Brain-Circuit-Based Therapies for OCD

I say it over and over again on my blog. The evidence-based psychological treatment for obsessive-compulsive disorder is a type of Cognitive Behavioral Therapy known as exposure and response prevention (ERP). Medication is helpful for some individuals as well. With proper treatment, most people with OCD will improve.

But what if you don’t? What if, after attempting these traditional therapies, there is no improvement and you are still suffering with severe OCD? While I’ve written before about some people with OCD erroneously being labeled treatment-resistant, there are indeed a small number of people who receive no benefit from ERP therapy and/or medication.

Is there any hope for those who are truly treatment-resistant? Absolutely. There have actually been some alternative treatments around for a while. I’ve written about Deep brain stimulation, focused ultrasound, and neurofeedback which have all shown promising results for those with treatment-resistant OCD.

But there’s more. The research continues and in the Winter 2016 OCD Newsletter published by the International OCD Foundation, there is an excellent article about brain-circuit-based therapies for OCD. I’ll give a synopsis but I highly recommend reading the article for detailed information.

So what are brain-circuit-based therapies? The article explains:

Your brain is made up of cells called “neurons” which
communicate with each other. When several neurons work
together, they are referred to as a circuit or network.
If you’ve ever taken apart a computer or other electronic device,
you’ve likely seen a green plastic board covered in gold circuits.
Much in the way electricity travels through this circuit board to
convey information from one part of the computer to another,
your brain uses neural networks to convey information from one
part of the brain to the other.
 
So, instead of targeting neurotransmitters (the chemicals used to
communicate between individual neurons) using medications,
researchers are now looking at how neural networks function
to communicate from the parts of the brain that regulate, say,
emotions to the part of the brain that regulates movement. It
is our hope that new treatment methods that focus on neural
networks may offer help to those individuals who have not had
success with other treatment methods.

 

Non-invasive treatment options do not involve surgery and have minimal side effects. Those discussed in the article include:

  • Transcranial Magnetic Stimulation (TMS)
  • Transcranial Direct Current Stimulation (tDCS)

Invasive procedures involve neurosurgery which involve a small risk of infection or seizures. Those discussed include:

  • Anterior Cingulotomy
  • Anterior Capsulotomy
  • Deep Brain Stimulation

Again, I highly recommend reading the article for details about each procedure as well as the success rates. What I find most interesting about most of these techniques is that those who were previously considered treatment resistant were often able to benefit from ERP therapy and/or medication after undergoing one of the procedures. How great is that – they were no longer treatment resistant!

Brain-Circuit-Based Therapies seem to hold a lot of promise as researchers continue to try to unlock the mysteries of OCD. But for most people, good ‘ol fashioned ERP therapy, a lot of hard work and commitment, and medication if necessary will be enough to triumph over OCD.

 

 

 

 

 

 

 

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OCD and SSRI-Induced Apathy

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I tend not to write too much about obsessive-compulsive disorder and medication. While I’ve shared some of my son’s experiences in the hopes of helping others, I am not a doctor. I realize that the decision to take medication for OCD is a very individual choice and I know that for some people, medication can be quite helpful. For others it is not.

I do, however, believe in being as informed as possible, which is why I think it is important to mention this article titled SSRI-Induced Indifference. The article isn’t new; in fact it was written in  2010.

In a nutshell, SSRI-Induced Indifference encompasses two categories: emotional and behavioral. The emotional aspect is what comes to my mind when thinking of typical side-effects of SSRI’s. Indeed, emotional blunting is not an uncommon complaint in those taking SSRI’s, and Dan experienced this side effect. People describe emotional blunting in many ways, but basically it is a lack of emotion – no highs, and no lows. You know you’re supposed to feel a certain way, but the emotions are just not there.

What I didn’t realize until I read the article is that Dan also experienced the behavioral aspect of SSRI-Induced Indifference known as SSRI-Induced Apathy, and this typically manifests through low motivation, or apathy. The article makes it clear that this apathy must not be attributed to a “reduced level of consciousness, cognitive impairment (e.g., dementia), or emotional distress (i.e., depression).”

What an eye opener! If you’ve read my book, you might remember that at one point in Dan’s recovery, he was doing the bare minimum needed to get from one day to the next. He wasn’t motivated in any aspect of his life, yet he didn’t really seem depressed. Once his medications were reduced and then eventually stopped, he easily became re-engaged in his life. I don’t know for sure, but my guess is that symptoms such as Dan’s might easily be misdiagnosed as depression.

So it’s something to be aware of. If you experience emotional blunting and/or apathy while taking an SSRI, I’d suggest discussing it with your doctor. The good news is that all symptoms of SSRI-Induced Indifference seem to disappear once the medication is stopped. As always, decisions regarding which, if any, medications to take need to be made alongside your health-care provider by carefully weighing the benefits of the drugs versus their risks.

 

 

 

 

 

 

 

 



 

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The Rhyme and Reason of Rituals

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A version of this post first appeared on my blog in 2011:

Whenever my children travel, I always make sure to tell them to “have a safe trip.”  Before my husband goes to sleep at night, he always makes sure the doors are locked. A basketball player says a specific prayer before each game, and a runner wears her lucky running shoes when she competes. Do any of these behaviors seem abnormal to you? Probably not.

In this 2011 study, researchers concluded that repetitive behavior, especially ritualistic-like behavior, is a common human (and animal) occurrence. This behavior is thought to have evolved as a means to induce calm and alleviate stress. Rituals provide us with the illusion that we are in control of a situation that is really out of our control.

Hmm, sounds a lot like obsessive-compulsive disorder, doesn’t it? While the researchers acknowledge a behavioral link between “normal” human rituals and OCD, they bring up a very important difference: those with OCD continually wrestle with the feeling of incompleteness, never truly convinced that their task has been completed. Doubt always manifests itself.

In general, people with OCD are more rigid in their adherence to rituals than those without the disorder. In this interesting post by Dr. Jonathan Grayson, he tells us, “Consistency is the measure of severity, the more consistent you are, the worse your OCD is.” In other words, the more tied you are to your rituals, the more your OCD is in control of you. For example, if for whatever reason I’m not able to tell my children to “have a safe trip,” I might feel a little uneasy for a moment or two, but I am unlikely to dwell on it.  Someone with OCD with this same ritual might become distraught if not able to perform it and might then develop other rituals to “make sure” everything will be okay. These are two very different reactions.

The thoughts and rituals of those with OCD are often no different from those who do not have the disorder. It is the severity that sets them apart. Thoughts become obsessions with lives of their own and rituals become compulsions that can overtake the life of the person with OCD. Researchers are working hard to figure out how and why this happens, and once they do, we will be one step closer to unlocking the mysteries of OCD.

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When Adult Children with OCD Live at Home

by stuart miles freedigitalphotos.net

Over the years, I have connected with many people whose lives have been affected by OCD. Because I’m a parent whose son has obsessive-compulsive disorder, some of the most heartbreaking stories to me come from parents who have done everything in their power to help their adult children, to no avail. Either these children insist they don’t have a problem, they resist appropriate treatment, or there are other issues that are hindering them from moving forward.

And they live at home.

As parents, we spend our lives doing everything we can to ensure our children are well cared for – that they are safe, healthy and happy. We share their hopes and dreams for the future and afford them every opportunity to reach these goals. They, indeed we, are on a path.

And then OCD comes to town, and all our lives are turned upside down.

But still, we try to do what we have always done. What we have always known how to do –  keep our children safe and warm.

Except with OCD in the mix now, it’s not so easy. Following our intuition only makes things worse, and before we know it we are enabling our loved one. In no time at all OCD is the head of the household.

So what should we do?

While every family has its unique set of issues, and seeking professional help is always wise, there are some basic premises to be followed when adult children with OCD live at home.

First and foremost, each member of the household has the right to feel safe at home, to be treated with respect and kindness, and to be heard. While those with OCD are no more likely to be violent than people without the disorder, they might be rigid in their daily routines and become angry if these are modified in any manner. Many parents and siblings of those with OCD feel as if they are always “walking on eggshells.” Nobody should have to live this way.

When our children are young, we take them to health-care professionals as we see fit, and then we follow the doctor’s orders. We can’t do that with our adult children (unless they are deemed unfit to make their own medical decisions, which is a topic for another day). They are not minors anymore and are legally responsible for making their own health-care choices (even though parents might very well be paying the bills). So they may or may not choose to get help. It’s their call.

But parents do have some control. If your adult son or daughter is living with you, it should be made clear that he or she must follow your rules. These requirements can be listed clearly on a contract, which all family members can sign. Some common conditions might include:

  • Attend regular therapy appointments and actively engage in treatment, including medication if appropriate
  • Treat all household members with kindness and respect
  • Accept that family members will not accommodate or enable you
  • Contribute to the upkeep of the home (keep room clean, help with chores, etc)
  • Keep communication open – perhaps with regularly scheduled family meetings

Then of course comes the really tough part. You have to mean what you say. If your son or daughter refuses to agree to your rules, you have to be willing to follow through and ask them to leave your home. Depending on the situation, some parents will help their adult child find an apartment and agree to help with rent for an allotted time while their son or daughter looks for a job. If your child is in no position to work, you can gently remind them that that is one of the reasons why they need help.

Of course the hope is that it will never come to the point where you have to ask your child to leave. But if it does happen, it might just be the necessary impetus for them to get the help they so desperately need.

 

 

 

 

 

 

 

 

 

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Examining the Latest Research on OCD

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I try to keep up with the latest research on obsessive-compulsive disorder, as I always find it heartening to know scientists are working hard to unlock the secrets of OCD.

A study published last month in the journal Cell Reports found evidence which suggests that neural dysfunction in a certain region in the brain can lead to obsessive and repetitive behaviors in mice.

The study, titled “Complete Disruption of the Kainate Receptor Gene Family Results in Corticostriatal Dysfunction in Mice,” was conducted at Northwestern University. It found that certain synaptic receptors are important for the development of a specific brain circuit. If these receptors are eliminated in mice, they exhibit obsessive behavior, such as over-grooming.

Lead author Anis Contractor, who is an associate professor of physiology at Northwestern University Feinberg School of Medicine, stated:

A number of studies have found mutations in the kainate receptor genes that are associated with OCD or other neuropsychiatric and neurodevelopmental disorders in humans…….I believe our study, which found that a mouse with targeted mutations in these genes exhibited OCD-like behaviors, helps support the current genetic studies on neuropsychiatric and neurodevelopmental disorders in humans.

To read more about the study, check out this article.

Another study has been highly publicized recently, and this one focuses on research which suggests the absence of a certain protein (SPRED2) triggers excessive grooming behavior in mice. You can read more about this study here.

What I found interesting about this study is not so much the study itself (which is certainly encouraging) but how it has been publicized:

Cause of obsessive-compulsive disorder discovered

German Researchers Discover Cause of OCD

What Causes OCD? Researchers May Have Found the Surprising Reason

You can’t believe everything you read. These are sensationalized headlines, and in a nutshell, they are not true. I want a cure for OCD as much as anybody, but more importantly I want the truth.

As Dr. John Grohol explains in this important article, there are a couple of problems at play here. One is that this press release was written by a writer at the university whose job  is to make sure his articles get picked up by mainstream news organizations. The second issue is that these news organizations pick up these headlines and run with them, with little to no checking of the facts.

I share Dr. Grohol’s frustration when he says:

Mainstream news organizations, however, have a responsibility to the public to start questioning the news releases from universities and do two minutes worth of Googling (as I did) to put new research in its proper context.

It’s not that hard. It’s something we used to call good journalism.

Is there valuable research being conducted on OCD?

Absolutely.

Has THE cause or cure for the disorder been found?

Absolutely not.

But that’s not to say it won’t happen. We need to be patient and we need to use the evidence-based treatments we currently have to fight the disorder. And we need to do our homework when we read about the latest research on OCD.

 

 

 

 

 

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Should OCD be a Family Affair?

This post originally appeared in 2011:

When my son Dan was first diagnosed with obsessive-compulsive disorder, I wanted details. What was he thinking, how was he feeling, is today better or worse than yesterday? The problem was, Dan would not, or could not, share the details of his disorder with me. He was even reluctant to see a therapist because he thought everything they spoke about would be relayed to his parents. Once I explained “doctor-patient confidentiality” to him, he couldn’t get out the door to the therapist fast enough.

I now realize that Dan was on the right track. I was better off not knowing. His OCD dealt with mostly mental compulsions and therefore was not obvious to me, and while I wouldn’t go so far as to say I had my head in the sand, I certainly had no idea how much he was suffering. I think if I had known, I would have accommodated him incessantly, and my heightened anxiety levels wouldn’t have done him any good.

I wonder how many teens and young (and not so young) adults are hesitant to share details of their OCD with their families, specifically their parents. From the blogs and sites I’ve visited, my guess is: a lot. Why? Is it because family members are just too close to share such personal struggles? Do those with the disorder feel embarrassed or think nobody could possibly relate to what they’re going through? One explanation I have seen often is that many parents minimize the OCD with comments such as, “Oh, I do that too,” or “It’s no big deal, you’ll be fine.” While these statements might be well-intentioned (or perhaps stemming from denial or guilt), this lack of understanding and support can be devastating for someone with OCD.

As with most illnesses or disorders, people with OCD seem to benefit from interaction with others who can truly understand what they are going through: other people with OCD. Social media sites, conferences and support groups for those with OCD are widespread.  So I don’t think family members need to know details of a loved ones obsessive-compulsive disorder if the person with the disorder is unwilling to share. What families really do need to know, however, is how to respond appropriately to their loved one with OCD, as this is essential to recovery. And maybe what those with OCD really need most from their families is what all of us need and deserve: acceptance, understanding, and love.

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“I’m Fine”

by stuart miles freedigitalphotos.net

by stuart miles freedigitalphotos.net

Another updated post from 2011…

My son Dan dealt with mostly mental compulsions, so his OCD was not obvious to me and my husband. In fact, we didn’t even know he had the disorder until he told us. Yet even when we knew he had obsessive-compulsive disorder and could see he was spiraling downward, he would always say, “Don’t worry, I’m fine.”

To this day those two words, “I’m fine,” make me cringe and stop in my tracks. Dan has been doing great for many years now, so you would think I would have moved on, because really, he is fine. For the longest time, however, I would focus intently on his every move, action, and expression, looking for the reassurance I needed to confirm that he indeed was fine. If I had any doubts, then I would ask him how he was doing just so I could hear those two words that caused me so much anxiety.

In a wonderful post about well-meaners (her friends and OCD support system), “Bobs” gives us insight as to what it is like to be worried about constantly, and then gives us some advice of her own. If you or a loved one has OCD, it is a post well worth reading. What rings true to me more than anything is this advice: Trust the person with OCD – especially if they’ve been working hard toward recovery.

I need to remember this, because although Dan used to say he was fine when he was not fine, that was a long time ago. He has changed a lot since those dark days. He has been through treatment, and has matured. Most importantly, he knows himself and his OCD, better than anyone. If at any point he is not fine, he might not tell me, but I am confident he will do what it takes to get well.

As more time passes, I’m getting better. I no longer analyze every move, expression, or comment that Dan makes. I’ve always tried to see him as separate from his OCD, but now that takes little effort, and I often forget he even has the disorder. I can almost hear the words “I’m fine” without cringing, because deep down I know. He is just as fine as the rest of us.

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