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Checking In, A Publication of the OCDI - Issue #2

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Merlin & Pendergast sit with Henry and Annie, two unique members of the OCDI team.

Puppy Love

Readers of Checking In may be surprised to know that two of the most important members of the Obsessive Compulsive Disorder Institute (OCDI)  staff don’t know a thing about the treatment of OCD.  In fact, this dynamic duo has never been to college, has no formal training in behavioral therapy, and has never even read a single book about OCD treatment.  How can two members of the OCDI staff be so unqualified yet effective in their endeavors?  

Despite not having any formal university education, both Annie and Henry have graduated from the Dog B.O.N.E.S. program: Dogs Building Opportunities for Nurturing and Emotional Support.  Dog B.O.N.E.S. is a Massachusetts non-profit, volunteer organization whose primary purpose is to provide well-trained, affectionate, and obedient dogs for a variety of therapeutic settings. 

Those who have experienced treatment at the OCD Institute will tell you that the OCDI staff will go to almost any length to enhance and optimize the treatment of our residents.  Proud owners Emily Pendergast, community residence counselor at the Institute, and Perrie Merlin, LICSW, OCDI social worker, enthusiastically pursued having their dogs trained and certified to be able to provide valuable therapeutic support to patients in treatment at the OCD Institute.

Annie and Henry have both made themselves right at home, adding some comfort and the familiarity of home for residents during an otherwise overwhelming and intense yet incredibly rewarding experience in their lives. Both dogs have a strong presence at the Institute several days each week and their arrival at North Belknap 1 and Orchard House is eagerly anticipated by many OCDI residents. During their time on the units, they are able to provide support to OCDI residents in a variety of ways - emotional support to residents missing pets at home, an engaging, lively outlet for free time that may otherwise be co-opted by rumination, isolation, or other OCD rituals, and even a direct opportunity for exposure work for some residents whose OCD symptoms may be triggered by their presence.  

“Henry often allows people to relax, lower their defenses, and show their softer side in family meetings,” says Merlin, “sometimes much sooner than one would expect.”  

Pendergast adds, “Annie often joins me in check-ins with patients, providing an extra level of comfort. She helps to ground the patient and bring them back to the present moment.  She often seems to literally ‘sniff-out’ someone in need, often before even I can.”  

Jennifer Loomis, a recent resident at the OCDI, recollects one memorable evening with Annie on the unit: “For a moment in time, all of us were unaware of the fact we had OCD. We were absorbed in the new-found friendship that Annie so freely gave. The loving pats, a few wet kisses, and lots of tail-wagging reminded me of Tasha, my own dog at home, and gave me the incentive I needed to continue with this new adventure of treatment that would soon lead me home, where my own tail-wagging friend patiently awaited my return.”

Radical Faith by Ethan Smith

We all have our stories of pain and triumph, and while they may completely differ in symptom and severity, we all share a common bond: obsessive compulsive disorder (OCD). While it can be a motivating factor to know there are individuals out there that have risen from the depths of hell and hear that journey in great detail, it’s always been the method behind their recovery that’s interested me. Therefore, I’ll give you the how in six hundred and ninety eight words but the why in just five:

Ethan Smith

I had awful, debilitating OCD.

I entered the OCDI in November of 2010 at the age of 32. I was diagnosed with OCD at the age of fourteen and not properly treated until the April before coming to the OCDI. Despite being more than a handful for the staff at the OCDI upon my arrival, I have no qualms about saying that the staff at the OCDI, without a doubt, saved my life. While I’m being completely honest, let me tell you that the journey is extremely difficult and it gets worse before it gets better. If you have OCD, treating it will be one of the hardest thing you will ever face. If you are a close friend or family member, being part of the process will be one of the hardest things you will ever face. However, in doing so, you will gain the ability to live or assist in helping someone live the rest of their life with joy and serenity. 

As miserable as I was before I started treatment, and despite the fact that I was not even able to function, I had a lot of trouble convincing myself to attempt to conquer my OCD. It appeared to be more comfortable and less dangerous to just live with it. There was just one factor that I simply could no longer ignore: my OCD was killing me, literally.

No matter how hard you try, you cannot rationalize OCD. The reason is that OCD is completely irrational and can never be figured out. The path of least resistance seems so very difficult to execute but couldn't be simpler: do everything your treatment team asks you to do, without fail, don't question, don't modify, try not to even rationalize it. As Nike says, just do it!
What you really need to do this: RADICAL FAITH. Your treatment team is asking you to jump off of a cliff because on the other side is this amazing and beautiful life. You can’t see the other side or what’s below you and your OCD is telling you not to jump because you'll die. You have to remember that your treatment team wants you to succeed. They are committed to seeing you leave the OCDI with the ability to be YOU and do the things that YOU want to do, not what your OCD wants you to do.

The fantastic paradox of letting go is that you'll feel more in control of your life than ever before. Once you completely surrender and relinquish the illusion of control that you have over your COD, you begin to gain that elusive happiness and peace for which you have been searching. You have to stop trying to negotiate. Stop trying to figure it out. Stop thinking that you can figure out another way. In fact, in regards to OCD, stop thinking completely. Turn over control to your therapist and blindly follow. Only then will you begin to feel the relief and live the life you absolutely deserve.

By the way, I currently live in Los Angeles, California three thousand miles away from my parents whose side I never left until I was 32 years old and went to the OCDI. I’m now a successful working actor, writer and director. I live in the moment and at the end of the day, whether it’s been amazing one or not, I can honestly say…it’s all good!

Cutting Edge: News from the Office of Clinical Assessment & Research

The OCR is currently working on more than a dozen projects in various stages of completion with many more in the works.  Our sincerest thanks go out to the patients, their families, the OCDI staff, and the various collaborators who have made research possible at the OCDI this year.  We are better able to help others because of your efforts.

Our Mission
The primary mission of the OCR is to advance the science and practice of exposure therapy and its pharmacological complement to improve the lives of current and future patients.  The OCD Institute  is a rich environment for this kind of work because we have many expert clinicians who also value and participate in research.  This means that our research is driven by the complex questions and practical issues faced in the day to day effort to help patients overcome their OCD.

Facing Our Fears
Just ask anyone you know if they’d volunteer to face their worst fear on a daily basis… most of us wouldn’t. Therefore, it’s not surprising that a major challenge for patients during treatment is maintaining consistent and meaningful engagement with the process.  Though Exposure and Response Prevention (ERP) is the gold standard treatment for OCD, many patients are reluctant to try this form of treatment, and others may stop practicing before getting maximum benefit. When patients use avoidance and/or compulsions during treatment, no new learning can occur during the ERPs and little, if any, progress will be made.

The OCR is currently running a clinical trial to enhance treatment engagement by making the experience of ERP more tolerable/acceptable to patients.  This trial is being led by two OCDI therapists (Nate Gruner and Jen Hicks) and pilot data from this project will be presented at McLean Research Day in January 2013.

How do we know if ERP is working?
Once a patient has decided to engage treatment without rituals or avoidance, the fear response naturally subsides over time.  This reduction in fear (i.e., habituation) is most commonly measured by asking the patient to rate their distress during the ERP, using a number scale (e.g., 0-10).  Therapists rely on these fear ratings to gauge whether or not the ERPs are working.  However, researchers around the world have failed to find a consistent relationship between habituation and overall improvement after treatment.  Instead, some new and exciting research suggests that fear toleration may be more important than fear reduction for obtaining a long-lasting response to ERP.  

The OCDI has been on the cutting edge, clinically, by offering specific therapy groups to improve distress tolerance (i.e., Emotion Regulation, Mindfulness).  The OCR has also been investigating measuring patients’ willingness to embrace uncertainty, likelihood to experience distress during ERP, and measuring fear reduction throughout treatment.  

Relapse Prevention
Unfortunately, some patients who benefit from ERP will experience relapse at some point after treatment.  The OCR is in the process of developing a comprehensive follow-up program, which will reach out to patients, their families, and their treaters to gather information that might help us better understand how relapse occurs and how to prevent it.  This is the result of collaboration between the OCR and Diane Davey, Brock Maxwell, and the OCDI social workers (Perrie Merlin, Thea Cawley, Rebecca Snyder, and Ben Eckstein). The OCR is also collaborating with Leslie Shapiro, an expert behavior therapist at the OCDI, who is exploring the role of untreated guilt as a risk factor for relapse.  Shapiro’s work has culminated in a specific protocol for addressing guilt during treatment at the OCDI.

New Lab
The OCR has new lab space on the third floor of North Belknap, made possible through creative problem-solving by Jesse Crosby and collaboration with Dost Öngür and his team.  This new space will streamline the process of data collection, lessening the burden on our patients and improving our efficiency in getting clinical data to treatment teams.

Thanks for your interest and support of the initiatives discussed above and all the others we didn’t have room for in this issue.  Best wishes for 2013!

Sincerely,

The OCR Team

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