Obsessive-Compulsive Disorder (OCD) is a mental health condition in which people experience unwanted thoughts (obsessions) and repetitive behaviours (compulsions). Compulsions are performed in order to reduce anxiety. Although our understanding of OCD has evolved significantly over time, treatment approaches have developed from rudimentary practices to sophisticated and evidence based therapies. This article explores the history of treating OCD around the world. How treatments have changed and how individual and group settings differ in addressing the disorder will be covered.

Ancient and Pre-Modern Understanding of OCD

The first widely known evidence detailing obsessive-compulsive symptoms can be traced back to ancient Greece. Hippocrates described symptoms resembling what we now understand to be OCD, even though there was little understanding of how to view OCD from a psychological paradigm. OCD, like most ailments, was often attributed to an imbalance of bodily humors.
Ancient cultures had a tendency to see obsessive behaviours through either spiritual or moral lenses. In some cultures throughout the world, people who displayed unusual rituals or compulsions were thought to be possessed by evil spirits or under some kind of divine influence.

During the Middle Ages in central Europe religious explanations tended to dominate. Obsessive behaviours were often viewed as sins or moral failings. People exhibiting these symptoms were sometimes subjected to harsh punishment or exorcisms in order to ‘cleanse’ them. The Renaissance and enlightenment provides the intellectual soil for the rise of early psychological thought. The first inclinations towards a more scientific understanding emerged. However, mental disorders were still often seen through a theological lense.

The Rise of Modern Psychiatry and Early Treatments

The 19th century experienced the emergence of psychiatry as a medical discipline. This laid the foundation for a more structured understanding of mental disorders. French psychiatrist Jean-Martin Charcot and his student Sigmund Freud made early contributions to the understanding of neurosis, including obsessive symptoms. Freud’s psychoanalytic theory linked OCD to unconscious conflicts, particularly those stemming from childhood experiences and repressed desires. This paradigm guided early approaches towards treating OCD. Treatments focused on uncovering repressed emotions through techniques such as free association and dream analysis.

Treatment options during the early 20th century were still largely experimental and often did not result in any meaningful reduction in symptoms. Interventions included methods like electroconvulsive therapy (ECT) and lobotomies. These were sometimes used for severe cases of mental illness. While these treatments had varying degrees of success, they were also often harmful.

The Birth of Cognitive Behavioural Therapy (CBT)

The landscape of OCD treatment began to change in the mid-20th century with the development of Cognitive Behavioural Therapy (CBT). Researchers such as Dr. Victor Meyer started to pioneer behavioural techniques specifically targeting the avoidance and compulsions associated with OCD through the development of ER. This entails exposing individuals to the situations that trigger their obsessions while preventing them from engaging in their usual compulsive behaviours. ERP has become a cornerstone in the treatment of OCD.

By the 1980s, CBT became recognised as the most effective non-medical treatment for OCD. The development of selective serotonin reuptake inhibitors (SSRIs) which are a type of of antidepressants which helped regulate serotonin levels in the brain also emerged as a very effective treatment option. SSRis and CBT to this day represent the most effective combination when addressing OCD.

Global Variations in OCD Treatment

To this day different regions of the world treat OCD differently. A uniform approach has not yet been implemented.
In Western countries, CBT with ERP is the gold standard for treating OCD.
In Eastern countries, particularly in parts of Asia, OCD treatment is heavily influenced by traditional beliefs. In countries like Japan and China, OCD symptoms may have been interpreted as a form of moral or spiritual imbalance. While modern CBT approaches are becoming more widespread, traditional forms of therapy such as acupuncture, herbal treatments, and spiritual counselling are sometimes still integrated into the treatment process. However, cognitive-behavioral interventions are gaining more and more recognition as the most effective treatment for OCD.

When people are happy they find it much easier to be able to connect with those around them. Being able to connect with others is a prerequisite to feeling a sense of belonging and satisfaction. This can be a difficult thing to achieve in modern times, because an adult's primary focus is on achievement. This can often make people believe that they have to focus on doing stuff in order to get a sense of well-being and self worth. Spending time with others enjoyably has to therefore be planned weeks in advance.

Another hindrance for being able to connect with others lays in the amount of distress someone may experience in their life. Constant stress and worry or low mood can make people withdraw or believe that even every day tasks are fires that urgently need to be extinguished.

A focus on achievement or a consistent sense of low mood, stress and / or worry can therefore hinder being able to connect with those around us. The chemicals related to well-being during the process of connecting are thus absent which means that people will be missing essential elements of an important stress mitigation process. Being able to connect can have an enormous soothing quality which is mainly achieved through face to face interaction.

The aforementioned tendencies mean that people often create environments that match these. This could mean that someone sets up a really busy work schedule, as being busy means that they don't feel bad or guilty. Next to this, staring at a screen and having that as a primary source of interaction with others is in no way a replacement of in-person connection.

It is therefore important that people create and manage their own environment in a way that allows them to make time to be able to connect with others. Ideally in a non task focused context. This could relate to doing enjoyable activities together such as football. Who is present is also important. If someone is very threat focused and constantly get's angry for example, then this too will act as hindrance from getting the most out of connecting.

It helps to understand that threat based thinking is a concept often addressed in Compassion Focused Therapy (CFT). This form of CBT looks at something called the treat mode. The threat mode is a mode someone can be in when they see their environment as dangerous. When the mind is in the threat mode, it will start a survival strategy by thinking ahead a lot, focusing on the threatening end of the spectrum when projecting into the future, whilst also responding strongly to even neutral stimuli (getting anxiety symptoms when receiving a letter through the post). 

Because of this, people will do something called safety seeking strategies and safety behaviours. These are behaviours that keep a view alive. Someone who for example avoids checking their e-mails because of experiencing a sense of threat every time an e-mail arrives, may get a sense of well-being in the short term by doing so, but in the long term they confirm that checking e-mails is a threatening activity. This can often keep threat perceptions going. That's why avoidance is one of the things that is addressed often in online therapy for anxiety.

Some people would address other types of safety behaviours during telephone counselling sessions. These could be safety behaviours that represent the opposite of avoidance. Such as over-addressing things. The anxious student that immediately has to address every perceived issue whilst needing to be very certain about things can be an example. This is  the opposite of procrastination which is form of avoidance.

Finding suitable therapy near you is therefore very important. When a qualified professional can view your difficulties from the 'outside', they can find it easier to spot problematic patterns compared to the sufferer who is more subjectively involved. It does not matter whether you do in-person sessions or something like telephone counselling, the important thing is that the professional you look for is qualified and knowledgeable.

Remote therapy can be offered by numerous therapeutic approaches, similar to those offered in traditional settings:

1. Cognitive-Behavioural Therapy (CBT): Well-suited for remote delivery, CBT focuses on identifying and altering thought and behaviour patterns in some CBT approaches, whilst others focus on addressing behaviour or the relationship one may have with their thoughts. Both phone and online modalities can effectively facilitate CBT.
2. Psychodynamic Therapy: While traditionally reliant on the nuanced dynamics of in-person interaction, adaptations allow for psychodynamic principles to be applied in online or phone sessions whilst still focusing on unconscious processes and client-therapist relationships.
3. Humanistic Therapies: Approaches focusing on self-development and present-moment experiences and learning from these can be adapted for remote delivery, although the lack of physical presence may challenge the depth of experiential processes.
4. Supportive Therapy: Offering emotional support and validation, this style can be effectively conducted via any remote modality, providing clients with a sense of connection and understanding.