Every year the Obsessive Compulsive Foundation hosts a weekend conference featuring seminars, presentations, and group support opportunities for treatment providers, OCD sufferers, and their families. The 2009 conference was held August 7-9 in Minneapolis and I had the opportunity to attend. I attended so many interesting discussions and met so many psycho therapists who specialize in treating OCD, that it will be a challenge to summarize the experience. For those who missed out this year, here are some of the more noteworthy things I noticed.
Across the board, Cognitive-Behavioral Therapy (CBT) is still considered the gold standard as the most effective treatment for obsessive compulsive disorder. Within this context, new discoveries and applications of CBT are making their way to the frontlines of treatment. In particular, there is a lot more emphasis being put on “mindfulness” and on the cognitive tools found in “third-wave” modalities such as ACT (Acceptance and Commitment Therapy). This approach focuses on learning to better acknowledge and accept unwanted thoughts without assigning a value judgment or an analysis to them. Using ACT and other third wave, mindfulness-based therapies, OCD sufferers can get a better handle on obsessive thoughts before doing compulsions, avoidant behaviors, or mental rituals.
A few presentations focused on the role uncertainty plays in treatment, how strengthening skills for tolerating uncertainty results in symptom reduction, and how people often practice living with uncertainty without being aware of it. Often times OCD sufferers narrow their intolerance of uncertainty to a specific idea about an obsession, failing to recognize that in other, equally significant areas, they are able to accept large amounts of uncertainty.
An interesting progress report I always try to attend at these conferences comes from the OCD Collaborative Genetics Association Study (OCGAS). For the past several years, research into families with OCD has brought us closer to identifying specific genetic regions related to OCD and OC Spectrum Disorders. Compared to other illnesses that affect large populations, relatively little is understood about the etiology of OCD. Each year the OCGAS gets a few steps closer to understanding where OCD comes from, suggesting important new considerations for early detection and treatment.
Another important discussion focused on Pure Obsessional OCD (Pure O), what is sometimes referred to as Pure O. In this manifestation of OCD, sufferers sometimes mistakenly believe they experience obsessive thoughts without compulsions, but in fact the compulsions almost always come in the form of covert mental rituals or avoidant behaviors. The use of imaginal exposure and other Cognitive-Behavioral strategies can be equally effective for the treatment of this kind of OCD, but may require more psychoeducation and cognitive work to help the sufferer better understand how their mental rituals and avoidant behaviors function as compulsions.
Also worth mentioning was a lively discussion about the ethics of Exposure and Response Prevention (ERP) and how therapists conceptualize the boundaries of exposure therapy. This is an especially important subject for sufferers caught up in a cycle of moral perfectionism that may present special challenges for engaging in effective exposure. The general rule of thumb the discussants appeared to agree on was that a therapist should never ask a client to engage in an exposure that could cause serious harm, an exposure that the therapist knows the client is not prepared to handle, or an exposure that the therapist would not do themselves. Going too fast and too far in exposures risks further sensitization to a trigger, whereas systematic and gradual exposure is more likely to result in symptom reduction.
Every year this conference offers so much for therapists, sufferers, and their families to learn about, far more than I could fully cover in a blog. For more information on the Obsessive Compulsive Foundation and their services, check out www.ocfoundation.org.
•The OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions. In addition to individual therapy, the center offers six weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment. To contact the OCD Center of Los Angeles, click here.