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Dr. Andrew Rynne

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Is exposure response prevention therapy effective in treatment of OCD?

Answered by
Dr.
Dr. Abhishek Kapoor

Psychiatrist

Practicing since :2007

Answered : 2496 Questions

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Posted on Wed, 20 Aug 2014 in Mental Health
Question: Hello Doctor,
My wife has 28 years old and is a house wife. We have a daughter of 8 years old.
My wife had a difficult child hood and had been affected by her mom and dad when she was still at school. They would not let her to play with other children in the neighboorhood and would put lock on the gate etc.

My wife has OCD since 3 to 4 years now.
We consulted a pychologist and a psychatric but the problem is not solved.

We read that Exposure Response Prevention Therapy (ERP Therapy), which is really the opposite of avoidance, has been shown to be a very effective therapy for the treatment of Obsessive Compulsive Disorder. In a nutshell, ERP Therapy involves facing one’s fears. Instead of avoiding using a public restroom, you force yourself to use it, and then you resist whatever compulsion you have developed to assuage your anxiety (in this case, most likely excessive hand washing). While this therapy initially is anxiety-producing, the OCD sufferer will eventually get used to, or habituate, to the task at hand until it is no longer anxiety-provoking.

It is clear to see that avoidance and ERP Therapy are at opposite ends of the spectrum. The more those with OCD use avoidance as a way to deal with their disorder, the more deeply entrenched their OCD will become. But if they can find the courage to engage in ERP Therapy with a competent therapist, they will then be going in the right direction on the road to recovery, leaving avoidance by the wayside.

We would like some help in the ERP Therapy.
My wife does not cook, sleep at 4am and wake up at 5 pm, feels that she is dirty and would wash her hand a lot, and would not like any one to touch her things at home, etc, etc. and somethimes will not eat and remain like a FREEZE person.

We want her to get back a normal life.
doctor
Answered by Dr. Abhishek Kapoor 19 minutes later
Brief Answer:
You can try ERP with relaxation exercise

Detailed Answer:
Hi
Thanks for using healthcare magic. I, Dr Abhishek Kapoor, would help you in this query.

You are right that Exposure Response Prevention Therapy (ERP) is very effective in OCD, but treatment of choice is combination of medications and ERP. In most of cases, patient gets improvement with combination of both. In medications, patient needs anti-obsessional drugs like fluoxetine, fluvoxamine or clomipramine with anti anxiety drugs like benzodiazepine. These drugs help in controlling obsessional thoughts and anxiety. If patient does not get sufficient improvement with medications, then ERP or relaxation exercise like JPMR helps. In therapy, first patient needs relaxation technique to control anxiety and then ERP.

In ERP, first we prepare the hierarchy of the situations that lead to OCD symptoms and step by step, we try to control the symptoms. Same thing you can do. First help her to prepare a list of situations or locations, that lead to OCD symptoms and then give her exposure one by one.

Usually, it takes time to get sufficient improvement. Some patients get result in few months and few in years, but that depends upon the severity of disease. You can take help of a expert therapist in ERP and relaxation technique.

If you have further query, you can ask.

Regards
Dr. Abhishek Kapoor
Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Abhishek Kapoor 2 hours later
thanks Dr. XXXXXXX XXXXXXX
My wife is not satisfied with this online consultation.
She does not find this effective.
Because she want something face to face to help her get out of this situation.
How can this site help us??
doctor
Answered by Dr. Abhishek Kapoor 2 hours later
Brief Answer:
We can only give to advise.

Detailed Answer:
Hi

In healthcare magic, we can only advise you about the treatment or can give phone consultation. For face to face consultation, you have to consult a psychologist or psychiatrist nearby in your locality.

If you have more query, you can ask.

Regards
Dr. Abhishek Kapoor
Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Abhishek Kapoor 40 hours later
thank you doctor for the answers.

We consulted a psychiatrist first, and the doctor gave my wife some medicines.
My wife took one or two and feel like getting mad, and would want to suicide, so she stop all medicines right after the 2nd or 3rd day.
She will never take any medicines again.

We went then to consult a psychologist who would only give advice; we spend 7 to 9 month with her and her fees was $35 per session, and we did around 25 sessions; then i stopped because i could no longer afford and my wife situation was not getting better;

What is ur advice to me, what should i do?
Should i again consult the same psychologist again and start the treatment again?

psychologist or
doctor
Answered by Dr. Abhishek Kapoor 11 minutes later
Brief Answer:
She needs medication and therapy

Detailed Answer:
Hi

In your wife case, she needs both, medication and psychotherapy. First consult a psychiatrist and start the treatment. Usually antidepressants take few days to show response and in initial few days, they show some side effects like nausea, vomiting or other anxiety symptoms. These side effects would decrease in few days. After few days of treatment, she could start psychotherapy again. Then she would able to get good response. Psychotherapy alone would not give good result, so go for both simultaneously.

If you need further help, you can ask.

Regards
Dr. Abhishek Kapoor
Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Abhishek Kapoor 2 hours later
Thanks doctor;
Ok i will follow your advice;

I have meeting with my Psychiatrist today to sum up on the current situation and abt how she will tackle again the case;

Then my wife will start treatment by next week;

I will update you on the situation.

What advice can you give me because i am getting very stressed in the current
situation and dont have much patience.

Thanks doctor
doctor
Answered by Dr. Abhishek Kapoor 7 minutes later
Brief Answer:
You need relaxation exercise

Detailed Answer:
Hi

I can understand your situation. Most of family member of psychiatric patients remain tense and lose their temper easily. In that case, i advise only one thing to them "Relaxation exercise". Same thing, you can try. You can do yoga or meditation or deep breathing as relaxation exercise. This would help you to keep your anger or frustration in control.

In case, you need further help, you can ask.

Regards
Dr. Abhishek Kapoor
Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Abhishek Kapoor 24 minutes later
can u please give me more details on
"Relaxation exercise" - how to do it?
- meditation - how to do it and when
deep breathing as relaxation exercise or i'll try to do this one
doctor
Answered by Dr. Abhishek Kapoor 16 minutes later
Brief Answer:
You can try deep breathing exercise

Detailed Answer:
Hi

In relaxation exercise, you can try JPMR. It is jacobson progressive muscle relaxation and would help to control anxiety. It has 13 steps and would take 30 to 45 minutes to complete. You can learn it from psychologist.

In meditation, you can see number of video on it. You have to try some technique at a time. It is effective, but it would take time. Along with it, in deep breathing technique, you can try following exercise:

Equal Breathing

To start, inhale for a count of four, then exhale for a count of four — all through the nose, which adds a natural resistance to the breath. You can aim for six to eight counts per breath with the same goal in mind: calm the nervous system, increase focus and reduce stress. You can try it anytime, anyplace — but this is one technique that’s especially effective before bed.

Regards
Dr. Abhishek Kapoor
Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Abhishek Kapoor 20 hours later
Suppose i am having discussion with my wife and we are fighting.. she will keep on talking and taking.. in this situation do i need to withdraw to a close and silent place to do the meditation to calm my anger or i can do it on spot, but then how to remain calm if she continue to talk and talk and excite me?
doctor
Answered by Dr. Abhishek Kapoor 10 minutes later
Brief Answer:
Move out of the situation

Detailed Answer:
HI

In that situation, you have to move to another place. That would help to stop the argument. Usually what happens, couple keeps fighting on issue and it lead to major clash between them. If you want to resolve the issue immediately, first you have to come out of the place. That would calm her down too and you can do relaxation exercise or meditation in another place. After that you can discuss with her about the issue. This is the best way to resolve fight.

If you have more query, you can ask.

Regards
Dr. Abhishek Kapoor
Psychiatrist
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Abhishek Kapoor 4 hours later
my wife time is completely disynchonized with me.
she comes to bed at 5-6 am and would wake up at 4/5 pm;

How can we solve this issue?

So at night we never sleep together.

For sex, i need to take her to hotel, because at home this is not possible with her.

so we go to hotel when i can afford :(
doctor
Answered by Dr. Abhishek Kapoor 6 hours later
Brief Answer:
Try some benzodiazepine

Detailed Answer:
HI

In that case, you can give her few benzodiazepine like xanax or klonopin in low dose to get sleep at night. That would help to maintain her sleep pattern. Once she gets her normal sleep pattern, then it would be easier for you to maintain your sex life.

Regards
Dr. Abhishek Kapoor
Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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