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First Look: Working Through OCD

OCDblogWhat if you felt the uncontrollable need to wash your our hands up to 100 times per day? Or were over an hour late for work each day because you had to keep returning home to make sure your front door is locked? Or couldn’t stop yourself from imagining horrible disasters striking everyone you love, or worse, imagining yourself being the cause of those horrible disasters?

Most people can’t conceive of living with these kind of obstacles, but for patients with obsessive compulsive disorder (OCD), these type of issues are fundamental to their daily lives.

People with OCD have intrusive, upsetting, unwanted thoughts, worries, or superstitions so excessive that they cause significant life distress or disruption. They sometimes spend hours each day performing behavioral or mental rituals to temporarily quell their anxiety. Most people with OCD recognize that their fears are irrational, yet feel unable to resist the obsessions and compulsions. The disorder affects up to 4 million people in the United States, but remains a relatively misunderstood condition.  Events such as OCD Awareness Week, held this year from October 8 – 14, seek to educate more people about this condition.

To help OCD patients, a team of Perelman School of Medicine researchers, led by Edna Foa PhD, director of the Center for the Treatment and Study of Anxiety, are conducting the first study that examines whether one of the most effective forms of psychotherapy for obsessive compulsive disorder (OCD), exposure and ritual prevention (EX/RP), can help people with OCD achieve and maintain wellness after they stop taking the medications their doctors prescribe for their OCD.

The study is funded by the National Institute of Mental Health (NIMH)*, and is being conducted in collaboration with Helen Blair Simpson, MD, PhD, at the Anxiety Disorders Clinic at the New York State Psychiatric Institute.

With EX/RP therapy, a patient with OCD is exposed to the feared object or thought, either directly or by imagination, and then is discouraged or prevented from carrying out the usual compulsive response.  With this controlled exposure, the patient gradually experiences less anxiety from the obsessive thoughts and becomes able to do without the compulsive actions for extended periods of time.

In previous studies, Drs. Foa and Simpson have demonstrated that EX/RP helps to reduce OCD obsessions and compulsions in patients currently on medication that are still suffering from distressing symptoms.

Kate, a 31-year-old who works in fundraising, experienced years of frustration, depression, and anxiety over her OCD symptoms. She constantly dwelled on disturbing thoughts that bad things would happen to her friends and family. She was able to cope day-to-day, but her fears prevented her from living a normal life.

“My entire life revolved around waking up, going to work to financially support myself, and coming home to head back to bed,” she recalls. “I didn’t want to leave the house to do anything else because I was afraid of triggering my obsessive thoughts. It was an enormous burden.”

She sought help from a variety of resources, but couldn’t find the right treatment.

The main pharmaceutical treatment for OCD is with selective serotonin reuptake inhibitors (SSRIs), which are antidepressants that block the re-absorption of serotonin in the brain. Although SSRIs are commonly given for depression, research has shown they can also be effective for the treatment of anxiety. Many patients with OCD respond well to a pharmaceutical therapy, but most  experience residual symptoms even with this treatment. Mental health experts say this partial response is common and “true” remissions (periods when patients experience no symptoms) are very rare. 

Kate was placed on an SSRI, but the medication didn’t provide much relief from her symptoms. “I really felt like I would never get married or have children because I would never be able to get control of my thoughts,” she says.

In addition to medications, EX/RP has been found to be effective in reducing OCD symptoms. Adding EX/RP to medication helps patients to further reduce their OCD symptoms but many patients either can’t or won’t use medications indefinitely because of health problems or because of the medication side effects.

For Kate, who eventually found her way to Penn, the EX/RP therapy was truly a life saver.

“With OCD, you spend so much time performing rituals to push the fears away,” she says. “Using the EX/RP therapy, I was able for the first time to hear myself say what I was afraid of and face those fears with the support of someone who understood. It truly saved my life.”

In the new study, OCD patients are receiving EX/RP for 8 weeks while staying on their medication. Those who achieve substantial reduction in their OCD symptoms will either remain on their medication or be switched to placebo pills; patients’ symptoms will be closely monitored by their psychiatrist and psychologist throughout the study. 

“Examining whether EX/RP can help OCD patients maintain wellness after discontinuing their SRI addresses an important clinical issue,” says Dr. Foa.  “Our goal with this new study is to provide clinicians with effective treatment strategies to help people with OCD live full and productive lives.”

*The research is funded by NIMH grant 5-R01-MH045404-20.

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