McLean Hospital 115 Mill Street Belmont, MA 02478
Jason Elias, PhD, is a licensed clinical psychologist specializing in the treatment of obsessive compulsive and related disorders. He oversees the training program in evidence-based practice at the Obsessive Compulsive Disorder Institute (OCDI), which serves practicum students, psychology interns, post-doctoral fellows, and psychiatry residents. Dr. Elias also developed the Office of Clinical Assessment and Research (OCAR) at the OCDI in the spirit of advancing the science and practice of exposure therapy to improve the lives of patients and their families.
The OCAR research model is unique by harnessing the creativity and expertise of frontline clinicians to address the most challenging questions affecting the patients treated at the OCDI every day. Dr. Elias' current research interests include understanding why exposure response prevention works; tailoring treatment to the individual; and evaluating innovative treatments and augmentation strategies.
The Obsessive Compulsive Disorder Institute (OCDI) research program was founded in 1997 and became known as the Office of Clinical Assessment and Research (OCAR) in 2013. As director of clinical research for the OCAR, Dr. Elias is committed to the program’s mission to excel in naturalistic clinical research that will directly improve the effectiveness of treatment for obsessive compulsive disorder (OCD) and related conditions.
The gold standard for treating OCD is exposure and response prevention (ERP). ERP changes the brain’s response to situations that trigger uncertainty and anxiety. During ERP therapy, patients gain experience with situations that have been avoided because they cause intense feelings of uncertainty, guilt, fear, or other unpleasant emotions. Patients practice “response prevention”—staying in the situation rather than avoiding or completing compulsions—in order to build confidence and resilience.
Dr. Elias and the OCAR primarily focus on understanding why ERP works (e.g., fear tolerance versus fear habituation; the roles of guilt, willingness, and acceptance; patterns of brain activation during exposure; functional connectivity among brain regions), tailoring treatment to the individual (e.g., elucidation of predictors of response and their underlying processes/mechanisms and neural correlates; rigorous diagnostic characterization of obsessive compulsive related disorders), and evaluating innovative treatments and augmentation strategies (e.g., acceptance and commitment therapy; optimization of inhibitory learning; pharmacological augmentation).
Though ERP is supported by a broad base of evidence as the optimal treatment for OCD, OCAR research shows, however, that many patients (approximately 25%) refuse this form of treatment and a surprising number of patients (approximately 20-50%) who try ERP do not benefit. The primary goal of Dr. Elias and the OCAR is to improve the lives of current and future patients by advancing the science and practice of exposure therapy and its behavioral and pharmacological complements.
The OCDI is a rich environment for informing clinical practice with research driven by the complex questions and practical issues faced in the day to day effort to help patients overcome their OCD. Dr. Elias and the OCAR staff supply the infrastructure and technical expertise to create a natural synergy with frontline clinicians at the OCDI and foster multidisciplinary collaborations with other research groups.
By design, the OCAR includes a multidisciplinary team of clinical researchers who strive to integrate complementary methodologies such as genetics, brain imaging, and psychophysiology with mainstay behavioral observation and patient self-report data.
The framing of research questions in the OCAR is influenced by the notion that many of the research aims could have broader applicability and transdiagnostic utility. This unique research model harnesses the creativity and expertise of physicians who treat patients every day.
Brennan BP, Tkachenko O, Schwab ZJ, Juelich RJ, Ryan EM, Athey AJ, Pope HG, Jenike MA, Baker JT, Killgore WD, Hudson JI, Jensen JE, Rauch SL. An examination of rostral anterior cingulate cortex function and neurochemistry in obsessive-compulsive disorder. Neuropsychopharmacology 2015;40(8):1866-76.
Van Kirk N, Mathes B, Elias JA. Review of psychotherapeutic approaches for OCD and related disorders. Current Treatment Options in Psychiatry 2015;2(3):284-296.
Monaghan SC, Cattie JE, Mathes BM, Shorser-Gentile LI, Crosby JM, Elias JA. Stages of change and the treatment of OCD. Journal of Obsessive Compulsive and Related Disorders 2015;5:1-7.
Belmont campus - North Belknap, Room 318