It is not easy to recover from obsessive compulsive disorder (OCD). Many sufferers question the effectiveness of the ‘once-‘, ‘twice-per-week’ therapy or conventional drug medication. In an OCD intensive program, patients are required to commit to specialised therapy every day for few hours. Patients will undergo therapist-guided exposure and response prevention (ERP) for a couple of hours almost every day as well as ERP practice of four or more hours between daily sessions.
Exposure and Response Prevention (ERP)
Exposure and Response Prevention (or Exposure and Ritual Prevention) is an effective form of psychotherapy for ODC treatment. ERP is now a preferred treatment for almost all OCD intensive programs. It is recommended that OCD sufferers seek well-trained and experienced counsellors in ERP.
There are two components of ERP:
Exposure – Direct confrontation of the anxiety-produced obsessive thoughts (and factors triggering them) instead of avoidance
Response prevention – Temporarily reducing the fear/anxiety triggered by obsessions through abstinence of the compulsive responses or “rituals” that the OCD patient normally used.
Combining these two components provides effective OCD treatments. Research shows that applying only either one of these is not effective enough.
Applying both methods at the same time is challenging. This treatment is inclined towards anxiety-provocation. It is important for the patient to be consistent and patient, because the effectiveness of this therapy is usually evident towards the end of the treatment. Ensuring that patients go through this journey until the end is one of the main goals of this OCD intensive program.
What are the “intensives”?
At the moment OCD intensive programs are categorised into inpatient and outpatient. Both contribute to daily ERP therapy and provide support, guidance and practice compared to the standard therapy program. However, there are distinct differences.
For the inpatient (hospital-based) program, the patient is required to live in the treatment facility. The ERP is carried out inside the facility with necessary support and treatment provided by medical experts. Other treatment programs are also available to complement ERP, for instance medication management, anger management training, life-skills group therapy or psychiatry/counselling service.
There are some inpatient programs that provide family therapy, where family involvement is considered essential in addressing the OCD issues. There are also other ERP options which consider gentler and more gradual approach. This might be particularly useful to treat more fragile OCD patients, to help them prepare mentally and physically. However, this approach is slower, thus takes longer to complete, probably months, compared to the normal ERP therapy which usually takes a few weeks.
The disadvantage of the inpatient program is that it is expensive, it has more restrictions, and it does not really offer real-world exposures. However, the additional services, the systematic and effective structure and support and guidance offered made it a popular choice to some OCD patients.
The outpatient option, on the contrary, takes a lot quicker, usually within 3-4 weeks, where patients were given schedule to undergo the treatment. These include attending the ERP therapy sessions at the therapist’s office and daily practice on the exposure and response prevention. The main idea is to provide quick but efficient service to the patient, ideal for patients who cannot afford to spend much for the treatment.
Dr Edna Foa and her colleagues at the Centre for Treatment and Study of Anxiety (CTSA) are the leading pioneers in this outpatient OCD intensive program. Patients undergoing CTSA intensive are required to start off the first day of treatment by undergoing total abstinence from their OCD rituals, so that by the sixth session, they are ready to tackle their major rituals or fears. Over the next weeks, patients are used to confronting their behaviours and are less distressed by them. This is a more manageable and systematic treatment.