Author: Phoebe Kranefuss


NOCD’s MARS Rating

By Phoebe Kranefuss,

Highlights

  1. The Mobile App Rating Scale (MARS) is a reliable, multidimensional measure for trialling, classifying, and rating mobile health apps
  2. MARS rates mobile health apps for reliability, quality, scope of information, aesthetics, subjective quality, and perceived impact
  3. The NOCD app received an objective quality score of 4.74/5.00, suggesting excellent quality across all measured categories

How to find the best mental health apps

There are thousands of mobile platforms claiming to improve users’ mental health now available on the iTunes and Google Play stores. Users might not know where to start: which of these are clinically effective? Which are easy to use, reliable, and safe? Are there additional criteria that should be considered in making the choice to use a mobile platform as part of a mental health treatment plan? Early evaluation criteria developed to rate mobile health platforms do exist, but were either too general to provide valuable insight, too complex to make useful information accessible to the average user, or too specific to be applied across all mobile health apps.

The Mobile App Rating Scale (MARS) was developed by a team of researchers at Queensland University of Technology to classify the quality of mobile health apps on a reliable, multidimensional scale. MARS rates app quality by quantifying engagement, functionality, aesthetics, information quality, and subjective quality, offering a comprehensive view of features deemed most important by top clinicians in the field.

NOCD’s MARS Rating

In an independent rating of NOCD, Queensland University and Psyberguide awarded the app a user experience score of 4.74/5.00, tied with Headspace as the third highest user experience score out of 182 ratings overall. Subcategories include a score of 4.90 for engagement, which qualifies the interactivity and customizability of the app; a score of 4.88 for functionality, which qualifies the performance, ease of use, and navigation within the app; and a score of 3.57 in credibility, or evidence-based research.

These scores showcase our continuing efforts to validate the efficacy of the NOCD platform, improve outcomes, and enable research as we work with our Scientific Advisory Board of expert researchers and clinicians. In tandem with the initial results from Columbia University Medical Center’s study of the NOCD app, which suggest that integrated treatment using the app can lead to “significant reduction” in some patients’ OCD symptoms, NOCD’s MARS rating backs NOCD’s incredible user experience. We’re proud of the positive ratings we’ve received, and eager to keep improving NOCD in all of the above criteria!

If you have any ideas as to how we can get better, get in touch!

Introducing NOCD Premium

By Phoebe Kranefuss,

Today, we’re launching NOCD Premium: an in-app, OCD-specific teletherapy service that connects our members with licensed mental health professionals. Premium offers unlimited messaging with one of these NOCD Pros, whether you’re just learning about OCD, trying to stick with your treatment plan, or working to maintain recovery.

NOCD Pros are specially trained in OCD treatment and licensed in the member’s state. They’re experienced clinicians, skilled at tailoring their work to specific needs and goals. Using HIPAA-compliant messaging within the NOCD app, members get reliable answers to all of their questions and improve ongoing treatment with individualized suggestions. Pros provide immediate support when symptoms worsen, allowing members to learn new techniques for responding to their thoughts without using compulsions.

We’re focused on building further resources for those in our community who need help but aren’t in a crisis. The NOCD app provides the resources we wanted during our own treatment journey: evidence-based OCD therapy in an intuitive form, a supportive community, and protected treatment data. But we pay close attention to our growing community, and we’re always hearing from people who need further care. Symptom severity exists on a wide spectrum– and shifts constantly. That’s why we, along with our Clinical and Scientific Advisors, decided to act on this need more urgently.

Like everything we build at NOCD, Premium was designed with constant input from experts. Our Clinical Director, Dr. Stephanie Lonsway, PhD, spearheaded Premium with the help of Scientific Advisor Dr. Patrick McGrath, PhD, and Chief Medical Officer Dr. Jamie Feusner, MD. All three have specialized training and extensive experience in treating OCD with exposure and response prevention (ERP), cognitive-behavioral therapy (CBT), and acceptance and commitment therapy (ACT). These techniques help people confront unwanted thoughts and feelings without trying to escape by performing compulsions. ERP is the most research-backed form of therapy for OCD; both CBT and ACT can play important roles in increasing treatment efficacy.

If NOCD Premium doesn’t provide sufficient support, Pros connect our members with carefully chosen resources nearby– from clinical trials to advanced care and emerging treatment options. Most recently, we’ve partnered with Actify Neurotherapies, a group of clinics focused on providing emerging treatment options for people with depression and OCD, and AMITA Health, a treatment continuum that includes outpatient and residential programs and is run by world-renowned OCD expert and NOCD Scientific Advisor Dr. Patrick McGrath.

While providing individualized education and support, NOCD Pros help members learn about additional treatment options that might be right for them. Getting people access to the best care as soon as possible, from the moment they start wondering if they have OCD all the way through treatment, is vital. The NOCD app, NOCD Premium, and our partnerships work together to create a seamless and comprehensive solution for anyone who might have OCD.

We’re thrilled to release Premium and have you along for the next step in NOCD’s mission to make care more accessible, more connected, and more effective.

NOCD Premium is available in Michigan today, and will be released in additional states throughout 2019. If you live in Michigan, just download the NOCD app to get Premium. Otherwise, please fill out a quick form:

Join the NOCD Premium Waitlist here!

  • We'll use your email to let you know when Premium is available in your location
  • NOCD Premium will be made available on a state-by-state basis

When ROCD Tries to Ruin Your Valentine’s Day

By Phoebe Kranefuss,

This week, we’re proud to feature a guest post from Dr. Belinda Seiger, PhD, LCSW. Dr. Seiger has substantial training from the world-renowned Child & Adolescent OCD, Tic, Trich & Anxiety Group (The COTTAGe). She received her PhD from New York University and her Master’s degree from Columbia University. She has more than 20 years of experience providing compassionate, friendly treatment for anxiety, OCD, neurodiversity, mood, and learning issues. Her approach draws upon evidence-based approaches like cognitive behavioral therapy, positive psychology, and neuroscience. 

Dr. Belinda Seiger

Relationship OCD, or ROCD, is a type of OCD characterized by obsessive, unwanted thoughts about intimate relationships. People with ROCD tend to be consumed by doubts about their partner: Do they love me enough? Am I as attracted to them as I should be? Are we compatible enough?

It’s normal for errant thoughts like these to creep into even the best relationships every once in a while. Feeling overwhelmed by constant, persistent doubts, when there’s no rational reason to worry, might be a sign that ROCD is taking over.

Valentine’s Day can be an especially tough holiday for people with ROCD. The societal pressure to be in a “perfect” relationship seems overwhelming in February: we’re surrounded by hearts, candy, greeting cards, and love songs practically everywhere we go. Our friends and family members might be discussing their Valentine’s Day plans or asking about ours. Maybe a partner has high expectations for the holiday.

Whether you’re single or in a relationship, the thoughts and feelings that come with ROCD might feel so intense in February that you’d rather avoid Valentine’s Day altogether! Avoidance can feel like the best option in the moment. After all, why would you purposefully engage in something that will just make you feel anxious? But avoiding situations that might trigger your obsessions and cause distress is actually counterproductive to OCD recovery, and will only serve in the long term to make symptoms more severe. Instead of avoiding the holiday, try planning and practicing exposures around your triggers– whether or not you have an intimate partner.

Let’s say you are in some kind of intimate relationship. If ROCD causes you to feel an immense amount of pressure to make the holiday “perfect” for your partner, you might days picking out a gift or making a card. This involves carefully considering the cost, size, and meaning of the present; then there’s all the repetitive, agitating consideration of whether or not it accurately represents the love you feel (or think you should feel) for your partner.

You might also feel uncertain about how your partner might have spent Valentine’s Day with someone else in the past, imagining all kinds of scenarios. When the anxiety becomes intolerable, you ask about the types of gifts they and their former partner exchanged or the activities they engaged in. It seems impossible not to compare this to your relationship. Was that other person better than me? Did my partner love them more? Have they had more intimate experiences than me? As the questions swirl, you might feel like asking your partner for reassurance in order to just get rid of the anxiety for a while.

Instead of giving into this pressure from OCD to seek reassurance, try using these kinds of situations as inspiration for doing exposures. Try limiting the amount of time you spend picking out a restaurant to twenty minutes, and draw a picture or imagine a scenario in which your partner doesn’t like the restaurant you chose. What would this feel like? What might the consequences be? Write out the worst-case scenario and read it out loud a few times. Leaning into your thoughts can feel scary in the moment, but is the basis for effective exposure and response prevention (ERP). When we’re able to handle discomfort, obsessions lose their power over us.

It’s easy to forget this on Valentine’s Day, but people without intimate partners are often just as deeply engaged in romantic rumination. We see couples walking around, doing the things intimate partners are supposed to be doing, and start to wonder why we’re not in a similar kind of situation. For people with ROCD, these feelings of loneliness and sadness can prompt an onslaught of obsessive thoughts: What if I’m not good enough? How can I be sure that I’ll have something like this one day too?

Because these kinds of thoughts tend to produce a lot of distress, people with OCD turn to compulsions. These behaviors can be a bit sneaky: maybe you find pictures of people on social media who aren’t any more attractive than you but still have partners, maybe tell friends and family you’ll be alone forever in the hope that they’ll say otherwise. No matter what the compulsion, exposures can help you feel better long-term, not just on February 14. If you’re constantly trying to prove to yourself that you won’t be alone forever, try writing out all the reasons you’ll never find an intimate partner. Make sure they’re reasons you really believe, and read them to yourself twice a day. If you want to be sure you’ll be in a relationship one day, record a story about being alone forever on your phone and listen to it a few times a day.

I once worked with a couple where both partners had ROCD. They planned their handmade gifts months in advance. They made a professional film, flew to a foreign country, and even brought in a chef to create a lavish meal! Most people don’t reach this extreme, but this illustrates how ROCD can completely take over when that OCD bully in your brain tries to seek one hundred percent certainty about your relationship or your choice of partner.

If OCD is starting to ruin your Valentine’s Day, try using your triggers to plan effective exposures. By next year, Valentine’s Day could be your favorite holiday!

Thanks to Dr. Seiger for this great guest post!


Why is OCD so Often Misdiagnosed?

By Phoebe Kranefuss,

Imagine you’re experiencing OCD symptoms for the first time. You know something is wrong because you’re feeling much more anxious than usual and you have thoughts that won’t go away. Maybe you’re having trouble sleeping, or your mind is constantly overwhelmed by thoughts that seem to run in a never-ending loop. You’re not really sure if you should risk telling your doctor that you lie awake at night repeating mantras and mentally reviewing whether or not you actually locked the front door of your apartment. Should you share with them the intensely disturbing thoughts you keep having about hurting your toddler son?

You’re pretty sure you’d never actually hurt your son. But what if your doctor doesn’t understand? What if he thinks you’re completely crazy? Or, worse, what if he thinks you might be a danger to your son and takes action? It’s too risky, so you decide to wait and see if it’s all temporary. But your anxiety only increases, and begins to affect your everyday activities. Your compulsions make it harder to be around family and friends. They make it almost impossible to get anything done at work, and you start faking sick more often because leaving your home means more risk. These thoughts won’t go away– it seems like they’re taking over your life now.

Recognizing these destructive patterns, you know it’s time to see a mental health provider. But you’ve never gone to therapy and you wouldn’t know how to find a decent therapist. On top of that, your insurance requires that you get a referral from a primary care physician first. It takes a lot of courage, but eventually you feel you’ve reached your limit. You’re suffering enough each day– every minute, it seems– that you decide to pick up the phone and dial your doctor’s office to set up an appointment later in the week.

Arriving at the doctor’s office, you feel almost unbearably nervous. A nurse comes in to check your vitals, which feels a little strange since your symptoms aren’t primarily physical. Then the doctor comes in, surprised to see you back so soon after your recent appointment. You tell him everything you’ve written down, and having bullet points to go through allows you to get through the worst part.

The doctor begins to ask you a whole bunch of questions, and you feel pretty vulnerable talking about your scariest thoughts, which you’ve never discussed with anyone. Out of fear and self-consciousness, you speak as generally as possible, disclosing your intense anxiety but hiding most of your obsessive thoughts. Or maybe you do decide to share some of your most upsetting intrusive thoughts and talk about the compulsions that follow.

Although your doctor listens carefully, and you know they’re well-trained in general medicine, they don’t seem to know a lot about obsessive compulsive disorder (OCD). Instead, they seem these symptoms as typical of general anxiety disorder (GAD) or depression, so he prescribes you an antidepressant or refers you to a therapist who works with these conditions, rather than an expert in evidence-based exposure-response prevention (ERP).

Most primary care physicians are great at what they do. But they’re trained in primary care. Accurate diagnosis and effective treatment of OCD require a mental health professional who’s well-versed in ERP and cognitive-behavioral therapy (CBT). Because of this gap in understanding, the average person with OCD will see three to four doctors and spend around 9 years looking for treatment before receiving a correct diagnosis. As Dr. Jill Fenske, M.D. explains in Physician’s Weekly, OCD is so often underdiagnosed and undertreated not only because people with OCD are often secretive about their symptoms, but also because “a lack of recognition of OCD symptoms by physicians often leads to a long delay in diagnosis and treatment.”

Sometimes this is because the kinds of repetitive thoughts people with OCD experience can come across to the OCD-inexperienced as normal, healthy patterns of identity and value formation. One recent study crafted vignettes about different OCD subtypes, including aggression, contamination, homosexuality, pedophilia, somatic concerns, and symmetry. They presented these vignettes to doctors, surveying their ability to diagnose fictitious patients with OCD. The study found that about 50% of doctors presented with vignettes of rumination patterns typical of people with OCD did not recognize these symptoms as indicative of OCD.

The most commonly misdiagnosed vignettes described obsessions around sexuality: 85% of doctors randomly presented with vignettes on sexual orientation OCD did not associate the ruminations with OCD. The process of coming to terms with one’s sexuality (no matter which part of the spectrum a person identifies with) should certainly be met with understanding and encouragement from doctors and mental health practitioners alike. But extreme and prolonged intrusive thoughts and/or rumination about sexuality– like persistent, constant doubts or constant mental checking– are usually not indicative of true identity formation. These can generally be identified pretty quickly by an OCD specialist as a symptom of the disorder. Like sexuality itself, thoughts about sexual orientation lie on a spectrum. At one extreme is OCD.

Some primary care physicians do diagnose OCD correctly. But in general, when people with OCD are able to get evaluated by a specialist experienced in OCD treatment, they’re much more likely to receive an accurate diagnosis and empirically supported treatment– usually a combination of medications and ERP therapy.

We recognize these difficulties, and we’re certainly not discouraging regular consultation with a primary care doctor as part of your OCD treatment and your efforts to be healthy in general. So, one of the ways we’re helping people get access to proper diagnosis is by making psychiatric evaluations with OCD specialists more readily available to people within the NOCD community. In addition, one of our partners, Biohaven Pharmaceuticals, is offering free psychiatric evaluations to many people who are interested in taking part in their study.

We’re hard at work putting together a directory of specialists trained in OCD, so people who suspect they might have OCD can skip the years of waiting– and probably getting worse– and see a doctor who’ll make an accurate diagnosis and provide effective treatment options.

Looking for more help?

By Phoebe Kranefuss,

Lots of people in our community have been asking great questions about what they can do when treatment doesn’t seem to be working. What if my weekly therapy sessions aren’t enough? What if the severity of my OCD is leading to severe depression or substance use? What if I’ve tried every option I can think of, but just continue to feel worse?

People whose symptoms are the most severe are often dealing with constant cycles of upsetting thoughts and taxing compulsions, which cause them to feel overwhelmed, scared, exhausted, and depressed. They urgently need high-quality, effective care, but often don’t know where to go or how to get it. Some turn to self-medicating with drugs or alcohol in an effort to drown out the thoughts and get some short-term relief. But using substances to cope with obsessions creates a major health risk, and often makes OCD symptoms far more severe in the long run, driving people into a vicious cycle of OCD and addiction.

This is a major problem, which studies show affects around 25% of people with OCD. And we want to address it. That’s why we’ve decided to provide more support to community members with the most severe symptoms who are also at the highest risk of developing substance use disorders by partnering with experts in OCD and addiction. AMITA Health offers a full continuum of care for OCD, addiction, and comorbid disorders, providing evidence-based, OCD-specific treatment at all levels of care. From outpatient therapy groups and partial hospitalization programs to residential treatment with round-the-clock support and supervision, their options enable people to progress through tiers of treatment that are right for them.

We decided to partner with AMITA because they’re committed to top-notch, evidence-based care. The program is run by world-renowned OCD expert Patrick McGrath, PhD, who has trained clinicians all over the world in cognitive-behavioral therapy (CBT) and exposure and response prevention (ERP) for OCD, and is also the author of The OCD Answer Book and Don’t Try Harder, Try Different. He works in partnership with Sarah Briley, EdD, LCPC, CADC, Clinical Director of the Center for Addiction Medicine at AMITA Health and the Foglia Residential Center.

Dr. McGrath has dedicated his life to helping people with OCD. As he told us, “Working with OCD patients is amazingly rewarding. I have gotten to see people get their lives back, start to smile and laugh again, and re-engage in their families and careers. That people trust me to guide them through this journey is humbling, and continues to inspire me to help all of my patients challenge their fears and live a value-based life again.” So yeah, he gets it.

A common space in AMITA Health’s Foglia Family Foundation Residential Treatment Center

There are tons of reasons to consider OCD treatment options that provide more support than typical one-on-one therapy sessions. If you’re interested in learning more about AMITA’s options, or if you’d like to ask questions about insurance benefits, logistics, or anything else, we’d love to hear from you. Just fill out this form, and AMITA’s program liaison, Shannon, will get in touch with you. (You can inquire on behalf of a loved one, too!)

Why Does NOCD Have Sponsored Posts?

By Phoebe Kranefuss,

OCD treatment has always been a bit of a maze. We know this because many of us at NOCD struggled to navigate the healthcare system for years before getting any better.

Today, research suggests most people with OCD are still navigating this maze. They’re not able to access specialists in exposure and response prevention (ERP), the most effective form of therapy for OCD, due to the high cost of ERP sessions, frequent misdiagnosis, and shortages of ERP providers. And many people with OCD are incorrectly prescribed medication by primary care physicians who don’t have a nuanced understanding of OCD.

Given these challenges, many people with OCD live in constant anxiety or go into free fall, causing them to drop out of school, lose their jobs, and withdraw from relationships. To make matters worse, the lack of support available throughout these intense struggles can increase the likelihood that people self-medicate with illicit substances, become severely depressed, or develop other comorbidities. It can rapidly develop into a cruel cycle.

Facing this string of issues, it’s easy to feel hopeless– but we shouldn’t. NOCD is committed to rapidly realigning the OCD treatment system, using a combination of technology and evidence-based clinical support to make care more effective and more widely accessible.

To start the process, we launched a free OCD treatment app with a built-in support community. The NOCD app helps people with OCD more easily understand ERP and start treatment down the best available path. After tens of thousands started using the app, we realized it was a one-stop solution for some of our members. But for those with more severe symptoms, it was only the start of their journey.

That’s why we recently introduced sponsored posts in the NOCD app: to help every one of our members find more robust care options around them, whenever and wherever a need arises.

We partnered with Biohaven Pharmaceuticals to help members who aren’t satisfied with their current treatment participate in clinical trials. As part of these trials, members may get free psychiatric evaluations. Getting to work with an experienced, innovative psychiatrist can be transformative.

To better support those with OCD and comorbid conditions like depression and substance use, we recently started working closely with two new partners:

Actify Neurotherapies offers additional treatment options for comorbid OCD and depression, including transcranial magnetic stimulation (TMS) and ketamine infusion– which involves supervised administration of low doses at one of their clinics. We’re helping our community learn about these options.

AMITA Health offers unique simultaneous treatment options for OCD, depression, and substance use, ranging from intensive outpatient programs to partial hospitalization and residential programs.  

You’re probably wondering: but aren’t these partners paying you guys?

Yes, but that’s not why we promote them. We pass on most partnership opportunities because they won’t help us get our community members immediate help. We only promote companies that fulfill this purpose and are validated by our clinical team as excellent resources.

If your symptoms are severe and you’re looking for more comprehensive forms of care, some of the partners we work with today might be a great fit for you, a family member, or a friend. Others might not feel quite right (feel free to ignore them!). Later this year, we plan to start offering options for those seeking OCD-specific outpatient therapy and teletherapy.

On average, it takes 10-17 years for people with OCD to get better. We think we can do better. Let’s work together to make it happen.

Check out the NOCD app to keep up with our innovative partners:

Why We’re Partnering With Actify

By Phoebe Kranefuss,

Our mission is to help people with OCD feel better by making care more effective, accessible, and connected. To do that, we’re enhancing our mobile platform’s capabilities while identifying resources for our community members who are severely affected by OCD and co-occurring disorders like depression.

Around 4 million Americans suffer from both severe OCD and depression, but many of these people don’t respond to first-line treatments, given the complexity of their diagnoses. The severity of their symptoms may feed into the cyclical nature of OCD, causing them to feel worse– or even lose hope. They may need help urgently, but it’s often very difficult to know how or where to get it.

To live up to our mission, we committed ourselves in 2018 to finding a partner well-versed in severe depression that hasn’t gotten better despite multiple trials of medication and/or therapy– often referred to as treatment-resistant depression– who could help us serve our community more effectively.

New options for treatment-resistant depression

When we met Dr. Steve Levine, MD and Kyle Snook of Actify Neurotherapies, a mission-centered group of clinics focused on providing safe and effective additional options for treatment-resistant depression, we knew we’d found a great partner.

Dr. Levine, a psychiatrist who values psychotherapy but also knows that medication can be an important part of treatment, founded Actify in 2011 after feeling frustrated by standard medications that offered little to no relief for patients with severe depression but piled on lots of side effects. His passion for helping patients get better led him to commit to making additional treatment options more accessible to people who really needed care for treatment-resistant depression.  And Dr. Levine has been very successful.

On average, it takes 10-17 years for people with OCD symptoms to receive treatment. For those with comorbid depression, treating OCD while also dealing with depression symptoms like low energy and low self-esteem can be an even tougher hurdle to cross. Finding safe, effective, and immediate support can be especially important– even lifesaving.

Working with Actify is another step in our mission to help all of our community members find the treatment options they need.

Any questions or concerns? Email us:

Meet Our Newest Scientific Advisor: Dr. Patrick McGrath

By Phoebe Kranefuss,

At NOCD, we work with experts to develop the most effective self-help tools and push mental health science forward. Our Scientific Advisory Board gathers some of the world’s top experts on OCD and related disorders. Our advisors have spent decades conducting research and treating patients at the highest level, and now they’re bringing their expertise to our work every day.

Today we’re thrilled to announce that we’ve welcomed a new member to our Scientific Advisory Board: Dr. Patrick McGrath, an enthusiastic and dedicated clinician who has provided invaluable guidance to the NOCD team throughout the past few years. He brings genuine energy to our work, not to mention his nuanced understanding of what people with OCD might find helpful.

Dr. McGrath is Assistant Vice President of Residential Services for the AMITA Health Behavioral Medicine Institute, Executive Director of the Foglia Family Foundation Residential Treatment Center, and Clinical Director for the Center for Anxiety and Obsessive-Compulsive Disorders and the School Anxiety and School Refusal Programs at AMITA. He is also a member of the Scientific Advisory Board of the International OCD Foundation and President of OCD Midwest. Dr. McGrath is the author of The OCD Answer Book and Don’t Try Harder, Try Different.

In addition to treating countless patients with OCD, Dr. McGrath has trained clinicians around the world in cognitive behavioral therapy (CBT) and its OCD-specific derivative, exposure and response prevention (ERP). In the words of Dr. McGrath, “Working with OCD patients is amazingly rewarding. I have gotten to see people get their lives back, start to smile and laugh again, and re-engage in their families and careers. That people trust me to guide them through this journey is humbling and continues to inspire me to help all of my patients challenge their fears and live a value-based life again.”

Welcome to the NOCD team, Dr. McGrath!

Ten Times OCD Was Treated Like a Joke But We Weren’t Laughing

By Phoebe Kranefuss,

1. Obsessive Christmas Disorder

There are a lot of reasons to love Christmas: spending time with family, drinking hot chocolate, making cookies, and taking a much needed vacation from school or work. But liking Christmas? That’s not obsessive, and it’s certainly not a disorder. Decorating a tree, opening presents, making a gingerbread house, and spending time with people you love are all really wonderful things. Pretending OCD is funny or quirky not so much.

2. Obsessive Cleaning Disorder

Sure, some people with OCD experience obsessions with cleanliness or contamination, or compulsions involving hand washing or cleaning. But the majority of people with OCD actually suffer primarily from upsetting intrusive thoughts about taboo topics like sexuality and violence. The stereotype that all people with OCD are overly consumed with being clean is inaccurate, and might even prevent people who are experiencing upsetting thoughts from seeking treatment.

3. Obsessive Corgi Disorder

Dogs are the best. And corgis are very cute dogs. Lots of people are obsessed with corgis, because they are 100% good boys/girls and they are great at splooting. I really like corgis, but I can’t think of a single similarity between liking a particularly cute breed of dogs and being constantly plagued by irrational fears. Corgis make you smile. OCD can make you feel unable to go outside, enjoy time with friends, or partake in the things that bring you joy. Like petting corgis.

4. Obsessive Compulsive Decoupaging Disorder

Seriously?? Is it not enough to just enjoy decoupaging?? What even is decoupaging? Why are we talking about it? Just. Decoupage. Without. Buying. This. Mug.

5. Obsessive Cow Disorder

Personally, I find cows smelly and kind of dirty. Not to mention huge contributors to global warming (not their fault, I know). So I may be a little biased when I say I have a hard time understanding how someone could be obsessed with cows in the first place. But I’ll put aside my lack of unconditional love for these ginormous spotted creatures to wonder out loud: is there no better way to express your love for cows than a silly acronym that pokes fun at a debilitating disorder? Is a shirt or mug or poster or billboard in front of your house that says “I REALLY LOVE COWS” not enough?

6. Obsessive Crawfish Disorder

Yeah… I don’t even have anything to say about this one.

7. Obsessive Coffee Disorder

We really like coffee. We wrote a whole article on how coffee isn’t as bad for your mental health as people might think it is, according to recent research. If there were anything on this list that I spend a lot of time of my day thinking about and pursuing, it’d be coffee.

But even the most enthusiastic coffee lovers spend maybe two hours a day with coffee cup in hand, at most. Considering the diagnostic criteria for OCD include up to ?? hours per day focused on obsessions or compulsions, there’s really no parallel. Taking something you really like a lot and comparing it to a disorder characterized by intrusive thoughts that can be disturbing, upsetting, and against one’s values, is kind of absurd.

8 Obsessive Cat Disorder

Whether you’re a cat person or a dog person, I think we can all agree: cats have nothing to do with an OCD diagnosis.

9. Obsessive Crochet Disorder, Obsessive Cycling Disorder….

More objects that pretend OCD means really liking something a lot. If OCD makes you check the lock on your front door over and over again, it’s not because you really love locks. It’s probably because you’re deeply afraid of something and OCD has convinced you that checking the lock will prevent that thing from happening. Liking something has nothing do with the onset of an obsession!

10. Obsessive Compulsive Action Figure

The stereotype of a super clean, neurotic person who can’t shake hands for fear of getting dirty encapsulates just one type of OCD. This sort of image also contributes to society’s misunderstanding of OCD as a “hypochondriac” disorder that only a certain type of person has. The reality is, lots of people you’d never expect to have OCD do indeed suffer from the disorder. Some people with severe OCD keep their homes really messy, and cleanliness has nothing to do with their obsessions. The majority of people with OCD probably suffer in silence– and in secret. 

The goal isn’t to scold people for making these flippant comparisons. It’s to remind us all that tons of people with OCD suffer for a lot longer than they need to because they don’t– or aren’t able to– get help. Inaccurate stereotypes of OCD make it even harder for people who don’t “seem OCD” to seek help, or even know they need it. 

 

Really liking something doesn’t mean you have a disorder. To meet more people who don’t throw OCD around like a funny acronym, join the NOCD Community in our mobile app.

What’s the strangest OCD riff you’ve seen? Let us know on Facebook, Twitter, or Instagram @treatmyocd. And be sure to share this post with anyone who might find it helpful! 

Announcing Our New Partnership with Actify!

By Phoebe Kranefuss,

A New Partner

NOCD and Actify Neurotherapies are partnering to make more treatment options available to more people who need them. Actify is a leading provider of ketamine, a safe, effective treatment for tough-to-treat mood disorders like major depression.

Ketamine has been used for decades as a local anesthetic during routine procedures like stitching up a child’s skinned knee; when delivered in small doses intravenously, it promotes the materials necessary to make repairs to communication systems between areas of the brain responsible for depression, anxiety, pain, and other forms of stress damage.

Steve Levine, M.D., a board-certified psychiatrist, therapist, and the CEO/founder of Actify Neurotherapies, worked closely with patients in his clinical practice who suffered from treatment-resistant depression and anxiety. 

Dr. Steve Levine

A common course of treatment for people who are diagnosed with mental health disorders might include first-line medications like selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) combined with cognitive-behavioral therapy (CBT) or one of its variants, like exposure and response prevention (ERP).

Many patients will benefit from a new medication or get the hang of CBT after a few weeks’ time, experiencing noticeably fewer symptoms. Some patients might need to work with their doctor to tweak the prescribed dosage, try a different medication, or practice more intensive therapy before they start to feel better. But about half of people who receive treatment– like a number of Dr. Levine’s patients– won’t achieve a meaningful decrease in symptom severity, even after trying different medications or therapeutic interventions.

Dr. Levine had always considered himself a therapist first and a provider second, so he combined his clinical experience with his research background to learn more about ketamine, which was gaining traction as a safe, proven, and fast-acting solution for treatment-resistant mood disorders– a potential good fit for some of his patients.

Guided by his mission to help his patients and his clinical expertise in treatment-resistant mood disorders, Dr. Levine founded Actify Neurotherapies, which is now the largest group of centers providing ketamine infusions for mood disorders, with 9 locations nationwide, and a track record of treating more than 3,000 patients with over 30,000 infusions since its founding.

Ketamine in the News 

Media headlines have recently and inaccurately called ketamine a “party drug” or “horse tranquilizer.” Dr. Lerner, who leads Actify’s Baltimore site, notes that cautious patients who are mislead by these inaccurate characterizations might feel dissuaded from considering ketamine therapy as an option. False information about ketamine can make treatment inaccessible to the people who need it, which is why we’re working to share accurate, evidence-based information about this type of treatment with the NOCD community.

Some people hear “horse tranquilizer” and assume ketamine is powerful enough to sedate a horse. While many medications that work well on people are also used on animals (Aspirin, Albuterol, and even allergy medications!), the amount of prescribed medication varies drastically based on factors like weight and metabolism. A 150-pound human would be administered a dose of ketamine significantly smaller than what would be necessary for a horse during surgery, much as a 50-pound child would never be given the same dose of ketamine– or another medication– as an adult. These sorts of headlines might be especially hard to read for people who deal with OCD and anxiety disorders, who might worry already about medication safety. With a history of treating more than 3,000 patients, Actify also has a proven track record of 70-80% of patients reporting feeling noticeably better after treatment. Their findings on the efficacy of ketamine are echoed by a research team at Stanford, who we’ve written about before.

NOCD is excited to share Actify’s experience and expertise with our own community. We think it’s important that organizations who offer treatments know firsthand what they’re talking about (our own clinical advisors have dedicated their careers to treating OCD, and many of us at NOCD have OCD ourselves). That’s part of the reason we’ve decided to partner with Actify: their work is heavily informed by their own clinical and personal experience with the disorders they treat.

As we’ve mentioned, Dr. Levine’s years of clinical experience inspired Actify’s founding. And Actify’s COO, Kyle Snook, brings his own experience with PTSD and major depression to Actify: while serving as an Army Captain in Afghanistan in 2010, Kyle sustained a severe injury from a roadside bomb to his leg. He was given ketamine as an anesthetic while being evacuated by helicopter. Healing from his injuries was taxing, but recovering from his subsequent post-traumatic stress disorder and major depression proved even harder. Kyle learned that thousands of veterans suffer from PTSD and depression each year, and too many of these men and women receive ineffective treatment, or no help at all. What if ketamine, which had helped Kyle in the immediate aftermath of his physical injuries, could also help people who suffered from PTSD and other mental health problems long after an injury had occurred? (Spoiler alert: it can!)

We’re so excited to work with Actify, and to help make innovative treatment options available to those who need them! Questions? Comments? Email info@nocdhelp.com or reach out on social media: @treatmyocd.

Big Announcement: We’re Launching the nocd Network!

By Phoebe Kranefuss,

If you have OCD, you probably already know how persistent and debilitating obsessions and compulsions can be. From disturbing intrusive thoughts and time-consuming rituals, to common misconceptions about what the disorder actually entails, living with OCD can be overwhelming and exhausting.  

OCD is considered chronic, meaning there’s isn’t a cure, but there are effective ways to manage the disorder and experience relief, typically with a combination of first-line medications like SSRIs and exposure response prevention therapy. Unfortunately, many people don’t receive treatment, either because therapy is too expensive, or because they don’t have access to therapists in their area who know how to diagnose and treat OCD. Others might not seek out treatment at all, due to the shame that often accompanies disturbing thoughts or embarrassing rituals. Still others receive incorrect diagnoses from primary care physicians or therapists unfamiliar with the disorder, which might further extend the amount of time it takes for them to access proper care.

At nOCD, our goal has always been to change the way OCD treatment works: where OCD can be isolating, we’ve created an in-app community for people to share their struggles and accomplishments with others who understand their journey. Where traditional treatment has been expensive, infrequent and scarce, we’ve made customizable ERP available to all people with our mobile app, which is also designed to work as an addendum to traditional therapy.

We also know that each person is different. If in-app ERP and a sense of community works well for one OCD sufferer, that doesn’t necessarily mean it will be effective for someone else. Some people will need more intensive interventions in order to feel better, like existing or emerging medications, residential or partial hospitalization, or a combination of therapies tailored to their individual needs.

That’s why nOCD is expanding to partner with all kinds of leaders in the field of OCD research and treatment. We’ve spent a whole lot of time meeting with researchers, like Dr. Rodriguez at Stanford, who’s studying a glutamate modulating agent for OCD treatment that makes us feel hopeful. We’re consistently impressed by the dedication and hard work so many intelligent people we’re working with put into finding effective treatments for OCD, and we’re excited to share these resources with the nOCD community.

OCD treatment has always been a bit of a maze. We know, because many of us at nOCD struggled to navigate OCD treatment for years prior to finding great therapists and effective treatments. That’s why we’re officially launching the nOCD network to help people access the best and most effective treatment, and to help treatment resources find and help more people who are suffering. You can expect information on a range of studies, organizations, and doctors we’ve decided to partner with, some of which may seem like great options for you (or for a family member or friend), and others that probably won’t make sense for you (feel free to ignore them!). You’ll see this information in upcoming posts on our blog, on Facebook, Twitter, and Instagram @treatmyocd, and on our website. On average, it takes 11 years for people who experience OCD symptoms to receive treatment. This is one more step to change that, and help people with OCD feel better.

Check out the nOCD app here

An Update on Android!

By Phoebe Kranefuss,

Last week, we released the beta version of nOCD for Android which was greeted with lots of enthusiasm and great questions. We know you’ve been patiently waiting for this release, and we want to address some common questions about the Android beta, why we released it, and how you can take part.  

What’s a beta?

A beta is a pre-release version of an app or piece of software that’s made available for testing, usually to just a small group of people, so companies can receive feedback before releasing it to everyone.

What functionality is available?

Building an entire app can take months or longer, so we decided to release the functionality in stages.  The first stage of our release plan is the Community feed. It’s a place where users can give and receive support, and share their wins and challenges with other real people with OCD.

Why did you start with the Community feed?

We decided to release the community section first because our therapy section is undergoing some design updates to make it more intuitive to use. We wanted Android users to be part of the supportive community iOS users have access to while we make the rest of the app even better.

When will the Android app be out with the therapy functionality?

Our team is working every single day on getting the Android version ready including the exposure and response prevention (ERP) section. A number of us have OCD ourselves, so it’s particularly hard for us when people want help for OCD but can’t access it yet because the app isn’t available on Android. We’re targeting to release the full Android app by the end of 2018.

How can I get access to the beta?

We’re so glad you’re interested! Please email info@nocdhelp.com, and we’ll add you to the list. You’ll receive an invitation to join within 48 hours.

OCD Isn’t About Handwashing! And Other Questions from Users

By Phoebe Kranefuss,

This week, we’re answering questions from our users via Instagram (@treatmyocd). We received tons of great suggestions: people wanted more about different subtypes of OCD, including Relationship OCD, Homosexual OCD, Pedophilia OCD, and Rumination. People were also curious about how to talk to friends and family about OCD, and to learn more about comorbid disorders (here’s an article about OCD and eating disorders, but we owe you more, and they’re coming!!).

Thanks for doing my work for me! Just kidding 🙂

This week, we’re talking about that scary fear that OCD might never go away, what to do when people say “I’m so OCD!!!”, mindfulness for when OCD feels out-of-hand, and how to live a value-based life no matter when obstacles land in your path.

Question: I worry I’ll never recover. How do I manage this fear?

During really bad OCD days, tolerating distress for even a few minutes can feel like an overwhelming task, and picturing a future free from OCD can be motivating. But even the most hopeful people can feel discouraged after a particularly hard course of exposure response prevention (ERP) doesn’t provide noticeable results, or when a therapist doesn’t pan out to have the expertise he or she claimed.  If you’re worried about never recovering, rest assured: this worry is normal. But there’s actually a surprising flipside to focusing on an OCD-free future, which can be detrimental to treatment.

ACT, or Acceptance and Commitment Therapy, teaches us to accept how we feel and what we’re going through, while identifying our values, and living our lives accordingly. Acceptance and value-based living contribute to psychological flexibility, or the ability to enter a situation with openness, rather than fear or anxiety. Living in fear of never recovering doesn’t give you a whole lot to actually work towards.  But identifying specific goals and values and moving towards them (as opposed to moving away from what you don’t want) is a more effective way to feel better, and helps you live the type of life you value, even when OCD is present.

Practicing ACT doesn’t mean that prioritizing your values will make your OCD thoughts go away. But over time, it can help you change the relationship you have with your decision making processes. Even if OCD  is present, you can still engage in the activities and relationships that give your life meaning.  Here’s an example: you value helping animals, and have always wanted to be a veterinarian, but your fear of germs has kept you from pursuing your goal.  Contamination exposures are hard, but if you keep in mind not just your interest in recovery, but also your goal of becoming a vet as you practice these exposures, you’ll derive motivation from working towards something you really care about. 

If veterinarians get to cuddle with puppies like this one, count us in!

Question: I really don’t like when people throw around ‘OCD,’ as in: “I’m so OCD!” How do I tell them OCD isn’t just about neatness or hand washing?

When people throw around ‘OCD’ as a synonym for ‘neat,’ they usually do it out of ignorance. It’s likely a well-meaning person who just doesn’t know what OCD is really about, and can you blame them? It’s not like OCD gets talked about a whole lot, which is part of the reason it’s so often misdiagnosed, misunderstood, or mistreated in people who really suffer. This is a great opportunity to contribute to the destigmatization of OCD (and mental illness in general) by educating the offending speaker on what OCD really is. Some people might feel comfortable saying something like: “actually, OCD is a really serious mental disorder, and I’d love to tell you about how it’s affected me and my life.” You might be surprised to hear people’s reactions – sometimes, a little vulnerability opens the conversation about how mental illness has affected all kinds of people in ways you wouldn’t expect.

Some might feel really uncomfortable confronting someone or talking about OCD in public. They might try sharing information about OCD in a different way (through social media, or just with people close to them). Don’t want to share that you have OCD? You can always share facts – like, did you know 1 in 40 people meet the criteria for OCD? Or that the average age of onset is typically childhood, adolescence, or young adulthood? No need to talk about your own experience if you don’t want to. But you have the right to let people know that ‘OCD’ isn’t just a term that means ‘clean.’

Question: How do I calm down when OCD gets out of hand?

I think every single person who struggles with OCD can relate to this challenge. There’s two ways that OCD gets out of hand: in the moment (especially during an exposure), and in a larger sense, affecting daily life for a period of days, weeks, or even months. Mindfulness exercises can be useful in both situations, but in different ways. If you’re experiencing an immediate increase in anxiety, using mindfulness to calmly observe your surroundings can help  you return to the moment. Use all five senses to experience what’s around you. What do you see? Do you smell anything? What colors are around you? Do you hear any noises? What does the temperature feel like? What does your breath sound like? What do your feet feel like on the floor? Make sure you’re breathing as you notice. Over the course of months and years of practice, mindfulness can become a part of your daily life, and you might find yourself incorporating practices like this one into daily activities, like brushing your teeth.  It might not make OCD go away, but it will help you to feel more present and grounded in the moment, changing your reaction to the way OCD makes you feel.

OCD and Social Media

By Phoebe Kranefuss,

Most of us use social media at least once a day: in the US, 90% of young people and 65% of adults are regular users. And many of those users, including me, are accustomed to opening Facebook or Instagram to see endless filtered images of seemingly perfect lives. I have a long-ago acquaintance who moved to Hawaii, and now seems to spend most of her time taking romantic walks on the beach with her photogenic boyfriend, prompting me to ask: who is taking these photos? And should I move to Hawaii??? I tap ‘like’ on Pinterest-worthy smoothies and quinoa bowls made by tanned, toned strangers, and have considered countless drastic life changes when I see an endorsement by someone I hardly even know.

Being inundated with images of curated perfection feels a lot like being flooded with intrusive thoughts. Logically, I know neither the pictures nor the thoughts are an accurate reflection of reality. But emotionally, I feel overwhelmed by their presence. Sure, I know my acquaintance in Hawaii isn’t always laughing at the beach – but I still can’t help but feel jealous of her life when this is the only part of it I see. If I have an errant thought about harming someone I care about, I know it doesn’t mean I actually want to hurt them, or that I’m a bad person, but in the moment, it’s hard to be logical, and sometimes, I panic.

Because aspects of social media and OCD can be quite similar, sometimes social media usage can exacerbate OCD. Because of this, it is particularly important for people with existing mental health concerns to use the Internet wisely. If we are careful and conscientious users, there’s much to be gained from the community-building power of global communication.There’s even evidence to suggest that social media can be an extremely valuable resource for individuals with OCD and other mental disorders. So many people suffering from mental health issues do so in silence. Sometimes, talking to family and friends about OCD can feel embarrassing and scary. With social media, including nOCD’s group feature (download here!) individuals can share concerns and stories with others who know exactly where they’re coming from. You might not walk through the cafeteria with a sign above your head that says “I HAVE OCD! DOES ANYONE WANT TO TALK ABOUT IT??” (but if you do – more power to you!!). The Internet allows us to anonymously join other people who have identified themselves as dealing with exactly the same kinds of struggles. Especially for people in early stages of recovery, talking about OCD with the anonymity of a screen name can be a very meaningful preliminary step towards destigmatization – especially when it leads to more IRL conversations about mental health.How do you use social media in the context of having OCD? Are certain platforms more triggering than others? Are any of them helpful? Speaking of social media, let us know on Facebook, Instagram, or Twitter at @treatmyocd

When OCD Isn’t Your Only Diagnosis

By Phoebe Kranefuss,

If you deal with OCD on a day-to-day basis, you probably already know that obsessive thinking can really get in the way. At nOCD, many of us have experienced firsthand how OCD can turn any ordinary activity– from grocery shopping to checking email– into a stressful and exhausting ordeal.

OCD is definitely a pain. But for many, the distress caused by OCD might only be part of the picture. A number of people who suffer from OCD deal with a second (and even a third) mental health condition, like depression, anxiety, social phobia, and/or an eating disorder. According to one study, a shocking 74% of patients diagnosed with OCD also met the criteria for at least one other disorder.

Treating OCD in the context of an additional diagnosis can be challenging. Which is the primary concern? Do the disorders exacerbate each other? Is an individual using effective coping mechanisms to tolerate anxiety, or is he or she using one symptom to manage another? And can the treatment methods for one condition make the other one worse?

For the 64% of individuals with eating disorders who also have OCD, the overlap between the two conditions can be hard to manage. Both rely on patterns of obsession, avoidance, and ritualistic behavior, making exposure and response prevention (ERP) exercises particularly difficult. For example, if someone is practicing exposures with the fear foods they normally avoid, they might be tempted to use OCD rituals to mitigate the onslaught of anxious thoughts that result. During an exposure, someone with an eating disorder must sit not only with the anxiety of eating a fear food, but also the anxiety of not partaking in an OCD ritual to calm the anxiety caused by the fear food in the first place.

An individual in treatment for both disorders might also struggle with their different perceptions of their diagnoses. OCD is generally experienced as an ego-dystonic disorder, meaning the disorder and its symptoms are in opposition to an individual’s nature, desires, values, and self-image. Eating disorders, on the other hand – especially anorexia nervosa – are more often experienced as ego-syntonic, meaning they’re congruent with an individual’s personality and values.

Dealing with the symptoms of multiple disorders can be quite challenging. But here’s the good news: because the disorders are so intertwined, participating in effective treatment for one disorder has been shown to diminish the other, too. This doesn’t mean OCD treatment with magically cure an eating disorder, or vice versa – but it does mean that practicing ERP for OCD might make food exposures a little easier, and that food exposures might make ERP for OCD a little bit easier, too. Sure, you deal with more symptoms and distress – but you also get more “bang for your buck” with treatment!

Dealing with comorbid diagnoses? Have any tips or best practices? Let us know on Facebook, Twitter, and Instagram @treatmyocd. We want to hear from you!

Join our app for ERP and treatment-centered community here

Harris Goldberg talks OCD in Hollywood

By Phoebe Kranefuss,

If you’ve laughed out loud during Master of Disguise or Without a Paddle, you might not think to associate director, writer, and producer Harris Goldberg with obsessive compulsive disorder. But speaking with Harris reveals a different history: his experience with anxiety and ineffective therapy reveal a wealth of perspective, knowledge, and candor about OCD. The nOCD team was lucky enough to speak with Goldberg last week, and we’re excited to share his inspiring story with you!

“Turtle Man” from Goldberg’s The Master of Disguise

nOCD: What’s it like having OCD in Hollywood?

Harris Goldberg: I think that if you have any sort of predisposition exacerbated by stress, whether it’s OCD or anxiety or depression, Hollywood and this business can exaggerate it. It’s been amazing here. But there’s a lot of up and down, and a lot of smoke and mirrors. Looking back, I think it was probably the worst business for me to go in, as someone who’s always had these OCD and anxiety issues lurking in the background.

nOCD: What’s been your experience with therapy?

HG: I’ve found that it’s really hard to find [a therapist] who’s really good. It’s really hard to get specific and find the tools you need for recovery. It’s like physical training – there are a lot of bad trainers out there, because they’re training people the wrong way, so they’re giving you exercises that are burning out your joints. I think the same thing holds true for mental illness. If you find someone who really knows what they’re doing, I think you can get better a lot faster, and you can cancel out a lot of the noise.

When I first started doing therapy, there wasn’t a lot of stuff on the Internet. And also, I did this thing where I’d cross the line and become friends with the therapist – in Los Angeles, with therapists, no matter how professional they are, when they found out I was in the entertainment business, they would kind of fall for that, and they would have scripts of their own, or they’d say, “hey, we should collaborate on something,” and it crossed the line from professional therapy to being friendly.  I felt disappointed that they fell for that, and I felt also disappointed in myself for pushing that button.

Harris Goldberg

I didn’t even know my anxiety was fueled by my OCD for years and years – I thought it was two separate things. And OCD, I just accepted as my own little secret thing that kept me comfortable: I have this little thing I do, and these ruminations protect me from bad things happening. But I never realized that the stress from that, and the overload on a daily and hourly basis, was actually making me way more anxious. And the more anxious I would get, the more other symptoms I would get.

When I would bring up OCD to therapists, they would say, “Oh, it’s not that bad, you’re fine, let’s talk about your anxiety, your depression.” But nobody focused on the OCD. It was only that I started to focus on OCD that I realized: that’s the fire I have to put out, right there.

nOCD: You played a lot of tennis growing up. Was your OCD around back then?

HG: I was obsessed with tennis growing up. I loved it because it was black and white. I love sports because the accountability is really easy to measure. To this day, I still feel way more comfortable on a tennis court than I ever would on a movie set, because I know how good I am, I know the outcome, and I know it very well. it’s an anchor for me. Routine and stability directly correlate to how I’m feeling. With tennis, if I had a great topspin down-the-line shot, no one’s gonna go: “that wasn’t a great topspin down-the-line shot.” It just is. But if I write a script, I can have 4 people go, “this is fantastic, we love this,” and I can have another 4 people go, “we don’t get this, we hate this.” In LA, that lack of predictability really started to unravel my feelings of uncertainty. The trick is to accept there’s no such thing as certainty, and somehow find the tools to navigate when you are in those more uncertain moments.

nOCD: It sounds like you’ve gotten more comfortable with vulnerability, which initially really triggered your OCD. And now you’ve learned to sort of find the power in your vulnerability in your writing.

HG: Yeah, like when I started, I was in the comedy world. I have an older brother who was a very successful comedy writer. I was always a funny guy in school; I was always sort of the class clown, but underneath I had my secret of OCD, which I’d mask by being funny, which I learned early on as a defense mechanism. So when i moved to LA, I naturally started following in my brother’s footsteps, and I started writing comedy, and had success with Deuce Bigalow and Without a Paddle and the Adam Sandler movies. But i never really liked these movies.

There was a point when I had – I don’t want to say breakdown – but I really hit a low point with the anxiety and OCD, and that’s when I said I can’t do this comedy anymore because it wasn’t what I wanted to do. So I started to write more into what I was feeling, and tapping into the things that drive the mental situations. And writing about it was really cathartic and helpful, because it made me examine it from a third person point of view, because I’m writing about a character who’s feeling these feelings, but is really not me, and that allows me to analyze it in a way I’d never done before. But I had to make that switch to tap into that stuff, which I’d never really done before, because I was hiding behind laughs, which was an easy thing to do.

nOCD: Is there anyone who looked at you and asked, “What are you thinking?” when you turned away from the successful comedy films?

HG: Everyone. Agents, managers. It was only when I did Numb, this movie with Matthew Perry [that people stopped doubting me]. I had done Without A Paddle, which did really well. And I hated it. I said, I can’t do this anymore. So I locked myself up, and I wrote this very cathartic autobiographical movie. I never thought it would get made in a million years. And then somehow it got financed, and I directed it, and Matthew wanted to do it, and he was in a vulnerable spot in his own life, playing a version of me, so it was very personal. We really got tight. And when that movie came out, the reaction to it was really palpable. I mean, we’d go to film festivals, and we premiered it at Tribeca in New York. And the reaction from people was: Thank you for making this! I have anxiety, I have OCD! I loved that feeling. I felt like, I can’t believe this reaction i’m getting, and that changed everything. But everyone in my camp – agents, lawyers – they thought I was crazy. They said, just do another stupid comedy!

Matthew Perry in Numb

nOCD: Where did you draw the strength to go into your vulnerability and take this more authentic path, especially as other people were telling you this wasn’t a good idea?

HG: I think desperation. In 1992, I was suffering [from anxiety and OCD], and the symptoms wouldn’t let me ignore it anymore. I didn’t feel funny, I didn’t want to write anything funny, and I thought, maybe I’ll quit and go into tennis, because I felt secure in that. And then I thought, well maybe I’ll write how I’m feeling. And I started writing almost a bit of a  journal. Then I thought, well this could make an interesting movie. So it really came out of almost hitting a rock bottom in a way, which forces you to change on a lot of levels.

nOCD: Do you have one or two top tips from your experience, if a new person came to you with OCD?

HG: Go directly to ERP and ACT. Forget everything else. If you want to do talk therapy about your life, do it afterwards. For now, learn what OCD is, and go with someone who really knows what they’re doing, and can nip this thing in the bud, and you can start to develop tools that can deal with the OCD. Find the right person, whatever it takes.  Realize that life is incredibly short, really. There’s no point in going through life unhappy, because it’s not going to change if you don’t change it now. As you get older, you become a caricature of yourself. It only gets worse, so you might as well try to recover now, so you can have as much remaining life as you have, or you’re supposed to have. And have some joy in it.

 

ERP and Value-Based Living

By Phoebe Kranefuss,

OCD can be a little bit like a new puppy.

It follows you everywhere, it requires tons of attention, and when you say “no,” it seems instead to hear: “DON’T STOP!” If you’ve ever trained a puppy, you know how hard it can be to discipline an adorable ball of fluff.

Disciplining a puppy might feel uncomfortable, but it’s crucial. Letting your puppy get away with mischief will turn him into a dog who jumps on the mailman and pees on your carpet. OCD definitely isn’t fluffy or cute, but managing it through exposure and response prevention (ERP) requires a lot of energy, repetition, and patience– kind of like training a dog.

ERP, which the International OCD Foundation identifies as the most effective treatment for OCD today, entails purposely exposing yourself to the thoughts, images, objects and situations that make you anxious and/or start your obsessions, and making a choice to withhold from a compulsive behavior or response once the anxiety or obsessions have been purposefully triggered. This can be distressing, especially during the preliminary stages of treatment when the OCD brain is accustomed to using compulsions to immediately eradicate uncomfortable or anxiety-provoking thoughts. Even people with a lot of experience doing ERP will find that  more challenging exposures trigger a higher level of discomfort.

Purposefully triggering anxiety? That might seem counterintuitive. It also might leave you feeling overwhelmed and exhausted. But giving yourself the opportunity to experience anxiety, and gradually get used to it, is critical, because it sends a powerful message to OCD: it doesn’t get to make the rules around here. You– not your OCD symptoms– are in charge of your life.

Think of it this way: if you’re training a puppy to sit, and you give up halfway through the lesson, rewarding him with a treat despite his inability to follow instructions, then you’ve trained him to see himself as head honcho. Next time, he probably won’t sit, either. Giving up on an exposure by giving in to a compulsive behavior similarly rewards OCD. But the reverse is also true: strengthening your ERP muscles by exercising your ability to practice exposures and ride out the anxiety they induce shows OCD you’re taking a stand.

Let’s say Dan struggles with Harm OCD. Dan isn’t a violent person, but he fears that if he’s given a knife, he’ll use it to hurt someone around him. He has a counting ritual he performs, which temporarily causes the violent imagery to dissipate. Dan’s friend invites him to a cooking class, and Dan knows he’ll be expected to use a knife around other people–  a major trigger for him. But Dan both values his friendship and enjoys cooking, and knows he would enjoy the class if it wasn’t for OCD. Dan has two choices:

  1. Reject his friend’s invitation, empowering OCD to dictate his life choices
  2. Accept his friend’s invitation, and view the class as an opportunity to expose himself to triggers and practice ERP (he might discreetly use nOCD’s app to track ERP during the class – download here!)

Does OCD conflict with your values and interests? How do you take a stand when OCD tries to keep you from participating in the activities and hobbies that give your life meaning? We’d love to hear from you!

Facebook and Instagram: @treatmyocd

email: phoebe@nocdhelp.com

Holistic Approaches to Mitigating OCD

By Phoebe Kranefuss,

 

Ever missed out on something because your OCD decided it was in charge for the moment, hour, or even the whole day? Yeah, us too. In fact, most of us already know what it’s like to feel as if our day-to-day life is ruled by OCD.

If you’ve ever been too distracted by obsessions or compulsions to focus on a good book or enjoy a cup of coffee, then you know what it’s like to have life’s simple pleasures robbed by OCD. Repetition and predictability are integral to a sense of security and groundedness in our daily lives, but when OCD hijacks these choices, usually, more obsessions follow.

Three people cheering with iced coffee and lattes at Verve Coffee

What if we could turn the tables? What if, instead of OCD “choosing” rituals that ultimately lead to increased anxiety, we could make healthy choices to integrate productive daily habits and rituals, which could help control and mitigate rather than contribute to OCD?

Clinicians like Alison Bested, MD, and Richard Brown, PhD, are asking some important questions about our daily habits – specifically how our eating and exercise routines affect mental disorders like OCD, including treatment-resistant cases.

Flat lay of fresh ingredients with avocado, herbs, jalapeno, and egg

Dr. Brown, clinical professor of psychiatry at Columbia University, chose a sample group of fifteen patients currently receiving therapy, medication, or both, who showed significant OCD symptoms despite treatment. He enrolled the patients in a twelve-week aerobic exercise program, and monitored OCD symptoms throughout the trial. At the end of the twelve-week trial, Dr. Brown noted a clinically significant reduction in symptoms. He then re-tested the patients three weeks, six weeks, and six months after the trial had ended, and noted a sustained decrease in OCD symptoms– even though the patients were no longer participating in monitored exercise routines.

In the words of Lena Dunham, who openly struggles with OCD, it can be “mad annoying when people tell… those struggling with anxiety, OCD, [and/or] depression…to exercise.” We get that. Adding exercise into your daily routine probably won’t make your OCD go away, and it doesn’t guarantee a decrease in symptoms, either. But making exercise a part of your daily routine – in addition to practicing ERP, or taking an SSRI if prescribed by your doctor, or both – might still be worth a try.

Even dedicating just a few minutes per day can lead to results. Justin Strickland at the University of Kentucky thinks strength training is the most effective way to treat anxiety through exercise, noting that “resistance training at a low-to-moderate intensity produces the most reliable and robust decreases in anxiety.” That doesn’t mean you need a fancy gym or strict workout regimen to see benefits – here are some exercises that require zero equipment and only nine minutes of your day. If working this routine into your daily schedule helps decrease your OCD symptoms, you might save a lot more than nine minutes per day in the long run!

The way we eat matters, too. The link between gastrointestinal and mental health dates back all the way to 1933, when clinical psychiatrist Joseph Kilman suggested in Psychiatric Quarterly: “We feel justified in recognizing the existence of cases of mental disorders which have as a basic etiological factor a toxic condition arising in the gastrointestinal tract.”

Alison Bested, MD, would probably agree. Dr. Bested is making the gastrointestinal relevant with her research on correlations between dietary choices, gut health, and mental health. She and her team noted that a diet rich in fermented foods, leafy greens, and probiotics can lead to decreased anxiety and depression as well as decreased intestinal permeability, which she correlates to mental health.

Have you noticed any correlation between your physical and mental health? Have you incorporated any routines into your daily life that have decreased your OCD symptoms? Let us know in our new community feature in our free app, available to download here!