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Dr. Deb’s Mental Health Vitamin: Obsessive-Compulsive Disorder

Dr. Deb Wade

By Dr. Deb Wade
GCU Vice President, Counseling and Psychological Services

I once had a client who entered my waiting room and could not find a seat. Oh, there was ample seating available in the waiting area  She came in and she chose one. After a few seconds, she got up and moved to another seat; again, in a few seconds, she got up and sat in a different one.

This action was repeated until it was her time to come into my office. Once in the office, she actually changed seats twice during the session. Why? Because she was living with Obsessive-Compulsive Disorder. It is a real diagnosis, can be very debilitating, and the one who is afflicted can feel powerless to change things.

Obsessive-Compulsive Disorder (OCD) can be the “go-to response” for many who are frustrated, overwhelmed, and scattered. They might say, “Oh, I’m so OCD today.” 

However, when the diagnosis is present, it is not a sometime thing; it’s an all-the-time thing.

Of course, virtually everyone has experienced worries, doubts, or fears at one time or another. And … it’s natural to worry about life issues such as one’s health, the wellbeing of someone you love, paying bills or what lies ahead. Likely, too, everyone has had an intrusive thought – even a “bad” one – but none of that is OCD.

OCD is characterized by obsessive thoughts, impulses or images and compulsions (either overt or mental rituals) that are difficult to suppress and take a considerable amount of time and energy away from the living of a normal, healthy life.  

Back to my client: Not only did she exhibit ritualistic and repetitive behaviors in my office (the rapid changing of seats and being uncomfortable in each of them); her work life was also greatly impacted by her condition.

She worked as a teller in a bank, which required that she “balance her drawer” every evening before leaving. She described to me, through much emotional pain and tearfulness, that she was “so afraid that I’ll get fired” because most nights she would check, re-check, re-check and re-check – even if the drawer balanced – because she could not trust herself enough to believe that she was free to go home.

Many nights she was there late enough to walk out of the building with the night custodian only after his task of cleaning the bank was complete.

Furthermore, her compulsions did not stop there – once home, she was involved in a “checking ritual.” She would repeatedly check the locks on the doors and make sure that her oven, stove and coffee pot were turned off.

Many times, she would not get sound sleep because she was in the compulsive ritual of getting out of bed repeatedly to “check” these items. Needless to say, she was physically and emotionally drained!

If any of this sounds familiar, let’s examine the symptomatology of Obsessive-Compulsive Disorder:

Obsessions – Intrusive, irrational thoughts or impulses that repeatedly occur. People who are afflicted know these thoughts are irrational but are afraid that somehow they might be true. Examples include:

  • Doubts about something being done right, such as turning off the stove or locking a door
  • Unpleasant sexual images
  • Fear of saying or shouting inappropriate things in public
  • Recurrent, persistent thoughts, urges or images that cause significant anxiety or distress

Compulsions – Repetitive acts that temporarily relieve the stress brought on by the obsession. People afflicted know that these rituals don’t make sense but must perform them to relieve anxiety and, in some instances, to prevent something bad happening. Examples include:

  • Excessive hand washing because of a fear of germs
  • Counting and recounting money
  • Reading a passage over and over because of a fear that something bad will happen
  • Walking in a specific pattern in order to prevent serious harm to a loved one

If any of this sounds familiar to you or you’ve witnessed a loved one engage in these behaviors, there is help for this.

My client worked extremely hard to understand the illogical nature of her thoughts with cognitive-behavioral therapy (CBT) but also was willing to be “flooded” with opportunities in which she then denied herself the engagement of her ritual behaviors (Exposure and Response Prevention – ERP).

It was a painful process – one in which she failed a few times before she succeeded – but, ultimately, she was able to break free and now lives a healthy life. Oh … and she did leave the bank job – she found something much less anxiety-provoking so that she could get a fresh, clean start.

If my client’s story is familiar, please get help. A licensed mental health professional can help you break the chains of bondage with this disorder! The time you dedicate to the therapy needed is a very sound investment! The powerful payoff?  Freedom … which never felt so good!

Gray Matters: Hoarding conference slated for early 2019

The Area 1 Agency on Aging was recently awarded a grant from the Humboldt County Department of Health and Human Services-Mental Health Prevention and Early Intervention to host “Dispelling Stigma: Hoarding Education, Treatment and Prevention Conference” at the Sequoia Conference Center in Eureka. On Friday, March 8, 2019, we will bring together mental health and social service professionals, licensed clinicians, private businesses and governmental entities who are impacted by hoarding, people who hoard, and families of people who hoard.

Our presenters will be Mark Salazar and Julian Plumadore from the Mental Health Association of San Francisco’s Hoarding Task Force as well as Dr. Robin Zasio, a nationally known talk show host, clinician and former member of the “Hoarders” TV series team.

Two self-help support groups will be established following the conference — one for people who hoard and one for their friends and families. The groups would initially be led by a paid facilitator then continue as peer led groups after the grant ends. The conference will encourage development of a local task force to address hoarding in a coordinated way.

It is estimated that between 2 and 6 percent of the population has hoarding disorder. Hoarding symptoms are almost three times more common in older adults (55-plus) than younger adults, although symptoms can appear as early as 11 to 15 years old. Symptoms tend to worsen with age, usually after a divorce, death of a spouse, family member or another personal crisis.

About 75 percent of people who hoard have a co-occurring mental health condition, the most common are major depressive disorder, social anxiety disorder/social phobia and generalized anxiety disorder. About 20 percent of people who hoard also have Obsessive Compulsive Disorder.

Severe clutter threatens the health and safety of those living in or near the home, causing health problems, structural damage, fire and even death. San Francisco Task Force on Compulsive Hoarding’s 2009 report captured actual costs due to compulsive hoarding and cluttering behaviors in San Francisco of over a million dollars a year ($1,166,105) incurred by a portion of service providers ($502,755) and landlords ($663,350).

The report noted that while they were unable to estimate costs to individuals or all identified providers and landlords, a conservative estimate of costs to providers and landlords was $6.43 million a year. While smaller than San Francisco, the costs to Humboldt County, both financial and human, are still too high.

Mental health professionals have previously viewed compulsive hoarding as a specific manifestation of obsessive-compulsive disorder. A 2004 study published in the American Journal of Psychiatry concluded that people affected by compulsive hoarding differ from people affected by OCD in several important respects. People who hoard have a relative lack of awareness regarding the condition’s real-world impact, a greater decline in overall mental function, and an increased likelihood of having co-occurring mental health conditions.

People who hoard need professional support and time to accept the removal of their things, followed by ongoing emotional support and care after the clean-up occurs. Attempts to provide “help” by spending a day or two “cleaning it up” may trigger a traumatic emotional response and will rarely result in a successful, long term outcome.

Most people don’t understand this illness, the toll it takes on people with the disorder or that ongoing treatment and support is needed.  Unfortunately, resources do not currently exist to provide the coordinated, compassionate, dignified, and knowledgeable support these people need to move forward.

Learning about successful treatment options and creating an informed service sector to help people who hoard will result in better health and emotional outcomes, as well as cost savings. We hope this conference will reduce the stigma associated with hoarding and increase our willingness and resources to support people with the illness.

Conference brochures will be available in mid-January at and at our office at 434 Seventh St., Eureka, 95501.

Maggie Kraft is the executive director of the Area 1 Agency on Aging.



OCD one of the most common mental disorders in Singapore

SINGAPORE: Obsessive compulsive disorder (OCD) is one of most common mental health conditions here, according to findings from a nationwide study released on Tuesday (Dec 11).

The disorder affected one in 28 people in their lifetime, making it the third-most prevalent condition after major depressive disorder and alcohol abuse. The illness is commonly characterised by recurrent and persistent thoughts, impulses or images, and when severe, impedes a person’s ability to function.

Younger people aged 18 to 34 were more likely to have the condition than those aged 50 and above, said researchers from the Institute of Mental Health (IMH) and Nanyang Technological University (NTU), citing the findings from the second Singapore Mental Health Study.

The study also found that those who had a monthly household income of between S$2,000 and S$3,999 were less likely to have the condition than those with a household income of less than S$2,000.

IMH’s Professor Chong Siow Ann said that one symptom of OCD is the fear of contamination and could manifest in excessive washing. The condition causes “tremendous impairment” to a person’s functioning, he said.

While the term “OCD” is loosely used in Singapore, and some people may even take pride in saying that they have OCD as it denotes a certain discipline, Prof Chong said that the clinical definition of the illness is different.

Such terms being loosely used could sometimes be a problem, said IMH chief executive Chua Hong Choon.

“That relates to the stigma and issue of what we understand of these disorders,” he said.


Associate Professor Mythily Subramaniam also said that the 6,126 participants surveyed were asked if they had had recurring thoughts or concerns about order or symmetry, which is related to OCD.

“It’s a very neglected disorder,” said Assoc Prof Mythily. 

When it starts off, it could be mild, she said, adding that it could get worse over time, interfering with a person’s life. She gave the example of a person who could start off washing his hands more frequently, but who could end up repeating the action so frequently that daily activities are interrupted and he suffers from infections. 

She gave examples of a person showering for two hours or taking an hour to wear shoelaces as signs of a person who has OCD.

Given that it could start off mild, the delay in seeking treatment by those with OCD was the longest among those who sought help for mental disorders.The estimated median number of years it took a sufferer to seek help was 11 years, compared those with other disorders such as alcohol abuse, which took four years.

Prevalence of lifetime OCD and OCD in the most recent one-year period in Singapore was higher than in South Korea, Australia and New Zealand.


Overall, one in seven people in Singapore has experienced a mood, anxiety or alcohol use disorder in their lifetime, according to the study spearheaded by IMH in collaboration with the Ministry of Health (MOH) and NTU.

This is a significant increase from 2010, when the study was last done, Assoc Prof Mythily said. The recent one was initiated in 2016 and completed in one-and-a-half years.

The most common condition was major depressive disorder, experienced by 1 in 16 people.

Younger people in the 18 to 34 age group were more likely to have major depressive disorder than those aged 50 and above. Those who were divorced and separated were also more likely to experience the condition in their lifetime.

Alcohol abuse was the next most prevalent, affecting 1 in 24 people.

Other conditions that were surveyed were bipolar disorder and generalised anxiety disorder and alcohol dependence.

The 2016 study found that the majority of people, three-quarters, with a mental disorder in their lifetime, did not seek any professional help. This proportion is similar to the proportion of people who did not seek help in the 2010 study. 

However, those who sought help for their mental illness did so much earlier than what was observed in the last survey, researchers found. 

OCD: ‘It’s not about being fussy or tidy’

Iestyn WynImage copyright
Iestyn Wyn

Image caption

Iestyn Wyn says it took him eight years to be correctly diagnosed with OCD

People should stop linking obsessive-compulsive disorder (OCD) with being fussy or tidy, says a man who has the “terribly misunderstood” condition.

Iestyn Lewis, from Anglesey, admitted he used to make throwaway comments about being “a little bit OCD” but that changed after he was diagnosed.

The condition sees people having unwanted and repeated thoughts that can lead to obsessive behaviour.

Charity OCD Action said better awareness was needed.

Mr Lewis, 25, said he believes that a lack of understanding about OCD leads to some individuals having to deal with symptoms for years without knowing the true reason behind them.

“OCD is seen as one of the 10 most disabling illnesses by the World Health Organisation, why then do we use such a serious illness to describe the way some people like being tidy or organised?” he said.

“The result of playing down the severity of OCD is dangerous.

“As a society we are much more open when it comes to discussing mental health issues, but we must go further – the battle is not over.”

Media captionLily Bailey busts myths about obsessive-compulsive disorder.

He added: “The worst thing about OCD is that it throws the worst possible thoughts at the individual, and as a result that person has to neutralise this anxiety by performing certain actions,” he said.

“It took me almost eight years before being correctly diagnosed. Why? A lack of personal understanding? Professional workers failing to recognise the symptoms? Embarrassment for having such thoughts? It was a mixture.”

According to the charity OCD-UK, around 36,000 people in Wales had OCD in 2017 – and around 1-2% of Britain’s population is believed to live with the condition.

The thoughts and behaviours of individuals living with OCD can often be seen as unreasonable, but cannot be ignored.

The severity of the condition can vary, but with care and support it is treatable – without treatment there is a danger of symptoms deteriorating, according to OCD-UK.

The charity added that the NHS does offer two types of treatment for the condition, but many find it difficult to receive adequate treatment and often have to wait a long time to be seen.

Image copyright
Kristina Banholzer

Image caption

Elis Derby is a Welsh-language singer and an OCD sufferer

Elis Derby, 22, from Y Felinheli, near Bangor in Gwynedd, who also has OCD, said: “I remember even since primary school that I felt compelled to keep everything in a certain way just to keep my mind at ease – but I started showing some more obvious symptoms during my preparations for my GCSE exams.

“I remember one time, when I had to get a taxi back to my flat after numerous ‘bad turns’. As I was pointing to my destination the driver got angry and thought that I was wasting his time – because it was so close.

“I didn’t want to make him feel bad by explaining the true reason behind me needing his services, so I said nothing. This is one example but it made me feel down for some time afterwards.”

A spokesman for OCD Action said: “OCD is widely misunderstood, and unfortunately, it’s common to hear people misusing it as an adjective to describe someone who is neat and tidy, but the reality for those living with OCD couldn’t be more different.

“These false portrayals can stop people who are genuinely affected by the condition seeking help, often due to a fear that they will not be taken seriously.

“They also contribute to a greater lack of understanding which can cause people affected to suffer unknowingly in silence.”

we all know social media can seriously harm your mental health, so what now? – i

This article originally appeared in i-D’s The Superstar Issue, no. 354, Winter 2018

“I wouldn’t go on that if I were you, you won’t be able to handle it,” my brother warned. It was 2006 and I’d joined this new thing called Facebook. A website where you could see photos of everyone’s lives. I wanted to join so I could ascertain whether my boyfriend at the time had cheated on me at university. I was desperate for ‘the truth’. The ability to see behind walls and into nights out that I hadn’t been on. A few clicks in and I found what I was looking for: several pictures of him with the girl (so much prettier than me) I had always suspected he liked. And so began my unhealthy relationship with social media.

I have always had generalised anxiety disorder and obsessive compulsive disorder. Facebook felt like a beast bespoke-designed to feed my insecurities and anxieties, plant new irrational fears in my mind, create masterful user journeys for my obsessional thinking. My brother knew this when he warned me against Facebook, but there was no way I was overcoming the temptation. 12 years later, certain Silicon Valley rebels are confirming that Facebook was actually designed to stir these emotions and feelings.

In December 2017, Facebook’s Director of Research, David Ginsberg, and Moira Burke, a research scientist, published a blog post admitting that the social network was having a negative impact on people’s mental health. They described how social media “might lead to negative social comparison – perhaps even more so than offline, since people’s posts are often more curated and flattering.” Facebook (who also own Instagram) admitting this was a relief, but it did grossly underestimate the scale of the problem.

In a recent article in The Telegraph, Chief Executive of the NHS, Simon Stevens, described the effect of social media and online addiction on young people’s mental health as “an epidemic”. A recent survey of 14 to 24-year-olds by The Royal Society for Public Health and the Young Health Movement showed that image-based apps in particular deepen young people’s feelings of inadequacy and anxiety, with Instagram listed as the worst app for mental health, followed by Snapchat and Facebook. All fuel anxiety, depression, poor sleep, loneliness, bullying, body image issues and FOMO.

Earlier this year, Apple CEO Tim Cook admitted he doesn’t allow his nephew to use social media. And no one has gone further in the exposing of Silicon Valley than former Google Design Ethicist Tristan Harris; described by The Atlantic magazine as “the closest thing Silicon Valley has to a conscience”. Harris left Google in 2016 and started the non-profit organisation Time Well Spent, which aims to hold tech companies and app creators to account for their impact on young people’s wellbeing. In a recent interview, released on the 5th of July 2018 on YouTube, Harris detailed the real-life Black Mirror world of social media app creators. “When I was in college at Stanford, I studied at a persuasive technology lab that basically taught a lot of young engineering students the principles of persuasive psychology. You learn about clicker training for dogs, you learn how casinos manipulate and shape the choice-making environment that gets people to play slot machines… My friends in that class were the founders of Instagram. The narrative that’s so common is that Facebook is just a tool, it’s just a hammer, and it’s up to us how we use it. But that’s not true at all. Behind the screen there are 100 engineers who know exactly how your psychology works.”

“Social comparison plagues me the most on social media. It’s not the influencers or models or celebrities that get to me – it’s the acquaintances and friends of friends. When all you know about a person is their perfect pout on a night out, their most recent work success, it’s all too easy to assume that that is their reality.”

Social comparison plagues me the most on social media. It’s not the influencers or models or celebrities that get to me – it’s the acquaintances and friends of friends. It’s the people who I very rarely see in real life that I compare myself to most, and constantly come up short. When all you know about a person is what their dazzling smile looks like on a pristine beach, their perfect pout on a night out, how amazing their midriff looks in a crop top and their most recent work success, it’s all too easy to assume that’s their reality.

Advertising has sold us beautiful people and aspiration since there have been things to sell, but this peripheral social scene is new. “It’s never before been true in human history that when I wake up in the morning and I turn this screen over, I can see photo after photo of evidence that my friends’ lives are better than my life,” Tristan Harris says. “I can see photo after photo of my friends having the time of their lives without me. That’s a new experience for humans.”

As a woman in her early 30s, Marianne Mikhail MSc of 5th Avenue Counselling is one of the few councillors I’ve come across who is an active user of social media, which gives her a unique perspective when working with young clients. “I’ve had clients as young as 14 suffering greatly from comparing themselves to each other on Instagram, Facebook and Snapchat. Young people are seeing their friends presenting themselves in a way that seems gloriously attractive but totally unattainable for them, leading their own self-image to be dashed and diminished, their self-worth shattered.” Mikhail refers to social media as “a stage for many people’s insecurities to be exposed and potentially exacerbated, providing an opportunity to create a visible online persona, which can be edited and adapted to eliminate negative realities.”

Jayne Hardy is the founder of The Blurt Foundation, a digital community which provides peer support for those battling mental illness. She believes in honest representation online. “I want my social presence to be a realistic window into my life: the good, the bad and the ugly,” she tells me. “There’s this horrible notion that vulnerability is a sign of weakness, but in my experience, when I’ve opened the door of vulnerability, it’s made it much easier for others to share their experiences.” After her #WhatYouDontSee campaign went viral, with people tagging their experiences of mental health, Jayne was invited to give a talk at TEDx, a platform she used to share her personal experiences of the depression that swallowed up her twenties. Hardy also struggles with social comparison. “We have front row seats to the ins and outs of other people’s lives,” she says. “We get to see what projects they’re working on and what opportunities might have come their way and it’s so easy to feel as though you don’t, and won’t, match up. But I always remind myself that social media is never the full story, it’s a snapshot of a second in time that doesn’t share the pain, the compromise, the sacrifice, their hard work, their insecurities, their anything. We take the images at face value but there’s so much that leads up to that point in time.”

Last summer was the lowest point in my mental health history. I was sleeping two hours a night, I felt dizzy from exhaustion, like nothing was real. I started a ritual of listing every feature I hated about myself over and over and comparing them to other people’s features on Instagram. I even hit myself a few times out of frustration. During this period, I went to the pub and saw a friend there I hadn’t seen for a while. He said “How are you mate? Well, I already know from Instagram, you’re having the best time ever. I don’t think anyone in London is having as good a summer as you.” I looked back over my posts that summer: Glastonbury, Notting Hill Carnival, a press trip on a private jet, countless humble brags about work successes. I had projected this ultimately happy person online. It was far from my reality.

“Realising I was part of the problem, when Mental Health Awareness Week came around this year, I decided to tell the truth and posted a list of my conditions and medications alongside mantras that help me cope.”

Realising I was part of the problem, when Mental Health Awareness Week came around this year, I decided to tell the truth and posted a list of my conditions and medications alongside mantras that help me cope with OCD, such as ‘You are not your thoughts, and your thoughts are not facts.’ That post got more likes than any exotic holiday pic, and 66 comments of empathy and support.

@mytherapistsays is a meme account with 2.7 million followers including everyone who works in fashion, run by two friends Nicole Argiris and Lola Tash who draw on their own experiences in therapy and with anxiety. The account posts funny memes about not wanting to get out of bed, only wanting to socialise with dogs, self-loathing, loneliness and the great lengths people go to to hide how they’re really feeling. “Having this account has definitely helped us laugh at some of the more questionable moments in our mental health history,” Nicole and Lola tell me, “but at the same time, spending so much time on our phones and turning it into a business has increased… not anxiety… but responsibility.” Being able to joke about these feelings comes from having experienced them. “We constantly compare ourselves to people on Instagram too; when we observe how somebody has transformed themselves with the help of plastic surgery or filters, we can’t help but be affected by what we see, not what went into it.” After three years spent articulating these complex feelings, Nicole and Lola have become wise to the problems – “You should always strive to be the best version of yourself,” they advise, “that should be your only source of comparison.” They also point to the positives of sharing dark feelings in the digital space – “We’re so incredibly grateful to the people who relate, reach out, and live out our memes with us. It’s always a nice reminder to know you’re not alone.”

Hardy also emphasises the mass power that social media can have in providing support. “Social media has been incredibly helpful for my mental health,” she says. “Especially when I was unwell with depression and isolated – it was my window into the outside world. It connected me with people who understood what I was going through and were incredibly kind. I was able to use their hindsight as my foresight and learnt more about depression from their experiences of it than I had from any book.”

Social media can be a dangerous game, but it can also provide friends and community support, a blue-light window in a dark room. So whatever measures the NHS, the government or Silicon Valley app creators put in place to tackle the epidemic of mental illness in young people, it mustn’t interfere with the positive aspects of online communication.

“I think it’s good self-care to understand ‘why’ in all that we do and to listen to how things make us feel,” Hardy offers. “If we’re having a visceral reaction to something and it’s leaving us feeling down, then it’s a good idea to take stock.” Mikhail also suggests building in time for reflection. “Put away your devices, pull out a journal, and give yourself space to reflect and process your thoughts and feelings. Writing something down on paper can give perspective and make it easier to challenge unhelpful thoughts. If you find yourself writing negative things about yourself, ask yourself what you would tell a friend who was saying these things about themselves. Use facts and logic to counteract the irrational negative thoughts. The likelihood is that the reality is not as perfect as the post.”

Replacing self-sabotage with self-care, talking to yourself like a friend, and trying to see the bigger picture on everyone else’s posts is a start. Personally, since that comment in the pub, I’m much more conscious of what I post, because the last thing I want is to get so obsessed with presenting the very best version of myself online, that I trigger someone else’s insecurities in my peripheral social scene. Change starts with your own profile.

Online CBT is not a therapy substitute, but a step to help manage anxiety

Anxiety, one of the most common mental health problems, is a many-headed monster. Anxiety disorders include panic disorder, generalised anxiety disorder, phobias, social anxiety disorder, obsessive-compulsive disorder, separation-anxiety disorder and post-traumatic stress disorder. Anyone who experiences an anxiety disorder will tell you how acutely disabling it feels.

We all get anxious from time to time, particularly when we are about to do something we see as threatening or frightening. In the short term, anxiety is functional, making us feel alert while improving our performance. However, acute or chronic anxiety is unhelpful. It negatively affects our thinking, behaviour and emotional reactions, and can have a significant physical impact, leading to disorder. In addition, more than half of individuals with an anxiety disorder will have a coexisting diagnosis of depression.

Overall, 30% of Britons will experience an anxiety disorder during their lifetime. The Adult Psychiatric Morbidity Survey (APMS), published by NHS Digital in 2016, indicates that depression and anxiety disorders are the most common mental health problems, affecting one in six adults. More recent figures from NHS Digital confirmed that emotional disorders, which include depression and anxiety, are the most prevalent conditions in children and young people, affecting 8.1% of five-to-19-year-olds. Anxiety disorders reach a peak in girls between the ages of 17 and 19, affecting 20.9% of this age group.

However, even with such high prevalence and impact, anxiety disorders are under-diagnosed and under-treated in the UK. The NHS crisis in the provision of adequate mental health care is well publicised. Years of underfunding have left mental health services poorly resourced. This creates a bottleneck for treatment; the long wait for treatment is also likely to lead to more complex problems, which in turn necessitates more specialist and longer-term intervention. The NHS is at breaking point, especially so in child and adolescent mental health services (Camhs).

The recent survey by stem4, the youth mental health charity I founded, shows that 90% of GPs in the survey think mental health services for young people are inadequate, with nearly all (99%) fearing that children in their care could come to harm while waiting for specialist treatment.

In such circumstances the NHS has had to unofficially perform triage when it comes to crisis-level mental health conditions. As a result, people suffering from anxiety disorders lose out. Under current government funding proposals, new services to tackle rising mental ill health among children and young people are being developed, but the wait is long in the face of an urgent need for good-quality, comprehensive services. Even under these new funding proposals, it is unlikely that a robust programme for anxiety disorders will be rolled out in the near future. Anxiety disorders are very responsive to early intervention in the form of evidence-based treatments such as cognitive behavioural therapy (CBT), but in many local areas services of this kind have been cut, denying young people access to expert treatment.

Stem4 offers early detection through education in secondary schools and early digital intervention. Based on the requests made by many students, and on awareness of need observed in the course of my own clinical practice, I developed Calm Harm, a mobile phone app to help young people manage their urge to self-harm.Since its launch 18 months ago, Calm Harm has had close to 900,000 downloads. It is mainly used by young people under the age of 19, and 93% of them report that their urge to self-harm passed after each use of the app.

More recently I have developed Clear Fear, an app to help children and young people manage symptoms of anxiety using the principles of CBT. It aims to provide them with tools to help them negotiate some of the challenges they may face. It does this by offering them relaxation training, self-monitoring and ways of challenging negative thoughts and solving problems. It also harnesses the benefits of humour, feeds them inspirational quotes and examples of inspirational people, and helps them find the “grit” they need to keep going when the going gets tough.

Digital therapies should not be seen as a substitute for face-to-face engagement, assessment and treatment. But a handful of studies confirm that online CBT is as effective as face-to-face treatment for anxiety and depression. It therefore constitutes a first step in helping young people self-monitor and benefit from simple techniques for anxiety management.

Why are so many people anxious and are there common threats? Although digital connections are now flourishing, our relationships and community links are weaker. Our connection with nature is reduced, while an atmosphere of increased competition leads to less collaboration and unity. The world appears divided – a good example is the current state of UK politics. Fomo (fear of missing out) has become a prevalent term. In my opinion, the fear of being left behind is even higher. Social support is a vital contributor to recovery from major stress, and social connectivity is an essential factor in resilience. In addition to treating anxiety, perhaps we need to listen to the message it imparts and get to the heart of the problem.

  • Dr Nihara Krause is a consultant clinical psychologist and the founder and CEO of stem4, a youth mental health charity

Study: OCD in top three mental disorders, sufferers seeking help later

Afraid that someone would break into his house, he would check the locks on his front gate and door.

He was so anxious about making a mistake and letting a burglar slip through that he would repeat this 50 to 60 times.

“He would end up not being able to do anything else because he would be terribly late for appointments.

“It came to a point where he seldom could make it for work,” said senior psychologist at The Therapy Room Lawrence Tan, 40.

He was describing the debilitating effect an obsessive compulsive disorder (OCD) can have on a sufferer.

His comments came in the wake of the latest national mental health study, which showed that OCD remains one of the top three mental illnesses here.

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It affects one in 28 people living here in their lifetime, behind alcohol abuse (one in 24) and depression (one in 16).

Spearheaded by the Institute of Mental Health (IMH), the second Singapore Mental Health Study found that in 2016, the median number of years that OCD sufferers delayed treatment was 11 years.

This is up from nine years in 2010 when the first Singapore Mental Health Study was done.

In contrast, findings from the latest study, released yesterday, showed that those with other mental disorders have been seeking help from healthcare professionals, counsellors, even religious and spiritual advisers earlier.

For example, the median number of years that people who abuse alcohol delayed treatment fell from 13 years to four.

Mental health professionals told The New Paper that denial, shame and guilt about their obsessions and illness, as well as the lack of awareness of the symptoms are some reasons why OCD sufferers can take a long time to seek help.


Dr Bhanu Gupta, a senior consultant at IMH’s Department of Mood and Anxiety, told TNP that despite its high prevalence, OCD is poorly understood and public awareness about the signs and symptoms, which can be hard to recognise, is lacking.

“Quite a lot of times, the symptoms are seen as normal behaviour, excessive normal behaviour. So it is understandable that some people don’t seek help early.”

He said that it is common to see patients who have had symptoms for 15 years or longer before they got help, adding: “OCD usually starts quite insidiously… So initially, most people are not affected so much that they think it requires any kind of treatment.”

Driven by anxiety, OCD has two parts – obsessions, which are persistent, recurring and intrusive thoughts that can increase that anxiety, and compulsions, repeated behaviours and rituals that relieve it.

“It becomes a bit of a feedback loop, where because the rituals take away the anxiety, (the sufferer) keeps doing them more and more,” Dr Bhanu said.

Patients are diagnosed with OCD when these obsessions and compulsions start to take up a significant length of time, more than an hour a day, or start to impair one’s day-to-day life, he added.

Medication and therapy help to break the vicious cycle and Dr Bhanu said the earlier OCD is treated, the better.

The latest Singapore Mental Health Study involved interviews with more than 6,000 Singaporeans and permanent residents aged 18 and above.

Michigan universities testing new Alzheimer’s drug


New research suggests MRI brain scans are better at predicting Alzheimer’s disease than common clinical tests. Veuer’s Mercer Morrison has the story.

Two Michigan universities will test a new drug designed to slow or stop the symptoms of Alzheimer’s disease in patients ages 50-85.

The University of Michigan and Michigan State University are among more than 30 academic medical centers and clinics nationwide conducting clinical trials of the drug troriluzole. The study, called T2 Protect AD, is being coordinated by the Alzheimer’s Disease Cooperative Study, or ADCS, a consortium of institutions that research interventions for the disease.

Dr. Judith Heidebrink, the principal investigator of the study at U-M, said the screening process started this month. Heidebrink said the study targets patients who already have developed mild to moderate dementia. 

“There are a lot of trials out there trying to prevent Alzheimer’s disease … and very few for those who have already established dementia,” she said. “We need to really have therapies for folks already showing symptoms, as well as prevent the following generation from showing symptoms.”

Patient eligibility

To qualify for the study, Heidebrink said patients must score within a certain range when taking memory and thinking tests to establish the severity of their condition and should be in otherwise generally good health. She saidother conditions or medications may affect eligibility. 

Dr. Andrea Bozoki, director for cognitive and geriatric neurology at MSU, said her team in East Lansing also has begun recruiting study participants. 

Bozoki, who is also an investigator with the ADCS, said the study requires participants to come in for visits every six weeks for a year. In addition, they must have a caregiver who can administer the drug and spend at least 10 hours a week with them. 

Read more:

Advocates gather to raise money for 6th leading cause of death: Alzheimer’s

Macomb County man losing himself to disease — but never forgets this

According to the Alzheimer’s Association Michigan Great Lakes Chapter, there are more than 180,000 people in the state living with Alzheimer’s. 

Dr. Irfan Qureshi, the executive director of neurology at Biohaven — the New Haven, Connecticut-based biotech company sponsoring the study —  said that U-M and MSU are particularly important sites because of the large number of Alzheimer’s patients that they serve. 

A different kind of drug

Qureshi added that troriluzole is a particularly exciting drug to study because it has a “unique mechanism of action.”

Other medications that have been studied or have gotten “a lot of buzz” in the Alzheimer’s space target a protein called amyloid or another protein called tau, but Qureshi said troriluzole is different, because it targets a neurotransmitter called glutamate.

Glutamate is a chemical that nerve cells use to send signals to other cells.

Qureshi said researchers  believe troriluzole will improve symptoms of Alzheimer’s disease, like memory and other cognitive problems, as well as reduce the progression of the disease by normalizing the level of glutamate in the synapse — the space between neurons.

“We think that brain cells communicate with each other through the synapse … and if there’s too much glutamate there, then the neurons don’t communicate properly, and if there’s too much there for too long, they die,” Qureshi said. “In Alzheimer’s disease, (the level of glutamate in the synapse) is probably too high.”

Qureshi said that the U-M and MSU sites were identified as two leading members of the ADCS, which is coordinated nationally by T2 Project Director Dr. Howard Feldman at the University of California San Diego.

“We want to be able to run the study and provide the opportunity for patients to participate who are in Michigan,” Qureshi said.

The Mini-Mental State Examination, which is a scale used to examine the condition of Alzheimer’s disease patients, is part of the inclusion criteria, Qureshi said. 

Qureshi said Biohaven is also working on studies with troriluzole that target other diseases and disorders, including the neurodegenerative disease Spinocerebellar ataxia, obsessive compulsive disorder and generalized anxiety disorder. 

“Glutamate is probably involved in 90 percent of excitatory transmission or communication between brain cells. So it’s really, really important, and that’s why it has the potential across these different diseases to have a potential benefit,” he said. 

“This is an exciting time for research … for investigators, and more importantly, for patients and their families.”

More information about clinical trials can be found on the T2 Protect AD website:

Contact Aleanna Siacon: Follow her Twitter: @AleannaSiacon. 

OCD: Brain mechanism explains symptoms

A large review of existing neuroscientific studies unravels the brain circuits and mechanisms that underpin obsessive-compulsive disorder. The researchers hope that the new findings will make existing therapies more effective, “or guide new treatments.”

New research analyzes the brain scans of almost 500 people to unravel the brain mechanisms in OCD.

Obsessive-compulsive disorder (OCD) is a mental health condition that affects more than 2 million adults in the United States.

People with OCD often experience recurring, anxiety-inducing thoughts or urges — known as obsessions — or compulsive behaviors that they cannot control.

Whether it is repeatedly checking if the door is locked or switching lights on and off, OCD symptoms are uncontrollable and can severely interfere with a person’s quality of life.

Treatments for OCD include medication, psychotherapy, and deep brain stimulation. However, not everyone responds to treatment.

In fact, reference studies have found that only 50 percent of people with OCD get better with treatment, and just 10 percent recover fully.

This treatment ineffectiveness is partly down to the fact that medical professionals still do not fully understand the neurological roots of the condition. A new study, however, aims to fill this gap in research.

Scientists led by Luke Norman, Ph.D., a postdoctoral research fellow in the Department of Psychiatry at the University of Michigan (U-M) in Ann Arbor, corroborated and analyzed large amounts of data from existing studies on the neurological underpinnings of OCD.

The scientists published their meta-analysis in the journal Biological Psychiatry.

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Studying the brain circuitry in OCD

Norman and colleagues analyzed studies that scanned the brains of hundreds of people with OCD, as well as examining the brain images of people without the condition.

“By combining data from 10 studies, and nearly 500 patients and healthy volunteers, we could see how brain circuits long hypothesized to be crucial to OCD are indeed involved in the disorder,” explains the study’s lead author.

Specifically, the researchers zeroed in on a brain circuit called the “cingulo-opercular network.” This network involves several brain regions that are interconnected by neuronal pathways in the center of the brain.

Studies have previously associated the cingulo-opercular network with “tonic alertness” or “vigilance.” In other words, areas in this brain circuit are “on the lookout” for potential errors and can call off an action to avoid an undesirable outcome.

Most of the functional MRI studies included by Norman and colleagues in their review had volunteers respond to errors while inside the brain scanner.

An analysis of data from the various studies revealed a salient pattern: Compared with people who did not have OCD, those with the condition displayed significantly more activity in brain areas associated with recognizing an error, but less activity in the brain regions that could stop an action.

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Study co-author Dr. Kate Fitzgerald of U-M’s Department of Psychiatry explains the findings, saying “We know that [people with OCD] often have insight into their behaviors, and can detect that they’re doing something that doesn’t need to be done.”

She adds, “But these results show that the error signal probably isn’t reaching the brain network that needs to be engaged in order for them to stop doing it.”

The researcher continues using an analogy.

It’s like their foot is on the brake telling them to stop, but the brake isn’t attached to the part of the wheel that can actually stop them.”

Dr. Kate Fitzgerald

“This analysis sets the stage for therapy targets in OCD because it shows that error processing and inhibitory control are both important processes that are altered in people with the condition,” says Fitzgerald.

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Findings may boost existing treatments

The researcher also explains how the findings may enhance current treatments for OCD, such as cognitive behavioral therapy (CBT).

“In [CBT] sessions for OCD, we work to help patients identify, confront, and resist their compulsions, to increase communication between the ‘brake’ and the wheels, until the wheels actually stop. But it only works in about half of patients.”

“Through findings like these, we hope we can make CBT more effective, or guide new treatments,” Dr. Fitzgerald adds. The team is currently recruiting participants for a clinical trial of CBT for OCD.

In addition to CBT, Dr. Fitzgerald also hopes that the results will enhance a therapy known as “repetitive transcranial magnetic stimulation” (rTMS).

“If we know how brain regions interact together to start and stop OCD symptoms, then we know where to target rTMS,” she says. “This is not some deep dark problem of behavior,” Dr. Fitzgerald continues.

OCD is a medical problem, and not anyone’s fault. With brain imaging, we can study it just like heart specialists study EKGs of their patients — and we can use that information to improve care and the lives of people with OCD.”

Dr. Kate Fitzgerald

Obsessive-compulsive disorder may offer protection from obesity


Abramovitch et al., 2015 A. Abramovitch, D.A. Pizzagalli, D.A. Geller, L. Reuman, S. Wilhelm Cigarette smoking in obsessive-comp; Abramovitch et al., 2014 A. Abramovitch, D.A. Pizzagalli, L. Reuman, S. Wilhelm Anhedonia in obsessive-compulsive disorder: beyo; Albert et al., 2013 U. Albert, A. Aguglia, A. Chiarle, F. Bogetto, G. Maina Metabolic syndrome and obsessive-compulsive disorder; American Psychiatric Association 2013 American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders: DS; Bejerot and Humble, 1999 S. Bejerot, M. Humble Low prevalence of smoking among patients with obsessive-compulsive disorder; Deng, 2013 C. Deng Effects of antipsychotic medications on appetite, weight, and insulin resistance; Drummond et al., 2011 M.L. Drummond, A. Kham Hameed, R. Ion Physical complications of severe enduring obsessive-compulsive disor; Figee et al., 2011 M. Figee, M. Vink, F. de Geus, N. Vulink, D.J. Veltman, H. Westenberg, D. Denys Dysfunctional reward circuitr; First et al., 2002 M.B. First, R.L. Spitzer, M. Gibbon, J.B.W. Williams Structured Clinical Interview For DSM-IV-TR Axis I Disor; Fontenelle et al., 2011 L.F. Fontenelle, S. Oostermeijer, B.J. Harrison, C. Pantelis, M. Yucel Obsessive-compulsive disorder, im; Gariepy et al., 2010 G. Gariepy, D. Nitka, N. Schmitz The association between obesity and anxiety disorders in the population: a; Garvey et al., 2016 W.T. Garvey, J.I. Mechanick, E.M. Brett, A.J. Garber, D.L. Hurley, A.M. Jastreboff, K. Nadolsky, R. Pessah-P; Gibson-Smith et al., 2016 D. Gibson-Smith, M. Bot, Y. Milaneschi, J.W. Twisk, M. Visser, I.A. Brouwer, B.W. Penninx Major depres; Goodman et al., 1989 W.K. Goodman, L.H. Price, S.A. Rasmussen, C. Mazure, R.L. Fleischmann, C.L. Hill, G.R. Heninger, D.S. Charn; Hasnain et al., 2012 M. Hasnain, W.V. Vieweg, B. Hollett Weight gain and glucose dysregulation with second-generation antipsycho; Henninghausen et al., 1999 K. Henninghausen, B. Rischmuller, H. Heseker, H. Remschmidt, J. Hebebrand Low body mass indices in ad; Husky et al., 2018 M.M. Husky, C.M. Mazure, A. Ruffault, C. Flahault, V. Kovess-Masfety Differential associations between excess; Jung et al., 2013 W.H. Jung, D.H. Kang, E. Kim, K.S. Shin, J.H. Jang, J.S. Kwon Abnormal corticostriatal-limbic functional conne; Kessler et al., 2013 R.C. Kessler, J.R. Calabrese, P.A. Farley, M.J. Gruber, M.A. Jewell, W. Katon, P.E. Keck, A.A. Nierenberg,; Lee et al., 2016 S.H. Lee, G. Paz-Filho, C. Mastronardi, J. Licinio, M.L. Wong Is increased antidepressant exposure a contributo; Luppino et al., 2010 F.S. Luppino, L.M. de Wit, P.F. Bouvy, T. Stijnen, P. Cuijpers, B.W. Penninx, F.G. Zitman Overweight, obesi; Penninx et al., 2008 B.W. Penninx, A.T. Beekman, J.H. Smit, F.G. Zitman, W.A. Nolen, P. Spinhoven, P. Cuijpers, P.J. De Jong, H.; Petry et al., 2008 N.M. Petry, D. Barry, R.H. Pietrzak, J.A. Wagner Overweight and obesity are associated with psychiatric disor; Pizzagalli, 2014 D.A. Pizzagalli Depression, stress, and anhedonia: toward a synthesis and integrated model; Rodriguez-Monforte et al., 2016 M. Rodriguez-Monforte, E. Sanchez, F. Barrio, B. Costa, G. Flores-Mateo Metabolic syndrome and d; Ruscio et al., 2010 A.M. Ruscio, D.J. Stein, W.T. Chiu, R.C. Kessler The epidemiology of obsessive-compulsive disorder in the Na; Schuurmans et al., 2012 J. Schuurmans, A.J. van Balkom, H.J. van Megen, J.H. Smit, M. Eikelenboom, D.C. Cath, M. Kaarsemaker, D.; Simon et al., 2006 G.E. Simon, M. Von Korff, K. Saunders, D.L. Miglioretti, P.K. Crane, G. van Belle, R.C. Kessler Association b; Subramaniam et al., 2013 M. Subramaniam, L. Picco, V. He, J.A. Vaingankar, E. Abdin, S. Verma, G. Rekhi, M. Yap, J. Lee, S.A. Ch; Wittchen, 1994 H.U. Wittchen Reliability and validity studies of the WHO–Composite International Diagnostic Interview (CIDI): a; Xie et al., 2017 C. Xie, L. Ma, N. Jiang, R. Huang, L. Li, L. Gong, C. He, C. Xiao, W. Liu, S. Xu, Z. Zhang Imbalanced functiona

TMS Associates of Pennsylvania First Facility in the State to Treat Obsessive-Compulsive Disorder (OCD) with Deep Transcranial Magnetic Stimulation (Deep TMS)

HAVERFORD, Pa., Nov. 27, 2018 (GLOBE NEWSWIRE) — TMS Associates of Pennsylvania LLC, Haverford’s leading mental health provider specializing in mood disorders, announced today that it is now offering BrainsWay’s latest FDA-cleared Deep Transcranial Magnetic Stimulation (Deep TMS) therapy to patients with Obsessive-Compulsive Disorder (OCD). The facility has been offering Deep TMS therapy for the treatment of depression since 2016. As the first medical device to be FDA cleared for OCD, Deep TMS can be effective for the many patients in need of relief.

“We have seen firsthand how much people with OCD can suffer without effective treatment, and Deep TMS can provide them with the relief they’ve been seeking,” said Deborah Kim, M.D., co-founder of TMS Associates of Pennsylvania. “We have seen very impressive response and remission rates when treating depression with Deep TMS. Bolstered by the effectiveness of the treatment for depression, we are confident that Deep TMS will help provide better outcomes for our patients with OCD.”

TMS Associates of Pennsylvania was co-founded by Dr. Kim and Susan Rushing, M.D., J.D., who use their respective specialties to treat patients with mood and anxiety disorders. Dr. Kim focuses her work on treating pregnant and postpartum women, in addition to women suffering from depression and anxiety. As a clinical and forensic psychiatrist, Dr. Rushing specializes in developing therapies for treatment-resistant OCD, engaging patients in medication management and therapy.

“As an illness where achieving remission is difficult with standard psychiatric medications, psychiatrist have been searching for an effective neuromodulation option to treat OCD,” said Dr. Rushing. “BrainsWay’s FDA cleared coil to treat OCD is the solution we have been waiting for. We are excited to provide this innovative treatment to our patients in need of relief.”

Deep TMS has no systemic side effects, allowing patients to continue with their daily activities immediately following treatment.

About BrainsWay
BrainsWay Ltd./ BrainsWay USA (TASE:BRIN), is engaged in the research, development and sales and marketing of a medical system for non-invasive treatment of common brain disorders. The medical system developed and manufactured by the company is based on a unique breakthrough technology called Deep TMS, which can reach significant depth and breadth of the brain and produce broad stimulation and functional modulation of targeted brain areas. In the U.S., the Company’s device has been FDA cleared for the treatment of major depressive disorder (MDD) since 2013, and is now FDA cleared (De-Novo) for the treatment of Obsessive Compulsive Disorder (OCD). The Company’s systems have also received CE clearance and are sold worldwide for the treatment of various brain disorders.

About TMS Associates of Pennsylvania
TMS Associates of Pennsylvania was founded by Dr. Susan Rushing and Dr. Deborah Kim in 2016. The practice specializes in mood disorders including: treatment refractory depression, anxiety disorders, post-traumatic stress disorder (PTSD), OCD, bipolar disorder, mood disorders during pregnancy and neuromodulation using TMS.

TMS Associates of Pennsylvania Media Contact:
Susan Rushing, M.D., J.D.

BrainsWay Media Contact:
Nechama Feuerstein

Stuck in a loop of wrongness: Brain study shows roots of OCD

No one knows exactly what drives people with obsessive-compulsive disorder to do what they do, even when they’re fully aware that they shouldn’t do it, and when it interferes with their ability to live a normal life.

That lack of scientific understanding means about half of them can’t find an effective treatment.

But a new analysis of brain scans from hundreds of people with OCD, and people without the condition, may help. Larger than any previous study, it pinpoints the specific brain areas and processes linked to those repetitive behaviors.

Put simply, the study suggests that the brains of OCD patients get stuck in a loop of “wrongness,” that patients can’t stop even if they know they should.

Errors and stop signals

Researchers from the University of Michigan gathered together the largest-ever pool of task-based functional brain scans and other data from OCD studies around the world, and combined them for a new meta-analysis published in Biological Psychiatry.

“These results show that, in OCD, the brain responds too much to errors, and too little to stop signals, abnormalities that researchers had suspected to play a crucial role in OCD, but that had not been conclusively shown due to small numbers of participants in the individual studies,” says Luke Norman, Ph.D., lead author of the new study and a postdoctoral research fellow in the U-M Department of Psychiatry.

“By combining data from ten studies, and nearly 500 patients and healthy volunteers, we could see how brain circuits long hypothesized to be crucial to OCD are indeed involved in the disorder,” he says. “This shows the power of doing this kind of research more collaboratively.”

New targets for therapy

Norman works with U-M psychiatry faculty members Kate Fitzgerald, M.D., M.S., and Stephan Taylor, M.D. Fitzgerald co-directs the Pediatric Anxiety Program at Michigan Medicine, U-M’s academic medical center and leads a clinical trial that is currently seeking teens and adults with OCD to test the ability of targeted therapy sessions to treat OCD symptoms.

“This analysis sets the stage for therapy targets in OCD, because it shows that error processing and inhibitory control are both important processes that are altered in people with the condition,” says Fitzgerald.

“We know that patients often have insight into their behaviors, and can detect that they’re doing something that doesn’t need to be done,” she adds. “But these results show that the error signal probably isn’t reaching the brain network that needs to be engaged in order for them to stop doing it.”

Zeroing in on brain differences

In their paper, the researchers focus on the cingulo-opercular network. That’s a collection of brain areas linked by highways of nerve connections deep in the center of the brain. It normally acts as a monitor for errors or the potential need to stop an action, and gets the decision-making areas at the front of the brain involved when it senses something is “off.”

The pooled brain scan data used in the new paper was collected when OCD patients and healthy people were asked to perform certain tasks while lying in a powerful functional MRI scanner. In all, the new analysis included scans and data from 484 children and adults, both medicated and not.

Norman led the combining of the data in a carefully controlled way that allowed for the inclusion of brain scan data from studies conducted as far apart as the Netherlands, the United States and Australia.

It’s the first time a large-scale analysis has included data about brain scans performed when participants with OCD had to respond to errors during a brain scan, and when they had to stop themselves from taking an action.

A consistent pattern emerged from the combined data: Compared with healthy volunteers, people with OCD had far more activity in the specific brain areas involved in recognizing that they were making an error, but less activity in the areas that could help them stop.

Disconnected brakes

The researchers recognize that these differences alone aren’t the full story — and they can’t tell from the available data if the differences in activity are the cause, or the result, of having OCD.

But they suggest that OCD patients may have an “inefficient” linkage between the brain system that links their ability to recognize errors and the system that governs their ability to do something about those errors. That could lead their over-reaction to errors to overwhelm their under-powered ability to tell themselves to stop.

“It’s like their foot is on the brake telling them to stop, but the brake isn’t attached to the part of the wheel that can actually stop them,” Fitzgerald says. “In cognitive behavioral therapy sessions for OCD, we work to help patients identify, confront and resist their compulsions, to increase communication between the ‘brake’ and the wheels, until the wheels actually stop. But it only works in about half of patients. Through findings like these, we hope we can make CBT more effective, or guide new treatments.”

Translating the findings to clinical care

While OCD was once classified as an anxiety disorder, and patients are often anxious about their behavior, it’s now seen as a separate mental illness.

The anxiety that many OCD patients experience is now thought to be a secondary effect of their condition, brought on by recognizing that their repetitive behaviors are not needed but being unable to control the drive to do them.

The U-M team will test techniques aimed at taming that drive, and preventing anxiety, in its clinical trial of CBT for OCD. The study is currently seeking teens and adults up to age 45 who have OCD, and healthy teens and adults who do not. It involves two brain scans at U-M’s research fMRI facility, and 12 weeks of free therapy between the first and last scan.

Fitzgerald notes that rTMS (repetitive transcranial magnetic stimulation) which was recently approved by the FDA to treat OCD, targets some of the circuits that the U-M team has been working to identify.

rTMS focuses magnetic fields on certain areas of the brain from outside the skull. “If we know how brain regions interact together to start and stop OCD symptoms, then we know where to target rTMS,” she says.

For severe cases of OCD, brain surgery techniques have emerged in the last decade as an option — and the new results are consistent with their effects. In such cases, neurosurgeons either disconnecting certain brain areas from one another with tiny burst of energy or cuts, or insert a permanent probe that can stimulate activity in a particular area.

The authors of the new paper call for neurosurgeons to consider the new findings about the role of the brain areas involved in the cingulo-opercular network in both inhibitory control and error processing when deciding whether and where to intervene.

The bottom line for patients

The researchers also call for studies that use genetic tests and repeated fMRI brain imaging of the same OCD patients over time, in what’s called a longitudinal study. That could help researchers piece apart the “chicken and egg” issue of whether the problems with error processing and inhibitory control lie at the heart of OCD, or whether they’re the effects of the symptoms of OCD.

In the meantime, Norman, Fitzgerald and Taylor hope that people who currently have OCD, and parents of children with signs of the condition, will take heart from the new findings.

“We know that OCD is a brain-based disorder, and we are gaining a better understanding of the potential brain mechanisms that underlie symptoms, and that cause patients to struggle to control their compulsive behaviors,” says Norman.

Adds Fitzgerald, “This is not some deep dark problem of behavior — OCD is a medical problem, and not anyone’s fault. With brain imaging we can study it just like heart specialists study EKGs of their patients — and we can use that information to improve care and the lives of people with OCD.”

The study was funded by the National Institutes of Health (MH102242).

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