The UCLA Obsessive-Compulsive Disorder Intensive Treatment Program

 

OCD Treatment at UCLA

The UCLA Obsessive-Compulsive Disorder (OCD) Intensive Treatment Program is designed for people who have moderate to severe OCD and/or Hoarding Disorder.  The treatments used in our program integrate research-based cognitive-behavioral and pharmacologic approaches for the most effective outcomes of these disorders.  Our program has been helping individuals with OCD since 1991. We have also been forerunners in the development of successful approaches to treating Hoarding Disorder (previously a sub-type of OCD and now its own diagnostic category).

What is OCD?

OCD is a disabling disorder consisting of distressing and time-consuming obsessive thoughts and compulsive behaviors that significantly impact one’s quality of life.
Obsessions are characterized by persistent, repetitive thoughts, impulses or images that are associated with distressing emotions such as anxiety, disgust, or guilt. Obsessions occur against one's will, are intrusive and recurrent and are, often, personally repugnant. These can include:

  • Concerns about becoming contaminated
  • Concerns that something terrible might happen if something isn't done correctly
  • Concerns about causing offense
  • Concerns that one may harm others or themselves, even though he/she does not want to
  • The urge for things to feel just right
  • Obsessive scrupulous, religious, or sexual thoughts

Compulsions are repetitive behaviors that are intended to prevent or correct some dreaded event associated with the obsessions. These can be physical or mental behaviors. People with OCD also often avoid certain situations that might trigger obsessive thoughts, or to prevent something bad from happening. Sometimes individuals with OCD test themselves or others or their environment to make sure that something bad will not happen, or that they know something sufficiently well.
Common compulsive behaviors include:

  • Washing
  • Checking
  • Ordering and arranging
  • Cleaning
  • Counting
  • Repeating actions

 

What is Hoarding Disorder?

Although Hoarding Disorder used to be considered an OCD-related disorder, it is now thought of as its own separate disorder. Regardless, it can still be effectively treated with techniques similar to, but not entirely the same, as those used for OCD.

Hoarding Disorder is defined as the acquisition of, and the failure to discard a large number of possessions that other people would consider useless or of limited value. In addition, living or work spaces are so cluttered that they preclude activities for which those spaces were intended. And, significant distress or impairment in functioning is caused by the hoarding behavior.

Hoarding Disorder is fueled by four fundamental problems: a difficulty with making decisions, a need to do things perfectly, difficulty organizing, and behavioral avoidance. Treatment for hoarding will target these four issues simultaneously.  This disorder can be effectively treated in the clinic setting provided the person with hoarding is willing and able to bring a steady supplies of boxes of their clutter to the clinic so that they can practice addressing the issues inherent to Hoarding Disorder.

Our Program

The usual requirement for admission to the program is that the individual has already tried outpatient CBT and medication management but did not respond sufficiently. Each individual admitted to the program must already have an outpatient therapist and be receiving medication treatment from an outpatient psychiatrist. 

Frequently Asked Questions

What does the treatment consist of?

The UCLA OCD Intensive Treatment Program is a comprehensive program that integrates individual therapy, group therapy, medication management with psychiatrists who specialize in OCD, and family education and support. The program primarily utilizes daily, individual exposure and response prevention (ERP) therapy to help reduce OCD symptoms. ERP is a form of cognitive-behavioral therapy that is based on the fact that prolonged and direct contact with a fearful stimulus, without engaging in compulsive behaviors or avoidance, can diminish anxiety and other distressing emotions. There is considerable research support for the effectiveness of ERP in significantly reducing OCD symptoms.
Two major advantages of the program, especially for those who have not responded well to outpatient treatment, are: 1) the treatment is supervised, such that each individual will be doing ERP exercises while being observed to ensure that they are done correctly; and 2) the treatment is intensive, in that these exercises are repeated every day, usually multiple times per day.

How is the treatment structured?

The UCLA OCD Intensive Treatment Program is an Intensive Outpatient Program (IOP) that operates from 9 -1 p.m., Monday through Friday. The usual length of treatment is 30 days (6 weeks). The program was previously referred to as the OCD Partial Hospitalization Program.
On admission to the OCD Intensive Treatment Program, each participant is assigned a cognitive-behavioral therapist with whom they will work daily on a one-on-one basis. The program’s cognitive-behavioral therapists have extensive training and experience in treating OCD.
The first week in the program involves a detailed and specific assessment of each participant's OCD and related problems; this involves questionnaires, interviews and self-monitoring of OCD symptoms. Based on this information, participant, therapist and psychiatrist can establish a personalized program of ERP therapy.
In the subsequent weeks, the therapist and psychiatrist implement an individualized behavior therapy regimen in the context of a highly structured program of education and support. In addition to one-on-one therapy with their therapist, participants also do supervised ERP exercises with trained behavioral coaches. Individuals are expected to do assignments on their own, as their anxiety allows. Participants also are assigned a psychiatrist who will comprehensively assess and review symptoms and treatment histories in order to ensure that their medication regimens are optimized. Participants additionally take part in daily therapeutic groups. Homework is a significant component of this treatment as participants must learn how to translate their newly-learned cognitive and behavioral skills to the home situation.

For some participants, the transition from the supportive environment of the Intensive Treatment Program to an outpatient setting can be particularly challenging. So we offer a ‘Step-Down’ program for those who have completed the 30 day program but need to transition more slowly. The Step-Down program offers an additional 6 days spread out over 3 weeks so that a participant can more gently acclimate to an outpatient setting.

There are some people with OCD for whom a 5 day per week program is too overwhelming, and for others 5 days per week of treatment may not be necessary. So we have a ‘Step-Up’ program which allows for a person to attend the program just 3 days per week. They would still complete 30 days of treatment, but it would be spread out over a longer period of time.

Will my family be involved?

Education of, and support from, family or loved ones can be important parts of treatment. Often, those people living with someone who has OCD have questions and concerns about how best to help. The program will provide support and information on how to cope with and help a loved one who has OCD. This will be achieved both on an individual basis and in a support group setting. Each participant in the program will be encouraged to meet with their family and their therapist to review specific ways the family can support the therapy, and take care of their own needs. In addition to individual meetings, the program has a support group for family members and loved ones which is held every alternate week. Family members and loved ones are strongly encouraged to attend at least two of these groups.

What can I expect by the time I’m finished with treatment?

As individuals with OCD may have a variety of different types of symptoms, other psychiatric conditions, and life circumstances, the response to treatment can vary. However, individuals with OCD who complete 6 weeks of treatment in the program have experienced on average a 40-47% reduction in symptoms, based on the Yale-Brown Obsessive-Compulsive Scale (YBOCS) (Bystritsky et al., 1996; Bystritsky et al., 1999). These improvements have been demonstrated to be maintained at 6, 12, and 18 months after completion of the program (Bystritsky et al., 1996). Individuals with compulsive hoarding have also been demonstrated to improve with treatment in this program (Saxena et al., 2002, 2004 & 2011).

For many people with OCD their symptoms make work and social functioning very difficult. One of the major goals of this program therefore is that each participant should be able to accomplish at least one of the following by the end of the program: return to work or a volunteer position, enroll in a class or educational program, or be able to live more independently.

Some participants may benefit from our weekly support group for those who have completed the Intensive Treatment Program. The one-hour, weekly group helps participants feel supported and prepared as they transition back into the bigger world and outpatient therapy. Members of the group utilize the insights and encouragement of peers to feel less isolated and alone as they make this difficult transition.

Will the program “fix” my OCD or Hoarding Disorder?

Treatment in the OCD Intensive Treatment Program provides an extremely helpful boost towards improvement for most participants. However, it is unrealistic to expect that treatment in the program alone will “fix” the problem. Both OCD and Hoarding Disorder are  chronic conditions that require months or years of treatment for one get to a point at which the symptoms are manageable and not interfering with one’s life. However, this can be achieved with the correct treatment, persistence, and hard work.
Follow-up with outpatient CBT and medication management is crucial to maintain gains and for continued improvement. Because of this, we emphasize relapse prevention strategies and begin helping individuals plan for follow-up treatment almost as soon as they start the program.

What makes this program different from other treatment programs? 

The UCLA OCD Intensive Treatment Program was started in 1991 and was the first program of its kind. Participants work one-on-one with licensed therapists and psychiatrists who specialize in treating OCD. The UCLA program has published data on the effectiveness of the treatment in peer-reviewed journals (see References, below). The program accepts most forms of insurance, unlike many newer programs. Because of its reputation and long history of effective treatment, over the years many participants from across the United States and from countries around the world have traveled to UCLA to receive treatment in the program.

How do I get screened for admission to the program?

To receive treatment in the OCD Intensive Treatment Program, individuals must first be evaluated. Please call 1 800 825-9989 option #2 for an appointment for an evaluation for the OCD Intensive Treatment Program. The program accepts most insurance policies including Medicare.
For more information about the UCLA OCD Intensive Treatment Program call (310) 794-7305.

If you are interested in being involved in an OCD research study that includes treatment, please contact Courtney Sheen at (310) 206-0468, or csheen@mednet.ucla.edu, or visit http://www.semel.ucla.edu/adc/research/project/adult-ocd-mrs-study

References:

Bystritsky, A., Munford, P.R., Rosen, R.M., Martin, K.M., Vapnik, T., Gorbis, E.E.,Wolson, R.C., 1996. A preliminary study of partial hospital management of severe obsessive compulsive disorder. Psychiatric Services 47, 170-174.
Bystritsky, A., Saxena, S., Maidment, K., Vapnik, T., Tarlow, G.,Rosen, R., 1999. Quality-of-life changes among patients with obsessive-compulsive disorder in a partial hospitalization program. Psychiatric Services 50, 412-414.
Saxena, S., Maidment, K., Vapnik, T., Golden, G., Rishwain, T., Rosen, R, Tarlow, G, Bystritsky, A. 2002. Obsessive Compulsive Hoarding: Symptom severity and response to multi modal treatment. Journal of Clinical Psychiatry.63.(1): 21-27
Saxena, S. and Maidment, K.M. 2004. Treatment of Compulsive Hoarding. Journal of Clinical Psychology 60(11): 1143-1154.
Saxena, S., Ayers, C.R., Maidment, K.M., Vapnik, T., Wetherell, J.L.,Bystritsky, A., 2011. Quality of life and functional impairment in compulsive hoarding. Journal of Psychiatric Research 45, 475-480.

Director: 
Jamie Feusner

For more information on physicians and services at UCLA, please call our Physician Referral Service at (800) UCLA-MD1 or (310) 825-2631. For UCLA Neuropsychiatric and Behavioral Services, contact our ACCESS Center at (800) 825-9989 or (310) 825-9989.

Service available Monday to Friday, 8 a.m. to 5 p.m. (PST) to assist you.

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