![]() Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD) Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD) I wanted to escape the confusion, the emotion (my own included), the forum postings and anecdotes. ![]() I wanted to see the evidence and know how good it was. I knew what I found there would be evidence based, free from vested interest, recent and reliable. I wanted to see the evidence and know how good it wasĪnd then I searched in the Cochrane Library. At the time there were confusing debates in the press and social media about the effectiveness of these anti-depressants, some of which denied their effectiveness and suggested tackling the perceived causes of depression and anxiety. I talked again with my brother and with a friend who had taken fluoxetine and was currently on citalopram. Unfortunately she didn’t challenge my fear of psychological treatment, saying she felt CBT/ERP seemed ‘cruel’ and when I talked about medication, told me an anecdote about her sister who hadn’t tolerated it well. The support of this kind, sympathetic woman was only of limited relevance, largely because my OCD was quite severe. My Carer Support Worker arranged for some funding for private counselling: I had to find someone from an online approved register. They told me that it would take at least six months to get an appointment. ![]() The waiting list would be shorter at my GP’s surgery, she said she would write a letter and I should contact them. The call handler talked to her supervisor and we agreed that I should try counseling first. I described my situation, my symptoms, my feelings, my fears of CBT/ERP, I cried and I felt ashamed. It was a difficult telephone conversation that I had to arrange at a time my mother would not overhear. The GP gave me the contact details of the local Increasing Access to Psychological Therapies (IAPT) service and told me to refer myself. I don’t recall that we had much discussion about this, though we did talk about respite care, something I knew my mother would hate. I told her I thought my OCD was situational and that I understood it was usual to try a talking therapy before medication. Nevertheless, since the OCD and anxiety were becoming increasingly hard to tolerate and making my carer’s role difficult, with the ongoing and patient support of my brother I made a ten minute appointment with my GP. What could I expect if I tried it? Unfortunately there were some out-of-date posts in which people described nightmare experiences: someone who had allegedly to sit for two hours with his hands in a toilet a specialist who made his patients ‘contaminate’ everything in their house including their bedsheets a popular self-help book with an example of an ERP goal of touching the toilet bowl without washing your hands, then all the ‘clean’ areas in your house, and then preparing a meal! The mere thought of this made my anxiety soar. I had a vague sense of stigma about mental illness and particularly about medication, so I was interested in talking therapies, especially Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP). I knew I should be careful about my sources, but I read fairly indiscriminately from forums, charity websites and a variety of health websites – some sensible, others less so – and that was a mistake. When I took to the internet I was amazed to discover that the obsessive checking, washing and acute, abnormal anxiety were symptoms of an illness with a name – and to recognize other symptoms from my past that I now realised were related to it. ![]() But it was when I was caring full time for my mother, who had multiple conditions including dementia, that I had an unusually distressing episode of contamination-related OCD. Without knowing what it was, I had experienced episodes of Obsessive-Compulsive Disorder (OCD) since I was an adolescent, usually when I was particularly stressed. This blog post was originally published on Evidently Cochrane. Karen Morley blogs about her experience of seeking help for her Obsessive-Compulsive Disorder (OCD) and how finding and using Cochrane evidence was a turning point.
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