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Summary: Yes, residential treatment is effective for OCD. Treatment for obsessive-compulsive disorder (OCD) may occur in a variety of settings, from residential treatment to outpatient treatment.

Key Points:

  • The symptoms of OCD can cause significant disruption in all areas of daily life.
  • New treatment protocols have led to increased success in treating OCD.
  • Most people with OCD can learn to manage their symptoms and live with minimal disruption.
  • Residential treatment can be effective for OCD and help empower patients to live a life dictated by their goals and choices, uninterrupted by unwanted symptoms of OCD.

Obsessive-Compulsive Disorder: Facts and Figures

We’ll start with five quick general facts about OCD everyone should know, which we adapted from this helpful resource:

  1. Obsessions and compulsions are symptoms of the mental health disorder called OCD.
  2. People with OCD do not choose obsessions and compulsions the way people with favorite musicians or styles of clothing choose to be committed Swifties or go to great lengths to acquire and wear the latest fashions.
  3. It’s possible to develop OCD at any time during life, but most people with OCD receive a diagnosis around age 19.
  4. Most adults understand their obsessions and compulsions are not verified by objective fact, but still fear the consequences of not acting on them.
  5. It’s possible to achieve full remission from OCD symptoms, but it’s also possible to relapse.

We offer these five points to help people without OCD understand things about the experience of people with OCD. For a person with OCD, obsessions and compulsions are not fun, nor are they things they can just stop doing or relax and let go of without evidence-based, professional support.

Here’s an official clinical definition of obsessive-compulsive disorder (OCD), as determined by the consensus panel of experts in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

“Obsessive-compulsive disorder (OCD) is characterized by recurrent, persistent, unwanted, and intrusive thoughts, urges, or images, which are called obsessions, and/or by repetitive behaviors or repetitive mental acts or patterns of thought that patients feel driven to do, which are called compulsions, in an attempt to prevent the anxiety caused by the obsessions.”

And here’s the latest prevalence data on OCD provided by the National Institutes of Health (NIH):

OCD Prevalence: U.S. Adults

Past 12 months:

  • Total: 1.2% (3.1 million people)
    • Females: 1.8%
    • Males: 0.4%

Lifetime OCD (received diagnosis at any point):

  • Total: 2.3% (6 million people)

Level of severity among people with current diagnosis:

  • Severe: 50.6%
  • Moderate: 34.8%
  • Mild: 14.6%

That last set of bullet points brings us to a topic directly relevant to why mental health providers have designed residential treatment effective for OCD: levels of severity.

Symptom Severity and OCD Treatment

When diagnosing OCD and determining an appropriate level of care, providers performing a psychiatric assessment will identify the disorder as mild, moderate, or severe, depending on the intensity, duration, and frequency of symptoms.

Here’s a breakdown of how they decide which level of severity matches the symptoms each patient experiences:

Mild:

A person with mild OCD reports has symptoms that are distressing, cause disruption, and take up a relatively small amount of time each day.

People with mild OCD often respond well to initial OCD treatment in an outpatient setting.

Moderate:

A person with moderate OCD has symptoms that are more distressing, cause more disruption, and take up more me each day than mild OCD symptoms. People with moderate OCD can and do improve with treatment. However, they often need more time in treatment, and more immersive treatment, than outpatient treatment.

People with moderate OCD can benefit from outpatient or intensive outpatient treatment, and likely do not need residential treatment.

Severe:

A person with severe OCD has symptoms that cause significant distress, cause disruption to the point of being nearly debilitating, and may take up hours each day. In the most severe cases, the symptoms can dictate how they spend nearly all day, every day.

People with severe OCD rarely experience success with initial treatment and often require residential treatment to make progress toward symptom improvement and remission.

When we think about severe OCD, it’s important to know that the World Health Organization (WHO) ranks “…anxiety disorders, including OCD, as the sixth largest contributor to non-fatal health loss, globally.”

Those levels of severity play a large part in determining which level of care is appropriate for each individual case of OCD. Now let’s take a look at how residential treatment can be effective for people with OCD.

The Benefits of Residential Treatment for Obsessive-Compulsive Disorder (OCD)

An effective approach to residential OCD treatment combines evidence-based therapies, innovative adjunct services, skills development instruction, and focused wraparound services to give each patient the best chance of a successful treatment experience, and help them move toward a life free of OCD symptoms.

Features of effective residential programs include, but are not limited to:

  • Symptom management: patients learn to manage the symptoms of OCD, with the long-term goal of regaining control of the intrusive thoughts and behaviors associated with OCD
  • Skilled, experienced clinicians and caring, compassionate treatment professionals
  • Workshops in life skills and work skills, combined with the personalized guidance to help patients develop essential competencies necessary for independent living
  • Case management to monitor treatment progress, ensure patients meet treatment goals
  • A plan to prepare patients for a successful return home.
Having an ongoing care plan – and sharing it with the people who matter – improves long-term outcomes.

During residential treatment for OCD, patients:

  • Spend time in a place purpose-built to help them heal, grow, and take the first steps toward full recovery.
  • Spend significant time in individual therapeutic sessions trained, experienced mental health professionals.
  • Learn from recovery peers in group therapy sessions. In some cases, words of support and encouragement from peers have a more powerful impact than the same words offered by a professional.
  • Have the time they need to learn practical skills that transfer directly to life back home.
Returning home with an effective toolbox of skills is essential.

When a person with OCD commits to residential treatment, the cumulative effect of benefits we list above can help them:

  1. Recognize the thoughts and behaviors clinicians consider obsessions and compulsions.
  2. Learn about the connection between obsessions and compulsions.
  3. Understand that committing to evidence-based treatment can be life changing.
  4. Apply what they learn in treatment to practical, real-world scenarios.
  5. Cultivate hope for the future and the belief they can learn to manage OCD and live a full and fulfilling life.

That last point is crucial: hope and belief help everything work, keep patients engaged, and improve overall treatment success.

 

Now let’s look at current, effective, evidence-based treatments that make residential treatment effective for OCD.

Residential Treatment for OCD: What Works

Unlike most questions people ask about mental health treatment, there’s really a very simple answer to this question:

The most effective treatment for OCD is exposure response therapy (ERP).

That’s according to a recent publication called “Management of Obsessive-Compulsive Disorder in Adults.” The authors describe this large-scale meta-analysis as follows:

“This review provides a comprehensive and up-to-date synthesis of evidence based treatments for OCD in adults, as well as emerging psychological and biological approaches.”

The research team – based on a review of the current literature and research available on OCD – identify the following cognitive behavioral approaches as effective:

  • Exposure Response Therapy (ERP)
  • Cognitive behavioral therapy (CBT)
  • Acceptance and commitment therapy (ACT)

They identify three types of medication as effective:

  • Selective serotonin reuptake inhibitors (SSSRIs)
  • Alternative SSRIs
  • Selective norepinephrine reuptake inhibitors (SNRIs)
  • Atypical anti-psychotic medication

Complementary/additional modes that are effective:

  • Mindfulness practices: relaxation, meditation
  • Distress tolerance techniques in dialectical behavior therapy (DBT)

Neuromodulation techniques that are effective:

  • Transcranial magnetic stimulation (TMS)
  • Deep brain stimulation (DBS)

In addition, there are four medications currently either under review or in use as off label medications for OCD: ketamine, Spravato®, psilocybin, and MDMA. Among the treatments we list above, a combination of ERP and SSRIs are considered first line treatments, with a combination of CBT, ACT, SSRIs, SNRIs, and DBT-derived mindfulness skills as second line treatments, while third line treatments for extremely treatment resistant OCD include the off label medications and neuromodulation techniques we mention above.

Why Residential Treatment Can Make a Difference

There are at least five (5) things that make residential treatment more effective than outpatient treatment for people with severe OCD or other serious mental illness:

  1. It’s often impossible to heal when you’re fully engaged in meeting the demands of adult life.
  2. It’s often impossible to heal when your symptoms dominate your entire day and you feel powerless in managing them.
  3. Healing becomes possible when you can put the demands of the outside world – work, school, family – on hold until you regain balance.
  4. Healing becomes possible when you’re not surrounded by the people, places, and things that can trigger your symptoms.
  5. When you have the time – not just once every other week or once a week, but every single day for a month or more – to drill down on your symptoms and work through your fears in ERP sessions with a skilled therapist, you can build the momentum necessary to manage your symptoms and return to daily life.

The message is clear. When you have time to focus on healing, and a team of professionals committed to helping you find your way, healing becomes possible. Let’s be clear: if you can learn manage your symptoms in an intensive outpatient program (IOP) or a partial hospitalization program (PHP), then those may be appropriate levels of care.

However, if you’ve tried outpatient treatment without success, then it’s important to understand that residential treatment can be effective for OCD. You can learn to manage your symptoms and live a full and productive life. We’ll close with this reminder:

The earlier a person with a mental health disorder gets evidence-based care at the appropriate level of care with techniques that match the diagnosis, the better the outcome.

Finding Help: Resources

If you or someone you know needs professional treatment and support for obsessive-compulsive disorder, please contact us here at Crownview Psychiatric Institute: we can help. In addition, you can find helpful information and support through the following online resources:

About Angus Whyte

Angus Whyte has an extensive background in neuroscience, behavioral health, adolescent development, and mindfulness, including lab work in behavioral neurobiology and a decade of writing articles on mental health and mental health treatment. In addition, Angus brings twenty years of experience as a yoga teacher and experiential educator to his work for Crownview. He’s an expert at synthesizing complex concepts into accessible content that helps patients, providers, and families understand the nuances of mental health treatment, with the ultimate goal of improving outcomes and quality of life for all stakeholders.