For many sufferers of obsessive-compulsive disorder (OCD) and other types of anxiety, deciding to seek help can be a difficult decision to make. Once that decision is made, another choice is required: what kind of OCD treatment is best for me?
Available OCD treatments
Two of the most researched OCD treatment options available are pharmacological treatment (medication) and cognitive-behavioral therapy. Many people prefer one or the other. They think, “Oh, I would never want to take medication unless I had to,” or alternatively, “Just give me the pill, what’s the big deal?” This is a personal choice that each person must make individually. For those that wonder how effective each option may be for them, good news! There is a good deal of research on exactly how effective each of these two treatment options can be.
Much of the research on the effectiveness of medication for OCD focuses on one class of medications. These are known as SSRIs (selective serotonin reuptake inhibitors). This class of medications is relatively new, having been first used in the late 1980’s. Medications like Celexa, Lexapro, Prozac, Zoloft, Luvox, and Paxil belong to this class. They are widely used, partially because their side effect profiles are favorable. Some possible side effects are difficulties with sexual arousal, lowered interest in sex, headache, and changes in appetite. However, each medication will have a different set of potential side effects. You should consult your prescriber before deciding which medication might be best for you.
Much of the research on psychotherapy for OCD and anxiety disorders focuses on different types of cognitive-behavioral therapy (CBT). Exposure and Ritual Prevention (ExRP), a form of cognitive-behavioral therapy, has been shown to be an effective OCD treatment. ExRP is the updated form of Exposure and Response Prevention (ERP). It focuses on changing the strategies used by the OCD sufferer to cope with anxiety. The two terms are sometimes used interchangeably.
Medication vs. Therapy: What does the research say?
Both SSRIs and CBT are first-line treatments for simple OCD. This means that one of the two is the preferred initial treatment for someone with OCD. Research has generally not shown either one to be more effective than the other. Both are effective in reducing symptoms of OCD. Patients received medications more often, however, although the reasons for that are complex.
Occasionally a study compares these two types of OCD treatment. In 2006, a group of researches in Brazil did just that. They compared Zoloft to a CBT group therapy. Group CBT therapy for OCD is similarly effective to individual CBT therapy for OCD. In the Brazilian study, a summary of which is included below, the therapy included “techniques of ERP” and some other elements of CBT.
Here is the summary, as reported in 2006 by Reuters:
OCD Responds Better to Cognitive-Behavioral Therapy Than to Sertraline
NEW YORK (Reuters Health) Aug 28 – Combination treatment withcognitive-behavioral group therapy plus sertraline (Zoloft) is effective for the treatment of obsessive-compulsive disorder (OCD), but when each treatment is given alone, cognitive-behavioral therapy is superior to sertraline. Although OCD is responsive to the combination of these two therapeutic approaches, Dr. Aristides V. Cordioli and colleagues from Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, wrote, “there is no consensus about which of these forms of treatment is more effective” when used alone.
In this study, published in the Journal of Clinical Psychiatry, the researchers compared the efficacy of cognitive behavioral therapy versus sertraline in reducing symptoms of OCD. They evaluated 50 OCD outpatients randomized to 100 mg/day sertraline or cognitive behavioral group therapy for 12 weeks. The patients were assessed at baseline and weeks 4, 8, and 12.
While the patients responded to both treatments, “the reduction of symptoms for cognitive behavioral group therapy patients was 44.07% while in the sertraline group it was 27.78% (p = 0.033),” Dr. Cordioli’s team reports.
Patients who received cognitive behavioral group therapy also experienced significantly greater reduction in the intensity of compulsions (p = 0.030).
Complete remission of OCD symptoms was observed in eight patients in the cognitive behavioral therapy group compared with only one patient in the sertraline group.
Study results: Both effective, CBT more effective
This study showed that the group receiving CBT experienced greater reduction in symptoms than the group receiving Zoloft. The authors point out that the study involved patients suffering from OCD but not from any other psychological problems (e.g., depression, social anxiety. The results obtained in the study may not apply to people with other difficulties in addition to OCD. This study is essentially confirmation of the effectiveness of both CBT and Zoloft in treatment of OCD. It also shows some new results about the superiority of CBT in the “intensity of compulsions, the rate of symptom reduction, and in complete remission.”
Using medication and CBT together: Considerations
Some people with OCD wonder about the advisability of taking medication while in therapy. There are advantages and disadvantages to this. One advantage to not taking any psychoactive medication while in CBT is that you will learn new skills to cope with your OCD while you are experiencing those symptoms. If you began CBT while on medication, and then later came off the medication, your symptoms may overwhelm your ability to use the tools you had learned in CBT. Some people report that while medication is helpful for them, it is not helpful after they stop taking it. They then are vulnerable to feeling that they are “back at square one.”
How important is brain research on OCD treatments?
There has been other recent research on the neurophysiology of OCD. This new research showed differences in brain activity patterns in people with OCD compared to people without OCD. Research has also found that these patterns change after successful CBT or SSRI treatment.
Some sufferers of OCD feel alarmed at the notion that their brains are different than anyone else’s. Remember that the brain is a complicated organ! It is dynamic and constantly changing. Every time we learn something new, nerve cells in our brains form new and different connections that were not there before. Patterns of activity in the brain change when we perform seemingly simple tasks: every time we open our eyes in the morning, a complex wave of electrical activity makes its way from our optic nerve to various parts of our cerebral cortex.
Given the sensitivity of the brain to new information and new habits (both mental and physical), it is not surprising nor alarming that brain activity patterns would be different in people with OCD. Research studies on the effects of OCD treatment on the brain are complementary to other studies showing the effectiveness of these treatment options.
In conclusion, the choice of whether to pursue CBT, medication, or both can be a difficult one. Fortunately, sufferers of OCD today can take some comfort in the fact that both of these treatments have been shown to be effective, as neither was available just a few decades ago. To learn more, read our post on comparing medication vs therapy for OCD.
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