Can Cognitive Behavioral Therapy Help Manage OCD Before Bariatric Surgery During the COVID-19 Pandemic?

What you need to know

• Obsessive-Compulsive Disorder (OCD) can complicate a patient’s decision to undergo bariatric surgery, especially during the COVID-19 pandemic.
• Cognitive Behavioral Therapy (CBT) can be an effective treatment for managing OCD symptoms in bariatric surgery candidates.
• Preoperative psychological interventions, such as CBT, can help increase patients’ readiness for bariatric surgery during challenging times like the COVID-19 pandemic.

Understanding Obsessive-Compulsive Disorder and Bariatric Surgery

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by persistent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that a person feels compelled to perform to alleviate anxiety or distress. For some individuals, these obsessions and compulsions can revolve around themes of cleanliness, contamination, and fear of contracting diseases.

Bariatric surgery, a type of weight-loss surgery for people with severe obesity, is an important treatment option for those struggling with morbid obesity. However, the decision to undergo such a procedure can be complicated by various factors, including mental health conditions like OCD.

The COVID-19 pandemic has introduced additional challenges for individuals with OCD, particularly those with contamination-related fears. The increased focus on hygiene and disease prevention during the pandemic can exacerbate OCD symptoms, making it difficult for some patients to proceed with necessary medical treatments, including bariatric surgery.

A Case Study: Managing OCD Before Bariatric Surgery

This research paper presents a case study of a 44-year-old woman with morbid obesity (BMI = 43) who was a candidate for bariatric surgery. The patient also had OCD and was refusing to undergo the surgery due to fears of contracting COVID-19. This case highlights the complex interplay between OCD, bariatric surgery, and the ongoing pandemic.

The Role of Cognitive Behavioral Therapy

To address the patient’s OCD symptoms and help her prepare for bariatric surgery, the medical team employed Cognitive Behavioral Therapy (CBT). CBT is a type of psychotherapy that focuses on identifying and changing negative thought patterns and behaviors. In this case, the therapy was specifically tailored to address the patient’s OCD symptoms and fears related to COVID-19.

The CBT intervention consisted of eight sessions, following a five-stage model:

1. Education about OCD and identifying initial misinterpretations of obsessions
2. Understanding the role of anxiety and neutralization in maintaining OCD
3. Exposure and Response Prevention (ERP) exercises
4. Cognitive restructuring to challenge unhelpful beliefs
5. Relapse prevention strategies

The Effectiveness of CBT for OCD in Bariatric Surgery Candidates

After completing the CBT sessions, the patient showed a significant reduction in OCD symptoms. This improvement allowed her to proceed with the bariatric surgery without excessive anxiety about COVID-19. The patient successfully underwent laparoscopic sleeve gastrectomy (LSG) two weeks after the last psychotherapy session and was discharged without complications.

This case study demonstrates the potential effectiveness of CBT in managing OCD symptoms for bariatric surgery candidates, even during the challenging circumstances of a global pandemic.

The Impact of COVID-19 on OCD and Bariatric Surgery

The COVID-19 pandemic has had a significant impact on individuals with OCD, particularly those with contamination-related fears. The increased focus on hygiene and disease prevention can reinforce and exacerbate OCD symptoms. For some individuals with OCD, the pandemic may have seemed to validate their fears and compulsive behaviors.

At the same time, the pandemic has also affected the scheduling and performance of elective surgeries, including bariatric procedures. Many hospitals and medical centers have had to postpone non-emergency surgeries to prioritize resources for COVID-19 patients. This delay can have negative consequences for individuals with severe obesity who are awaiting bariatric surgery.

The Importance of Preoperative Psychological Interventions

This case study highlights the importance of preoperative psychological evaluations and interventions for bariatric surgery candidates. By addressing mental health concerns such as OCD before surgery, healthcare providers can help improve outcomes and increase patients’ readiness for the procedure.

Cognitive Behavioral Therapy, in particular, has shown promise in helping patients manage OCD symptoms. The therapy can help patients:

1. Develop a better understanding of their obsessions and compulsions
2. Learn to challenge and modify unhelpful thought patterns
3. Practice exposure to anxiety-provoking situations while preventing compulsive responses
4. Develop coping strategies for managing anxiety and stress

Broader Implications for Mental Health and Surgery

While this case study focuses on OCD and bariatric surgery, its findings have broader implications for the intersection of mental health and surgical procedures. The COVID-19 pandemic has heightened anxiety and stress for many individuals, potentially exacerbating existing mental health conditions or triggering new ones.

Healthcare providers should be aware of the potential impact of the pandemic on patients’ mental health, especially when considering elective surgeries. Offering appropriate psychological support and interventions may help patients better prepare for surgical procedures and improve overall outcomes.

Conclusions

• Cognitive Behavioral Therapy can be an effective treatment for managing OCD symptoms in bariatric surgery candidates, even during challenging times like the COVID-19 pandemic.
• Preoperative psychological interventions are crucial for improving outcomes and increasing patients’ readiness for bariatric surgery.
• The COVID-19 pandemic has highlighted the need for integrated care that addresses both physical and mental health concerns, particularly for individuals undergoing major medical procedures.