Treatment of obsessive-compulsive disorder, help for partners also

Most people occasionally worry about germs, strange noises in the night, or whether they forgot to turn off the oven before leaving on vacation.

But for as many as 5 million Americans with obsessive-compulsive disorder (OCD), such anxieties are constant – and can almost literally take over their lives.

Now two expert clinical psychologists at the University of North Carolina at Chapel Hill will, for the first time, use cognitive-behavioral therapy (CBT) to treat couples in which one partner has OCD. The therapy has been effective in treating individuals who have OCD, and in treating couples where one partner suffers from another health problem. This is the first time the therapy will be used in couples involving a partner with OCD.

Jonathan Abramowitz, Ph.D., associate professor and associate chair of the psychology department in UNC's College of Arts and Sciences, who is also director of UNC's Anxiety Disorders Clinic, and Donald Baucom, Ph.D., professor of psychology and director of UNC's Couples Therapy Clinic, will provide treatment for about 20 couples as part of a new study funded by the Obsessive Compulsive Foundation. The foundation, an international non-profit educational organization, supports research on the causes and treatment of OCD. Abramowitz is also a research associate professor and Baucom is a research professor in the UNC School of Medicine's psychiatry department.

Participating couples will receive 16 free therapy sessions and follow-up evaluations and will be paid $80 at the end of the study.

Obsessive-compulsive disorder is a psychiatric condition defined by recurrent, unwelcome thoughts (obsessions) and repetitive behaviors (compulsions) that the sufferer feels driven to perform. Persons with OCD are anxious about germs, mistakes, numbers, or obsessive thoughts, and have problems with compulsive checking, washing, asking for reassurance or repetitive rituals.

People with OCD often recognize their obsessions and compulsions are irrational or excessive, but without treatment, they have little or no control over them. Abramowitz, an expert on OCD and a range of anxiety disorders, has used cognitive-behavioral therapy to successfully treat OCD patients individually.

“This therapy involves helping patients learn strategies to reduce their obsessional fears and compulsive behaviors,” he said. Over time, many patients learn that they do not need to perform these rituals to stay safe.

However, coping with OCD can be complicated by a relationship, Abramowitz said.

Stress makes OCD worse. If individuals suffer alone, they worry about being late to work because they spent too much time checking the door lock, or fret about what others would say if they knew they washed your hands incessantly. But for those in a relationship, OCD can lead to stress and arguments between sufferers and their partners, which makes OCD even worse. “It's a vicious cycle,” Abramowitz said.

Another complication is how the non-OCD partner responds to the compulsive behavior. Even spouses with the best intentions may make matters worse by over compensating for their OCD partner's fears and rituals.

In the UNC study, trained therapists under the supervision of Abramowitz and Baucom will work with both partners in each couple.

“First we will find out about the OCD symptoms and how the couple has been managing with these problems,” Abramowitz said. “Then we will help the couple learn to work together to address the OCD patient's obsessions and rituals and assume a healthier relationship in which their interactions do not make OCD worse.”

Study participants will be given “homework” between sessions. They will receive specific help with the OCD symptoms as well as counseling to enhance their overall relationship.

“The hope is that when both partners learn the CBT techniques, the partner without the disorder can be more helpful in encouraging the OCD mate to work through fears realistically,” Abramowitz said. “This would be good for the OCD sufferers and their spouses.”

http://www.unc.edu/