People with OCD Prefer Exposure to Alternative Treatments

Mad in America published a summary of a recent study that surveyed people with OCD about treatment preferences. I spent the last hour trying to track down a copy of the actual research article, which has not been officially published yet, but I was unable to locate a pdf and read it myself.

One of the authors is Dr. Helen Blair Simpson, whose brief information video about OCD is a good one.

The study

The researchers surveyed 216 people with OCD about their treatment preferences. Most people preferred Exposure and Response Prevention (ERP) as a 1st line treatment. The 2nd most popular treatment was serotonin reuptake inhibitors (i.e., antidepressants). Based on how the abstract was worded, there may be no statistically significant difference between preference for ERP (55%) and preference for antidepressants (45%).

Interestingly, people who preferred antidepressants were more likely to have higher income, private insurance, and a longer history of OCD treatment. According to the Mad in America article:

The researchers theorized that this may be due to this group having “received high-quality psychiatric care that afforded them the time and attention to discuss and resolve concerns about medication.” That is, people without these resources may have had poor experiences with medication management in which they felt pressured or their concerns were not heard. Psychotherapy may have provided an approach tailored to their individual concerns, making it more desirable.

People with OCD didn’t want antipsychotic drugs

People with OCD already taking antidepressant medication preferred ERP as an adjunct treatment over augmenting the antidepressant medication with an antipsychotic. In a prior post, I wrote about research that suggested that antipsychotics were not a useful adjunct treatment for OCD.

Acceptance and Commitment Therapy (ACT), an evidence-based treatment that we offer, was also well received among alternatives to ERP and medications. In a prior blog I used to write for, I wrote about a study on the use of ACT for OCD without deliberate exposure, and OCD researcher Dr. Michael Twohig has a page about ACT and OCD on the IOCDF website.

One theme that stood out to me reading about the study was how well-informed the sample of people with OCD is. Their preferences are remarkably consistent with current research about OCD treatment.

You can read the Mad in America article here, and an abstract of the research study here.

If you or some you know is struggling with anxiety-related problems, please check out the Portland Psychotherapy Anxiety Clinic. If you would like to learn more about my approach to OCD specifically, check out my OCD website, where I described how I use Acceptance and Commitment therapy to help enhance exposure and response prevention.

The Importance of Treating OCD Earlier: The Washington Post Article on Ethan’s Struggle from Childhood OCD through Adulthood

In people who develop obsessive-compulsive disorder, there are often signs in childhood. However, OCD in children can be hard to distinguish from childhood fears and age-appropriate magical thinking. For OCD Awareness Week, The Washington Post published an article by Sarah Maraniss-Vander Schaaf about the experiences of Ethan, a young man who developed OCD in childhood. It’s an effort to help people look past the stereotypes of people with OCD as being excessively clean and organized or washing their hands excessively. As the writer notes:

“…true OCD is often unspoken. It’s hard to recognize, as well, when growing up in a family where anxiety is normal, or in a school where behavior might be labeled school avoidance, or when no one else talks about the secret rituals that are too private to mention.”

The article traces the development of Ethan’s OCD from early childhood, though college, and the following decade of adulthood. It documents how OCD obsessions and rituals can escalate when left untreated and unchecked, and it provides a sober illustration of how the accommodation by the loved ones of someone with OCD’s obsessions/rituals—however well-meaning—can have disastrous consequences over time.

I’ve written in other posts about how some people with OCD have difficulty accessing appropriate treatments. Ethan was eventually accurately diagnosed and offered effective treatment, but it took several attempts before he was fully willing and able to engage treatment. He was even kicked out of OCD Institute at McLean Hospital, one of the leading residential treatment programs for people with OCD. Ethan didn’t recover from OCD until he was willing to commit to proper treatment—particularly exposure and response prevention. Ms. Maraniss-Vander Schaaf writes:

His improvement came when he accepted CBT and Exposure Response Prevention (ERP). He was taught to develop a new relationship with his thoughts. He learned to live with the uncertainties of life and not push away anxiety with obsessive-compulsive thoughts and actions.

Ethan’s story is inspiring as, even after 2 decades of struggling with severe OCD, he is currently enjoying a productive and independent life. As I work with adults, I don’t often have a full view of how OCD progresses across the lifespan in the clients I see. I found this article of Ethan’s personal journey into OCD illuminating in how it presents a narrative of someone’s struggles with OCD across more than 2 decades, and the way OCD symptoms can change, transform, and evolve over time.

You can read the full article here.

If you or some you know is struggling with anxiety-related problems, please check out the Portland Psychotherapy Anxiety Clinic. If you would like to learn more about my approach to OCD specifically, check out my OCD website.

If you want to learn about OCD, here’s post about a great introductory book, Tompkins’ OCD: A Guide for the Newly Diagnosed.

Resources for self- and other-care in difficult times

Many of us have been impacted by the election results.  Whether you are feeling shock, fear, anger, sadness, confusion, disbelief, or excitement, joy, satisfaction or hope, you are likely not alone.

If you have been struggling, some of these resources might be helpful (thanks to Jennifer Villatte for sharing this list).  I prefaced each with a quote that spoke to me.  I also noticed the urge to provide a more in depth review of each, but eventually decided to practice self-care by calling it good :).  I hope you find something you might be seeking.

Resources for Self-Care in the Face of Social Injustice and Marginalization

“When we hold space for other people, we open our hearts, offer unconditional support, and let go of judgement and control.”
What It Really Means to Hold Space for Someone, by Heather Plett
http://upliftconnect.com/hold-space/

“Have you showered in the past day? If not, take a shower right now.”
4 Self-Care Resources for Days When the World is Terrible, by Miriam Zoila Perez
https://www.colorlines.com/articles/4-self-care-resources-days-when-world-terrible

“Oppression is far more effective when the oppressed are also mentally drained and physically ill, so our physical and mental wellness is, in itself, a personal counter-attack on oppression.”
3 Ways to Prioritize Self-Care While Resisting Dehumanization: Because #BlackWellnessMatters, by Akilah S. Richards
http://everydayfeminism.com/2015/07/self-care-resisting-dehumanization/

“There are things you can do for yourself right now to get prepared for the next four (to eight) years.”
What to Do If You’re Trans and Live in America Now, by Jessica Lachenal
http://www.themarysue.com/trans-in-america-2016/

“Anger used as a catalyst for social transformation can go a long way.”
Transforming Anger into Building Solidarity, by Beth Berila
http://www.contemplativepracticesforantioppressionpedagogy.com/blog/transforming-anger-into-building-solidarity-by-beth-berila-phd

“Sometimes saying no is a radical act of self-care that’s as vital to our struggles as the marches, teach-ins, and walk-outs in which we participate.”
5 Self-Care Tips for Activists – ‘Cause Being Woke Shouldn’t Mean Your Spirit’s Broke, by Kim Tran
http://everydayfeminism.com/2016/04/self-care-for-woke-folks/

“The antidote for exhaustion isn’t rest.  It is wholeheartedness.”
What’s Missing When We Talk About Self-Care, by Carmenleah Ascencio
https://www.youtube.com/watch?v=4eX5Wjm4FrE

Resources for Engaging in Difficult Conversations and Being an Ally

“I’m more interested in helping them change their oppressive behavior than publicly shaming them for it.”
Calling In: A Quick Guide on When and How, by Sian Ferguson
http://everydayfeminism.com/2015/01/guide-to-calling-in/

“Comfort IN, dump OUT.”
How not to say the wrong thing – The “Ring Theory” of Comfort, by Susan Silk & Barry Goldman
http://articles.latimes.com/2013/apr/07/opinion/la-oe-0407-silk-ring-theory-20130407

“13. Recognize That Yes, You’re Going to Do it Wrong and 14. Apologize Without Caveats”
30 Ways to Be a Better Ally, by Jamie Utt
http://everydayfeminism.com/2014/01/30-ways-to-be-a-better-ally-in-2014/

“We Center The Voice and Leadership of the Survivor and Oppressed Communities.”
Being An Ally/Building Solidarity, by Southerners On New Ground (S.O.N.G.)
http://southernersonnewground.org/wp-content/uploads/2012/12/SONG-Being-An-Ally-Building-Solidarity.pdf

“Create and Share Art, Support People with Disabilities”
26 Ways to Be in the Struggle Beyond the Streets, by Anderson, Barett, Dixon, Garrido, Kane, Nancherla, Narichania, Narasimham, Rabiyah and Richart
https://issuu.com/nlc.sf.2014/docs/beyondthestreets_final

To those who feel afraid or hurt after the election

For many of us, these are frightening and uncertain times. We at Portland Psychotherapy want to make a declaration of support to the millions of people around the nation and here in Portland that have been targeted, oppressed, attacked, or silenced and to those who feel fearful of what may come.  Portland Psychotherapy does not endorse discrimination in any form and is invested in ensuring the safety of all members of our community.

If you feel marginalized, oppressed, angered, hurt, afraid, ashamed, or stigmatized, we want you to know you are welcome here.  You are all part of the community we love and serve. This is a safe place for you to speak and to be heard. We value you.

The Staff of Portland Psychotherapy

Blue light at night is bad

We have known or suspected for quite some time that there are significant harmful health and environmental consequences associated with excessive light use at night, especially blue-rich light. Advances in technology and the widespread transition to light emitting diodes (LEDs), which emit substantial amounts of blue light, have made this especially important to understand and address.

The American Medical Association (AMA) recently released an important and timely report, providing scientific evidence in support of these concerns. They affirm the potential health hazards of blue-rich light, including its links to increased risks for cancer, diabetes, cardiovascular disease, and circadian rhythm disruption. They also find that blue-rich LED street lighting is five times more disruptive to our sleep than conventional street lighting and that brighter neighborhood lighting is associated with reduced sleep and impaired daytime functioning.

This interesting article outlines some of the AMA’s findings and describes some of the implications.

On an individual level, there are things we can do to minimize the impact on our sleep and our health from light exposure at night.

Here are some suggestions for more healthy and responsible light use:

  • Use “warm-white” or filtered LEDs to minimize blue light emission
  • Choose products with adaptive controls, such as dimmers, timers, and motion sensors
  • Dim or turn off lights during overnight hours
  • Light only the area needed in the minimal amount required
  • Avoid using blue-rich light devices (e-readers, laptop and phone screens, etc.)  in the evening as much as possible (2-3 hours before bedtime)
  • Download an app that filters out the blue light from your devices (http://www.makeuseof.com/tag/get-good-nights-sleep-filtering-phones-blue-light/)
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