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I Have a Phobia, and I Wish People Understood Just How Debilitating It Can Be

When people hear about phobias, they usually think that they’re silly or over-exaggerated — but while phobias are, in fact, irrational, that does not make them any less frightening or crippling for those of us who live with them.

I know this because I live with a serious phobia: emetophobia, or the fear of vomit. I don’t remember how or when it began. I have an anxiety disorder, depression, and obsessive-compulsive disorder, and I have had all three for most of my life, despite not being diagnosed until college. For years, I’ve tried to trace back what “caused” my phobia and have come up empty handed, beyond it being linked to my other mental health issues. Phobias are somewhat common in people with obsessive-compulsive disorder, specifically. While OCD is often thought of as an obsession with cleanliness and checking things like whether or not you locked the door, for many people, obsessive and intrusive thoughts are a large part of the disorder. These can include phobias.

My specific phobia tends to escalate in times of extreme stress. In college, when I was under a significant amount of stress, I noticed that my anxiety about the idea of me or someone close to me getting sick began to skyrocket. At that time, I worked at a call center. Instead of being able to brush it off, I started worrying about using the restroom at work. Most of the time, I would ask a friend to “check” the restroom first, making sure that no one was actively ill before I entered. After awhile, even that was not enough for me and I would use my lunch break to drive home and use my bathroom instead of eating lunch. On days when I could not go home, I would hold it until the end of my shift, resulting in a bladder infection that spread to my kidneys and made me so ill I was nearly hospitalized.

While something like using a restroom seems simple for most folks, phobias can affect daily activities in extreme ways. For example, a severe fear of flying can keep people from traveling, even for important family events. People with a fear of public speaking may lose out on opportunities for advancement at work or doing well in school if they refuse to speak in front of others. Phobias may seem ridiculous, but the consequences of suffering from one can be serious and far-reaching.

How I Coped With Having OCD in College
When I Moved to College, I Faced the Unique Challenge of Navigating OCD on My Own

Even when my stress levels aren’t as high, this phobia makes my life extremely complicated. I never lived in dorms or drank in college. I’m also not able to enjoy concerts or music festivals at times because of my deep fear of someone near me becoming ill. Before I see movies, I check a website that notifies parents of all kinds of potentially upsetting scenes in films, so I can decide whether to forgo the movie or simply leave the theater during a scene that might be triggering. When I’m at my most anxious, flying is nearly impossible. While these things may feel small or silly, they impact how I spend my time and the things I do.

Like many people with phobias and OCD, I have rituals, routines, and habits designed to keep me from encountering the thing I’m afraid of, or to prevent something bad from happening. I have a protocol in place for any time I feel nauseous. But while there’s no “cure” for my phobia, it has gotten better. I’ve been working on my general anxiety for years now, and I have fast-acting medications, mantras, and breathing exercises that really help me when I’m forced to confront my fear. I’ve been in regular therapy since I was 19, where we often focus on reducing the number of intrusive thoughts I experience.

While I still experience fear, on the average day, it does not change the things I do in most cases. I’ve learned to live within the phobia and to most people, on the outside, my life and behaviors appear to be “normal.” Those close to me are aware of my fear, as well as my other diagnoses, and I welcome their help and support when I’m struggling.

Not everyone understands the severity of this phobia, or of phobias in general, but I try to be patient and kind when I encounter people who do not take it seriously. Most of all, I try to be patient and kind with myself. I remind myself that I did not choose this phobia, and that there is nothing “wrong” with me, just like there is nothing wrong with anyone with any other mental illness. Instead, I do the best I can to live a normal life and not beat myself up when my phobia gets the best of me.

How to help someone with OCD

Published Sunday, Aug. 9, 2020, 8:55 am

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OCD is an anxiety disorder that causes repetitive thoughts or sensations (obsessions), which lead the patients to do something repeatedly (compulsions). These obsessions and compulsions interfere with daily functioning, leading to distress if the compulsive actions are not undertaken – even if most patients know that their compulsions are unnecessary.

Challenges of people with OCD

For someone with OCD, or as a caregiver for someone with OCD, you know that thoughts that are very random turn out to be unreasonably overwhelming. For some people, it is the irrational urge to clean, or the irresistible need to arrange objects in patterns, or overwhelmingly consuming thoughts of religious or forbidden sexual thoughts. The most common challenges of OCD are:

  • Fear of rejection or discrimination: People with OCD are constantly afraid that people would dismiss them because of their mental illness, even though discrimination based on mental health is illegal.
  • Not knowing where to find treatment: Many people with OCD say that they don’t know where to find the treatment for their illness, and others may have financial restraints in seeking psychotherapy. However, there are many financially-assisted programs for people with mental illnesses that would help them get the treatment they need free of cost or for a minimal fee.
  • Not believing symptoms to be severe enough: Many people reject treatment or help because they don’t think that their symptoms are severe enough or that getting help would improve their quality of life.
  • Fear of change: Seeking treatment may look like you’re giving up control of your life the way you’re used to, but treatment actually helps patients gain greater control.
  • Embarrassment: It is understandably embarrassing to reveal your obsessions to someone, especially if they pertain to sex or forbidden thoughts, but therapists are experienced in all kinds of obsessions and know how to deal with them.

Providing support to someone with OCD

There are four steps to help someone with OCD, and these would be especially useful if you’re a family caregiver for someone with the condition.

  • Help them develop a determination to overcome the problem. This is a tough call, and going through short-term pain for long-term gain may seem daunting, but if a patient sets their mind to it, they can greatly help themselves.
  • Make them understand that their worries are irrational. The obsessions may be powerfully disturbing, but the patient has to learn to dismiss them and realize that what they fear is not going to happen.
  • Make them see that ritualizing a compulsion is not the solution to their distress. Resisting the urges is the only way to understand that nothing will happen if they don’t act on their compulsions.
  • Help them accept their obsessions. This may seem terrifying, but once a patient learns to admit that they have obsessions and that they don’t need to act on them, they will be on the path to a better, less anxious life.

Getting support

If you are a family caregiver for someone with OCD, we understand that you’ve taken on a tough role, which is all the more applaudable. If you ever feel exhausted or stressed and want to speak with someone who relates, try ExtendaTouch’s OCD support group online. You can use the online helpline to connect with other caregivers with similar experiences. The online community members can provide you emotional support besides sharing useful information with you.

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Mental disorders affect more than half of COVID-19 survivors: study

TORONTO —
An alarming new study suggests that the majority of people who recover from COVID-19 suffer from at least one mental disorder a month after treatment, raising serious concerns about lingering psychological effects of the virus.

The research, published online last week in the journal Brain, Behavior and Immunity, screened 402 adult survivors of COVID-19 and found that 55 per cent presented a clinical score for at least one mental disorder.

Anxiety was the most prevalent affliction, impacting 42 per cent of affected patients, followed by insomnia (40 per cent), depression (31 per cent), post-traumatic stress disorder (28 per cent) and obsessive-compulsive symptoms (20 per cent).

One patient described how, three weeks after their treatment, they suffered from terrifying panic attacks in the middle of the night that made them feel “as if I was to die.”

“I stayed there out on the balcony, for hours, trying to put fresh air into my lungs. It was terrible. Panic made me suffer more than COVID,” the patient wrote in a follow-up report.

Researchers surveyed 265 men and 137 women during follow-up appointments one month after hospitalization. Women were more likely than men to suffer from anxiety and depression, researchers found, and patients with a history of psychiatric diagnoses had a higher rate of mental disorders.

Researchers call their findings “alarming” and recommend that survivors undergo mental health assessment as part of their recovery. As well, they say more research on inflammatory biomarkers is necessary in order to treat emergent psychiatric conditions.

The high prevalence of mental health disorders among COVID-19 survivors may be due to inflammation, researchers say, pointing to an earlier study that suggests inflammation has a direct impact on several neurotransmitter systems in the brain responsible for motivation, anxiety and arousal. Other factors may include traumatic memories of severe illness and social isolation during treatment, researchers wrote.

Other research released earlier this month suggested that a significant proportion of COVID-19 patients may experience delirium in the acute stage of the illness, and that doctors should be aware of the possibility of long-term issues such as depression, anxiety, fatigue, post-traumatic stress disorder, and rarer neuropsychiatric syndromes. However, the same research suggested that if COVID-19 follows a similar trajectory as SARS and MERS, then “most patients should recover without experiencing mental illness.”

Exposure to other coronaviruses, including SARS and MERS, has been linked to neuropsychiatric diseases such as depression, PTSD, obsessive compulsive disorder and panic disorder among some patients. These conditions were reported anywhere from one to 50 months following treatment.

Persistent physical symptoms that last for months have also been reported among some COVID-19 survivors. These self-described “long-haulers” say they continue to suffer from a range of chronic ailments including fatigue, chest pain, heart palpitations, high-blood pressure, sinus issues, loss of taste, shortness of breath and a dry cough.

Mental disorders are not currently listed among Health Canada’s list of 11 symptoms of COVID-19. However, multiple studies have suggested that levels of anxiety and depression have spiked among Canadians since the start of the pandemic.

Exposure and Response Prevention for Obsessive-Compulsive Disorder: A Case Study of a Veteran With Violent Intrusive Thoughts.

Exposure and Response Prevention (ERP) is the gold standard treatment for obsessive-compulsive disorder (OCD); however, few studies have evaluated the use of ERP with veterans. This case study describes ERP and medication treatment of a veteran who experienced violent sexual thoughts, countered by compulsions of focusing on the distressing thought to ensure a negative emotion or reversing the thought to a nonviolent thought or image. The veteran had previously received supportive psychotherapy and medication for depression, anxiety, and sleep difficulties, with poor treatment adherence. Upon reengagement in treatment, the therapist provided ERP in 34 sessions over 14 months, with 15 sessions via video telehealth to home. The patient used the OCD Workbook as a resource throughout treatment. The patient developed a hierarchy of target obsessions and rituals with associated subjective units of distress; completed exposures, beginning with lower-level items; and wrote imaginal scripts. He also received zolpidem for insomnia and venlafaxine for anxiety and depression. His scores on the nine-item Patient Health Questionnaire and Yale Brown Obsessive-Compulsive Scale decreased significantly.© Copyright 2019 Springer Publishing Company, LLC.

References

PubMed

Did Actress Take ‘Healthy’ Eating Too Far?

A photo of Teresa Palmer and her children
A photo of Teresa Palmer and her children


Australian actress Teresa Palmer revealed that she previously had an eating disorder called orthorexia, and that becoming a mother had “liberated” her. According to the National Eating Disorders Association, orthorexia is “an obsession with proper or ‘healthful’ eating.”

Palmer, known for her roles in the films “Bedtime Stories,” “The Sorcerer’s Apprentice,” “The Ever After,” and “Hacksaw Ridge,” spoke about her struggles on the podcast “Mama Mia: Me After You“: “I was incredibly clean with my eating, so I didn’t have anorexia or bulimia, but I had something different, which is when you become so obsessed with the amount of calories you’re putting into your body; everything had to be of the highest quality. I wouldn’t eat anything stripped of its nutritional value.”

Palmer says her eating disorder started in 2008, when an agent, after seeing a paparazzi picture of her in a bikini, told her that she needed to work out more: “She said, ‘Do you know what? You should start working out, because that’s a part of your job. You need to make sure that you look really good.’ And I was like, ‘Oh, I thought I did look good.'”

But Palmer said that having orthorexia took a toll on her: “It was exhausting, utterly exhausting, to log every calorie and to just be so overly conscious of the food I was putting into my body.”

Now, being the mother of three children, ages 1, 3, and 6, she says pregnancy made her see her body in a different light. “My body just blossomed and I had this big belly and I could feel life within me, and it was just incredible seeing what my body could do.”

“I was finally liberated from these judgments that I had surrounding my body, which I realized had existed since I was … a teenager,” she said. “Since being a mum, I’ve embraced it all. The lumps and the bumps and the stretch marks … it’s a map of my journey of bringing my babies into the world.”

What is Orthorexia?

The term “orthorexia,” or orthorexia nervosa, was coined in 1997 as an eating disorder associated with an obsession with proper or “healthful” eating. Those with the disorder become so fixated on healthy eating that they can damage their own well-being.

Currently, orthorexia is not formally recognized in the DSM-5. It is sometimes put into the “unspecified eating disorder” category. This makes it difficult to get precise numbers of how many people are affected with the disorder, but several studies estimate the prevalence at about 1%.

Moroze et al. suggested the following diagnostic criteria for orthorexia nervosa:

Criterion A: Obsessional preoccupation with eating “healthy foods,” focusing on concerns regarding the quality and composition of meals. A patient should have two or more of the following:

  • Consuming a nutritionally unbalanced diet due to preoccupying beliefs about food “purity”
  • Preoccupation and worries about eating impure or unhealthy foods and of the effect of food quality and composition on physical or emotional health or both
  • Rigid avoidance of foods believed by the patient to be “unhealthy,” which may include foods containing any fat, preservatives, food additives, animal products, or other ingredients considered by the subject to be unhealthy
  • Excessive amounts of time (more than 3 hrs/day) spent reading about, acquiring, and preparing specific types of foods based on their perceived quality and composition
  • Guilty feelings and worries after transgressions in which “unhealthy” or “impure” foods are consumed
  • Intolerance to other’s food beliefs
  • Spending excessive amounts of money relative to one’s income on foods because of their perceived quality and composition

Criterion B: The obsessional preoccupation causes impairment by either of the following:

  • Impairment of physical health due to nutritional imbalances (i.e. developing malnutrition because of an unbalanced diet)
  • Severe distress or impairment of social, academic, or vocational functioning owing to obsessional thoughts and behaviors focusing on the patient’s beliefs about “healthy” eating

Criterion C: The disturbance is not merely an exacerbation of the symptoms of another disorder such as obsessive-compulsive disorder or of schizophrenia or another psychotic disorder.

Criterion D: The behavior is not accounted for by orthodox religious food observance or with concerns with special dietary requirements due to medical diagnoses, such as food allergies or medical conditions with dietary restrictions.

Because of the overlapping symptoms, some have questioned whether orthorexia is a unique disorder or a subset of anorexia nervosa or obsessive-compulsive disorder. However, Koven and Abry pointed out that there are “notable points of departure between orthorexia and these other conditions.”

For example, there are currently no medical treatments designed specifically for orthorexia. Experts recommend a multifaceted approach that includes physicians, psychotherapists, and dietitians. As there is an overlap in symptoms with anorexia nervosa and obsessive-compulsive disorder, serotonin reuptake inhibitors may help with anxiety and obsessive-compulsive traits. However, there are no reported studies on the efficacy of psychotherapies or psychotropic drugs for orthorexia.

Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.

Casey Chertavian ’21 Investigates Obsessive-Compulsive Disorder in Children

Chertavian is one of more than a dozen Bowdoin students who received funding this summer from Bowdoin’s office of Career Exploration and Development to support internships, only to have the pandemic derail their plans. They all got resourceful, though, and rescued their summer work plans by finding new programs.

Chertavian is currently assisting Dr. Alexander-Bloch’s lab at the Children’s Hospital of Pennsylvania. The lab is researching the neural connectivity of children with symptoms of obsessive-compulsive disorder (OCD), with the ultimate goal of improving the diagnosis and treatment of the disorder in young people.

Using data from resting-state functional magnetic resonance images (fMRI) of children with OCD symptoms, the lab is trying to better understand how different areas of the brain are connected and coordinated. “Children or people with OCD have certain parts of their brains that are overconnected, and parts that are underconnected,” Chertavian said.

Research on pediatric OCD is rare. To help provide Alexander-Bloch with background knowledge, she is reading and writing summaries of previous resting-state fMRI studies that have examined the brains of children with a variety of disorders like OCD, schizophrenia, major depressive disorder, generalized anxiety, bulimia, and attention-deficit disorder.

She is also helping to analyze a large set of pertinent neurodevelopment data with R programming language—a language for statistical computing and graphics widely used among statisticians and data miners. Using her analyses, she is making graphs called connectograms to visually represent functional connectivity with lines showing which areas of the brain are coordinated. 

The internship is remote, and Chertavian has had to independently become more adept with the R language this summer—a skill she has appreciated sharpening. She also said that after reading 100 or more science papers, her ability to synthesize scholarly articles has also taken a leap forward.

“That is always a good skill, especially because I want to be someone who translates research into a way people understand it better,” she said.

A neuroscience and education major, Chertavian is interested in pursuing a research career that helps put the science on effective pedagogy into the hands of teachers. When educators aren’t aware of what science is discovering, “kids aren’t studying or learning in ways that have been proven to be the most predictive,” she said.

Best Life: Coping with OCD during COVID-19

Although you may believe you are becoming OCD due to the coronavirus, experts say being overly organized or excessively clean are just personality traits. To be diagnosed with OCD, your actions and thoughts have to be followed with obsessive patterns. Once everything calms down, experts believe all of our anxiety levels will go back to normal. If you would like more info on OCD and ways to find help, go to the international OCD foundation at iocdf.org.

How COVID-19 crisis is impacting those with OCD

Fears of transmitting coronavirus have everyone checking the news and being extra careful with handwashing.

For people with obsessive-compulsive disorder, or OCD, this crisis is particularly difficult because it can be hard to decide which behaviors are reasonable and which reflect excess anxiety.

Patients with OCD live with excessive fears that turn into obsessive thoughts that spark compulsive behaviors, and now coronavirus is intensifying all of it.

“I think the biggest issue for people with OCD is that everything is out of control,” said college professor Michelle Szydlowski, who lives with OCD.

With medication and therapy, Szydlowski was able to control her OCD — until COVID-19 rattled her world.

“On the way to the store, I actually had what I would describe as a panic attack,” Szydlowski said.

Experts say the fear of the virus can intensify OCD symptoms.

“I have actually seen that it’s affecting people more in the way that their routines have changed,” said Kelsey Blahnik, a licensed clinical social worker.

But there are ways to regain control.

“The No. 1 thing would be to limit media absorption to maybe once a day,” Blahnik said.

Follow the media exposure by doing something positive, like writing in a gratitude journal, exercising or connecting with someone.

“Have a trustworthy person nearby to help you decipher what are those obsessive thoughts and what are true thoughts,” said Lauren Eadie, a mental health counselor.

And don’t let your behaviors get out of control.

Szydlowski hopes the pandemic will help to change opinions about OCD.

“It is somewhat liberating when I go to the CDC website and see them making recommendations of things that I was doing anyway, I feel like saying, yes,” Szydlowski said, smiling.

Although you may believe you are experiencing OCD due to the coronavirus, experts say being overly organized or excessively clean are just personality traits.

To be diagnosed with OCD, your actions and thoughts have to be followed with obsessive patterns. Once everything calms down, experts believe all of our anxiety levels will go back to normal.

If you would like more info on OCD and ways to find help, go to the international OCD foundation at iocdf.org.

COVID-19 pandemic: Incidence of phobia, anxiety disorder up: Experts

Minna Zutshi

Tribune News Service

Ludhiana, July 24

A few tips

  • Stay informed

  • Do not keep watching news the entire day

  • Remain in communication with your near and dear ones, video chatting helps

  • Follow a dincharya (daily routine)

  • Stay active

  • Hobbies help

  • Music therapy, art therapy are healing

  • Meditation, playing with pets, talks with friends have a positive impact

Even as the ‘normal behaviour’ is registering a change in the wake of the Covid-19 pandemic, psychologists and counsellors from the city are reporting an increase in the incidence of phobias and anxiety disorders among people. “People are experiencing social isolation. Problems like anxiety, depression, Obsessive Compulsive Disorders (OCDs) are showing an increase,” says a city-based psychologist and counselor, Dr Ravinder Kala.

Emotional deprivation is exacerbating these problems. “We, as a people, are used to touching and hugging. But with restricted social interactions, the people are feeling emotionally deprived,” she adds.

A 35-year-old Ludhiana-based schoolteacher, requesting anonymity, says the pandemic dominates his thoughts. “The first thought that crosses my mind in the morning is Covid-related. I worry about the safety and health of my children. At night, too, I have anxious thoughts about Covid-19. I get very worried when youngsters in the family show carelessness about precautions and guidelines,” says the teacher.

According to experts, in some cases, the precautions become ritualistic and elaborate to a pathological degree. There is a feeling of loneliness and a worry about life. Such people are too scared even to venture out of their homes. Those who are already anxious and have low coping abilities are more affected. At the other extreme are the individuals who throw all caution to the winds. “Whenever we face any potentially threatening situation, with time our anxiety level becomes a little less intense. This is due to habituation. In fact, habituation makes us less fearful and also less cautious,” explains Dr Kala.

An Ayurveda consultant and counselor, Dr Suneet Aurora, talks about ‘emotional immunity’. “As the world grapples with the Covid-19 pandemic, the term ‘emotional immunity’ assumes significance. Just as we need immunity in our body to prevent and fight infections and inflammations, so we need a strong emotional immunity too,” he said during a web-talk. He defines ‘emotional immunity’ as having a balanced mind that is resistant to negative stimulus. “Lockdown was same for everyone, but people suffered according to the condition of their physical, emotional and financial immunity.”

How is the COVID-19 pandemic affecting those with OCD?

ORLANDO, Fla. (Ivanhoe Newswire) – Fears of transmitting coronavirus have everyone checking the news and being extra careful with handwashing. For people with obsessive-compulsive disorder, or OCD, this crisis is particularly difficult. It can be hard to decide which behaviors are reasonable and which reflect excess anxiety.

“I would sit on the edge of my couch with baby wipes, a container of baby wipes and a can of Lysol,” explained Cathy Fowlkes.

“I would have to take five steps forward and five steps back for some reason, five became my number,” shared college professor Michelle Szydlowski.

Living with excessive fears that turn into obsessive thoughts that spark compulsive behaviors, and now coronavirus is intensifying all of it.

“I think that’s the biggest issue for people with OCD is that everything is out of control,” continued Szydlowski.

With medication and therapy, Szydlowski was able to control her OCD until COVID-19 rattled her world.

“On the way to the store I actually had what I would describe as a panic attack,” stated Szydlowski.

Experts say the fear of the virus can intensify symptoms.

“I have actually seen that it’s affecting people more in the way that their routines have changed,” said Kelsey Blahnik, Licensed Clinical Social Worker.

But there are ways to re-gain control.

“The number one thing would be to limit media absorption to maybe once a day,” continued Blahnik.

Follow the exposure by doing something positive. Write a gratitude journal, exercise or connect with someone.

“Have a trustworthy person nearby to help you decipher what are those obsessive thoughts and what are true thoughts,” shared Lauren Eadie, LMHC, Mental Health Counselor.

And don’t let your behaviors get out of control. Szydlowski hopes the pandemic will help to change opinions about OCD.

“It is somewhat liberating when I go to the CDC website and see them making recommendations of things that I was doing anyway, I feel like saying, yes,” smiled Szydlowski.

Although you may believe you are becoming OCD due to the coronavirus, experts say being overly organized or excessively clean are just personality traits. To be diagnosed with OCD, your actions and thoughts have to be followed with obsessive patterns. Once everything calms down, experts believe all of our anxiety levels will go back to normal. If you would like more info on OCD and ways to find help, go to the international OCD foundation at iocdf.org.

Contributors to this news report include:

Psilocybin & OCD: Can psychedelics treat obsessive compulsive disorder?

A new review from neuroethicist Eddie Jacobs, and published in the Journal of Psychedelic Studies, is suggesting psilocybin may have great potential as a treatment for obsessive-compulsive disorder (OCD). Jacobs, from King’s College London and the University of Oxford, says it is surprising how little focus has been on the therapeutic potential of psilocybin in treating OCD, and he points to a number of new clinical trials that are finally exploring this promising treatment.

The ongoing psychedelic science renaissance has delivered a number of remarkable breakthroughs in recent years. From the incredible results seen in MDMA-assisted psychotherapy trials for PTSD, to the equally potent data coming from psilocybin psychotherapy for major depression, we will inevitably see psychedelic medicine finally become a legal therapy within the next few years.

Psilocybin, a natural psychedelic compound found in magic mushrooms, has been granted Breakthrough Status designation by the FDA on two occasions in recent years for treatment-resistant depression and major depressive disorder. The Breakthrough Therapy status is an indication early clinical evidence is strong and clinically meaningful. Alongside depression, psilocybin therapy is also seen to be effective in helping terminal cancer patients deal with end of life anxiety.

How can psilocybin help OCD?

OCD is the fourth most common mental illness, after depression, substance abuse and specific phobias. Affecting more than 2 percent of people at some point in their life, OCD can be profoundly distressing and disruptive.

Eddie Jacobs’ interest in psilocybin for OCD arose when he discovered how little research attention had been directed at this particular therapeutic outcome. He suggests that, although much excitement surrounds the results of psilocybin therapy for conditions such as depression and anxiety, the treatment should hypothetically also be effective for OCD.

“OCD seems to perfectly encapsulate the sorts of maladaptive processes that we know – from clinical and experimental trials, and anecdotal report – psychedelics can interrupt rigidly repeating patterns of thought and behavior that people want to escape, but struggle to,” says Jacobs in an email to New Atlas.

Jacobs’ new review article set out to fill a gap in our body of knowledge, effectively summarizing what we know about OCD and psilocybin therapy, while also offering an outline of what research has been done up till now.

“There are reports from back in the first age of psychedelic therapy that suggested OCD symptoms were amendable to this sort of treatment,” says Jacobs. “Frustratingly, a lot of the research from those days doesn’t match up to modern standards of rigor, so we’re probably best to consider them clues pointing in a direction, rather than firm evidence in and of themselves. The other evidence for psilocybin in OCD – case reports and (quite a lot!) of anecdotal reports, are the same.”

Alongside these anecdotal reports and case studies there are several strong mechanistic hypotheses to explain how psilocybin could be useful in treating OCD. One of those hypotheses, for example, relates to a large-scale interconnected collection of brain regions, known as the default mode network (DMN).

The DMN is essentially the state of our brain when we are at rest, not sleeping, but instead the “default” mode of brain connectivity when we are not performing active tasks. DMN activity is linked with self-reflection and daydreaming, and dysfunction in one’s DMN has been associated with depression and anxiety.

Psilocybin has been found to serve a little like a reset button for a dysfunctional DMN. Imaging studies have revealed a single dose of psilocybin can temporarily disintegrate resting state networks such as the DMN. And many researchers hypothesize this pharmacological action plays a part in the positive therapeutic outcomes seen in psilocybin therapy.

Jacobs suggests there is some evidence dysfunctional DMN activity plays a role in OCD by enhancing self-referential cognitive processing. And it is reasonable to hypothesize psilocybin could help “reset” this dysfunction in OCD patients.

“The disruption and reintegration ‘reset’ in DMN activity that is seen with psilocybin may, in OCD patients, allow the easing of an overly strong, top-down filtering bias, thereby re-establishing normal responsiveness towards the environment,” explains Jacobs in the published review.

The one modern clinical trial

To date there has only been one clinical investigation of psilocybin for OCD, conducted in the early days of the psychedelic science renaissance by Francisco Moreno and colleagues at the University of Arizona. The study, published in 2006, recruited nine OCD patients classified with moderate to severe symptoms.

Each patient was administered three doses of psilocybin, separated a week apart, with each dose escalating in potency. As well as establishing a safety profile for administering the psychedelic in this type of cohort, the study was primarily looking at whether the treatment offers short-term relief from severe OCD symptoms in the 24-hour period following a dose.

The results found all patients displayed some kind of symptomatic relief from their OCD symptoms in the 24-hour period following a treatment. The long-term effects were less impressive, but still relevant, with two subjects reporting relief for up to a week, and one patient remarkably showing sustained remission from OCD symptoms at a six-month follow-up.

“OCD is currently not very well treated; even when our current approaches work, there’s still significant residual symptoms,” says Jacobs, in reference to the Moreno study. “Considering that context, and considering the Moreno study wanted to confirm an effect over the course of 24 hours following treatment, having a patient in remission six months later is pretty impressive.”

Moreno and his University of Arizona team are currently running a more rigorous, placebo-controlled trial investigating the effects of psilocybin on OCD. The trial involves eight weekly psilocybin doses, accompanied by comprehensive neuroimaging, and a long follow-up to measure any sustained effects six months later.

The drug, the therapy, or both?

An interesting question raised by Moreno’s work is whether psilocybin treatments need to be embedded within a larger therapeutic program. Most of the advanced clinical trial work investigating psilocybin for depression and anxiety incorporates one or two active drug sessions into a longer program involving preparatory psychotherapy and follow-up integration therapy. All up, a clinical treatment for psychedelic-assisted psychotherapy can last up to three months.

The Moreno research notably divorces a psilocybin session from any broad psychotherapy program. This implies the sole pharmacological effect of a few psilocybin doses is enough to generate broadly beneficial outcomes. Jacobs suggests psilocybin most likely does confer some degree of intrinsic pharmacological effect, but the current research also affirms the benefits are indeed amplified when integrated into a larger psychotherapeutic program.

“My sense is that, in general, psilocybin therapy is enhanced by placing it within a wider psychotherapeutic program: it’s well established now that there is an ‘afterglow’ period following a psychedelic session, where there is an enhanced level of psychological and neurological flexibility,” Jacobs tells New Atlas. “I suspect that in most conditions, this period of malleability is a powerful opportunity to make positive changes, which therapy can help.”

However, Jacobs also notes this does not mean administering psilocybin outside of psychotherapeutic structures would be useless. He says the ideal methods for administering psychedelic therapies have yet to be determined, and there may be some conditions that benefit from shorter therapies.

“… a long program of therapy is expensive to administer, and there may be some conditions for which this is a nice extra, rather than a necessity,” says Jacobs. “Perhaps OCD is one of these – you see a good deal of reports of people successfully self-medicating their OCD by microdosing Psilocybe mushrooms. OCD doesn’t tend to respond to placebos as much as other conditions, so it seems plausible that the treatment effect is real, and comes about by physiological, rather than psychological, processes.”

Looking forward…

Moreno’s current clinical trial is not the only one investigating psilocybin’s potential for OCD. A similar Yale University clinical trial is underway looking primarily at the short-term effects of a single psilocybin dose on acute OCD symptoms. A UK organization called Orchard is also currently raising funds to conduct a psilocybin/OCD trial in association with a psychedelic research team from Imperial College London.

Ultimately, while all the signs promisingly suggest psilocybin therapy could be an effective treatment for OCD, the research is not quite there yet. And despite the explosion of progress in psychedelic science over the past decade, there are still huge hurdles slowing research down. Legal restrictions inhibit easy access to the psychedelic compounds; political and social taboos still frustrate academic processes and study approvals; and the inability to easily profit from these old, off-patent compounds mean big pharmaceutical companies have no interest in paying for novel studies.

So, while we may be seeing some incredible and innovative studies demonstrating novel therapeutic uses for psychedelic drugs, there are still a number of research questions that need to be answered. Not the least of which is exactly how psychedelic therapy works, and what are the best techniques to optimize its outcomes.

“We’re still a long, long way from determining how psilocybin (therapy) works,” says Jacobs. “There are a lot of dials to adjust that we have good reason to believe influence treatment success: e.g., dosage, number of sessions and space between them, style of therapy during and around the sessions. Frustratingly, the obstacles put in the way of psychedelic research mean it’s going to be a long time while we tune these dials to get the best effect.”

The new review article was published in the Journal of Psychedelic Studies.

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