One Less Obsession, One Less Compulsion
NOTE: Before seeking treatment, look over the
"First of All" section on
my main OCD web page. Pay particular attention to the need for you to
get some background on treating OCD for the purpose of determing whether
a therapist or psychiatrist is knowledgeable about OCD and whether or not
you will feel personally comfortable working with the OCD professional.
The International OCD Foundation (IOCDF) has
several brief articles about treatment that may be useful to you. I also
mention these on my "First of All" page,
but I repeat the links here in case you're unable to dig into that page. As
I say, the IOCDF articles are brief and, although not in-depth, will provide
at least a cursory introduction to the different methods of treating OCD.
Cognitive Behavioral Therapy (CBT) is probably the most effective
form of treating most types of OCD. It can be done in conjunction with
medication, although it is recommended that the patient be on a stable dosage
throughout the treatment. The particular type of CBT used for OCD is called
Exposure and Response Prevention (ERP). The therapist and the
patient work together to draw up a list of the patient's obsessions, from
least distressing to most distressing. Beginning with the least distressing
obsession, the patient is exposed to the obsession and is prevented from
responding to it with a compulsion. At first, the patient's anxiety level
is extremely high after the exposure, but, gradually, after repeated exposures,
the patient's distress decreases until he/she no longer feels the need to
counteract the obsession with a compulsion. Once the CBT course is complete,
the patient can use the techniques learned should old or new obsessions become
distressing at a later date.
Behavior therapists are usually psychologists (Ph.D. or Psy.D.) or licensed
clinical social workers (LCSW). It is important to choose a therapist
(i) who has experience treating OCD with CBT and (ii) with
whom you feel comfortable. The two articles below will help you know what
to look for in a behavior therapist.
Should you be unable to make use of a behavior therapist (e.g., for OCD or
financial reasons), there are self-help books available for building and
working through your own course of CBT. Scan through this
book list for examples of such books.
Self-help requires some discipline, so you might ask a family member or
close friend to help support you in the process.
- Anxieties.com - is a self-help
site run by Dr. Reid Wilson, co-author with
Edna Foa of Stop Obsessing! How to Overcome Your Obsessions
and Compulsions. Although Dr. Wilson hopes you'll also buy
the book, the web site contains detailed (and readable) instructions
for the treatment program
(OCD) advocated in the
book. A very useful site—visit it. (And buy the book!)
Splitting - is a self-help technique for reducing obsessive
thoughts and is a possible addition to traditional CBT. As I
understand it, the goal of the technique is to break the association
between a person's obsessions (or words that trigger the obsessions)
and the fears or compulsions associated with the obsessions. For a
person with OCD, obsessions trigger negative associations; association
splitting works by teaching the person to develop positive or neutral
assocations instead. The web page has links to further information
about the technique in the following languages: English, French, German,
Italian, Montenegrin, Russian, and Spanish. The manual, written by
researchers Steffen Moritz & Lena Jelinek, is very interesting and
can be downloaded for free as a PDF document (in any of the languages).
- OCD Center of Los Angeles (OCDLA) -
was founded by Tom Corboy, MFT, and specializes in Cognitive-Behavioral
Therapy (CBT) for OCD and related anxiety disorders. The web site
provides excellent overviews of OCD and related disorders, CBT, and
the Center's own treatment and support programs. In addition, the
site has links to organizations, research centers, clinics, and support
groups around the world - well, at least in the USA, Canada, and the UK!
- OCD HOTLINE - is operated by
Dr. Steven Brodsky, a clinical psychologist who specializes in Cognitive
Behavioral Therapy (CBT) for OCD, phobias, and panic disorder. A unique
feature of his site is reflected in its title: you can submit questions
to him by E-mail or by phone and receive confidential replies.
- OCDCentre - treats OCD using a
program developed by India Haylor and Dr. Jeffrey Schwartz (of
Brain Lock fame). Individual treatment programs can
be conducted on-line, by telephone, or in person. The center also
has a companion blog,
- San Francisco Bay Area Center for
Cognitive Therapy - has some useful articles on Cognitive Behavioral
Therapy (CBT) for OCD, trichotillomania, depression, and panic disorder.
- Your Greater Good -
"a joint outreach project of
author Jeff Bell and
The Anxiety Center
of Sacramento, aiming to offer a new perspective on proven
strategies in the treatment of Obsessive-Compulsive Disorder (OCD)
and other anxiety-related conditions."
Computer-Assisted Behavior Therapy
- Anti-Zwangs-Training -
"Ein virtueller Co-Therapeut für die Behandlung von
Zwangsstörungen". This appears to be computer-asssisted behavior
therapy featuring the animated "Brainy". Programmed by Andreas Seebeck
for Dr. Christoph Wölk. The web site has links to videos of TV
shows that discuss the therapy program and there is a
demo movie of the
computer program by itself. All in German, unfortunately for me!
- OC-Fighter: Online OCD
Treatment - CCBT (Computer-aided Cognitive Behaviour Therapy),
derived from the
- Virtual Reality and Ambient
Intelligence Reference Site - "This site contains information about
the use of advanced technologies - virtual reality, mixed reality,
interreality, ambient intelligence - in health care." While not
explicitly concerned with OCD, the site, "aimed at a scholarly
audience", does have an on-line journal with a couple of papers about
immersion therapy for anxiety disorders. Software is freely available
for download, although I don't know if it can be used for or adapted
for use with OCD patients.
Reality (VR) Therapy for Spider Phobia - describes computer-aided
exposure therapy for various phobias. Of special interest is the story
of "Miss Muffet", whose OCD revolved around spiders. (University of
Washington, Human Interface Technology Lab)
- Virtually Better -
develops "virtual reality products to treat phobias, addiction, and
PTSD." The company's Atlanta Clinic treats OCD and other disorders;
it appears that the company's virtual reality products are not used
in OCD treatment.
- nOCD - "A mobile treatment
solution for Obsessive Compulsive Disorder". Pronounced
know-C-D, this iPhone/smartwatch app is a newer (2016)
technological aid for patients undergoing exposure and
response-prevention (ERP) therapy. I don't have an iPhone and
smartwatch on which to test the app, but my impressions based on
browsing the company's website are that the app (i) sounds
useful, (ii) appears well-thought-out, and (iii)
provides extensive capabilities for directing and monitoring an OCD
patient's ERP therapy. There is a subscription fee paid monthly or
at longer intervals; the fee doesn't seem out of line considering
the sophistication of the app. After viewing the app's
video, my only reservation about nOCD is that the OCD patient
must have a certain level of organization and self-discipline in
order to take full advantage of the app. I don't fall in that
category myself, but I imagine an avid iPhone and smartwatch user
Historically, drug therapy for OCD began with an old trycyclic antidepressant
(brand name Anafranil) and, then, further experimentation with a different
class of antidepressant drugs exploded into the use of Selective
Serotonin Reuptake Inhibitors (SSRIs) for OCD,
fluoxetine (brand name
Prozac) being one of the earliest and most popular SSRIs. Serotonin is a
neurotransmitter, a chemical released by a neuron to transmit a
signal to the next neuron(s) in sequence. After the signal has been received,
the serotonin is either taken back up by the first neuron or flushed out of
your system. SSRIs inhibit the reuptake of serotonin into the first neuron.
Despite years of research, it still not known why SSRIs affect depression
and OCD; e.g., is there too much or too little serotonin?
SSRIs generally have fewer side effects than clomipramine. There are many
SSRI brands and individual patients react differently (or don't react) to
different SSRIs. Furthermore, it can take months to ramp up to a clinically
significant level of dosage for a particular drug. Consequently, trying to
find a drug that works for you can be a long, tedious process. In
the end, you may or may not find such a drug. If you do find a drug that
works, hopefully you're able to live with its side effects and hopefully its
effect is not short-lived. (Spoken by someone for whom Zoloft magically
worked for a year and then stopped working, never to work again, even years
Fortunately, medications do help enough people with OCD to keep the industry
and research active. Newer drugs that affect other neurotransmitters alone
or in conjunction with serotonin have become available (e.g.,
Serotonin-Norepinephrine Reuptake Inhibitors or SNRIs).
Atypical antipsychotics—seen all the TV commercials lately for
Abilify?—are sometimes added to enhance the effect of an antidepressant.
Read the two articles below about the many different drugs used to treat OCD.
Keep in mind, especially when considering drugs for children, that drugs have
side effects. In my own family, the most common side effect was ravenous
appetite coupled with severe weight gain. That and tiredness. Counseling
self-discipline is not an option in the face of the drug's effects.
- Arizona Center for Education and
Research on Therapeutics (AzCERT) - is "an independent research
and education center whose mission is to improve therapeutic outcomes
and reduce adverse events caused by drug interactions and drugs that
prolong the QT interval". The site has a
list of drugs for which prolonged QT intervals or Torsades de
Pointes have been reported as side effects; a
list is of additional drugs—potential triggers—that
susceptible patients should avoid.
- Celexa (citalopram HBr)
- OCDCenter.org - is a web site
sponsored by the maker of Luvox
- Paxil (paroxetine HCl) - the "Paxil
Mental Health Weather Station", with panic disorder represented by a
severe lightning, depression by relentless rain, and OCD by a swirling
hurricane! (Warning: Beware of Paxil
withdrawal; if you're going off of Paxil, do so very gradually.
See Quitpaxil.info for more
- Prozac (fluoxetine hydrochloride)
Neurosurgery is only considered for very, very, very serious cases of OCD.
"How could I possibly be depressed after becoming a human transistor?
I think I've finally found meaning and purpose in life."
- jczer68 on Digg
Seriously, these types of therapy should, at the moment, be classified as
"Alternative Therapies". The effectiveness of the therapies remains to be
seen. Deep Brain Stimulation and Vagus Nerve Stimulation require invasive
surgery, reversible in both cases; alternate non-surgical methods of VNS
are becoming available.
- Deep Brain Stimulation (DBS)
- DBS for OCD
Study - Butler Hospital, Brown University. This is the study's
web page; for stories about the effectiveness of DBS, see the
Brain Stimulation as Depression Treatment" - is a Slashdot
discussion (April 27, 2006) about "the application of DBS therapy
in the treatment of intractable depression and OCD". The discussion
is very interesting in that it includes (i) postings from
people who don't know much about depression and OCD, and
(ii) responses from people who live with these disorders
every day. Naturally, there are a number of comic references to
the depressed robot in The Hitchhiker's Guide to the
- Transcranial Magnetic Stimulation (TMS)
My personal, unsuccesful experience with one-sided TMS for depression:
TMS consists of daily (Monday through Friday) sessions that last about
45 minutes and extend over a 6-week period. Approximately every 20
seconds in a session, there is a rapid-fire burst of magnetic pulses.
It feels like a woodpecker tapping on your head. Although just
slightly uncomfortable at first, it was not painful. I had no adverse
effects after each session, but, from reading about TMS on online
forums, it sounds like people prone to headaches are more likely to
get headaches. (From anecdotal evidence based solely on what was
reported in the forums, it sounded as if these folks were also more
likely to be helped by the treatment!) I have since learned that
there is ongoing research into more advanced forms of TMS.
- Vagus Nerve Stimulation (VNS)
- Cerbomed -
makes a transcutaneous VNS (t-VNS®) device, NEMOS®,
which stimulates the vagus nerve via an earphone-like electrode
that the patient wears, well, like an earphone. As such, no
surgery is required. NEMOS® looks like an MP3 player with
an earphone. The device is not yet approved for use in the
- Cyberonics, Inc. -
makes the implantable medical device, VNS Therapy®, commonly
used for VNS.
Look before you leap! I'm leery of
alternative therapies, hence my admonition. I much prefer the "evidence-based"
methods such as psychopharmacology (a big word for drugs) and behavior therapy.
That said, an individual may or may not find a drug that works for them;
a course of behavior therapy may or may not be effective, possibly
depending on the therapist you happened to choose. (A second admonition:
Do your homework beforehand!) Consequently,
trying alternative therapies is not out of the question. Simply the knowledge
that you're doing something to alleviate your OCD may make it easier
to live with. (Third admonition: Research safety
precautions and drug interactions for dietary supplements and herbal
- Cure OCD Naturally - using
"Emotional Freedom Techniques
(EFT)", "a form of psychological acupressure". A self-help book,
5 Milestones to a Cure to OCD, can be purchased and
downloaded in PDF format.
- Designed Thinking -
"For well over a decade Designed Thinking has provided help
to those needing to release unwanted thoughts and negative emotions."
The group, located in Rochester, Michigan, specializes in
An interesting aspect of the practice is that they primarily, I think,
work via phone consultations, not in-office or in-house visits, thus
enabling them to provide help to anyone with a phone.
- Dr. Fear - author of
Curing Phobias, Shyness, and Obsessive Compulsive
Disorders, apparently via relaxation techniques.
- Help-For Anxiety, Phobias, OCD and
Depression - advertises a self-help book, Evolving
Self-Confidence, that shows you how to overcome various anxiety
disorders by increasing your insight into your problems and increasing
your self-confidence. A free 40-page book,
Phobias, OCD and Depression, can be downloaded in PDF format.
OCD Alternative Therapies - lists more alternative therapies for
OCD than you can shake a stick at.
- The Kundalini Yoga
Meditation Video for Obsessive Compulsive Disorder -
demonstrates various meditation techniques to treat OCD.
Extension - recommends the standard drug therapies and
psychotherapies for OCD and suggests nutritional supplements that
"may help"; the web page commendably includes "Safety Caveats" for
- Mary's Herbs &
Iridology - takes a very sympathetic look at OCD and suggests
dietetic and herbal remedies. Also visit the related
OCD Free web site: "Alternative
Treatments for Obsessive Compulsive Disorder".
- MindSoothe -
"is a specially formulated herbal remedy that has been successfully
used in the treatment of OCD, Depression, Insomnia, and Anxiety." It
is a combination of St. John's Wort and Passiflora ("one of nature's
- NeuroMatrix Neural Efficiency
Training™ - appears to rely on neural feedback to treat OCD
and other disorders. Non-invasive EEGs are used to determine abnormal
frequency groups in a patient's brain waves; feedback training is then
used to bring the dysfunctional frequency groups back in the normal
range. (Dr. Marvin Sams of The Sams Center, Plano, Texas, USA)
- OCD, FOOD, EXERCISE
- OCD Hypnotherapy
- StopStressingNow.com -
advertises a self-help audio course on overcoming anxiety disorders
by Steven Diamond, author of OCD: A Life Among Secrets.
The site, formerly known as "When Anxiety Attacks", used to have an
excellent phone interview with Christopher Gibson, Ph.D. (formerly
of the Center for
Cognitive Behavioral Psychotherapy?). Dr. Gibson provided a more
nuanced view of the course than the testimonials on the web site do:
he saw possibilities in the course as an adjunct to, not a
replacement for, traditional treatment programs.
Field Therapy - think and tap? (TFT practitioners are found at
various places on the web; the link is to a Skeptical
Inquirer article, "Can We Really Tap Our Problems Away?
A Critical Analysis of Thought Field Therapy".)