The History of OCD Treatment

By Jason Swift

Do you know someone with Obsessive-Compulsive Disorder (OCD)? It can be a very time-consuming, debilitating disorder consisting of obsessions (repeated, intrusive thoughts) and compulsions (repetitive behaviors).

Some examples of compulsions include washing hands or checking to make sure doors are locked. These behaviors can occur dozens or even hundreds of times a day, severely disrupting life. People with OCD may experience a great deal of distress or anxiety when they are unable to complete their compulsions.

For decades, OCD was considered untreatable and associated with a poor prognosis. For most patients, conventional therapy was not helpful. Interestingly, animal research (by behaviorists) led to some important discoveries in learned behaviors, which helped guide treatments for OCD.

Researchers who were studying classical conditioning placed dogs in a contraption called a shuttle box, which was a box that had two compartments separated by a hurdle.

 

In one experiment, a light was turned on just before the floor became electrified. In other words, the light signaled to the dog that it was about to be shocked. The dog quickly learned to jump the hurdle to the side of the contraption where it was safe from the chock.

Interestingly, researchers found that the dogs continued to jump when the light came on, even if the electricity was unplugged. Some dogs continued to jump hundreds of times despite no actual threat of shock! This experiment raised some important questions: What, if anything, can stop the dog from jumping over in an OCD-like fashion?

Researchers discovered that if they turned on the light, but then gave no option for the dog to move to the other side, it would provoke an intense fear response in the dog. The dog would begin to yelp, jump, urinate, and/or defecate. That is, the dog anticipated the shock and became so afraid, it had an emotional and physiological reaction.

 

Importantly, however, this reaction subsided after several trials in which the light was paired with no shock. Finally, the dogs displayed calmness without the slightest hint of distress when the light was turned on. Thus, after several trials, the fear response was “extinguished.”

So what does this research have to do with treatment of OCD? In 1966, Victor Meyer is credited as first utilizing Exposure and Response Prevention (ERP) as a treatment for OCD. He persuaded patients with severe OCD to intentionally confront situations and stimuli they usually avoided such as bathroom floors (Exposure). He told the patients to refrain from engaging in ritualistic behaviors such as hand washing (Response Prevention).

Like the fearful dogs, individuals with OCD may have very strong reactions to exposure to the things that distress them. However, most individuals who receive ERP treatment make and maintain clinically significant improvements. Researchers have demonstrated, using randomized controlled trials, that ERP is more efficacious than placebo, relaxation training, and anxiety management training.

Thus, when it comes to OCD, one of the best treatments is to literally face your fears, (with the guidance of a professional of course). To read more about the history of treatment of OCD, please see:

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