online conference transcript
Dr. Lee Baer talks about OCD symptoms and treating Obsessive Compulsive Disorder with OCD medications and cognitive behavioral therapy. Included in the discussion: coping with obsessions and compulsions, what to do about obsessive and intrusive thoughts (bad thoughts), defining and treating scrupulosity and OCPD (Obsessive-Compulsive Personality Disorder) and more.
David Roberts is the HealthyPlace.com moderator.
The people in blue are audience members.
David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "OCD: Getting Control of Your Obsessions and Compulsions." Our guest is author and OCD researcher, Lee Baer, Ph.D. Dr. Baer is an internationally known expert in the treatment of obsessive-compulsive disorder. He is an associate professor of psychology at Harvard Medical School and the director of research at the OCD unit at Massachusetts General Hospital as well as the OCD Institute at McLean Hospital.
Dr. Baer has written two excellent books on OCD:
- The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts
- Getting Control: Overcoming Your Obsessions and Compulsions
Before we get started, I also want to mention that we have an OCD screening test on our site. Please click the link and check it out.
Good evening, Dr. Baer and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Is it possible to actually get control over your obsessions and compulsions? And, if so, how?
Dr. Baer: It is good to be here. Most of our patients do see much improvement in obsessions and compulsions, using either behavior therapy, medications or a combination.
David: Does it take both cognitive behavioral therapy and OCD medications to make a significant recovery or will one of those suffice?
Dr. Baer: For people who are very severely affected, both are usually needed. However, for milder or moderate cases, sufferers often do very well with cognitive behavioral therapy alone, if they are willing to work hard.
David: Maybe you could explain how cognitive behavioral therapy works and give us an example or two of using it with an OCD patient?
Dr. Baer: The simplest example is someone with contamination fears who washes their hands too much. The behavior therapy, in this case called exposure and response prevention, involves having him/her touch things he/she thinks are contaminated and would usually avoid, (this is the "exposure" part) and then resist urges to wash for as long as they can (this is the "response prevention" part). Over a few practice sessions, their fear and avoidance goes down. We modify this basic approach for other types of rituals (another name for compulsions) and obsessions.
David: It sounds very rational and easy -- the therapist teaches the patient his or her thoughts are irrational and the patient comes to understand that. But apparently, it isn't that simple or everyone could be easily cured.
Dr. Baer: I usually say that behavior therapy is simple, but not easy. Some people are not bothered enough by their symptoms to be willing to endure any anxiety during treatment. Also, as you know, most Americans would rather take medications and get better fast. Our colleagues in London notice this is less true of their patients, who usually would rather not take OCD medications but want to do behavior therapy instead.
Finally, when people have many different kinds of obsessions and compulsions mixed together it is more complicated to devise an effective treatment program. For example, when they have only obsessions in their head, but no observable compulsions.
David: Are there a great number of people with OCD who have that difficulty?
Dr. Baer: Yes, we think so. As a matter of fact, although the large majority of people who come to our clinics have both compulsions (physical actions they perform) and obsessions (bad thoughts or images), door-to-door surveys suggest that most people in the world with OCD have mainly obsessions. That is the reason I wrote my latest book, Imp of the Mind. I think that many people who have seen people on network TV shows washing their hands, or checking locks or light switches may not have identified their problem as Obsessive-Compulsive Disorder.
For example, a new mother with obsessions about harming her baby, or a man with sexual thoughts (homosexuality, incest) that he feels very guilty about. So these may really be the most common kinds of OCD.
David: And some of these obsessions can be deeply disturbing, like thinking you want to kill your baby or something similar. We talked a bit about controlling the compulsions using cognitive behavioral therapy. But how does one keep these deeply disturbing intrusive thoughts from entering into their minds?
Dr. Baer: A big part of the problem is that our natural first impulse is to try to push the thoughts away. Unfortunately, we now know this only makes them stronger. It is like telling yourself not to think about a pink elephant. The harder you try, the more you think about it.
So the first thing we teach is to let the thoughts pass through your mind, even if they are disturbing. We also teach that everyone has bad thoughts like these from time-to-time, the difference is that people with OCD dwell on them more and feel more guilty about them. Then we have the person expose herself to things she obsesses about. For example, if she is afraid of violent thoughts, we might have her watch a violent movie, if she usually avoids things like this. This is how we modify the usual exposure and response prevention for what I call "bad thoughts".