ERP and Virtual Reality

Exposure and response prevention (ERP) therapy is the evidence-based psychological treatment of choice for obsessive-compulsive disorder. Basically, the person with OCD is exposed to his or her obsessions, encouraged to feel the anxiety, and asked to refrain from engaging in rituals (compulsions) to reduce the fear.

I hear from many people with OCD who say that while they understand what ERP therapy is, and even how it could be helpful to many people, they don’t think it would work for their type of OCD, and therefore they don’t pursue treatment. This is indeed unfortunate as ERP can truly benefit all those who deal with OCD.

But wait a minute. What if people’s obsessions involve horrible things happening to those they love, or a fear of going to hell? Certainly these are not obsessions we want to, or are even able to, expose ourselves to. How can ERP ever help someone with these types of obsessions?

I addressed this issue a few years ago when I discussed imaginal exposures, which are based on imagining different scenarios as opposed to them actually happening. These types of exposures can be extremely helpful in certain cases. So you see, while OCD can be tricky, it can always be beaten. Sometimes you just need to be more creative than usual.

Speaking of creativity, researchers at Stanford University have been studying the use of virtual reality (VR) in the treatment of various brain disorders including OCD. They describe VR as using “computer technology to simulate physical environments, sights, sounds and other sensations to make the computer images seem more ‘real’.”

Now that could be quite an exposure!

Professor of psychiatry Elias Aboujaoude says:

“In illnesses such as OCD, a patient faces situations such as contamination fear. VR provides a convincing atmosphere so the patient can expose themselves to the stimulus and gradually become desensitized to this fear.”

Dr. Aboujaoude believes VR can be effective but acknowledges it is not available to everyone. VR is also still typically associated with video games, and that perception might be a hindrance.

While the research at Stanford is new, the use of virtual reality in the treatment of OCD has been around for a while. In this 2009 NIH article the use of VR in the assessment and treatment of OCD is evaluated and discussed. The article is long and detailed for those who wish to read it, but the bottom line is researchers conclude that the use of VR does have value for those with OCD.

While the premise of ERP therapy might be simple, its implementation is not always straight forward. But we are smarter than OCD, and as I said earlier in this post, it can always be beaten. If you are willing to engage wholeheartedly in ERP therapy with a qualified therapist who understands the importance of imaginal exposures and even VR, you will be on your way to a life of freedom from OCD.


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OCD and The Holiday Season

Image result for happy holidays sign



A version of this post first appeared November 2015…..

With the holiday season upon us, many of us are firmly entrenched in the excitement, anticipation, and busyness of this time of year. Maybe we will visit friends or relatives. Perhaps a small army of loved ones will descend upon us in our own homes, or maybe we will be part of smaller, more intimate gatherings.

Whatever our holiday plans involve, there are bound to be changes in our routines. While this can be unsettling for many people, those suffering from obsessive-compulsive disorder might have a particularly tough time, especially when dealing with vacationing and traveling. It’s not hard to see why these situations might trigger all kinds of concerns for those with OCD. No matter what type of OCD they are dealing with there’s always lots to worry about when stepping out of one’s comfort zone. Some concerns might include:

Will I be able to use the public or hotel restroom?

What if I hit someone while driving on the highway?

What if I get sick while I’m away?

Will my family be safe?

The questions are endless and will be different for each person with the disorder. As you can see, however, all these concerns revolve around one thing: the uncertainty of what will be. Those with obsessive-compulsive disorder have the need to know, for sure, that all will be okay.

Friends and family also are affected when traveling and vacationing with someone with OCD. Having to alter plans, not being able to be spontaneous, and dealing with high levels of anxiety are just some of the many examples of how OCD can impinge upon a vacation. Before actually leaving home, anticipatory anxiety with all of its “what ifs” and doubt can be particularly distressing. Interestingly, anticipatory anxiety is often worse than the actual event being agonized over. So what should those with OCD do when faced with all these holiday events fraught with doubt and uncertainty?

The answer is clear. They should push through their anxiety as much as they can and embrace the doubt and uncertainty that is holding them hostage. Yes, there is uncertainty that comes with traveling or vacationing or entertaining. Indeed, there is uncertainty in every aspect of our lives, and we all need to learn to accept, not fear, it.

I know it’s not easy. But it is possible.

If you have obsessive-compulsive disorder, I propose that you give yourself a gift this holiday season and make the commitment to stand up to your OCD. Embrace exposure and response prevention (ERP) therapy in the year to come and reclaim your life. You deserve to enjoy the holidays, and every day, with your family and friends instead of being controlled by obsessions and compulsions. It will not only be a gift to yourself, but just might be the best gift you could ever give to those who love you.


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Thanksgiving and Gratitude

by depspoons

Thanksgiving has always been my favorite holiday. I love the simplicity surrounding the  day – it began as a gathering to give thanks for the bounty of the harvest. Today, for many, it has become a day to be thankful for all our blessings.

Sonja Lyubomirsky, the author of The How of Happiness: A New Approach to Getting the Life You Want, says:

“Gratitude is many things to many people. It is wonder; it is appreciation; it is looking on the bright side of a setback; it is fathoming abundance; it is thanking someone in your life; it is thanking God; it is ‘counting blessings.’ It is savoring; it is not taking things for granted; it is coping; it is present-oriented.”

There are real health benefits to expressing gratitude. Lyubomirsky’s research concluded those who are grateful are more likely to be happy, hopeful and energetic as compared to their less grateful counterparts. They also appear to have more positive emotions overall.

So how do we cultivate this gratitude, especially when we are struggling with obsessive-compulsive disorder or other serious health issues? Scores of books and articles have been written on this subject, but maybe taking a look at events surrounding the Thanksgiving holiday can give us some clues:

  • Reaching out to others – As we begin planning for Thanksgiving Day, we decide who to invite: immediate family, good friends, or others who have nowhere to go to celebrate the holiday. Perhaps we remember those who have reached out to us in the past and let them know how much we have appreciated their thoughtfulness.
  • Planning the feast, grocery shop, and cook – This preparation involves mindfulness. Engrossed in the holiday preparation, we are totally focused on NOW and the task at hand, and that can be incredibly calming. An added bonus is when family members join in to help. We spend quality time together, have fun, and create lasting memories.
  • Expressing our thankfulness – Before the meal, many families acknowledge this day of thanks. Some might pray, others might give speeches, or still others might take turns saying what they are grateful for.
  • Watching the children – Joy, hope for the future, and living in the moment (aha, mindfulness!) are just some of the things we experience when we are blessed with little ones at our Thanksgiving table.
  • Giving back – Whether through food drives or volunteering to serve meals at homeless shelters, many of us feel compelled to help others at Thanksgiving.

All such powerful acts of gratitude!

I realize that Thanksgiving  for some families, for whatever reason, is not always a happy time. Families have issues – some more serious than others. But gratitude comes into play in these situations as well. We can acknowledge whatever drama or sadness exists, and still choose to focus on the positive. For example, instead of bemoaning the fact that you have to be in the same room as your horrible brother, be thankful that you still have your horrible brother, and a home where your family can gather.

Whether our lives are negatively affected by OCD or other illnesses or circumstances, it is still possible, and beneficial, to embrace gratitude. Not only on Thanksgiving, but every day of the year.

Wishing everyone who celebrates Thanksgiving a happy, healthy, gratitude-filled holiday!

Posted in Mental Health, OCD | Tagged , , , , | 7 Comments

Overcoming OCD: A Journey to Recovery – Now Available in Paperback!

I’m happy to announce that the paperback version of Overcoming OCD: A Journey to Recovery has now been released!

You can receive a 30% discount by ordering it directly through Rowman & Littlefield at Use promotion code RLFANDF30 at checkout for 30% off – this promotion is valid until December 31, 2018. This offer cannot be combined with any other promo or discount offers.

The book can also be ordered through Amazon, Barnes and Noble, Books-A-Million, and other major book retailers.

Another idea: See if it’s available at your local library, and if not, you can ask them to order it! Don’t forget to mention it is published by Rowman & Littlefield, as they are well known in the library circuit.

For those who prefer hardcover books, those are still available as well!

Posted in Mental Health, OCD | Tagged , , , | 10 Comments

The Paperback is Now Available!

I’m happy to announce that the paperback version of Overcoming OCD: A Journey to Recovery has now been released!

You can receive a 30% discount by ordering it directly through Rowman & Littlefield at Use promotion code RLFANDF30 at checkout for 30% off – this promotion is valid until December 31, 2018. This offer cannot be combined with any other promo or discount offers.

The book can also be ordered through Amazon, Barnes and Noble, Books-A-Million, and other major book retailers.

Another idea: See if it’s available at your local library, and if not, you can ask them to order it! Don’t forget to mention it is published by Rowman & Littlefield, as they are well known in the library circuit.

For those who prefer hardcover books, those are still available as well!

Posted in Mental Health, OCD | Tagged , , , | 2 Comments

OCD and Seasonal Affective Disorder

by ankush1208

Daylight saving time has ended, and winter is in the air. During these darker months, it is estimated that up to five percent of people in the United States suffer from seasonal affective disorder (SAD). SAD is described as follows:

Seasonal affective disorder is characterized by feelings of sadness and depression that occur in the fall or winter months when the temperatures begin to drop and the days grow shorter. The depressive episode is often associated with excessive eating, sleeping, and weight gain. Depressive symptoms begin in the fall or winter and persist until the spring. Women are twice to three times more likely to suffer from the winter blues than men.

Seasonal affective disorder can also impact people during the summer months (“the summer blues”), too, but it is less common. People suffering from SAD either are unable to function or function minimally during the season in which their disorder occurs. Seasonal affective disorder shares several symptoms with other forms of depression including lethargy, sadness, hopelessness, anxiety and social withdrawal.

A recent study published in Psychiatry Research explored the possibility of a connection between obsessive-compulsive disorder and SAD. Study author Oguz Tan and his colleagues at Uskudar University in Turkey referenced past research that indicates the prevalence of OCD is highest in Autumn, and light therapy, which is used to treat SAD, has been shown to benefit some people with OCD. According to the researchers, it has already been established that both SAD and OCD share some of the same underlying neurophysiology involving some type of dysfunction in regards to the neurotransmitter serotonin.

Interesting results of the study include:

  • More than half of patients with OCD have seasonal mood changes
  • Only one-fourth of controls without OCD reported seasonal mood changes
  • The severity of seasonal affective changes does not appear to affect the severity of OCD

Most participants with OCD who reportedly had SAD suffered in the colder months, though there were some subjects who had a more difficult time in warmer weather. For this sub-group of people who had both OCD and SAD, compulsions were also worse during the time of year they were affected by SAD. For those who specifically had SAD during the colder months, the severity of their compulsions directly correlated with the lack of daylight hours.

The scientists have acknowledged that their study has some drawbacks, such as relying on the participant’s self- reporting of OCD and SAD symptoms. They recognize that a better study model might involve measuring people’s OCD symptoms over a longer period of time and noting if and how they fluctuate with the seasons. They believe the connection between SAD and OCD certainly warrants further study, and hope to answer questions such as, “How does SAD affect the prognosis, treatment response, and risk of suicide in those with OCD?”

We already know that OCD is often seen with other conditions, and now we can add SAD to the list. At the very least, it is something to be aware of.

If interested, you can read more details about the study here.


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Four Genes Linked to OCD

by dream designs

Last month (October 2017), a team of researchers from Broad Institute published a study in  Nature Communication which truly delves into the biology of OCD. They used a multispecies comparison between dogs, mice, and humans who suffer from compulsive behavior disorders, and by doing this, were able to identify new genes and biological pathways associated with OCD. The genes in question are involved in synapse maintenance and neurotransmitter signaling, suggesting potential mechanisms at work in the disorder.

Hyun Ji Noh, a postdoctoral associate who led the study, says:

We were seeking ways to take advantage of information from other species in order to inform and focus the study in humans. Each additional species that we looked at gave us more information about possible factors in the brain that contribute to OCD.”

Using genetic associations noted in previous studies of OCD in humans, compulsive behavior in mice, and dogs with canine compulsive disorder, Noh’s team compiled an array of approximately 600 genes that appeared to have some type of connection to OCD. They then designed targeted sequencing panels for these genes and examined them in more than 1,300 cases and 1,600 controls. Their hard work paid off, and the scientists were able to single out four genes expressed in the brain that appear to be involved in OCD in humans. The genes — NRXN1, HTR2A, CTTNBP2, and REEP3, — had variants in either protein-coding or regulatory DNA significantly associated with human OCD. These gene variants disrupt synapse development and also interfere with neural pathways in an area of the brain knows as the cortico-striatal loop, affecting serotonin and glutamate, two terms which are familiar to many with OCD.

The science gets more complicated, and if interested, you can read more details here. But really, what does this actually mean for those with OCD?

Well, the more we know about OCD, the closer we might be to diagnosing it earlier as well as developing new treatment options. While not everyone with mutations in these genes will develop OCD, the researchers believe you are more likely to develop OCD if you do have these gene variations.

And so the exciting research into the mysteries of OCD goes on, and progress, albeit slowly, is being made. I always find it heartening to know there are so many people dedicated to understanding this complex disorder and working hard to help those who are suffering. Not only the research scientists, but also all the dedicated health-care professionals who help those with OCD regain their lives through exposure and response prevention (ERP) therapy.







Posted in Mental Health, OCD | Tagged , , , , , , | 19 Comments