42 christian counseling today SPECIAL EDITION relationship with God. At some point, she had a sudden and intense thought that entered her head, “What if God is really the devil?” As silly and incon- gruent to her own beliefs as this thought is, it has resulted in the crippling fear that she may have committed the unpardonable sin. She obsesses about the verse in Matthew 12 that causes her to feel eternally condemned and forever separated from God. Her distress is so great, she has considered suicide. These cases sound very different from one another. However, they all represent the many faces of OCD. What is similar across each case is that each person suffers from intrusive and irrational thoughts, fears, worries or doubts that create devastating anxiety, and each person feels compelled to “do something” to alleviate the anxiety. Treatment Options Before discussing some of the treatment options available for people who suffer from OCD, it is important to under- stand these three truths: n OCD is a genetic and biological disorder that results from abnormal brain functioning (an overactive region of the brain known as the basal ganglia and a deficiency of the neurotransmitter serotonin). n OCD does not represent a spiritual problem or sickness, even though the symptoms can often include spiritual themes and content. Therefore, no amount of prayer alone, or deliverance alone, can resolve the disorder. Let me be clear that I am not discounting the power of prayer here, as I believe God should be asked to help clarify understanding of the problem and to empower the means to a solution. n The symptoms of OCD should not be “interpreted” as being a clue to an unresolved psychological issue or something that one can control simply as an act of the will. Often, the symptoms of OCD simply manifest in a form that causes the person the most acute anxiety. At other times, they seem to be quite random and arbitrary in their presentation. Reflecting the origins of the disorder, there are two forms of treatment that are very effective in reducing OCD symptoms: n exposure/response prevention, and n medication. Exposure/response prevention simply involves coaching people to go against their instincts to avoid the anxiety-producing situations that trigger obsessions and expose themselves to these situations (exposure) while resisting the urge to engage in the compulsive behaviors that they have relied on to alleviate or reduce their anxiety (response prevention) . A crucial component to this approach includes helping people learn to increase their tolerance for anxiety during exposure. Most people can only increase their exposure/response preven- tion incrementally. I encourage them to set goals for themselves. For example, touch the “contaminated” door knob and wait five minutes before washing their hands and then increase the wait to wash their hands by one minute each subsequent time. Individuals are encouraged to continue this until they are able to no longer wash their hands at all. There are some tools that they can use to manage the anxiety during the wait time (such as prayer, relax- ation, imagery, distraction, rational disputing). However, the key to success is to refuse to give in to the compulsive behaviors. At times, it helps to encourage the individual to become angry with their OCD (viewing OCD as a “bully”) in order to help them “defy” the urge to give in to the compulsions. With children, the same treatment approach works. However, parents should never get into power struggles with kids or “force” them to comply. Exposure/ response prevention must be voluntary in order for it to be effective. While exposure/response prevention has been shown to be highly effective in reducing OCD symptoms, many people find that medication is necessary as well. Most of the standard anti-depres- sant/anti-anxiety medications such as Zoloft ® , Prozac ® , Lexapro ® , Paxil ® , etc., work very well. However, many people need higher doses than those used to treat simple depression in order to find relief from OCD symptoms. There may be some side effects associated with these types of medications that should be discussed with the prescribing physician. It is important for individuals to know that while OCD medications can offer significant symptom relief, they should also be encouraged to practice exposure/response prevention during treatment in order to obtain long-term relief from their symptoms. A long line of research shows that a combined approach is more effective than using either one without the other. Finally, it is important to under- stand that OCD symptoms can wax and wane and are highly reactive to stressful situations. Some people find success with the above treatment options but then experience a “relapse” in response to a stressful event. However, the same treatment options should be encouraged in order to get the symptoms back under control. Mark Crawford, Ph.D., is a clinical psychologist in Atlanta, Georgia. He is the author of The Obsessive-Compulsive Trap , published by Regal Books, as well as several other articles and book chapters. In addition to his general outpatient practice with Lyles & Crawford Clinical Consulting, PC, he is a consultant to several local schools and is the team psychologist for the NBA’s Atlanta Hawks.