact that the person despairs, and thinks that he cannot cope with the disease.







Difficult? Yes. It is difficult for therapist and patient, so, as I said earlier, many do not stand up and gone off course. For the remaining therapy shows a very high degree of efficiency. Duration is an average of 20-40 sessions, when "fresh" it can be 5 sessions with "hardened" comorbid personality disorder therapy may last a year or more.

I Hope this article was useful to you, and more or less clear. Write comments, ask questions:)

Kirill Skladanov
2018-05-12
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