online conference transcript

How to Help Patients with OCD

James Claiborn Ph. D. specializes in providing cognitive-behavioral therapy to adult OCD sufferers.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

BEGINNING

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. I hope everyone's day has gone well. The weekend is almost here :)

Our conference tonight is on "OCD: What Can Be Done To Help". Our guest is James Claiborn, Ph.D. Dr. Claiborn is a Ph.D. psychologist. Some of you may recognize Dr. Claiborn from the OCD (Obsessive-Compulsive Disorder) mail list where he responds to "ask-the-expert" questions. Dr. Claiborn is a member of the scientific advisory board of the Obsessive Compulsive Foundation. At his "day job" though, one of the things he does is provide cognitive-behavioral therapy to adult OCD sufferers.

Good Evening, Dr. Claiborn and welcome to HealthyPlace.com. We appreciate you being here tonight. Very briefly, because maybe we have some visitors tonight who are learning about Obsessive-Compulsive Disorder for the first time, what is it and how do you know if you have it?

Dr. Claiborn: OCD is well-named as it is a disorder where people have obsessions and/or compulsions. Obsessions are ideas thoughts, images, impulses, etc. that intruded into one's mind and that are upsetting. Compulsions are things people do often, over-and-over, in a stereotyped way to reduce their distress. The disorder is diagnosed if a person is suffering from these and it takes up significant time or causes interference with functioning in life.

David: What causes OCD?

Dr. Claiborn: We don't know the cause of OCD but there is reason to believe it is partly genetic. Some children may get it as a reaction to strep infections. We also know that it is not caused by bad toilet training, as Freud used to think.

David: You provide cognitive-behavioral therapy to help OCD sufferers. What is that? How does it work? And how effective is it in relieving the symptoms? (For those in the audience who need a more detailed explanation of Obsessive-Compulsive Disorder, visit our OCD community.)

Dr. Claiborn: Cognitive behavioral therapy, or CBT, is a treatment method that includes doing things like intentionally exposing a person to what they fear and stopping them from carrying out compulsions. It also includes methods like looking at errors or problems in thinking that lead to distress. CBT is as effective, or more effective, as a treatment for OCD, than medication. Most people who go through CBT will get a significant benefit in reduction of symptoms.

David: How important are medications in controlling the OCD symptoms and also in helping to be more receptive to therapy? Is it imperative for a person with OCD to be on medications?

Dr. Claiborn: On any given trial, about half of the people will get a benefit from medications, and if we look at trying several medications about 70% can benefit. However, some people believe that the reason medication helps is because it reduces anxiety and allows people to do the exposure-based things that really help.

If we look at someone with mild to moderate Obsessive-Compulsive Disorder, they may get as much help as they need from Cognitive Behavioral Therapy alone and never need to take medication. Some people will not do CBT until after they are on medication.

In either case, if they ever want to be off medications, they will need to do CBT. Experts on children recommend that all children with OCD get CBT and some get medications. I would say the same for adults.

David: Before we get to some audience questions, what about self-help for OCD? How effective would that be?

Dr. Claiborn: We have reason to believe that self-help methods can be very useful especially for mild to moderate OCD (Obsessive-Compulsive Disorder). There are several good OCD self help books and some good support groups.

David: Could you please mention one or two titles?

Dr. Claiborn: I often recommend Lee Baer's, Getting Control, or Hyman and Pedrick's The OCD Workbook. Also books by Steketee or Foa are very good.

David: I was also wondering if a person can ever make a full recovery from Obsessive-Compulsive Disorder, or whether it is a lifelong disorder that is constantly managed?

Dr. Claiborn: If we say that a person whose symptoms are so mild as to not be a problem is cured, then some people will get there. For most people with OCD, however, it is a chronic problem and needs to be managed.

David: Here are some audience questions, Dr. Claiborn: