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OCD research study

If you are interested in receiving Exposure and Response Prevention (ERP) therapy for OCD but cannot get to a therapist, you might consider participating in the following research study:

http://www.drexel.edu/psychology/research/labs/atrp/onlineocd/

The project is conducted through the psychology department of Drexel University in Philadelphia.  The project investigates ERP as delivered via Skype.

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Meditation and your brain

A recent and important research study out of neuroimaging researcher Sara Lazar’s lab (my old lab) at Massachusetts General Hospital was published in late January.  The study found changes in the structure of the brains in people who completed an eight-week class in mindfulness meditation.  This finding is another example of scientists finding evidence that that the brain can experience far more physical changes than previously thought.  This study suggests that we can change our brains in just eight weeks!  The authors of the study tell us that in their study, people who completed the eight-week mindfulness meditation program experienced changes in parts of their brains “responsible for learning and memory processes, emotion regulation, self-referential processing, and perspective taking.”

The eight-week meditation program used in that study is known as Mindfulness Based Stress Reduction (MBSR), a meditation program developed at the University of Massachusetts that has been shown to be helpful in the reduction of anxiety and stress.  MBSR has also been shown to reduce the impact of chronic pain, and to have other positive health effects. In the past 25 years, MBSR has become more widely available.  In the New York area, the Mindfulness Meditation New York Collaborative is a good resource for learning more about MBSR and for finding local MBSR classes.

Thanks to research studies like the brain study described above, we are learning more about how helpful mindfulness meditation can be.

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OCD: Medication vs. therapy

For those persons suffering from obsessive-compulsive disorder (OCD), there are effective ways to get help. In fact, research has shown two treatments to be quite effective in reducing OCD symptoms: 1) Exposure and response prevention therapy (also known as ERP), and 2) psychotropic medication. Medications such as fluvoxamine (Luvox), sertraline (Zoloft), and fluoxetine (Prozac) are commonly prescribed for OCD. These medications belong to the same class (SSRIs) of medications, and are often used because of their low rates of severe side effects – they are quite safe. Clomipramine (Anafranil) has been shown to be significantly more effective than SSRIs in treatment of OCD (see Greist et al., 1995 for details) but is generally held to have a less desirable side effect profile. Unfortunately, a disadvantage of using any such medication is that symptoms often return once the medication is discontinued. One study found that this sort of relapse happens in almost 90% of cases (Pato et al., 1988). ERP has the advantage of lower relapse rates following treatment. Research has found that between 63% and 90% of patients respond to this type of therapy (Wilhelm et al., 2004), and that relapse rates following treatment are significantly lower than they are for the SSRIs. Why would this be? A likely reason is that ERP teaches patients skills they can practice and use to reduce their symptoms. They can continue to use these skills for years after therapy is complete; ideally, their use becomes automatic, and long-lasting change follows.

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Dr. Greene’s and colleagues’ research featured on WABC-TV

Psychotherapy is more effective today than it was 50 or even 25 years ago.  Why? Because of research.  In the United States, National Institutes of Health (NIH) and other agencies fund clinical trials of specific types of psychotherapy for various problems.  One example of such a clinical psychotherapy trial can be seen in the work I have been involved with at Mount Sinai School of Medicine and Memorial Sloan-Kettering Cancer Center.  We conducted a five-year study of cognitive-behavioral therapy, and our results were recently published in the Journal of Clinical Oncology.  The work has gotten more attention lately after it was featured on a well done WABC-TV television news segment.  Click here to see the report as televised on September 29, 2010.

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Meditation and mindfulness research

For several reasons, mindfulness and meditation have been the subject of more and more well executed scientific research over the past twenty years.  Much of this research has investigated the effect of meditation on mood and on the brain’s ability to regulate emotion.  Other research has investigated the capacity for meditation to help people suffering from anxiety disorders such as panic disorder and generalized anxiety disorder.  It may be that the study of meditation’s ability to make us happy has gotten more publicity than the study of meditation’s capacity to reduce anxiety.  However for people with diagnosable anxiety disorders, the potential to be gained from meditation is perhaps greater than it is for everyone else.  Meditation can “quiet the mind,” and pave the way for certain types of anxiety (e.g., worry, panic attacks) to improve.

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The Manhattan Center for Cognitive-Behavioral Therapy

I am proud to announce the opening of the Manhattan Center for Cognitive-Behavioral Therapy, located at 276 Fifth Avenue, 9th Floor. The Manhattan Center for CBT provides psychological services by experts in this type of therapy. The Center has a sliding fee scale, with different rates available (based on the years of experience of the therapist). For further information, see the website link above, or call us at (646) 863-4225.

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A Compulsive Need to Confess

One rarely discussed symptom of OCD is an overwhelming urge or need to confess “sins,” even when the transgressions are very slight.  Typically this will arise in the context of a marriage or romantic relationship.  At first, what is confessed may not seem so minor.  However if this problem is not addressed, the confessed acts often become quite trivial.  For example, let’s say that a man with OCD feels attracted to a co-worker.  If he suffers from this form of OCD, he Continued…

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Antidepressant news – recommended reading

On January 29th there appeared a well researched and well written piece in Newsweek on the effectiveness of antidepressants. The article, by Sharon Begley, explains some important aspects of the process by which pharmaceutical agents are brought to market and are prescribed.

The article explains about the relevance of the placebo effect in clinical trials and explains that for antidepressant medications, much of the improvement they produce can be attributed to the placebo effect. The placebo effect is the extent to which our experiences and expectations that a drug will work actually help us improve. For example let’s say that you get frequent headaches, and find that aspirin gets rid of them pretty effectively. Then one day your prankster roommate replaces your aspirin with breath mints… but your headache still goes away after you take one! Some would explain this via the placebo effect – you expected it to work, and so it did. The placebo effect is a mysterious and very important part of medical research; so much so that it is a focus of significant ongoing research at medical institutions around the world (e.g., at UCLA and at Harvard Medical School.)

Scientists have known about the placebo effect for many decades and account for it in research often by using what are called placebo-controlled studies — i.e., studies where half the patients receive the drug under investigation, and the other half receive a placebo. Thus they can look at the difference in improvement between the two groups and conclude that any difference is likely due to the true effect of the drug.

Begley’s Newsweek article not only may surprise you in its description of how strong the placebo effect is for antidepressant medications, but in its description of how such medications are approved by the FDA. She describes how the FDA, at present, does not have a mechanism by which trials with negative results (showing that a drug was ineffective) are accounted for in its pharmaceutical approval process. That means that a drug shown to be no better than placebo in six studies, but shown to be somewhat effective in two others, can be approved for widespread use.

Read the article, and be an informed consumer!

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Reassurance

One way to recognize OCD is to look for excessive efforts to get reassurance. This can take many forms, and in my experience often comes up as questions asked to a spouse. “Did you check the locks on the door?” “I’m feeling a little ill, do you think I have lupus?” A recent interview with Dr. Wayne Goodman correctly suggests that the best way a spouse can respond to such questions, in cases of OCD, is to try to avoid providing that reassurance that only strengthens the compulsive tendency. Sometimes arguments over such requests for reassurance can become problematic for couples. In that case, consultation with an OCD specialist is appropriate.

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Is your therapy actually helping?

previous posting on this blog discussed the recent controversy over “effective” psychotherapy. A more recent article in the LA Times outlines the two sides of the debate. Regardless of what you think about this controversy, one important message to take away is that it’s important to consider whether your therapy is helpful. That may sound obvious, but whatever the reasons you sought therapy to begin with, it can be helpful to periodically ask yourself whether you feel that things are tangibly changing for you. If not, have a frank discussion with your therapist — a good therapist will share your desire for tangible meaningful change and would welcome such a discussion.

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