Obsessive Compulsive Disorder (OCD) Therapy in Calgary

What is OCD?

Obsessive Compulsive Disorder, or OCD, is a serious mental health condition that is characterised by obsessive thoughts, impulses, or images and compulsions consisting of repetitive behaviours, rituals, or mental acts. These cause significant distress and take up considerable time and get in the way of important every day activities.

What are Obsessions?

Most of us have obsessive or intrusive thoughts at some point in our lives. For example, have you ever been driving over a bridge and had the thought pop into your head of driving off it, or questioned whether you locked the door when you left the house? Studies have shown that, in the general population, between 80%-99% of individuals in the general population have unwanted thoughts. Unlike those with OCD, these thoughts are viewed as just random thoughts and are able to move on from them fairly quickly and easily.

The American Psychiatric Association (APA) defines obsessions as being “recurrent and persistent thoughts, urges, or impulses that are experienced at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety and distress.”

The obsessions are typically “ego-dystonic” which means that they don’t align with the individual’s values and beliefs. For example, someone who is religious is more likely to experience scrupulosity OCD, the pathological guilt or obsession about religion and morality. Because these thoughts are not in alignment with one’s true self, they produce significant distress which results in compulsive behaviour aimed at alleviating the distress caused by these intrusive thoughts.

What are Compulsions?

We all have daily routines and rituals that we go through each day including wanting to have things arranged or done in a certain way that may make no sense to others – our quirks that we, or others, may even refer to as being compulsive behaviour.

The American Psychiatric Association (APA) defines compulsions as being repetitive behaviours or rituals that an individual feels driven to do in an attempt to prevent or reduce their anxiety or distress, or to neutralise or prevent the dreaded event or situation.

Unlike those who don’t have OCD, it is not a preference and, despite the goal of the compulsion being to reduce distress and prevent bad things, it often brings its own distress. Compulsions can be overt, for example checking, hand washing, seeking reassurance from others, or covert such as mentally reassuring oneself, counting to a certain number, or praying.

What are the different Types of OCD?

While there are no official ‘types’ of OCD, symptoms are categorised into different common themes.

Common obsessions in OCD include:

• Fear of germs or contamination
  
• Unwanted thoughts or images related to sex
  
• Fear of causing harm to oneself or others
  
• Religious obsessions involving fears of blasphemy (also known as scrupulosity)
  
• Moral obsessions related to excessive concerns with right and wrong
  
• Extreme concern with order, symmetry, or exactness
  
• Identity related concerns regarding one’s sexual orientation or gender identity
  
• Relationship obsessions regarding being in love, or one’s partner being “the one”
  
• Existential obsessions regarding death, the meaning of life/one’s purpose

Common compulsions in OCD include:

• Excessive cleaning or handwashing
  
• Avoidance of contact with contaminants
  
• Repeated checking, for example, that the door is locked, the oven is off, that you haven’t made a mistake, haven’t harmed others
  
• Repeating things multiple times or in a certain way
  
• Ordering or arranging items in a particular, precise way until it “feels right”
  
• Seeking reassurance from others or self
  
• Counting during a task and ending on a “good/safe/right” number
  
• Praying or repeating words silently to prevent harm to self or others
  
• Performing a mental review of events
  
• Cancelling or undoing words/thoughts or images by replacing a “bad” word with a “good” word
  

How is OCD diagnosed?

Only trained therapists can diagnose OCD, such as a psychiatrist, psychologist, or other licensed mental health professional. Here at Clear Minds in Calgary, an assessment with Michelle Fox, a registered psychologist, will involve evaluating the presence and severity of obsessive thoughts and compulsive behaviour, their impact on daily life, and determine if they meet the criteria for OCD. For a diagnosis of OCD to be made, the obsessions and compulsions must consume excessive amounts of time i.e. one hour or more each day, cause significant distress, and interfere with important activities of daily functioning, social activities, family and/or relationships.

What is the best treatment for OCD?

Exposure and response prevention, or ERP, is considered the gold standard treatment for OCD. It is a form of CBT and often combined with medication, typically a SSRI, to help control the symptoms of OCD. ERP helps break the cycle of obsessions and compulsions by systematically confronting situations that trigger your obsessions and then refraining from performing the compulsions. Traditional exposure therapy is based on habituation, the idea that if you stay in a situation long enough, your anxiety will reduce over time. We now know that habituation is not enough for some individuals.

At Clear Minds in Calgary, my approach is based on the latest research on inhibited learning theory. Inhibitory learning suggests that, in order for ERP to be effective, new learnings of safety need to be developed which inhibit existing obsessional fear. This approach also helps with relapse prevention as new information related to safety and tolerance to uncertainty is learnt whether anxiety is present or not.

Acceptance and Commitment Therapy (ACT) for OCD

ACT is another treatment approach that is recommended in the treatment of OCD. ACT, used in combination with ERP, helps people with OCD develop psychological flexibility to manage obsessions and compulsions, accepting them as thoughts and urges that don’t need to be controlled, allowing them to live their life in alignment with their values, doing what matters and gives them joy.

Accelerated Resolution Therapy (ART) for OCD

ART can also be used in the treatment of OCD. It can help with reducing the distress associated with the obsessions using bilateral stimulation, in the form of eye movements and/or tapping, and imaginal exposure as part of the procedure. Visit my page on ART to learn more about how it can help you.

To find out more how Clear Minds in Calgary can help you deal with your OCD, please contact me or call to arrange a free 15 minute brief consultation or to book an appointment.