Mais Samhoury Center
Dr Raghad Shnaigat is a psychiatrist and addiction-treatment specialist with the Jordanian Board in psychiatry. She practises at Mais Samhoury Center in Abdoun,…
Treatments
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Treatment for obsessive-compulsive disorder targets the loop the condition runs on: intrusive thoughts, images or urges that cause intense distress, followed by a repeated behaviour, ritual or request for reassurance that relieves the distress briefly. The brain then learns that the ritual is necessary, and the reach of the obsession widens. The forms are varied: contamination fears with repeated washing, repeated checking of doors and gas, ordering and symmetry, counting, obsessions about worship, ritual purity and doubts over whether prayer was performed correctly, and obsessions with aggressive, sexual or blasphemous content that terrify the person and lead to avoidance and secrecy. Many people wait years before seeking help precisely because of this content. The best-established treatment is exposure with response prevention: situations that trigger obsessions are approached in a planned, graded way while you practise not performing the ritual and not seeking reassurance, so the brain learns that distress subsides on its own without a ritual. A medication plan may be set by a clinician in moderate to severe presentations, and in OCD its effect usually takes longer to appear than in depression — a common reason people abandon treatment too early. The family's role is pivotal and often inverted. Every reassurance given, and every wash or check performed on the person's behalf, brings minutes of relief and entrenches the obsession for months. Families are therefore coached to withdraw gradually and by agreement from this participation, gently and without punishment. The limits matter too. Treatment does not stop intrusive thoughts from occurring — they occur in everyone; the aim is for them to lose their authority and for you to be free of the ritual. Medication does not replace practising response prevention. Damaging myths need naming: OCD is not weak faith, not possession, and not a fondness for cleanliness and order. Most importantly, an intrusive thought is not a wish and not an intention, and having it does not mean a person will act on it — that fact alone lifts years of silent fear for many people.
1 specialists
Procedure steps
- 1
Assessment, mapping patterns and measuring severity
Obsessions and compulsions are documented with their patterns, the daily time they consume and their effect on work, study, worship and relationships, and severity is measured with a consistent scale. OCD is distinguished from generalised anxiety and other conditions, and coexisting depression is assessed, as it is common and slows progress.
- 2
Psychoeducation and unpicking the obsession-ritual loop
How the loop works is explained: an intrusive thought, then distress, then a ritual or a request for reassurance, then temporary relief that strengthens the loop. It is stated explicitly that intrusive thoughts occur in everyone and that their content says nothing about a person's character or intentions.
- 3
Building the exposure and response prevention ladder
Trigger situations are ranked from easiest to hardest. You begin exposure with the easiest while refraining from the ritual and from seeking reassurance, staying in the situation until distress falls on its own. Distress is rated before and after, and daily between-session tasks are completed — these are the core of treatment.
- 4
Medication when needed, and monitoring
In moderate to severe presentations, or when starting exposure is too hard, a clinician sets, titrates and monitors a medication plan, explaining that the effect in OCD usually appears more slowly than in depression. If an adequate plan brings no response, advanced options such as transcranial magnetic stimulation are considered on clinical grounds.
- 5
Family involvement and relapse prevention
Families are coached to stop participating in rituals and giving repeated reassurance, gradually, gently and by prior agreement, and to support exposure rather than shield the person from it. A setback plan is then written: early warning signs, the exercises to resume immediately, and when to ask for review.
Before the procedure
Before the appointment, write a frank list of what triggers your obsessions and what you do afterwards: how many times you wash, check or repeat, how much time this consumes daily, and whom you ask for reassurance and how often. Do not hide the content of distressing thoughts, however frightening or shameful — naming it is what makes treatment possible, and having a thought means neither wanting it nor intending to act on it. Note what you have begun avoiding, whether places, people or tasks, and any physical harm from repeated washing such as cracked skin. Bring a list of everything you take and previous reports, and note any treatment you tried and why it stopped. If possible, bring a relative who takes part in rituals or reassurance, since involving them speeds up progress.
After the procedure
Keep doing exposure and response prevention exercises between sessions even once you feel better, because stopping them is the best-known cause of relapse. Do not ask for reassurance and do not accept it when offered, and do not swap an outward ritual for a mental one such as repeating phrases silently or reviewing memories. Agree with your family on a single standard reply when you ask, and hold to it. Expect some days to be harder than others, and measure progress in weeks rather than hours. **Seek review promptly if deterioration keeps you from work, study or leaving home, if you stop eating, drinking or using the bathroom, if washing causes wounds, cracked skin or infection, if rituals consume many hours a day, or if clear depression appears.** **If thoughts of harming yourself or of suicide arise, get urgent help straight away: call emergency services, go to the nearest emergency department, or tell someone you trust right now. Do not wait for your next appointment.** Do not stop medication at the first improvement or abruptly; discontinuation follows a gradual medical plan. Psychotherapy and medication are not rivals, and OCD frequently needs both.
Expected duration
The initial assessment usually takes 45 to 90 minutes, with weekly exposure and response prevention sessions of 45 to 90 minutes over roughly 12 to 20 sessions, plus daily practice between visits.
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