Cognitive and behavioral therapies, including applied behavior analysis (ABA), have been shown to be an effective course of treatment for individuals with obsessive-compulsive disorder (OCD).
A number of psychological disorders frequently co-occur with autism, including obsessive-compulsive disorder (OCD). Applied behavior analysis has proven to be an effective treatment for the psychological disorders that often accompany autism spectrum disorders (ASD), including OCD, as well as being effective in treating OCD in patients that are not necessarily on the spectrum.
OCD in the General Population
About 1.2 percent of all Americans have OCD, although as adults, women are affected slightly more than men. OCD symptoms usually begin in childhood, adolescence, or early adulthood, with 19 being the average age symptoms begin to appear.
Although the exact causes of OCD in the general population are unknown, a number of risk factors have been identified:
- Genetics: People with first-degree relatives (parent, child, sibling) who have OCD are at a higher risk of developing OCD themselves.
- Brain Structure and Functioning: Researchers have found a connection between OCD and abnormalities in certain areas of the brain, but the connection is not clear.
- Environment: Individuals who have experienced physical or sexual abuse in childhood or other trauma are at an increased risk of developing OCD.
OCD in Individuals with Autism Spectrum Disorders
According to Autism Speaks, children and adults with autism spectrum disorder (ASD) have a higher rate of psychiatric disorders than the general population, including anxiety, ADHD, and OCD. Research suggests that about two-thirds of individuals with autism have been diagnosed with one or more of these disorders.
Repetitive behaviors are a core symptom of autism spectrum disorders (ASD). Those behaviors that bring comfort or enjoyment are considered restrictive and repetitive behaviors (RRBs), while compulsive thoughts and behaviors that cause anxiety are characterized as obsessive compulsive disorder (OCD). RRBs in those with ASD often include hand flapping, lining up items, or insistence on sameness, such as using the same cup every day or taking the same route to school every day. These behaviors and activities bring many individuals with ASD comfort and enjoyment, while OCD brings about considerable anxiety.
Both RRBs and OCD are prevalent characteristics among children and adults with autism spectrum disorders. It is therefore important to distinguish RRBs from OCD thoughts and behaviors.
What is Obsessive Compulsive Disorder (OCD)?
OCD is characterized by obsessions, compulsions, or both:
- Obsessions: Recurrent, persistent thoughts that are unwanted and intrusive
- Compulsions: Repetitive, often time-consuming behaviors that individuals feel compelled to perform in response to an obsessive thought
Obsessions and compulsions go hand-in-hand because the obsessive thoughts cause significant distress that leads individuals to try to manage the distress by performing a particular action. The compulsive behaviors continue as the unwanted obsessive thoughts persist.
Types of obsessions often include:
- Fear of germs or contamination
- Unwanted thoughts
- Thoughts of aggression, either toward oneself or others
- A need for perfection
Types of compulsions include:
- Excessive cleaning, handwashing
- Ordering and arranging things in a precise way
- Repeatedly checking on things, such as repeatedly checking to make sure the door is locked or the light is turned off
- Compulsively counting
OCD differs from rituals and habits (which are part of many peoples’ lives) in several ways; specifically, people with OCD:
- Can’t control their thoughts or behaviors
- Spend at least an hour a day on obsessive thoughts and behaviors
- Attain no pleasure when performing the compulsive behaviors or rituals, albeit a brief relief from the obsessive thoughts
- Experience significant problems in their daily lives due to the obsessive thoughts and compulsive behaviors
It is common for individuals with OCD to also have a tic disorder, characterized by sudden, brief, and repetitive movements, such as eye blinking, facial grimacing, and shoulder shrugging, and vocalizations, such as repetitive throat clearing, sniffing, or grunting. Symptoms of tic disorders can come and go, ease over time, or become worse.
Treating OCD with Applied Behavior Analysis
Applied behavior analysis involves an antecedent (stimulus), a behavior, and a consequence (known as the ABCs of applied behavior analysis). When using ABA to treat OCD, the applied behavior analyst manipulates either the antecedent or the consequence.
Behavioral activation (BA), a type of behavior therapy based on ABA, focuses on setting specific goals that allow those with OCD to engage in more meaningful, healthy behaviors. BA is recognized as a leading therapy for individuals with major depressive disorders (MDD). Because MDD often accompanies OCD, and because OCD is more difficult to treat among individuals with MDD, recent research has focused on examining the effects of BA on chronic co-morbid OCD and MDD.
A case study published in the June 2015 issue of Psychotherapy revealed symptom alleviation and improvement in psychological health among a group of patients after 21 months of treatment at a community mental health clinic. According to the case study authors, both OCD and MDD symptoms were no longer at “clinical level” following this course of treatment. The results add to the growing evidence of BA for co-morbid disorders.
Manipulating the Antecedent
BA interventions involve manipulating, or adjusting, the antecedent as to eliminate specific variables that set the occasion for the target behavior and replacing them with the adaptive replacement behavior. For example, an individual with ASD who has checking rituals may experience anxiety and negative thoughts that lead the compulsive checking activity. Activities that work to replace these negative thoughts and feelings will help eliminate the compulsive activity.
Manipulating the Consequence
Consequence variables are events and environmental factors that follow a behavior. Individuals with ASD positively or negatively reinforce the consequence, which strengthens the behavior. For example, the individual with OCD who performs a checking ritual experiences a brief respite from anxiety. Therefore, the checking ritual becomes the negative reinforcement.
The BA focus in this case may be to eliminate the source of reinforcement by encouraging the individual to resist the checking ritual and providing the child with positive reinforcement when they demonstrate they are able to do so.