What is First Steps

First Steps to Freedom was established to achieve the following:

Anxiety           Tranx

Obsessive Compulsive Disorder
 

"The thing that upsets people is not what happens but what they think it means."
the philosopher Epictetus

Obsessive compulsive disorder (OCD) is sometimes called "the doubting disease" or "mental hiccups". To the sufferer it represents fear, frustration and often panic.

It is an anxiety disorder and the the essential features of OCD are recurrent obsessions (thoughts) that create an awareness of alarm or threat, examples: "I might get AIDS from the germs on that door knob;" "Since I had the thought of killing my baby, I might be capable of doing it" or "If I don't pick up that dirty litter someone else might get sick from it, and I would hold myself responsible;" etc.

OCD consists of two elements: obsessions and compulsions. The obsession is the recurrent thought that creates fear and the compulsion is the ritual or rumination that a sufferer carries out in response to the obsession to reverse or relieve the fear. Common OCD obsessions include (among others) fears of contamination, harming self/others, losing control, sexual worries, excessive religious or moral issues, a need to tell/confess or hypochondria. Common compulsions include (among others) washing, repeating/checking, repeating words/ speech/conversation, touching, counting, seeking reassurance, ordering/arranging, hoarding or praying.

From our experience we tend to group OCD into 3 distinct areas or categories. Purely obsessive, compulsive obsessive or responsibility OCD. Sufferers can fall exclusively into one category but is more likely to display symptoms from more than one or all three.

Compulsive-obsessive is the most common form of OCD. It involves the performance of distinct behavioural "rituals" through which the OCD sufferer seeks to relieve their anxiety. The rituals and obsessions are complex and can change form. It is generally the case that the more the rituals are carried out the stronger the compulsion to do them becomes.

Responsibility OCD is distinguished from other types of OCD by the overriding presence of guilt. Sufferers are plagued by the notion that failing to carry out a ritual will cause harm or illness to some other individual or individuals. The problem with treating this type of OCD is the conflicting debate within sufferers whether it is their innate concern for others or the disorder that is prompting them to act.

Purely obsessive is considered the least common "type" of OCD - less than 10% have obsessions with no physical compulsions or rituals. "Pure-O" or purely obsessive is manifested by a two part process: the originating unwanted thought and the mental activity which attempts to escape, solve, or undo the thought, called rumination

There is no single, scientifically proven cause of OCD but there are various theories which include environmental and habitual issues, genetic disposition, biological imbalances, streptococcal throat infection or in some cases meningitis. As yet no specific genes for OCD have yet been identified but research suggests that genes may play a role in the development of the disorder in some cases. Some practitioners believe that OCD is a learned behaviour and stems from the sufferers environment at an early stage although this theory is being somewhat superseded by the compelling research concerning biological imbalances. Research suggests that OCD stems from problems in communication between the front part of the brain (the orbital cortex) and deeper structures. Brain-imaging studies of OCD sufferers using a positron emission tomography (PET) scanner suggest that OCD patients have patterns of brain activity that differ from those of people without mental illness or with some other mental illness. It is believed that insufficient levels of serotonin are prominently involved in OCD. It is true that drugs that increase the brain concentration of serotonin or slow it's reuptake often help improve OCD symptoms.

OCD can have serious implications for a sufferers lifestyle, career and relationships. Many sufferers tend to avoid situations where they know their OCD becomes intense and social events which could cause embarrassment. Since OCD is anxiety-related, stressful situations such as moving home, travel/holidays and illness intensify OCD symptoms causing the sufferer great discomfort. The condition can have a negative impact upon the sufferer's career or render them housebound and unable to work.

In terms of personal relationships sufferers will try as much as possible to mask their symptoms outside the home. Friends are rarely aware of the problem since lack or awareness means sufferers are fearful of ridicule, resentment, discrimination or dismissal of the condition.
However, sufferers are often least able to disguise their symptoms at home so that relationships with immediate family and spouses can become strained. Often it is the family member that seeks help first. Since OCD can render sufferers unable to perform daily tasks, they rely upon their family to carry these out for them, e.g. fear of contamination may result in inability to wash dishes or clothes, clean the house, share the same loo, bath or shower

The proven treatment for OCD concerns a combination of psychotherapy (usually cognitive behavioural therapy) and medication. Medication alone may relieve the symptoms but should be viewed as a compliment and not a substitute for effective psychotherapy. Cognitive behavioural therapy or CBT has been shown to be highly effective in treating OCD. Many studies suggest that CBT, correctly applied for a sufficient period of time, is more effective than medication. As it's name implies, CBT deals with the "cognitive" or thought processes of sufferers as well as their behaviour. CBT was originally developed in the early 1970's in the US by Albert Ellis and Aaron Beck for treatment of depression. For OCD sufferers the "behaviour" element of CBT is based around exposure and ritual/response prevention, i.e. the fact that anxiety will decrease if one is exposed to the fear for a sufficient period. This method is very similar to the desensitisation methods used for phobias, e.g. arachnophobics are slowly exposed to spiders until they no longer cause them anxiety.

An alternative method of cognitive behavioural therapy which can be very effective in treating OCD (and anxiety) is mindfulness. This is essentially a mental training process enabling people to observe their inner experience calmly and with a feeling of clarity without responding to it. Our President, Dr Jeffrey Schwartz, expands on this concept in his highly respected book Brainlock (see books and tapes), often seen as the seminal text for OCD sufferers. Dr Schwartz's "Four-step programme" also provides the basis for the First Steps to Freedom anxiety self-help groups.

In the UK psychotherapy is available on the NHS. Sufferers must see their GP and then be referred to a specialist. Psychotherapy is also available privately. In this case sufferers should ensure they contact accredited psychotherapists registered with the BABCP (British Association for Behavioural & Cognitive Psychotherapies). Some therapists offer telephone-based services or on-line services via the Internet and sufferers should take care to establish the credentials of any practitioner offering their services in this manner.

As far as medication is concerned the majority of drugs that help OCD are antidepressants, namely SSRI's, e.g. Luvox, Prozac, Paxil, Celexa, and Zoloft. These must be prescribed by a practitioner and generally take a few weeks to produce the required effect. As with most medication, SSRI's and SRI's can have side-effects. Any questions regarding medication should by addressed to a sufferers GP or consultant. It should be stressed however, that medication, whilst easing the symptoms of OCD, is unlikely to be highly effective in the long-term without complementary psychotherapy.

Some practitioners of alternative medicine claim to cure OCD and these claims should be treated with caution. Whilst alternative therapies can be very beneficial in terms of relaxation, they are unlikely to treat OCD directly, e.g. Reiki, aromatherapy, hypnotherapy or acupuncture.