Can Artificial Intelligence Predict Success with OCD Treatment?


In some interesting research on obsessive-compulsive disorder, researchers at the University of California Los Angeles have developed an artificial intelligence system that predicts whether patients with OCD will benefit from Cognitive Behavior Therapy (CBT). The February 2018 study, published in the Proceedings of the National Academy of Sciences, used a functional MRI machine, or fMRI, to scan the brains of 42 people with OCD before and after four weeks of intensive, daily cognitive behavioral therapy. Researchers specifically analyzed how different areas of the brain activate in sync with each other — a property called functional connectivity — during a period of rest.

The researchers then fed the participants’ fMRI data and symptom scores into a computer and used machine learning (that’s where the artificial intelligence comes in) to predict which people would respond well to treatment. The machine-learning program demonstrated 70 percent accuracy. It also correctly predicted  participants’ final scores on a symptoms assessment within a small margin of error, regardless of how they responded to the treatment.

Dr. Jamie Feusner, a clinical neuroscientist and the study’s senior author, said:

“This method opens a window into OCD patients’ brains to help us see how responsive they will be to treatment. The algorithm performed far better than our own predictions based on their symptoms and other clinical information.”

Dr. Feusner goes on to say that if the study’s results are replicated, treatment for OCD could someday start with a brain scan.

While I find this study fascinating, it also makes me a little uncomfortable. I will be the first to admit I have a limited understanding of neuroscience and artificial intelligence, but I shudder to think that CBT (specifically exposure and response prevention therapy which is the evidence-based treatment for OCD) would not even be offered to someone with OCD based on a preliminary scan of their brain. I see obsessive-compulsive disorder as so complicated. Could it really be that easy to predict who will or will not benefit from Cognitive Behavioral Therapy?

There are already many known reasons why exposure and response prevention (ERP) therapy doesn’t work for some people. You have to be totally committed to it, and there are various aspects of OCD and this therapy that can make that commitment difficult. The degree of family support and understanding of OCD as well as comorbid diagnoses are just two more examples of why exposure and response prevention therapy might not initially be successful. In addition, there are therapists out there who think they understand ERP therapy, only to make common mistakes during treatment that jeopardize their patients’ success. Conversely, there are people out there who are exceptionally motivated (my son was one of them) and are determined to beat OCD no matter what obstacles they might face. As I’ve said, OCD is complicated, so it is not surprising that treating it is often a complex undertaking best left to experts in obsessive-compulsive disorder.

To me, it’s a bit of a paradox – the fact that an impersonal machine (artificial intelligence) might lead to more personalized treatment. I know this is the wave of the future, and of course I can imagine the possible benefits and discoveries that are likely to arise from cutting edge research involving the brain. I just hope that we don’t get so caught up in data and test results that we neglect to pay attention to the whole person and their individual circumstances.


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OCD and Identity

by stuart miles

This post first appeared in June 2013……..

I’ve previously written about some of the factors involved in recovery avoidance in OCD. Often those with the disorder are fearful of giving up rituals they believe keep them and their loved ones “safe.” Even though people with OCD usually realize their compulsions do not make sense, the terror that comes with losing what they perceive as control over their lives can be so real that they choose not to engage in exposure and response prevention therapy. They are afraid of getting better, of living a life without the “safety net” of OCD.

My friend Jackie over at Lights All Around posted about what she calls OCD Stockholm Syndrome, where hostages (those with OCD) side with their captors/abusers (OCD). While I’d known people with OCD might find it hard to leave their disorder behind, it had never occurred to me that they might not want to rid themselves of this horrible disorder. To me it is so counter-intuitive that I never considered it. Why would anyone want to live with an illness that robs them of everything they hold dear?

It’s hard for me to comprehend, but then again, I don’t have OCD.

Maybe because living with OCD is the only life some people have known, it might feel, in a way, comfortable. It is like family (though a dysfunctional one, at best). No matter how much our family might annoy us, and no matter how much we might even despise some of our family members, we still love them and want them around. Is this same type of love/hate relationship common with OCD?

Also, there is no question we are all shaped and influenced by many factors in our lives, including our illnesses. Do those with OCD believe they won’t be their real selves if their OCD is under control? For those who are able to see obsessive-compulsive disorder as separate from themselves, I wouldn’t think this would be an issue. But maybe it is. Maybe those with OCD believe not having their disorder as an integral part of their lives might change their true identity. To complicate matters more, it might be difficult for those who are suffering to even know what they believe. Are their thoughts their own or is it their OCD talking?

In my son’s case, getting treatment for the disorder is what allowed the real Dan to emerge. I have never heard from anyone with obsessive-compulsive disorder who felt their true self had been compromised after ridding themselves of OCD. Indeed, it is just the opposite. With OCD on the back burner, they were finally free to be themselves.


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OCD and Selfishness


by stuart mies free

This post first appeared in 2013……

Soon after my son Dan was diagnosed with obsessive-compulsive disorder, he and I were out with some friends and decided to get a bite to eat. We were all casually chatting about various restaurant choices when Dan suddenly insisted we go to one particular place. He was adamant; we needed to eat there. So off we went. If I remember correctly some glances were exchanged (“What’s up with him?”) but nobody complained and we all went along.

I knew very little about OCD at the time, but what I did know was that this seemingly selfish behavior was totally out of character for my son. In fact, it was the exact opposite of the “real Dan” who’d always been so easy-going and eager to please others. I’ve written before about the convoluted way in which OCD operates and how it usually makes sense for those with OCD to do just the opposite of what their disorder demands. I think it’s also true that  those without the disorder often get the wrong impression, indeed the opposite impression, of the true nature of those suffering from OCD.

At the time, our friends didn’t know that Dan had OCD, but I’m not convinced that would have mattered. They likely thought Dan was selfish because he demanded we eat where he wanted to eat, with no regard for anyone else’s preference. The truth was Dan’s OCD made him believe we all had to go to that particular restaurant or something bad would happen. He wasn’t being selfish; he thought he was protecting those he cared about. Compulsions involving doing certain things at specific times or in a particular way, or being inflexible in various ways, all can be misconstrued as acts of selfishness. I’m sure everyone who has OCD as well as their loved ones could easily come up with their own examples.

But really, it’s all a big misunderstanding. Most people without OCD do not understand that those with the disorder feel they do not have a choice. They don’t choose, or even want, to act this way; they have to. It’s not about what they want; it’s about what their OCD demands. They are held captive by obsessive-compulsive disorder.

If I had understood what was happening when Dan insisted on going to that restaurant, I could have not enabled him, which we know only makes OCD stronger. Those with and without OCD need to be educated and those who are suffering need to get the appropriate treatment. Once they choose to fight it will be clear to others, as well as to themselves, who they really are.

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ERP Therapy: Better to be Proactive or Reactive?

by stuart miles

This post first appeared on my blog in March 2011. I revised it slightly and think it is worth sharing again…..

I recently read this blog post which brings up a discussion that occurred at an OCD support group. I think almost everyone with OCD who has used exposure and response prevention (ERP) therapy would agree it can be very effective. One of the problems with it, however, is that by its very nature it is anxiety provoking. Who wants to willingly subject themselves to sometimes seemingly intolerable levels of anxiety and discomfort?

So the question is: Do you seek out these anxiety provoking experiences, even going so far as to create them yourself, or do you just wait for them to come to you? You know they will, sooner or later.

When my son Dan began dealing with his severe OCD he would often say to me, “Make me do this,” or “Make me go here,” or “Don’t let me do this or that.” I don’t think either of us realized it at the time (I know I certainly didn’t) but he was instinctively engaging in ERP therapy. At that point, he had not had any proper treatment for his OCD. Still, even in his debilitated state, he somehow knew that exposing himself to what he feared most was his ticket out of the torturous cycle of OCD.

To those of us without obsessive-compulsive disorder it might seem like a no-brainer. If this is the therapy that works, of course you should continue to practice it as much as possible. Sure, easy for us to say. But if you have OCD, and your brain has been relatively quiet for a while, why would you want to shake things up? Why not enjoy the peace when you have it and deal with whatever you need to deal with when it comes along?

There is no right or wrong answer here. Or is there? OCD is tricky and often rears its ugly head when you least expect it to. The more you choose to embrace ERP therapy, the better your chances are of beating OCD at its own game. So should you try to enjoy the calm before the storm, or should you create your own storms regularly in hopes of completely changing the weather pattern?

I’d choose the latter.

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OCD, Learning, and Memory Problems

I’ve written posts and articles about my son Dan’s struggle with OCD in college, and our family’s experience is also fully chronicled in my book Overcoming OCD: A Journey to Recovery. The most frustrating aspects of this portion of Dan’s journey were not only the widespread lack of understanding of obsessive-compulsive disorder, but also dealing with an academic support staff who had no idea how to help him.

To be fair, it really wasn’t their fault. They were willing to help; they just didn’t know how. Aside from offering extra time on tests (which is often not even a good idea for those with OCD) they were at a loss. And so were we. Once we realized that Dan was struggling with time management, the balance of details within the big picture, and over-thinking, we asked that these issues be addressed mainly through the open-mindedness and flexibility of his professors.

But now there is something more concrete those with OCD can offer the academic support staff at schools and colleges. A January 2018 study published in the journal Psychological Medicine involved questioning 36 adolescents with obsessive-compulsive disorder and 36 healthy adolescent controls. Participants were asked to complete two memory tasks designed to measure learning and cognitive flexibility. Adolescents with OCD struggled with cognitive inflexibility and showed significant impairments in both learning and memory. The study is summarized nicely here if you’d like to learn more about it.

I believe the implications of this study are huge. For one, unaddressed learning and memory issues in an academic environment are sure to stress already anxious children or adolescents. Their confidence and self-esteem are also likely to be affected. Not surprisingly, all of these issues can exacerbate OCD and quickly lead to a downhill spiral in both academic performance and overall well-being. The results of this study have already been shared with the appropriate professionals who have subsequently helped students with OCD achieve a level playing field and realize their potential. What a relief this must be for students and their families who have struggled for so long, yet haven’t quite been able to put into words what they are actually struggling with.

Another important implication of this study is that it educates and enlightens those who still have little to no understanding of obsessive-compulsive disorder. There are academic support staff out there who believe those with OCD just need to be able to leave the room if they “have” to wash their hands – that is the extent of their comprehension of the disorder. But problems with memory, learning, cognitive inflexibility? Who knew? This study provides concrete evidence that those with OCD can use to advocate for themselves.

We are making progress. Slowly but surely, researchers are working hard to chisel away at the mysteries of obsessive-compulsive disorder, helping those with OCD along the way and giving them hope.





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How Effective is CBT for Children with OCD?

by sattva

There is no question that having a child with obsessive-compulsive disorder affects the whole family. I’ve written before about how pediatric OCD results in disrupted routines, stressful social interactions for children, and poor job performance for parents. Elevated stress and anxiety levels, as well as feelings of frustration, anger, and sadness become the norm in a household dictated by OCD.

I’ve also written about how important it is to get the right help as soon as possible. Even if parents or other caregivers think things are “not that bad,” the situation is likely worse than they imagine. Because children (and adults) with OCD can be adept at hiding their symptoms, they are often the only ones who know the real extent of their disorder – parents don’t often recognize the extent of their children’s suffering. And on the off chance that the OCD really isn’t “that bad,” it’s still always better to seek treatment sooner rather than later.

In an interesting review published in Psychiatry Research, predictions related to the effectiveness of Cognitive Behavioral Therapy (CBT) in children and adolescents (all under the age of 18) with OCD were made:

In predictor analyses, worse response to CBT was associated with older age, higher OCD symptom severity, higher level of OCD-related impairment, worse depressive symptoms, the presence of any comorbid mental disorder, and higher family accommodation of OCD symptoms. Medication at baseline was not a predictor of CBT effectiveness.

No surprises there. This analysis confirms the importance of getting help for OCD as soon as possible, before OCD has become firmly entrenched.

There is also some discussion in the report about CBT for children and adolescents with OCD who have comorbid tic disorders. Honestly, I found the wording and conclusion confusing, but it did bring to mind my son Dan’s experience with facial contortions, twitching, and tics. It is known that tics and Tourette syndrome are not uncommon in those with OCD. Statistics vary, but approximately 50% of children with OCD have, or have had, tics and 15% of them have been diagnosed with Tourette syndrome. In Dan’s case, it’s possible some of the medications he was taking contributed to his tics. Thankfully, once he was taken off the meds and was working hard on his exposure and response prevention (ERP) therapy, all his tics, twitches and facial contortions disappeared. It’s interesting to note that his comorbid diagnoses of depression and GAD (Generalized Anxiety Disorder) also fell by the wayside.

The bottom line is CBT in the form of exposure and response prevention (ERP) therapy works for children and adolescents. The sooner help is sought, the better the results will likely be. Once OCD is under control, an added bonus might be the disappearance of comorbid conditions such as depression, GAD, and even tic disorders.

There are no good reasons to delay treatment of obsessive-compulsive disorder for our children. If your child or adolescent is struggling with OCD, please do the right thing. Get help for them now.







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OCD News

by stuart miles

I’ve recently become aware of some exciting programs, studies, and projects going on aimed at helping those with obsessive-compulsive disorder, so I thought I’d highlight three of them for you:

Ryan Bernstein, a high school junior from Portland, Oregon, has undertaken an amazing project to raise money for the International OCD Foundation (IOCDF). He is writing a book titled: OCD to Me: an anthology of anxieties and is seeking contributions for his book. You can read more about Ryan’s personal story, as well as complete his short survey (four questions) here.


Boston University runs a wonderful program for college-aged students. From the article:

For the past three years, Boston University has offered one of the few programs in the nation dedicated to teaching students who have had to leave college the coping skills that will give them a shot at getting back into school or work while managing severe anxiety, depression, and other serious mental health conditions.


An exciting five-year study involving home-based ERP therapy for children is in the works, and you can read about it here. From the article:

The Pediatric Anxiety Research Center (PARC) at the Bradley/Hasbro Children’s Research Center, has received a $3.4 million funding award from The Patient-Centered Outcomes Research Institute (PCORI) to compare patient-centered (primarily in the home/community) to provider-centered (primarily in the office) outpatient treatment for kids with anxiety and obsessive compulsive disorder (OCD). The aim of the study is to devise an alternative outpatient treatment model featuring a bachelor’s level clinician, or mobile exposure coach, working in conjunction with PhDs to conduct in-home therapy visits.


I’ve highlighted the above project, program, and study because they are all exciting, innovative ways to help those with OCD. I hope you’ll take the time to read more about them.  Who knows? They just might be exactly what you or someone you care about is looking for!







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