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New from Dr. Bruce Hyman...
The "Classic" Self-Help Manual for OCD |
Frequently Asked Questions (FAQ's) about Behavioral Treatment for OCDIntensive Cognitive-Behavioral Treatment for OCDIntroductionThe 15 Day Intensive Cognitive-Behavioral Treatment Program for OCD is an outpatient program that utilizes the principles of exposure and response prevention (ERP), originally developed in the 1980's by Dr. Edna Foa and Dr. Gail Steketee at the Temple University School of Medicine. The program is based upon the idea that anxiety and fear is overcome when patients directly confront their fears, such as the fears of harm, danger or disgust that characterize people with OCD. Through one-on-one guidance with an expert therapist, the patient with OCD is helped to confront feared thoughts and situations to learn more appropriate responses to those situations, and ultimately, to overcome the fear of them. In addition, patients effectively learn to manage their anxiety without excessive hand washing and checking. While not a cure for OCD, these proven procedures offer hope to patients to significantly diminish OCD symptoms in as high as 80% of patients treated. Frequently Asked Questions (FAQ's)
What does the program consist of? An Overview of TreatmentThe intensive treatment program involves individual one-to-one cognitive-behavioral therapy that is conducted in three phases: I - Initial evaluation and treatment-planning phase This phase takes between two and four hours (two to four office visits) during which the patient undergoes an evaluation and cognitive-behavioral assessment of his/her OCD problem by their individual therapist. A treatment plan is then devised to specifically address the most severe and disabling symptoms through exposure and response prevention (ERP). II - The intensive phase This phase consists of 10-15 two hour ERP therapy sessions working one-to-one with their cognitive-behavioral therapist, conducted daily over a two to three week period. The daily two hour sessions involve gradually confronting feared stimuli and situations while concurrently fighting the powerful urge to engage in compulsive, ritualistic behavior (e.g., hand washing, checking). The exposure exercises are repeated frequently in many different "real life" situations (also called "in vivo exposure") until the powerful urges are reduced. In addition, the patient is assigned daily ERP exercises to carry out on his/her own. The patient gradually learns to master these situations without the need to ritualize and engage in compulsive behaviors. For patients whose symptoms occur largely within their home, a visit to your home by your therapist is usually extremely helpful to further your progress. For patients who live outside of the south Florida region, the follow up home visit can be arranged. Home-based exposure sessions can in some cases be conducted via telephone or over the internet using webcam video conferencing technology. III - The follow-up phase Following the intensive phase is the follow-up phase. These "booster" sessions are intended to reinforce and maintain new response patterns, solidify new, more appropriate washing, cleaning, and checking, etc., and to deal with any issues that come up that may affect progress. This phase typically involves once or twice per week one hour sessions for a month, gradually diminishing in frequency as the patient takes further control of his/her OCD problem. Out-of-town patient's follow-up sessions may be conducted via telephone, or video conferencing over the Internet. Click here for more information about this option.. Where is the Treatment Conducted?The initial evaluation sessions (two to four hours of therapist contact) are held in our offices in either Hollywood, or Boca Raton. During the intensive phase, patients are required to secure lodging in a local hotel nearby our Hollywood office. There are several quality hotels options in the area at different price levels. For local Florida patients, it may be necessary to conduct several home visit sessions. Can a family member stay with me while I participate in the intensive program?Yes. Patients may be accompanied by a cooperative, supportive and encouraging spouse, parent or partner during their stay. How effective is exposure and response prevention treatment for OCD? Does progress last?While presently there is no "cure" for OCD, exposure and response prevention (ERP) is considered the "gold standard" treatment for OCD. Over 30 controlled clinical research studies conducted over the past 25 years at major universities throughout the world attest to its effectiveness. Though several factors contribute to success, most patients with OCD can expect between a 60-90% improvement in symptoms post-treatment. Research has also confirmed that these results are enduring, though patients may require occasional "booster" sessions during stressful and transition periods in the life span. One of the most important factors in patient improvement is the skill, training and experience of the cognitive-behavioral therapist. To achieve the best outcome, therapists treating OCD effectively must have specialized training and extensive experience treating OCD and its spectrum disorders. We at the OCD Resource Center of Florida pride ourselves on the excellent results achieved with our patients. How can I be assured that I will improve? Are there factors that can get in the way of improvement?While ERP is helpful for the great majority of OCD patients, some patients have accompanying problems that make it difficult to optimally benefit from ERP. For example, patients who truly believe in the necessity of their rituals may not progress as well as patients who, despite doing them, are convinced that their compulsions are senseless. Patients diagnosed with severe personality disorders (such as avoidant, schizo-affective or borderline personality disorder), or persons with bipolar or psychotic disorder may not progress with ERP. Patients who have a primary major depressive disorder in addition to their OCD, or who are actively abusing drugs or alcohol must get these conditions under control prior to the start of ERP. Out of town patients may request an initial telephone screening by one of our associates to determine if any of our programs are likely to be helpful for you. How much does the treatment cost?Treatment is priced based upon our therapist hourly fees that range from $150.00 to $200.00 per hour. Figure upon approximately four hours of assessment and evaluation, plus two hours of daily intensive ERP for 2-3 weeks (five days per week). Add to that four to six one hour follow-up visits and you can get an idea of the out of pocket costs of the program. These charges do not include the costs of lodging, meals, or travel. We require a $1500.00 non-refundable deposit at least two weeks prior to the start of treatment. The deposit is used as credit toward subsequent treatment sessions. Payment can be made with either cash, cashier's check or credit card. We accept MasterCard, Visa or Discover cards. Payment of all outstanding balances must be made in full on a weekly basis while involved in the program. What about Insurance? Do you accept payment from my insurance plan?Our center does not accept payment directly from insurance companies. We are not members of any managed care provider panels. We are considered "out-of-network" providers by your insurance company. Check your insurance company's mental health benefits to see what they will pay for intensive outpatient mental health treatment by an "out-of-network" provider. As a courtesy to our patients, we will assist you in obtaining reimbursement from your insurance company by filling out whatever forms are needed and mailing the appropriate claim forms on your behalf to your insurance company, directing payment to you. You are responsible for insuring that you obtain the maximum benefits allowed by your insurance plan. While I can certainly see the benefits of the intensive program, I have a busy career and family life, and just don't have the time or money for such a program. What am I to do?While the intensive program is the best option for patients with severe OCD symptoms, patients with moderate or mildly distressing symptoms can make significant progress with sessions held once or twice per week over a course of six to twelve weeks. Using "self-directed exposure," patients can be "coached" to carry out exposure and response prevention on their own between sessions. I see you treat mainly OCD patients. But I have another anxiety disorder (such as panic, agoraphobia, social phobia, specific phobia, generalized anxiety disorder, or post-traumatic stress disorder). Do you treat other anxiety disorders in addition to OCD?The skills to effectively treat OCD are skills that can be readily applied to the cognitive-behavioral treatment of other related disorders. Therapists at the OCD Resource Center are trained in a variety of treatment methods and achieve excellent results with many related disorders, not only the OCD spectrum disorders. Feel free to ask us about our treatment services for other disorders by calling 954-962-6662, ext. 2, or email Is there a role for the family in cognitive-behavioral treatment?Most definitely! The support and encouragement of family members closest to the patient is crucial to
the success of treatment. Family members often are at a loss as to how to help the
patient, and must learn more appropriate reactions to the patient's OCD problem.
Therefore, family members are encouraged to learn as much as they can about the
treatment process, including the basic principles of exposure
and response prevention treatment. This can be accomplished through
reading appropriate books and articles on OCD (including
The OCD Workbook
by Dr. Hyman, and
Loving Someone with OCD Won't I go crazy if I don't do my rituals?Absolutely not! There is no evidence that OCD patients "go crazy" from doing exposure and response prevention. Initially, you may be uncomfortable as you change long-standing behavior patterns and responses to anxiety provoking situations. But it certainly is not dangerous! Besides, whatever discomfort you initially experience in the treatment comes under control within a relatively short period of time. What about medications? How useful are they in the treatment of OCD? Does your center prescribe them?Anti-OCD medications, known as "selective serotonin reuptake inhibitors" or SSRI's (including such medicines as Anafranil, Prozac, Paxil, Luvox, Zoloft, Celexa and Lexapro) can be very useful in lowering the level of obsessive-compulsive, anxiety and depression symptoms. They should be prescribed by a physician familiar with OCD, usually a psychiatrist. Those patients presently taking medication should continue to have them monitored by their prescribing doctor. While medication management is not offered within the center, if you need a referral for medication issues, your therapist can refer you to a qualified psychiatrist knowledgeable about OCD. Can cognitive-behavior therapy (CBT) help patients who don't have obvious compulsions, such as "primary or "pure" obsessionals?"Persons with so-called "pure" obsessions and intrusive thoughts suffer from persistent, unwanted and entirely uncharacteristic thoughts of possibly causing harm or danger to persons they care about, or of possibly being the opposite gender to their own (being "gay"). Extensive study of these patients confirms conclusively that there is no risk whatsoever of acting upon these thoughts. However, the doubts are literally tormenting and cause severe disruption to ones life, job and relationships. These patients can be helped significantly with cognitive-behavioral procedures including exposure and response prevention, it should be considered the treatment of choice for this form of OCD. When severe depression accompanies these symptoms, medication can often help in addition to CBT. Isn't insight into "unconscious factors" required to make progress?No. Belief in the "unconscious forces of the mind" and its influence upon behavior is a never-ending source of curiosity and speculation by patients and therapists alike. Since the existence of "unconscious forces" cannot be scientifically verified, its relationship to OCD is highly uncertain. Therefore, there is little evidence that so-called unconscious forces or factors play a role in the development of OCD symptoms. Exposure and response prevention (ERP) is the only form of psychological treatment that has proven to effectively and reliably reduce OCD symptoms. Does sexual abuse (or bad parenting, childhood neglect, abuse, early loss) cause OCD?While the quality of one's upbringing and early experiences can strongly influence one's susceptibility to OCD and other psychiatric illnesses, there appears to be a strong genetic and biological basis for OCD symptoms. Most patients are most likely to have inherited the tendency from the genes of your parents, thus making them susceptible to the brain abnormalities that cause disturbances of thinking and behavior that characterize OCD. Symptoms often surface under the stresses and strains of life events, transitions and changes. But aren't you failing to treat the underlying problem by focusing upon the OCD symptoms alone?Again, there is no evidence that treating an "underlying" psychological problem through uncovering "talk" therapy will result in a reduction in OCD symptoms. Talk therapy may provide you with support, insight and guidance in managing stress and handling the problems of life, but it is not likely to break the disturbing cycle of obsessions and compulsions. Many patients benefit from concurrent cognitive-behavior therapy as an adjunct to the talk therapy that helps them in other ways. If OCD is mainly a problem in the brain, then how can cognitive-behavior therapy help?It is now scientifically demonstrated (by Dr. Lewis Baxter at the UCLA School of Medicine) that not only are abnormalities in brain chemistry and circuitry the source of the behavioral and thinking disturbances seen in OCD, but that behavioral changes undertaken in exposure and response prevention treatment have a direct influence upon the chemical activity within the brain! These changes are beneficial similarly to those changes seen resulting from successful treatment with OCD medications. Will I ever be cured of OCD?To date, there is no known cure for OCD. It is a chronic neurobehavioral disorder that one must be prepared to manage throughout his/her lifespan, similar to diabetes, thyroid disease and many other chronic medical conditions. The severity tends to wax and wane over time, with the greatest susceptibility occurring during periods of significant life stress or major life transitions such as marriage, divorce, separation, job loss or change, birth of a child or family illness. Without treatment, the symptoms tend to worsen over time. However, with appropriate treatment most persons with OCD can learn to effectively manage their problem and live normal and productive lives. What commitment is required of me?The cognitive-behavioral program is demanding of the patient's time and resources. Initially, it will be somewhat uncomfortable as you break old habits and learn new responses to formerly feared situations. Your therapist will inform you in advance exactly what is expected. He or she is available between sessions for support and clarification of treatment procedures. As you improve and begin to gain increasing control over your symptoms, you will rely less on your therapist's support and more upon your own newly acquired skills, tools and personal strengths. What age groups are appropriate for treatment with ERP?There is no age limit of those who can benefit from ERP. Patients of all ages can make significant progress. By gearing the procedures to children's level of development and motivation, they can be treated successfully as well. Obviously, the motivated, cooperative patient is most likely to benefit, regardless of age. Prior to your acceptance as a patient for the intensive program, we want to know if our program is the right one for you. Please provide us some brief information about your problem (the form is confidential) by filling out the following screening form and send to the center. It will be read by an associate within 24 hours and you'll be contacted by telephone to complete the initial screening process. |
 Bruce M. Hyman, PhD, LCSW
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by Landsman, Rupertus and Pedrick), and attending family consultation sessions to target
specific ways the family can further the treatment and recovery process.