A couple of weeks ago, I spent a day listening to Sue Vitek (MA, MSW, LCSW-R) present a sobering and enlightening workshop on OCD (She wrote the workbook). She was representing Cross Country Education which is a well organized source of continuing education. Here are several new insights I learned:
1. As recently as 1970, OCD was considered both extremely rare and untreatable. The realization that anti-depressant medication could help treat it was a breakthrough. The biological nature of OCD involves the deficiency of the neurotransmitter, serotonin.
2. Sue says that the very best source of information on Obsessive-Compulsive Disorder is The OC Foundation in New Haven, CT.
3. Treatment involves doing the opposite of what makes sense. “If you’re worried about the thoughts, think about them more.” “Anticipation is always worse than the actual experience.” “Insight therapy” to discover the “cause” of the anxiety through talking does not help. What does work is Cognitive Behavior Therapy. That is, (a) Exposure-Response-Prevention Exercises, (b) Subjective Units of Distress Levels, (3) Hierarchy developed collaboratively (I call this creeping up on it), and (4) actual fear activation leading to systematic desensitization. So it’s very much hands-on, guided therapy. Medication typically involves an SSRI (e.g. Prozac, Zoloft, Paxil) in combination with a benzodiazepine (e.g. Klonopin).
4. A common misunderstanding is that “just because something doesn’t happen all the time doesn’t mean it can be controlled.” So a teacher or family member may say, “You went all last week without that tic, so I know you can stop it.” How demeaning to the person who actually can't help it!
5. The aspect of OCD that mixes with religion is referred to as “Scrupulosity.” This involves a feeling of personal responsibility for making sure that all things are fair and honest, like test-taking, buying, selling and competing.
6. Obsessive Compulsive Personality Disorder is different that OCD. OCPD is ego-syntonic. That is, the person is comfortable with the obsessive behavior while he/she is doing it. OCD is ego-dystonic. That is, the person is very distresses, sometime disgusted with himself, while engaging in the behavior.
The only thing that was left unclear was how to locate a trained therapist in the Dallas area. I’ll continue my search for this.
This was well-worth the time (six hours) and the money. Now, when I think of OCD treatment, I’ll associate it with Sue Vitek. When I get another brochure from Cross Country Education, I’ll most likely open it and check my calendar.