OCD, Medication, and Attitude

by david castillo dominici freedigitalphotos.net

by david castillo dominici freedigitalphotos.net

I’ve previously written about how complicated the topic of OCD and medication can be. I’ve talked about stigma and the process of “trial & error.” I’ve discussed how there are those who feel weak for deciding to take medication, and still others who feel empowered by this decision. I’ve talked about how there is not one specific drug for obsessive-compulsive disorder, and what works for one person might not work for another. Some people find medication to be helpful, and others never derive any benefits from them, no matter how many meds they try. There are those who are plagued by intolerable, and often dangerous, side-effects, and  others who say medication saved their lives.

To say the subject of medication and OCD is an individual thing is an understatement.

There is one aspect of medication in relation to OCD that I have yet to touch upon, and that is attitude.  Specifically, does one’s beliefs about medication influence its effectiveness?

Apparently so.

In this wonderful post, Dr. Kelly Brogan shares study after study that all arrive at the same conclusion: Mind-set matters.

Most of us are familiar with the placebo effect, which in the case of medication, involves beneficial effects produced by the patient’s beliefs in the “drug” (typically nothing more than starch and sugar) they are taking. Not as well known, but equally powerful, is the nocebo effect, which is associated with harmful effects due to the person’s negative beliefs about the “drug” they are taking.

Dr. Brogan quotes from the New England Journal of Medicine:

Placebo effects rely on complex neurobiologic mechanisms involving neurotransmitters (e.g., endorphins, cannabinoids, and dopamine) and activation of specific, quantifiable, and relevant areas of the brain (e.g., prefrontal cortex, anterior insula, rostral anterior cingulate cortex, and amygdala in placebo analgesia).

In other words, the placebo and nocebo effects are real, and have been recognized as such by the medical community.

It is interesting to note that the placebo and nocebo effects are not limited to medication. As an example, Dr. Brogan highlights a study which produced data that focused on outcomes of belief. She says:

…One of my favorite studies took 84 hotel attendants with cleaning responsibilities and told half of them that their daily work satisfied the Surgeon General’s recommendations for an active lifestyle as exercise. They told the other half nothing.

As a result, compared with the control group, they showed a decrease in weight, blood pressure, body fat, waist-to-hip ratio, and body mass index. These results support the hypothesis that exercise affects health in part or in whole via the placebo effect.

So interesting! But what does all this mean for those with OCD? I’m no expert, but I’d guess that if someone is forced to take medication for their OCD when they really don’t want to, and when they believe it won’t help, there is a good chance it won’t benefit them. Conversely, if someone is gung-ho about meds and can’t wait to take them because they’re convinced they’ll quell their OCD, chances are they’ll experience at least some relief.

Of course, there is more to these medications than just believing or not believing they will work. But attitude is a piece of the complicated OCD puzzle. Also, it’s not difficult to see how attitude and beliefs are likely to affect exposure and response prevention (ERP) therapy as well. Hmm, sounds like a good topic for another post!







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8 Responses to OCD, Medication, and Attitude

  1. Love this! While the benefits of a positive attitude has strong scientific support, we only have to look at our own lives to see it for ourselves (yes, that dreaded “anecdotal evidence” I find difficult to believe has so little credence among other science nerds).

    On days when I wake up grumpy (most Mondays, oddly, since I haven’t followed a M-F week since graduation – years ago now), if I can force myself to add to my gratitude list or when I stumble across something uplifting on the web as I tend to my blog, I not only feel significantly more cheerful, my “can do” attitude improves considerably and I usually find that I can actually get something done that I have been avoiding.

    It doesn’t help a great deal with my own nemesis – the high distractibility and hyperfocus quicksand of my ADD dx – but a “can do” attitude does seem to encourage me to keep getting back on the intended horse when I find myself deep in concentration as I click link after link online. 🙂
    (Madelyn Griffith-Haynie – ADDandSoMuchMore dot com)
    – ADD Coach Training Field founder; ADD Coaching co-founder –
    “It takes a village to educate a world!”

  2. flubadub says:

    Attitude is critical. Relabeling and revalueing can be the difference between peace of mind and torment..It is hard to understand when one is under the grip oof an obsessive dilemma how changing your thinking can convert a lobsided brain back to some kind of normal.state.

    I have been tormented by overwhelming compulsions for 60 years and only thru learning and applying cognitive behavior have I improved. Drugs, therapy, and all other treatments are valuable depending on the situation and the obsession/compulsion.

    I have suffered the tortures of the damned. I have learned that although there is help only the sufferer can make their condition better.

    • Hi David, Thank you so much for sharing what you’ve learned over 60 years of suffering. I’m sure it will help others and motivate them to get the right help. Wishing you all the best!

      • flubadub says:

        Hi again-
        It is dfifficult to remember that OCD is a “thinking disorder” when in the throws of a spike. But, I can tell you that by relabeling and refocusing one can break the vicious cycle of obsession and find relief at least temporarily.. Work has to be done continually to remember to keep thinking straight but it gets easier to keep a clear mind with practice. . I still struggle mightily most everyday and knowing what is happening helps get one out of OCD grips..

      • Hi David, It sounds as if you work very hard to keep your OCD at bay and I’m glad you’ve found what works for you. I am wondering if you’ve ever tried exposure and response prevention (ERP) therapy and what your experience has been.

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