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Understanding OCD and associated therapies

Understanding OCD and associated therapies
Photo: Understanding OCD and associated therapies
Obsessive compulsive disorder (OCD) is a chronic anxiety disorder that affects about two per cent, or more than 500,00 Australians. It’s characterised by the presence of obsessions, which are recurrent and persistent thoughts that are intrusive and unwanted and paired with compulsions performed to try and minimise anxiety.

OCD interferes with family and social relationships, employment and education as the thoughts and associated compulsions can take up many hours a day.

Fortunately, there are many psychological therapies and medication to treat OCD.

Noosha Anzab, a clinical psychotherapist and psychologist, says there are exceptional treatments for OCD, but it can a complex cycle to break for those experiencing the condition.
“Obsessions and compulsions are usually accompanied by rigid rules and preoccupations and repetitive behaviours or mental acts which can be incredibly challenging for those diagnosed with OCD.

“There can also be body-focused recurrent and repetitive behaviours with cycles of trying really hard to cease or decrease the behaviours which can be equally distressing.”

Ms Anzab says a crucial psychological therapy for treating OCD includes a combination of cognitive behavioural therapy and exposure and response prevention (ERP).

“The gold standard psychological treatment and intervention for OCD is cognitive behavioural therapy-based exposure and response prevention (ERP).

“This is usually the key treatment option provided for OCD, and we see some incredible results within this realm.”

However, Ms Anzab is also a big supporter of eye movement desensitisation and reprocessing as a gentler form of therapy for those with OCD.

“I’ve seen EMDR used for OCD, and it has been incredible. It helps significantly reduce symptoms by navigating the negative cognitions with the emotions and sensations felt in the body.

“This lets those who are diagnosed with OCD think about their distress in short bursts while actively altering the way our brains process the distress.

“While CBT can really help – it can reduce up to 80 per cent of symptoms – there can be a great deal of stress that comes with the emotional difficulty of facing emotional pain in comparison to EMDR.”

Types of psychological therapies for OCD

Cognitive Behavioural Therapy (CBT)
A therapy that aims to change the way people think, their beliefs and behaviours that likely trigger anxiety and obsessive-compulsive symptoms. It is an education-based therapy that aims to help people have some degree of control over symptoms.

Exposure and Response Therapy (ERP)
An important part of CBR involves slowly exposing the client to situations that trigger obsessions while helping them to reduce compulsions and avoidance behaviours.

Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR is a psychotherapy that aims to relieve emotional distress, which is the result of disturbing life. It is a structured therapy that encourages clients to briefly focus on emotional trauma or memory while concurrently experiencing bilateral stimulation (typically eye movements).

Reality Therapy (underpinned by Choice Theory)
Reality therapy is a client-centred form of cognitive behavioural therapy that focuses on improving current relationships and circumstances and avoiding exploring past events.

OCD can be devastating for relationships and can impact them in many ways.

“Those with OCD may lack confidence and can struggle with feelings of shame around their symptoms - often fearing rejection.

“This can understandably affect relationships a lot, mainly through avoidance, isolation and maintenance of distance both emotionally and physically.

“We can see some communication barriers arise, and our relationships can start to bear the brunt of it all,” says Ms Anzab.

The stigma of OCD can be one of the most challenging aspects for those seeking treatment, but mental health professionals that take a holistic approach can ease this burden.

“Mental health professionals can help in diagnosing OCD, in making sure the diagnosis is accurate and that comorbidity is also explored.

“We can ensure that we are looking at the person with OCD as a whole person, with their unique narrative rather than isolating them to their disorder.

“The proper diagnosis of OCD and psychoeducation regarding the variations of OCD can help us in destigmatising the disorder.

“We can learn to stop referring to OCD as a general label we carelessly through around at people who may have strong habits, maybe be sticklers for routine or may have high hygiene standards.”

OCD is a term used too loosely, says Ms Anzab, and we all have a part to play in reducing stigma by choosing different language when talking about mental health.

“We often hear friends say ‘oh, you’re so OCD’ or reducing someone’s habits to being ‘OCD’ and that can be so hurtful (for those with OCD) because they’re faced with something stigmatised and debilitating while others are flippant about it.

“Mental health professionals can help educate people in understanding the disorder, in accepting its subtypes and in taking the clinical diagnosis more seriously.

“Conversations with mental health professionals can help ensure we learn not to use negative throwaways when discussing mental health - instead of holding a safe space for people to explore their presentation.”

As a nation, Australia can also do a lot more to improve outcomes for those with the condition, and it starts with funding, explains Ms Anzab.

“We can stop the two-tier debate, make the rebate for seeing a psychologist a flat rate, regardless of the therapist’s title.

“We can increase the number of sessions that are rebateable. There is a huge difference in rebate for essentially the same service.

“There is currently a divide with many organisations not allowing clients access to psychologists without a clinical endorsement, and that is a huge disservice to Aussies.

“Some psychologists without the clinical title have paved the way for psychology, supervise clinical psychologists and may even have more experience.

“However, their clients are disadvantaged with the out-of-pocket cost being greater.

“Medicare has not had an increase to the rebate for psychologists higher than $2.66 in over a decade!

“That’s just not good enough for clients whose living expenses are increasing, who are experiencing more financial stress and yet are starting to become more open to seeking help.

“Our mental health care system provides a lot of funding for those under 25, however with the pandemic, we see those over 25 suffering greatly.

“We can do more - if we all use our voices, maybe we can be heard, and psychological treatment can become more affordable and readily accessible for all Aussies.”

We also need to streamline the process of accessing psychological help so that clients can continue treatment as required.

“At the moment, our care system means if you have a mental illness, you must see your GP who completes a mental health care plan, diagnoses you, then you can attend therapy.

“Once committed to therapy, you must head back to your GP after six sessions for a review and to receive a referral letter to be able to attend four more sessions.

“If we reduce the back and forth and allow clients to self-refer as we did during the bushfire recoveries, then access to vitally needed services can be increased.”

Author JL Keez, who experienced OCD for many years, says treatment was anything but straightforward.

“I felt that the diagnosis of OCD was met with closed ears. The initial diagnosis of simply requiring medication and ‘she’ll be right’ completely missed the mark.

“My learned opinion is the myth held that OCD simply manifests itself, without cause, is one requiring close examination.

“It is as though OCD pops up one day, and with the proper medication, all will be right.

“My recovery demonstrated very clearly that OCD is the result of tightly held thoughts filled with fear, or anger, shame, blame, low self-esteem and more."

In the end, the battle of OCD was won with empathy, understanding and reality therapy provided by an understanding mental health professional.

“I met a female psychologist who practised reality therapy, underpinned by choice theory.

“She guided me in acknowledging the onset of OCD, which was during my first pregnancy.”

Exploring relationships and taking a holistic approach to treatment was crucial to solving OCD, explains JL Keez. 

“She asked the important questions about thinking associated with the disorder, the emotional aspect, where I experienced OCD in my body … and current beliefs and values and whether they had a role to play.

“I explored the relationships connected to this being in my life, through examining my life, my story to date and how I interpreted life.”


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Haley Williams

Haley Williams has a Bachelor of Communication in Journalism and over a decade of experience in the media, marketing and communications industries.

She is a widely published journalist with a particular interest in writing magazine features on parenting, health, fitness, nutrition and education.

Before becoming a freelance journalist, Haley worked as a writer for NeoLife (a worldwide nutrition company), News Limited and APN News & Media.

Haley also has extensive experience as an SEO Content Writer and Digital Marketing Strategist.