Differences in Early and Late Onset OCD

Differences in Early and Late Onset OCD

Pinto et al. (2006) defined OCD as “a neuropsychiatric condition characterized by recurrent intrusive thoughts (obsessions) and repetitive behaviors that the individual feels driven to perform (compulsions)” (pg.1 ).  The researchers sought to investigate predictors of remission/relapse among those treated for OCD.

Over five years, 293 adults were monitored and researchers measured their OCD symptoms. Researchers found those with early and late onset symptoms experience an increase in symptoms over time without effective treatment. Additional findings show a considerable amount of time between symptom onset and first initiation of treatment. Individuals in the study reported an average of 17 years from initial symptom experience to treatment initiation and 11 of delay from meeting diagnostic criteria for OCD until treatment initiation. Many clients reported spending a number of years misdiagnosed before initiating appropriate treatment for OCD.  

Researchers found the average onset for early onset OCD was 11-12 years old, while late onset OCD was 25-26 years-of-age. The first clinical symptom(s), obsessions and compulsions, 53% of participants indicated an obsession and 47% experiencing a compulsion. Interviews also found aggressive content obsessions, hoarding obsessions and compulsions as primary themes in distress. Contamination was shown as the most frequently reported subcategory for obsessions. Those with earlier onset symptoms also experienced higher rates of panic symptoms and disordered (Pinto et al., 2006).

Written by Perry Leynor, MA, LPC Associate supervised by Paula Maloney, LPC Supervisor.

Pinto, A., Mancebo, M. C., Eisen, J. L., Pagano, M. E., & Rasmussen, S. A. (2006). The Brown Longitudinal obsessive COMPULSIVE Study. The Journal of Clinical Psychiatry, 67(05), 703-711. https://doi:10.4088/jcp.v67n0503

Identifying and Treating Race-based Trauma

Identifying and Treating Race-based Trauma

Statistics indicate the United States of America (USA) is becoming more diverse and a nation of plurality. Despite statistics, USA has consistently struggled with its ability to respect, accept, and include diverse populations. Individuals of color experience direct and indirect health care disparities such as unequal access to material, social, and educational resources on a prevalent and consistent basis. They are often not able to afford health insurance, in addition, experience racist behaviors and discrimination amongst healthcare providers.

Racial and ethnic discrimination can cause negative psychological consequences that cause race-related stress and could eventually cause race-based trauma (Hemmings & Evans 2018). These psychological issues encompass feelings of helplessness, paranoia, anxiety, fear, medical health issues, numbing to their emotions, denigration of one’s sociocultural in-groups, and the onset of PTSD.

One solution is improving the health of individuals of color. Healthcare professionals would need to make better efforts to address racism when working with minorities. Research shows facilitating multiculturally competent care would require awareness of race, racism, discrimination, and how these factors contribute to subpar healthcare practices (Hemming & Evans 2018). Multicultural training within the mental health field also needs to be improved. A solution would be more effective training and treatment models for counselors to be better prepared to establish a therapeutic relationship with a person of color.

Written by Victoria Fontenot – Behavior Therapist. To seek care with us – please call 972-332-8765.

Hemmings, C & Evans, A. M. (2018). Identifying and treating race-based trauma in counseling. Journal of Multicultural Counseling and Development, (4), 20-37. https://doi:10.1002/jmcd.12090

Offering Your Anxious Clients the Standard of Care

Offering Your Anxious Clients the Standard of Care

                              Offering Your Anxious Clients the ‘Gold Standard’ of Care

         Exposure therapy has long been supported as the ‘gold standard’ treatment for anxiety disorders. Despite strong empirical support for the effectiveness of exposure therapy, many therapists underutilize exposure therapy in the treatment of anxiety and related disorders.

Studies examining why clinicians tend to underutilize exposure therapy indicate several important factors.

These factors include:

  • Lack of appropriate training or supervision to learn these methods.
  • Holding negative or inaccurate perceptions about exposure therapy and when it is contraindicated.
  • Clinician belief that clients will reject the treatment, drop out of treatment, or that exposure therapy may cause harm to clients by asking them to engage with aversive experiences.

In summary, clinicians tend to underutilize the ‘gold standard’ of treatments for anxiety and related disorders because they tend to have little training or experience with it. A key factor in alleviating these issues is offering more training and consultation on utilization of exposure-based treatments.

If you would like to learn more about using exposure therapy in your practice:

  • Sign up for our blog, below.
  • Contact us at 972-332-8733 to join our consultation group or to set up individual case consultation.

     by Perry Leynor, LPC Associate under the supervision of Paula Maloney, LPC-S.    

Meyer, J. M., Farrell, N. R., Kemp, J. J., Blakey, S. M., & Deacon, B. J. (2014). Why do clinicians exclude anxious clients from exposure therapy? Behaviour Research and Therapy, 54, 49-53. https://doi:10.1016/j.brat.2014.01.004

Scrupulosity: When religion and morality become impairing

Scrupulosity: When religion and morality become impairing

Although most people are familiar with Obsessive Compulsive Disorder (OCD)—or at least have a general idea and may even feel that they personally have some OCD tendencies—a lesser known form of OCD exists called scrupulosity. Scrupulosity involves obsessions related to religious or moral ideals which cause an individual to be overly concerned that their actions are sinful or are violating religious or moral doctrine (International OCD Foundation, 2010). This concern is so great that it often leads to excessive praying or trips to confession, repeating rituals involving cleansing and purifying, and avoiding situations where some religious or moral error may occur (IOCDF, 2010). One effective and recommended treatment for scrupulosity is Exposure and Response Prevention (ERP); however, another form of treatment, Acceptance and Commitment Therapy (ACT) was shown to be another effective form of treatment in a recent study by Dehlin, Morrison, and Twohig (2013). Acceptance and Commitment Therapy traditionally involves accepting undesirable thoughts and feelings, reducing the meaning of and attachment to these thoughts and feelings, and working toward acting in a way that fulfills one’s values in life and has been used in the treatment of OCD.

Dehlin and colleagues (2013) evaluated the effects of ACT on scrupulosity with five adults (three females and two males) across eight treatment sessions. In order to measure the effects of treatment, researchers tracked the participants’ compulsive behaviors as well as engagement with valued activities. In addition, researchers had participants complete assessment questionnaires. Treatment sessions were 1-1.5 hours each week and consisted of activities that helped the participants incorporate the core processes of ACT. Participants also completed weekly homework assignments. Throughout treatment, participants learned to accept unwanted thoughts, separate themselves from obsessive thoughts, view the self as a context in which thoughts occur, contact the present moment, and commit to actions in alignment with values. Results of the study showed a 74% reduction in compulsions and a 79% reduction in avoided valued behaviors, and these reductions were maintained during a 3-month follow up. In addition, participants reported high levels of treatment acceptability which, combined with the positive results of treatment, makes this a promising treatment for individuals with scrupulosity.

Dehlin, J. P., Morrison, K. L., & Twohig, M. P. (2013). Acceptance and commitment therapy as a treatment for scrupulosity in obsessive compulsive disorder. Behavior Modification. DOI: 10.1177/0145445512475134

International Obsessive-Compulsive Disorder Foundation (2010). Retrieved from https://iocdf.org/wp-content/uploads/2014/10/IOCDF-Scrupulosity-Fact-Sheet.pdf

Social Anxiety: Making a difference with exposure and Acceptance and Commitment Therapy

Social Anxiety: Making a difference with exposure and Acceptance and Commitment Therapy

According to the National Institute of Mental Health, 12.1% of adults experience social anxiety disorder (SAD) at some time in their lives. Social anxiety disorder is characterized by a high degree of fear related to social situations which usually leads to avoidance of situations involving other people (National Institute of Mental Health). Several treatments have been evaluated for SAD including Cognitive Behavior Therapy (CBT) and Acceptance and Commitment Therapy (ACT). Cognitive behavior therapy emphasizes changing beliefs about negative thoughts as well as exposing the person to unpleasant thoughts and situations, and although CBT is effective for the majority of patients, about 25% do not respond to treatment (Dalrymple & Herbert, 2007). Acceptance and Commitment Therapy is different from CBT in that it encourages acceptance of negative thoughts instead of focusing on changing the thoughts. In addition, ACT promotes the use of mindfulness, which aids the patient in fully experiencing the present moment without judgment. The results of ACT have been positive for a number of conditions including depression, substance abuse, chronic pain, and psychosis; however, less research has been conducted evaluating ACT for social anxiety (Dalrymple & Herbert, 2007). Therefore, a recent study by Dalrymple and Herbert (2007) examined a treatment package that included exposures combined with various components of ACT to treat SAD. In this study, the authors recruited 19 adults with social anxiety disorder and provided individual treatment for 1 hour per week. Initial sessions focused on aiding participants in recognizing that attempts to control the past have no value. Later sessions focused on accepting undesirable thoughts and acting according to personal goals while being exposed to challenging social situations which caused some anxiety. Mindfulness was also incorporated to help participants become aware of undesirable thoughts without making judgments about their thoughts or trying to control their thoughts in any way or make them go away. Throughout treatment, participants also completed homework outside of scheduled treatment time. At the end of the study, 17 participants had completed treatment and on average, their levels of fear decreased by approximately 30% and levels of avoidance decreased by approximately 60%. In addition, 93% of the participants were highly satisfied with the treatment.

Dalrymple, K. L., & Herbert, J. D. (2007). Acceptance and commitment therapy for Generalized Social Anxiety Disorder. Behavior Modification, 31, 543-68.

National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/statistics/social-anxiety-disorder.shtml