Dr. Peggy Richter, psychiatrist and head of Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre, talks about the pandemic’s impact on OCD and what we can do to help those who may be struggling.

How has the pandemic impacted people with OCD?

For people who already have OCD, the pandemic has had very mixed effects. There are some people who, of course, are made much more anxious by it. But there are also many who say the pandemic has made things easier.

For example, during COVID, recommended public health measures have included limiting contact with items, cleaning surfaces, using sanitizer and having more frequent hand washes. For people who would call themselves “germaphobes” or who have contamination as the focus of their OCD, these actions actually reduce their anxiety. Before COVID, these individuals might have found themselves feeling anxious going into supermarkets. Now, they know that in some stores, carts have been wiped off before every use, and if they’re concerned, they can take their own wipes with them, clean their cart, and nobody notices.

Contrarily, for individuals whose OCD focuses on illness anxiety, the pandemic has been very difficult because they are ordinarily preoccupied with potentially developing a medical illness or problem. This means they are highly vigilant around any risks in their environment and are very concerned that sensations that don’t necessarily mean COVID could be COVID. I am seeing individuals in that population struggle.

Another group that may be having a hard time are those who need orderliness and things precisely in position. If you’re in a home that’s gone from people coming in and out at the start of the day to now everybody spending more time in the home, working or doing school remotely, there is a lot more chaos, which can be very difficult.

OCD is an illness that affects individuals in different ways.

Has the pandemic caused more people to develop OCD?

Though I haven’t seen the data to back it up, anecdotally, mental health colleagues in the community feel they are seeing a lot more OCD. My colleagues in child and adolescent mental health, especially, have expressed they are seeing more cases of new-onset OCD compared to past years.

OCD does very much seem to occur on a spectrum of severity, so the pandemic may also be leading to obsessions or compulsions for many that are milder than required to make a formal diagnosis, while nonetheless causing some degree of distress.

How will easing restrictions impact people with OCD or those who are experiencing symptoms?

In the case of anxiety disorders, avoidance can make symptoms worse. With the pandemic, that avoidance has been mandated, which may have felt better in the short-term, but will make re-entering the wider world that much harder.

In fact, one of our best first-line treatments for all anxiety disorders is a form of treatment called cognitive behavioural therapy (CBT), in which people are encouraged to systematically confront their fears by triggering them.

With OCD, many people have been avoiding a lot of the situations that normally would trigger them. For example, for someone whose OCD would ordinarily compel them to check the doors, lights and appliances when they leave the house, lockdown and working from home may have made things easier. However, going out to work and socialize will now trigger them like before, and may feel even harder as they have not had to challenge this fear for a while.

Returning to these triggers that have been avoided, it’s going to be hard.

When should someone seek help?

The simple answer, for any psychiatric or psychological problem, is for someone to seek help when it causes distress or when it begins to interfere with their ability to function. If it’s getting in the way of their relationships, causing problems in their work environment or in their functioning at home, that’s a clear indicator that maybe it’s worth talking to a professional.

The core features of OCD are the presence of obsessions or intrusive, recurrent anxiety-provoking thoughts and urges, as well as compulsions, which are repetitive acts the person does in response to obsessions. When these symptoms cause significant distress, impaired functioning or waste an hour or more of the day, it is considered severe enough to make the diagnosis. With that said and as mentioned before, OCD does very much seem to occur on a spectrum of severity. So, if someone is unsure if they meet the criteria for an OCD diagnosis but are still having a hard time, they shouldn’t hesitate to get help.

How can I help my loved one who’s struggling with OCD or OCD-like symptoms?

If someone you know is struggling, be supportive and non-judgemental. Just being there for someone and letting them know that you care is incredibly helpful for most people.

You can also encourage them to seek professional help. Seeing their family doctor is often a very good place to start, as they can help them find effective treatments for OCD, including drug therapy and CBT. In general, most people will greatly improve with treatment.

Also, one thing that’s happened because of the pandemic is a mushrooming of resources online, so it is much easier than in the past to find great online educational material, to find online therapy and to find support groups.

Further, help your loved ones have hope. This is a tough time, but they are not alone, help is available, and things can get better.

Resources for OCD:
OCD information and resources
OCD handbook
Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre

The post COVID-19 and its impact on obsessive-compulsive disorder appeared first on Your Health Matters.

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.”

Harlan’s story and the Thompson Centre were also featured on CTV Toronto »

The post How Canada’s only residential OCD treatment program went virtual during the pandemic appeared first on Your Health Matters.

These days he is working part-time and volunteering with Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre helping clients diagnosed with severe obsessive-compulsive disorder, also known as OCD.

Matthew understands this journey. He was diagnosed with OCD when he was 16 years old. Now, seven years later, he is on an inspiring path of his own and managing his OCD.

“I never thought I’d be able to enjoy life and fully commit to giving something my all,” he says.

What is Obsessive-compulsive disorder (OCD)?

OCD has been recognized by the World Health Organization as one of the top 10 most disabling illnesses worldwide. Symptoms of OCD may include repetitive, intrusive or disturbing thoughts, impulses or images that cause anxiety which are known as ‘obsessions.’ They are often accompanied by compulsions or rituals which involve repetitive behaviours or actions.

“Patients with OCD can experience symptoms that are extremely debilitating to the point where they may be severely disabled, often becoming homebound, and unable to work or engage in activities important to everyday life,” says Dr. Peggy Richter, head of the Frederick W. Thompson Anxiety Disorders Centre at Sunnybrook, Canada’s most specialized centre in OCD and related disorders. “Treatment-resistant OCD occurs when an individual has tried psychotherapy as well as medication, but these conventional treatments haven’t worked or helped to improve the OCD.”

Looking back, Matthew remembers counting footsteps as a child.

“I could only go to 22 and then I’d get stuck and have to start over,” he explains. “I had a hard time moving place to place or going anywhere.”

Counting led to other rituals including pacing, going up and down stairs, and progressed to Matthew hitting himself in the head to cope with unwanted and intrusive thoughts around the fear that his mother would die if he did not complete his rituals.

Innovative treatment options

Over the years, Matthew’s OCD consumed his life. By 2017, he was barely eating or taking care of his personal needs.

That year, Matthew was referred to Canada’s first and only OCD intensive residential program at Sunnybrook. The team recommended a non-invasive procedure called The Gamma Knife Icon, which uses highly targeted high-dose radiation to reach a precise location in the brain to disrupt misfiring cells associated with OCD, without the need for cutting into the skin or scalpels.

Sunnybrook was the first in Canada to use the technique for treatment-resistant OCD.

With treatment, Matthew says he was able to “talk more fluidly and had motivation to do things again.”

Eventually, doctors recommended he resume treatment at the intensive residential program at the Thompson Centre where the team-based approach, therapy and program helped Matthew develop skills to manage his OCD. A journey that Matthew says involved “some of the hardest work I’ve done in my life.”

He now shares his insights and provides support to new clients at the centre, which continues to provide services virtually during the COVID-19 pandemic.

Matthew: “Don’t stop fighting your OCD”

Matthew connects with clients by phone or video-conferencing to help answer their questions and provide support.

He offers this message to those dealing with their OCD.

“Don’t ever stop fighting your OCD. Even if you lose the fight, it’s good to resist [to help you improve],” he says.

It has taken a lot of hard work to get to where he is today and Matthew hopes to continue helping others and sharing his inspiring story of hope.

“I feel proud that I’ve come this far,” he smiles.

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Patients living with OCD experience a cycle of obsessions, intrusive, and unwanted thoughts or urges that lead to repetitive actions or behaviours called compulsions.

Treatment can include psychotherapy, medication, inpatient, outpatient, or residential treatment options. Approximately 20 per cent of patients do not respond to conventional treatment and are diagnosed with treatment-resistant OCD.

Investigating a possible treatment option for OCD

Focused ultrasound (FUS) is being studied in a North American first trial for treatment-resistant obsessive-compulsive disorder (OCD). The study is investigating safety of this treatment and began in 2017.

FUS is an incision-free, image-guided technology that uses ultrasound waves to target parts of the brain.

In this trial, FUS is used to cause a lesion and disrupt a specific brain pathway in a region of the brain called the Anterior Limb of the Internal Capsule, or ALIC, which is active in OCD.

“This ‘highway’ of fibres is critical in connecting the frontal lobe to deeper structures that we know are important for anxiety, mood and decision-making,” explains Dr. Nir Lipsman, principal investigator and director of Sunnybrook’s Harquail Centre for Neuromodulation. “By targeting this pathway, the goal is to help ‘reset’ this part of the brain and improve communication.”

Study: Focused ultrasound for OCD

Since the study began, eight patients with OCD have been treated with FUS. Researchers say while they are still in the preliminary stages of their investigation, results are promising so far.

“Our early data suggest that at least 50 per cent of patients experience a significant improvement in OCD symptoms by the 12-month follow-up,” says Dr. Benjamin Davidson, neurosurgical resident and study team member.

“It’s important to emphasize that each patient responds differently to treatment,” explains Dr. Davidson. “It may take many months for some patients to notice a difference in symptoms, while other patients may not experience any changes.”

Researchers say FUS is not a treatment solution on its own and it’s important for patients to work with their health care team to determine an appropriate treatment plan that may include medication, psychotherapy and other treatment options.

“We view focused ultrasound as part of a larger more comprehensive treatment strategy where patients continue getting treatment, and potentially go on to residential treatment, and continue seeing a psychiatrist,” says Dr. Lipsman.

Read about the first patient in North America to participate in this trial investigating the safety of using FUS to treat OCD.

Currently, Canadians between the ages of 20 to 80 years old are eligible to participate in this trial. Ten participants will undergo a round of focused ultrasound and participate in a series of assessments at certain points in the year following treatment.

“If you are interested in learning more about the focused ultrasound clinical trial for OCD, speak with your psychiatrist and your primary care physician about whether this is appropriate for you and your care,” says Dr. Lipsman.

• Learn more about the FUS for OCD study
• Learn about Canada’s first intensive residential program for severe OCD

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Here at Sunnybrook, we piloted a program a few years ago that combined 15 weeks of CBT treatment with 12 weeks of aerobic activity, which included things like biking, running and using an elliptical machine. We found there were symptomatic improvements for all the participants, and they found exercise to be a “doable” component of their treatment.

While we know exercise appears to provide benefits, more research is needed to understand why that happens. Exercise could be likened to a form of exposure therapy, in that it exposes the person to uncomfortable feelings that they get through and feel better afterwards. Exercise may also improve cellular function and blood flow in the brain, as imaging scans have actually shown that exercise changes brain activity and structure.

Combined with a few earlier studies looking at aerobic exercise in OCD, we can say that exercise does appear to provide benefits. Exercise also seems to have a synergistic effect when combined with CBT. In short, the more people do, the better they feel. This is great news, as exercise is generally low cost and accessible in some form to most people.

OCD is not the only mental health condition that can benefit from exercise. There is a larger body of research around exercise (mainly aerobic) and its beneficial effects for major depression. Regular physical activity has also been associated with a decreased prevalence of panic disorder, agoraphobia (a type of anxiety disorder), social phobia and general anxiety. Increased physical activity in childhood has also been associated with a reduced risk of depression in adulthood.

So how much exercise is enough? For general health, Canadian physical activity guidelines recommend adults aged 18-64 get 150 minutes of moderate-to-vigorous physical activity (meaning activity that makes you sweat) every week. That equals about five proper workouts lasting 30 minutes, five times per week. Despite this recommendation, research has found only 15 per cent of Canadian adults currently meet this standard.

For depression specifically, current guidelines recommend about three exercise sessions per week, each lasting about 45 minutes to one hour. While aerobic activity has been studied the most, there is no indication that other types of exercise won’t be also beneficial.

The bottom line is that exercise is important for your physical and mental health. If you’re not sure where to start, talk to your doctor about setting up a program that is the best and safest for you.

View the whole Speaker Series event here:

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