Treatment for Obsessive-Compulsive Spectrum Disorders (OCSDs)
Obsessive-Compulsive Spectrum Disorders (OCSD) refer to several different types of disorders that have obsessive-compulsive features, but are not currently classified as anxiety disorders. Cognitive-behavioral techniques for the Obsessive-Compulsive Spectrum Disorders (OCSD) are quite similar to those used with Obsessive-Compulsive Disorder (OCD) but with modifications necessary to address the unique characteristics of each particular disorder.
People with Body Dysmorphic Disorder (BDD) tend to have higher rates of depression and suicidal thoughts than people with OCD. Thus, treatment for BDD may proceed at a slower pace and cognitive therapy may focus on strategies to reduce the characteristic hopelessness and depression, prior to jumping into exposure and response prevention (ERP). Acceptance and Commitment Therapy (ACT) has also shown promising results with this disorder
People with Hoarding Disorder tend to experience financial strain, compromised living conditions, and greater family discord. Therefore, family therapy may be an essential component of successful treatment. In addition to family therapy and traditional cognitive-behavioral therapies, therapists may need to specifically address financial concerns, including a referral to a financial management expert. Similarly, therapists may need to assist the therapy participant to create a safer and healthier living environment.
Treatment for Trichotillomania and Tourette's Syndrome requires a slightly different approach. Cognitive therapy targets the specific dysfunctional thoughts which are associated with each disorder, such as "I must tic/pull because I can't stand the urge," or "I'll just pull one hair and then stop." Exposure and response prevention therapy for both disorders consists of intentional exposure to situations which increase the urge, followed by a deliberate effort to block or prevent the behavior. For example, people with trichotillomania frequently pull when engaged in an idle or boring activity such as watching TV. ERP would consist of them watching TV, while focusing on not pulling.
Although cognitive therapy, and exposure and response prevention therapy are a necessary component of treatment, another type of cognitive-behavioral therapy called "habit reversal training (HRT)," is also utilized as a strategy to block or prevent the hair-pulling or tic. HRT has several components including: 1) building an awareness of the behavior, 2) identifying situations which increase the behavior, 3) developing relaxation strategies, and 4) practicing a "competing response" which refers to engaging in opposite muscle movements, or other activities that make it difficult or impossible to hair pull, or to perform a verbal or motor tic. Common, competing-response strategies for hair-pulling include: tensing the arm and hand muscles used in pulling; performing activities to keep the hands busy such as knitting; or the use of Band-aids®, or long, artificial nails which make it difficult to pull. For tics, people are taught to engage in an opposite muscle movement, whenever the urge occurs, to block or prevent the tic; for example, squeezing the eyes shut for an eye blinking tic.