Harlan Kirshenbaum is working through treatment for his obsessive-compulsive disorder (OCD) with the help of virtual technology.
“I am being treated right from my own home and it’s really beneficial because that’s where all of my top triggers are,” says Harlan. “It’s the hardest, most challenging therapy, but it is worth it.”
In March 2020, due to COVID-19 pandemic restrictions, the team at Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre, Canada’s only intensive residential program for OCD, had to change course.
Typically, patients in the program would live in residence and receive intensive treatment in group and individual settings.
“We quickly pivoted, moved our patients online, and developed a virtual day treatment program,” says Dr. Peggy Richter, head of the Thompson Centre. “We have been running virtual day hospital groups ever since.”
Obsessive-Compulsive Disorder (OCD)
OCD is a chronic psychiatric illness. A person with OCD experiences intrusive and disturbing thoughts, images or impulses called obsessions, which lead to repetitive actions or behaviours, known as compulsions.
OCD affects one in 40 people over the course of their lifetime. Approximately 25 per cent of patients have severe OCD where conventional treatments do not help improve symptoms.
Since the launch of Sunnybrook’s intensive residential program in 2017, many patients with severe OCD have been able to successfully manage their OCD.
Dr. Richter says the program’s switch to a six-week online program has allowed treatment to continue during the pandemic.
“The beauty of doing the day treatment virtually has been that people are treated while they’re in their home environment. Our team members coach clients online, by video call or phone, when they’re doing their actual exposures,” says Dr. Richter, referring to Exposure and Response Prevention (ERP) therapy, where individuals are exposed to a situation that triggers anxiety but encouraged to not complete their usual rituals.
“My treatment team has been supporting me and helping me understand and push through my exposures,” says Harlan. “My anxiety level gets up there, but I know it’s for a good cause and I can feel the benefits.”
Virtual therapy for OCD
“OCD has taken over my entire life. It has controlled every move I have made 24/7, 365 days, for many, many years. I lost all freedom,” explains Harlan, who also shared his OCD story in 2012. “It is exhausting, a burden, financially draining, and never-ending. At times, I feel like I am a puppet on strings and OCD is my master.”
After years of treatment, Harlan says he was feeling better. He and his wife got married in 2013, and he was managing his OCD well.
Within the last decade, Harlan’s OCD concerns have became more intensely focused on his wife and children.
“I remember sterilizing some baby bottles and that’s when it started getting bad again,” says Harlan. “All the pressure with a newborn and not sleeping, lead to anxiety and stress, and the OCD came back, hard.”
“My triggers are my two sons and my wife,” he goes onto explain. “For example, if I make skin-to-skin contact with them, my OCD makes me feel like I have to tap them with my left hand to save them from getting cancer or dying. Another thing is, I don’t want to see my bare feet or that will trigger my OCD and those thoughts.”
In the intensive virtual OCD program, clients log on in the morning to check in with the team, review their ERP therapy goals, work independently and then report back on their exposures. The program also includes mindfulness groups, debriefs and continued exposure therapy in the afternoon and evening.
For Harlan, that sometimes means walking around the whole house in his bare feet, which leads to him feeling anxious with thoughts and worries about death and danger to his family.
“It is very hard. My anxiety is intense. For example, it could go up to 90 per cent and I feel very anxious,” says Harlan. “But then, the anxiety gradually comes down and you realize that they’re just thoughts coming into your head and that the danger is not actually real. That’s why it’s important to just practice; let the thoughts come in and try not to fight them. They’re just thoughts. They’re not dangerous.”
Over the course of the new virtual pilot program, team members say clients have been responsive to the online program.
“The virtual aspect of the program means clients can also ‘take’ us with them to other locations that may trigger their OCD. For example, a client who has concerns about germs or contamination, could bring their smartphone to the grocery store and our team can help clients engage in public health guidelines around COVID safety measures and help them navigate something like grocery shopping,” explains Dr. Marlene Taube-Schiff, team lead of the OCD treatment program.
“Overall, there appears to be a benefit in providing virtual care to clients in their own environment. Over the course of the virtual program, we have seen some clients return work and continue to function in their day-to-day lives during the pandemic. OCD is a complex mental illness and each individual manages it in their own way, so it can be helpful to take different approaches to treatment,” she adds.
“The virtual program has been the most beneficial for me. Participating from my house is challenging but it is where most of my triggers are,” says Harlan. “I am doing a lot of things now that I haven’t done or have had a difficult time doing in recent years. After taking part in the program, I am changing diapers. I am playing with the kids more and making diners and lunches when I can.”
While the online program is still in the early stages, it is showing promising results, which could lead to the virtual component being included in the program longer term.
For Harlan, he says his hard work at home has been paying off. “My treatment has been extremely effective. I have more of a sense of freedom from the OCD.”