An App to Enhance OCD Treatment – nOCD

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I recently had the pleasure of speaking with Stephen Smith, the face behind the app known as nOCD. I was impressed with Stephen’s intelligence, enthusiasm, and passion as he explained why he created this app and how it acts as an effective supplement to therapy  for those who are battling obsessive-compulsive disorder.

Stephen knows what he is talking about. He suffered from severe OCD himself, and like many, was frustrated by the lack and availability of good, quality care. While nOCD is not meant to be a substitute for ERP therapy, the evidence-based psychotherapy used to treat OCD, it can greatly enhance this therapy and treatment in different ways.

While reaching individuals with OCD is of the utmost importance to Stephen, it is not his only goal. He knows how helpful and necessary support is when dealing with OCD, and his app provides ways to connect with others and even create your own support groups. The importance of community and raising awareness of OCD are woven into the app.

I don’t have OCD so I haven’t used the app myself, but with Stephen’s knowledge and commitment to helping those with the disorder, along with an impressive team of professionals, my guess is it’s a worthwhile addition to anyone’s OCD toolbox. You can download the app for free by clicking on the nOCD icon on my blog’s sidebar.

OCD and Brain Inflammation

A very interesting study was published this past week in JAMA Psychiatry stating that brain inflammation in those with obsessive-compulsive disorder is significantly elevated (by more than thirty per cent) compared to those without the disorder.

Dr. Jeffrey Meyer, senior author of the study and Head of the Neuroimaging Program in Mood & Anxiety at the Centre for Addiction and Mental Health (CAMH) Campbell Family Mental Health Research Institute, says:

“Our research showed a strong relationship between brain inflammation and OCD, particularly in the parts of the brain known to function differently in OCD,”…..”This finding represents one of the biggest breakthroughs in understanding the biology of OCD, and may lead to the development of new treatments.”

Another very interesting finding from the study is that researchers found a connection between resisting compulsions and brain inflammation. Those with OCD who experienced the greatest stress or anxiety when they tried to avoid acting out their compulsions also had the highest levels of inflammation in one particular brain area. This factor could prove helpful in determining who might benefit the most when and if new treatments are developed targeting inflammation.

I do think it’s worth mentioning that while this study seems to hold great promise, so much more work needs to be done. There were only twenty participants with OCD in the study, and twenty in the comparison group.

And as often happens, new findings generate more questions. Where does this inflammation come from? Where (if anywhere) does PANDAS fit into this picture? How will this information lead to better treatments for those with OCD?

I’m always excited and heartened to learn of new research and discoveries related to OCD, and this does appear to be a breakthrough of sorts. We are learning more and more about obsessive-compulsive disorder thanks to dedicated researchers who work tirelessly to unlock the mysteries of this potentially devastating disorder.

 

 

 

 

 

 

 

 

 

ERP Therapy – An Analogy

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This post first appeared on my blog in January 2012….

One of the reasons I became an advocate for OCD awareness was to spread the word that exposure and response prevention (ERP) therapy is the therapy of choice for treating obsessive-compulsive disorder. Unfortunately, I sometimes come across first-person blogs where those with OCD equate this therapy with torture, and therefore refuse to try it. Others feel it might be helpful but are just too afraid to attempt it.

On his blog, Dr. Steven Seay compares ERP therapy to an exercise program, and using this analogy, really sets the record straight as to what this therapy involves when dealing with a competent therapist:

I often think about ERP as an exercise program for your brain. Why do people exercise? Typically to improve their quality of life in some way — be it related to health, aesthetics, or the way it makes them feel. People don’t take up exercising for no reason at all–it’s always purpose-driven. This is just like ERP. Why would you do it? Because it’s going to enhance your life in some way.

The analogy can be taken a bit further, though.

Exercise is not a singular activity. It’s something that’s often based around targeting a particular muscle group or certain aspect of health. People who want big biceps do different exercises than people who want to lose weight. This is similar to ERP. People who want to be less bothered by unwanted thoughts (e.g., thoughts of hitting someone with your car) do different exposures than someone who is afraid of contracting a deadly disease. The form of the “exercise” reflects a specific therapeutic goal.

Moreover, there are multiple ways to target the same muscle group. People who want to work on their abs might consider crunches, leg lifts, push-ups, etc. In ERP, there is no one exposure that will help you get better. Instead, there is an array of options that might work for you.

There’s also the hierarchical nature of exercise. If you want to get stronger, it’s smart to start with light weights and build up to heavier weights. It would be downright dangerous to attempt a 500lb bench press without proper training. In ERP, going for that “10″ on your hierarchy is ill-advised at the beginning of treatment. Before going there, you need to lay the proper groundwork first. A gradual approach might take more time, but it will get you to the destination without subjecting you to unnecessary injuries.

Finally, the world is full of different types of trainers. Not everyone is a drill sergeant. The best trainers will listen to you, work with you, and try to understand where you’re coming from. They’ll then use their expertise to design an individualized plan for you that is based on your goals, preferences, and perspective. The best therapists I know follow this same approach to treatment.

My position is that if you’re completing an exposure under duress, you’re unlikely to benefit from it. It’s the process of choosing to face your fear (and willingly embracing the uncertainty that comes with it) that really makes the difference.

Thank you, Dr. Seay.  Here’s hoping your words inspire all those with OCD to “hit the gym!”

Children, Rituals, and OCD

 

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When my daughter was two or three years old, she had a bedtime ritual where she lined up ten of her dolls and stuffed animals on the floor. They had to be in the right order, at the right angle, touching or not touching each other in a specific way. If these “friends” were not arranged just so, she would get upset, and then have to adjust each and every one of them until she got it just right. Then she could go to sleep.

She does not have OCD.

Rituals are a normal part of childhood, and they play an important role in children’s overall development. Rituals create order for children as they grow and try to make sense of the world around them. For example, a bath, story time, and cuddles every night before bed give children structure and a sense of security. They feel safe; they know what to expect.  Everything is as it should be.

Wow. Rituals never sounded so good.  So how could something so wonderful cause so much distress?

Typically, children without obsessive-compulsive disorder will be soothed and comforted by their rituals, whereas a child with OCD will experience only a fleeting calm. Anxiety and distress will always return, and the child will feel compelled to complete the ritual again. As I discussed in this previous post on rituals, this feeling of “incompleteness” is a telltale sign of OCD.

Another thing to watch for if you think your child might have OCD is the amount of time he or she spends ritualizing, and how much it interferes with his or her life. Typically, spending an hour or more a day completing rituals should raise some red flags.

Diagnosing OCD in young children is not always easy, as there are many ways the disorder can manifest itself. And OCD is tricky. Just when I was really starting to worry about my daughter, she began to care less and less about the arrangement of her “friends.” On the other hand, my son, who has never lined up anything in his life, developed OCD.

It is known that OCD often begins in childhood. I know this is no surprise to a lot of people, as I’ve often been told, “I’ve had symptoms of OCD for as long as I can remember.” I’d love to hear from those with OCD. When did you first realize you had the disorder, or that something was wrong? What were your early symptoms? How did your families react? Chances are the more we share, the more people might see themselves or their children, and seek appropriate help.

What Makes It So Hard to Seek Help for OCD?

Source: GDJ/Pixabay

I’m very happy to share this guest post by my friend and co-author Seth J. Gillihan, PhD. Seth’s bio and blogs are listed at the end of this post. If you haven’t already, I’d suggest you check out Seth’s new book Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks as well as his other guest post on my blog. Thank you for this great post, Seth!

Karen Robinson suffered with OCD for 24 years before finally seeking treatment. Fortunately she found effective therapy at a specialist clinic in the UK, which she described as “completely life-changing.”

Robinson chose to “pay it forward” and use her personal experience to help others, like Janet Singer and many others whose lives were profoundly affected by OCD. While still undergoing treatment, Robinson began researching why individuals with OCD delay getting help.

Unfortunately Robinson’s story is a common one among people with OCD—the typical gap between first symptoms and looking for treatment is 17 years. Whereas previous studies had used questionnaires to understand what accounted for this gap, Robinson chose to do one-on-one interviews. This approach allowed for in-depth discussion of the “barriers and enablers” of seeking help.

Robinson also let her participants know that she suffered from OCD, which likely increased their willingness to speak candidly about their experiences.

Robinson and her co-authors summarized her findings in a recent article published in Psychology and Psychotherapy: Theory, Research and Practice. 

Barriers to Seeking Help

1. Not Knowing It Was OCD: Even professionals can miss or misdiagnose OCD, so it’s no surprise that individuals with OCD and their families may not know what they’re dealing with. It’s especially difficult to recognize OCD when the content is not what we commonly think of (like hand washing and checking the stove).
2. Stigma: The number one reason people delayed seeking help was that they simply didn’t want to tell people—even family members. Some feared that having a psychiatric diagnosis could hurt their career. Revealing one’s OCD seemed especially challenging when the content could be upsetting to others, like the fear of harming children. Others worried about their doctor’s response. Thus the people best positioned to help—loved ones and medical professionals—were often in the dark about the person’s OCD.
3. Beliefs About One’s Symptoms: Several participants said they didn’t think their condition was “bad enough” to warrant seeking help—even when the OCD was consuming 3 hours of their day or influencing their decision about having children. Others said they simply never thought to get help. When OCD has permeated one’s life for several years, it may be hard to imagine an alternative. Some participants described feeling like they must be the only person having these kinds of struggles; in reality I’ve found that even seemingly “one-of-a-kind” forms of OCD are not unique.
4. Concerns About Doctor’s Reaction: For many people with psychiatric diagnoses, the first professional they’ll talk to about their struggles is their family doctor, as was the case with Janet’s son Dan. Individuals with OCD often don’t tell their doctor about it because they doubt she’ll know what it is or be able to help—and perhaps with good reason. For example, Dan’s doctor concluded that his OCD was “no big deal,” which obviously did not turn out to be right. Other individuals worried about what the treatment might be—heavy-hitting medications with unwelcome side effects? An extended course of grueling psychotherapy? These fears about possible treatments made seeking help less appealing.
5. Fear of Being Labeled a Criminal: Perhaps the most tragic reason to
   

   Source: Daniel Vanderkin/Pixabay

   avoid seeking help was the fear of being “locked up” for divulging one’s symptoms, which was common among people with obsessive fears of harming children. As one participant said, “I just thought other people would think, ‘Oh my God, what a monster.'” (See this related post: Mental Illness and Violence: Would I Do That?)

Of the 17 study participants, 16 had eventually sought help. Many of the factors that pushed them to seek help were direct antidotes to the barriers.

Factors that Enabled Treatment Seeking

1. Reaching a Crisis Point: As discussed above, thinking one’s OCD wasn’t severe enough prevented help seeking. On the other hand, an acute crisis often drove a person to treatment, as fully half the participants recalled. Apparently it had to get quite severe to compel a person to ask for help; one participant described becoming “extremely depressed” and contemplating an overdose prior to seeking help (and then only at a partner’s urging).
2. Nature of the Obsessive Thoughts: While obsessions about harming kids led to keeping the thoughts secret in some cases, the same thoughts spurred other individuals to “confess.” As one person said, “I thought my children were in immense danger.” Thus in these cases individuals didn’t seek treatment so much as turn themselves in.
3. The Support or Urging of Others: OCD can be a very lonely illness, and the presence of others can be invaluable at any point in one’s journey to recovery. The vast majority of participants said people in their lives—most often family, and often friends—were instrumental in getting them to treatment. Even strangers played a part in several cases, through OCD Internet forums; those who have gone through similar struggles can be a tremendous source of information and support, as many of you have found on this and other blogs.
   

   Source: Ilmicrofono Oggiono/Flickr

4. Confidence in Health Care Providers: While concerns about a doctor’s reactions can prevent a person from seeking help, confidence in the doctor’s ability to help has the opposite effect. Apparently it’s not only about the doctor’s knowledge of psychiatric conditions; one participant decided to tell the doctor because she “was good at listening to people.” Simply showing that one is open and available to discuss a patient’s concerns can go a long way.
5. Information From the Media: Multiple barriers to treatment can be overcome through an understanding of what OCD is. Thus it’s hard to overstate the importance of the media—including this blog—in shedding light on OCD. One study participant described watching a morning news show that featured someone with OCD, and said it was “just like a revelation! …. I was relieved to find out I wasn’t going to get sent to prison.” Sharing personal stories and accurate information about OCD changes lives.

Karen Robinson got her life back by seeking and finding treatment for OCD. The goal of her research is to “encourage people to seek help much, much earlier.” Understanding what helps and hinders treatment seeking is a big step in that direction.

If you delayed seeking help for your OCD, do you identify with any of the factors described here? Are there barriers or enablers that aren’t listed here that you experienced? Please leave a reply in the comments section below.

Seth J. Gillihan, PhD, is a clinical assistant professor of psychology in the psychiatry department at the University of Pennsylvania Perelman School of Medicine. He is the author of Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks and co-authored Overcoming OCD: A Journey to Recovery with Janet Singer. Dr. Gillihan blogs on  Psychology Today and his website. His clinical practice is in Haverford, PA, where he specializes in the treatment of anxiety, depression, PTSD, and related conditions.

Reference:

Robinson, K. J., Rose, D. and Salkovskis, P. M. (2017). Seeking help for obsessive compulsive disorder (OCD): A qualitative study of the enablers and barriers conducted by a researcher with personal experience of OCD. Psychology and Psychotherapy: Theory, Research and Practice. doi:10.1111/papt.12090

Where is Dan?

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My son Dan’s twenty-eighth birthday is in a couple of days, so I thought I’d share this post written in November 2013. He continues to do well after suffering with severe OCD almost nine years ago – and I continue to be enormously grateful…..

I have been fortunate to share the story of my son Dan’s recovery from severe OCD with so many whose lives have been touched by this horrible disorder. The fact that he is doing so well is concrete evidence that OCD, no matter how severe, is indeed treatable, and it is gratifying to know that people have found hope through our story.

When I connect with those who have either read my book or heard me speak, they often ask “How is Dan now?”

I am incredibly thankful that the answer continues to be, “He is doing very well.”

The next question is often something such as, “Where is he? Why don’t we ever see him at these conferences/meetings/other OCD events?”

In 2012 I wrote a post discussing whether “OCD advocacy” should be a responsibility of those who have recovered from severe OCD. Better than my post, I believe, are the comments from those who pointed out that advocacy comes in many ways, shapes, and forms. By continuing to do well, keeping his OCD at bay, and living his life to the fullest, Dan is giving hope to all those who suffer from obsessive-compulsive disorder.

Maybe my son’s choice to not focus on his OCD any more than he needs to is one of the reasons he has learned to cope so well. After all, OCD is something he has, not something he is. Dan has made a conscious effort to put his OCD on the back burner and focus wholeheartedly on living his life to the fullest. He fought his way back from the brink of despair, and perhaps this fact fuels his resolve to leave OCD out of his life as much as he possibly can.

Still, I’m not fooling myself. I know at some point Dan might not have a choice. While he might go years with mild obsessive-compulsive disorder, there’s still a chance it could flare up at any time with a vengeance. It could overtake him again. The bottom line is I don’t know what the future holds, and neither does Dan. Uncertainty. The word that those with OCD (and many of us without the disorder) hate. Nobody knows what will be.

For now, however, I will revel in the fact that Dan is doing well. I will continue to advocate for OCD awareness and proper treatment, and I will respect his decision to not want to make OCD a focal point of his life. Because after all, isn’t that the whole idea?

1 Million Steps 4 OCD Walk

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From the IOCDF website:

Each year, members of the OCD community from across the country — including individuals with OCD, mental health professionals, friends, family members, coworkers, children, and even four-legged friends (dogs must be on a leash, of course) — join together at the 1 Million Steps 4 OCD Walk to raise awareness, hope, and funds to support the important programs of the International OCD Foundation and our partnering Local Affiliates.

The Walk began in 2013 with the flagship event in Boston, and has since expanded to 4 cities around the United States, as well as countless communities across the globe. See below for details about all of our walks, including how to start a walk in your hometown if there is not a walk near you.

Walks are being held in Boston, Sacramento, Atlanta, and Houston.

And yes, you can start a walk in your own hometown! Don Grothoff, a long-time reader of my blog, has organized his own virtual walk. For more details visit his site.

The walks will take place between June 3, 2017 and June 10, 2017. For more detailed information on all the walks, including how to start your own, visit the IOCDF website.

Happy Walking!