Obsessive-compulsive disorder can be defined as a psychological disorder in which we find, on the one hand, obsessions (thoughts, images or impulses that unintentionally invade our minds) and, on the other hand, compulsions (mental acts or motors whose purpose is to neutralize the anxiety caused by obsessions and prevent a supposed threat)
Everyone, to a greater or lesser extent, may have obsessions at some point. As thoughtful people, our minds sometimes create absurd, unrealistic or exaggerated mental products.
- When this usually happens we do not give them much importance or value.
- We let them pass and follow our day to day without mixing with them.
- We are aware that they are thoughts and nothing else.
- Which do not have to be related to reality.
In the case of obsessive-compulsive disorder reasoning is not done that way, unlike people who have thoughts of any kind but do not appreciate them, people who have ODO are very concerned about the thoughts that appear in their mind and give them excessive power. .
This generates a lot of anxiety and, although these people do not identify with those thoughts and they seem uncomfortable, they believe them.
Therefore, they feel the need to do something that neutralizes this irritating feeling and somehow warns of the threat that, according to their minds, is about to happen.
When a patient with ODO performs compulsion, he or she experiences invigorating relief. Eventually the anxiety disappears and so does the obsession, so does the person think he has avoided it?a disaster that could have been devastating, as we see, although they are extremely intelligent people in most cases, their thinking is distorted.
We know that a thought alone cannot generate a real threat, but it is the model of thought that exists in the minds of these people, who follow to the letter.
As a result, patients with ODO end up exhausted, extremely exhausted and hopeless, as they never manage to get rid of the obsession forever.
Faced with this situation, exposure prevention intervention is perhaps the most successful intervention in this area, however, this same efficiency involves a number of drawbacks, such as disruption practices.
In general, exposure is usually the preferred treatment for disorders related to a strong anxiety component.
Anxiety is a normal emotional response that occurs when a person interprets a fact, situation, or stimulus as a threat and believes that something can happen that will jeopardize their survival or that of others.
In this sense, anxiety is an ally that helps us to face the problems inherent in life.
When the same anxiety that benefits us appears in circumstances that pose no risk, it no longer has functionality and meaning.
It is at this point that anxiety becomes a problem, since it does not respond to reality since we are able to perceive it with our senses, in turn corresponding to an expectation.
It is when a person expresses obsessions, mistakenly thinks that something will happen that will hurt him, that is immoral or that reflects a lack of responsibility.
These obsessions are unrealistic, there is no evidence to support them in any way, but the patient who has ODO cannot get them out of the head without any other illusory result, exactly what the restriction offers.
That is why it is necessary to expose the patient to the stimulus that, in his opinion, can cause him harm, including his obsessions, so that he can prove for himself, without neutralizing, that what he fears never happens.
The idea of preventing the response is that, through adaptation, the person reaches a point where he can tolerate, control and manage obsession without leaving room for coercion.
It’s about finding that nothing really happens after pressing the buttons on an elevator, for example, that is, allowing reality itself to end its negative expectations more than once, until, one way or another, it doesn’t really represent that feeling.
We must understand that if the person performs the compulsion, it is impossible for him to disprove his unreal thoughts, she will mistakenly believe that through coercion what he fears has not happened, but the truth is that this did not happen because he has no real support.
Exposure with response prevention, as we have already indicated, is the treatment that has shown the best results in the control of ODO. It works, above all, with patients performing rituals. However, it is difficult to apply to pure obsessions.
Exposure to the preventive response has the disadvantage that patients perceive it as very aversive, since their anxiety levels tend to increase at the beginning of treatment.
This is an indicator that treatment is done correctly, because the patient is exposed and does not block their anxiety.
It is extremely necessary to explain to the patient how the technique works so that he realizes the importance of exposing himself to what he fears and understands how his rituals are responsible for the impossibility of solving the problem.
First, we need to define a hierarchy of stimuli that cause anxiety and vary from case to case, this hierarchy must be performed by the therapist.
If the patient does, there is a risk that much forgiveness will be given and not exposed to stimuli that actually cause anxiety.
The patient evaluates stimuli that cause discomfort according to the Scale of Subjective Distress Units (SUDS) ranging from 0 to 100.
Ideally, it is important to start exposing yourself with intermediate SUDS levels (40-50), it is important that anxiety is reduced to at least 50% during the consultation, otherwise we should not move on to the next element of the hierarchy, because we could make the person sensitive rather than used to.
In addition, exposure outside the consultation is not desirable if the early stages of adaptation have not been made in the sessions and if it is not partially addressed.
Sessions should be as long as possible. In some cases, the patient may be exposed for up to 24 hours, altering some stimuli in the patient, for example, which makes adaptation much easier.
Although effective, the response-preventable exposure technique has the disadvantage of therapeutic withdrawals. Tolerating anxiety caused by obsessions, without performing the ritual, is very aversive for the person with ODO.
The secret is to offer quality psychoeducation, to establish a good and solid therapeutic bond for the patient to trust in the treatment, trying, as far as possible, to get the person involved in his recovery and to perform the tasks correctly, both in out of sessions.
It is also recommended to work with the family, partner or other co-therapist to ensure that they do not reinforce the obsessive-compulsive behavior of the patient.
Having a co-therapist more present in the patient’s life helps the patient’s recovery, motivating the person to avoid rituals and promoting exposure in established form and measures.