To Drug or Not to Drug? Cognitive Behavioral Therapy and The Latest Research for OCD

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To Drug or Not to Drug? That Is the Question.

Many parents agonize over the dilemma – “Should my child be medicated for OCD?” To make an informed decision, let’s take a look at the latest research.

Drugs approved for OCD by the U.S. Food and Drug Administration (FDA) include Zoloft, Anafranil, Luvox, Prozac, and Paxil. Overall, research within the past 25 years suggests that only slightly more than half of all patients taking these antidepressants for OCD show some improvement. However, even the average improvement achieved is only moderate at best. Moreover, reduction of OCD symptoms is only maintained as long as the drug is continued. In fact, when patients rely solely on medication to manage OCD, most of them relapse within weeks of the drug discontinuation.

What is OCD?

To get a better understanding of why medications have limited value, it’s important to first understand OCD, a mental health condition that affects as many as 1 in 200 children and adolescents.

As the name implies, there are 2 parts to OCD: obsessions and compulsions.
Obsessions are unwanted thoughts, images, or sensations that occur repeatedly. The content of the obsessions are often frightening, induces the feeling that something bad will happen, and leads to intense anxiety, discomfort, and fear. Essentially, it is equivalent to your child having a nightmare that keeps replaying in his/her mind relentlessly like a broken record.

On the other hand, compulsions are physical or mental reactions that you feel driven to perform to escape from unpleasant feelings and keep dreadful things from happening. Since the relief is short-lived, you must keep repeating the compulsion whenever an obsession arises. Eventually, the bond between obsessions and compulsions become stronger and more difficult to break. Some of your child’s compulsions may include checking and rechecking, counting (good and bad numbers), ordering and arranging, washing and cleaning, and other mental rituals with a lot of variation in kids.

Because medications only work to reduce anxiety, and don’t lessen the obsessions themselves, they have moderate effect against OCD. Medications are also costly over a lifetime, and come with a whole host of unpleasant side effects, such as weight gain, restlessness, fatigue, stomach upset, diarrhea, nausea, and insomnia. A more effective prescription for defeating the OCD Monster permanently is through training the brain with Cognitive-Behavioral Therapy (CBT).

How Does CBT Train the Brain to Defeat Your Child’s OCD Monster?

CBT is the evidence-based treatment for OCD and anxiety disorders. This type of treatment is short-term with lasting benefits. CBT is not simply traditional talk or play therapy. It provides your child with tools that need to be practiced in order to develop the necessary skills to defeat OCD.

More specifically, Exposure and Response Prevention (ERP) therapy is a particular type of CBT that helps your child confront fears in a stepwise manner in order to learn that the fears actually are not so threatening. ERP also helps your child to disobey those ritualistic behaviors so that OCD rules become weaker and weaker. This is essentially exercise for your child’s brain. The more s/he flexes those brain muscles, the stronger s/he becomes. Overtime and with enough practice, the sufferer can break free from OCD.

Over the past four decades, countless studies have replicated the effectiveness of ERP for OCD. Patients who complete ERP show the most progress, and maintain the improvements following treatment discontinuation as demonstrated by numerous brain-imaging research results. Although medication may be useful in certain situations, no study to date has found conclusive, long-term superiority for combined Rx + ERP versus ERP alone in treating OCD. Given the extensive amount of research on its effectiveness, ERP remains the “evidence-based treatment” for OCD today.

Still having a hard time deciding whether to medicate your child to get rid of the OCD Monster? Consult with an OCD expert. You can find one on the International OCD Foundation website.