Occupational Therapy in OCD

Can Occupational Therapy help OCD (Obsessive-Compulsive Disorder)?

Yes. Occupational therapy has an important role in the treatment of obsessive-compulsive disorder. Occupational therapist involves the patient in a purposeful activity so the patient can experience gratification and the level of anxiety (Due to obsessive thoughts) become less. The occupational therapist focuses on the activities of daily living (e.g. Self-care) and Occupational task (job performance).

The areas of occupation impacted by OCD can include activities of daily living, education, play, work, leisure, and social participation.

What is OCD?

In this disorder, an obsession is usually associated with compulsion(s). An obsession is defined as:

• An idea, image or impulse which intrudes into the conscious awareness repeatedly.
• It is recognized as one’s own impulse or idea but is perceived as others.
• It is recognized as irrational and irrelevant.
• Patient tries to resist against it but is unable to.
• Failure to resist leads to marked distress.
• Insight is present.

A compulsion is defined as:

• A form of behavior which is usually followed obsessions.
• The behavior is not realistic and is either irrational or excessive.
• Insight is present, so the patient realizes the irrationality of compulsion.
• Compulsion may diminish the anxiety associated with obsessions.

OCD has a negative impact on the patient’s process skills, while the motor and communication skills are well intact.

Obsession and compulsive thoughts generally impacted negative effects on other areas of daily functioning.

For example, a person having OCD, having compulsive thoughts to check the lock of his house again and again before leaving for office may be frequently late to work, which will likely to have a negative impact on his/her job performance.

Occupational Therapy Assessments for OCD-

Occupational therapist deals with the patient of OCD. They assess and treat the patient in daily living and occupational areas.

The obsession and compulsion behavior of the patient affect the routine tasks. They are not able to focus on their daily activities because of the continuous thoughts of obsession and followed compulsions.

An Occupational therapist assesses various areas of the functioning includes, habit, interest, thoughts, personal care, environment, work behavior, etc.

An occupational therapist may use the model of human occupation (MOHO) frame of reference in assessment and treatment planning.

Interview, observation, and different scales can be used by the therapist. Interest checklist, the role checklist, occupational performance screening, Assessment of Motor and Process Skills (AMPS), these are the common tools occupational therapist use while doing the assessment.

Occupational Therapy Goals and Objectives-

Planning of goals and objectives are the first step towards treatment planning. The therapist observes and investigates the main problematic areas of the patient and plan accordingly.

Examples of goals and objectives, planned by the occupational therapist for OCD client.

Problem 1: poor time management.
Goal: To improve the time management.
Objective: patient will complete the activity within the allotted time.
Objective: patient will follow the given schedule.

Problem 2: limited interaction skills.
Goal: to increase interaction skills.
Objective: patient will actively participate in group activities.
Objective: patient will interact positively with peers.

Occupational therapy treatment for OCD-

An Occupational therapist can help the patient of Obsessive-Compulsive Disorder by providing different therapeutic approaches to lessen down the anxiety, stress, and inability to work may arise due to the compulsive thoughts.

• Rapport building-

It’s the first and most important step of OT treatment. Initial positive bonding between the therapist and patient, help the therapist to bring positive changes in the patient.

• Relaxation Techniques-

An Occupational therapist can teach the relaxation techniques to the client. An OT can also teach them about lifestyle changes, which may help in reducing the anxiety-provoking situation in OCD patients.

Yoga, Jacobson’s relaxation techniques, Breathing exercises, Meditation, are the common techniques used by the occupational therapist.

An Occupational therapist can help them in identifying and reducing the exposure to environmental triggers that stimulate obsessive and compulsive thoughts.

• Desensitization Techniques-

An Occupational therapist can help in desensitization of obsessive thoughts. The obsession is followed by compulsion. And if the patient tries to break the chain, he/she may suffer from the anxiety and restlessness.

In this technique, the patient is asked to make a hierarchy of the obsession and grade them accordingly. Start with the low impulse thought and progress slowly towards the moderate level of impulse.

• Occupational therapy Activities for OCD –

Distraction through purposeful activities can be very helpful in getting “unstuck” from an obsession. When the patient stuck, they often rage. Get them quickly involved in something they really enjoy.

Graded activity– an occupational therapist can break down the specific task and ask the patient to do a specific part of the task. When he/she feels satisfaction or fully achieved without any anxiety or problem. The therapist may provide the next part of the activity.

For example- The patient is asked to write down about him/herself. The therapist can break down into two parts – a positive side and a negative side. First, ask him/her to write about the positive things about himself/herself. If the result is good and the patient is not afraid, the therapist may look forward to the next step, i.e. ask him/her to write about the negative things (therapist must observe the patient’s anxiety level and thought processing).

Purposeful Activity-

A patient can be asked to perform his/her favorable and familiar meaningful activity. If the patient is familiar, he can perform easily as well as enjoy the activity. This activity can be similar to occupational or daily living activity. But in the daily routine, the work pressure is more and time limitation is there. The therapist can teach him/her about time management skills.

Summary-

An Occupational therapist provides activity-based therapy to OCD patients. A person can perform his/her daily routine activities without any anxiety/stress/obsession is the ultimate goal of occupational therapy treatment.

References-

• Bavaro, Stephanie M. “Occupational therapy and obsessive-compulsive disorder.” American Journal of Occupational Therapy (1991).
• Rapoport, Judith L. “Obsessive-compulsive disorder.” International Handbook of Phobic and Anxiety Disorders in Children and Adolescents (1994): 207.
• William M. Marcil. “Occupational therapy: what it is and how it works”. Thomson Delmer learning.(2012)