Recently I had the honor of interviewing Dr. Jonathan (Jon) Abramowitz about OCD. Dr. Abramowitz is a internationally recognized expert in the treatment of OCD and other anxiety disorders. He has a private practice in Chapel Hill, NC and is Professor and Associate Chair of Psychology at the University of North Carolina (UNC) at Chapel Hill. Dr. Abramowitz has written two self-help workbooks and published over 200 articles, books, and book chapters for professionals. Before moving to North Carolina in 2006, Dr. Abramowitz was Director of the OCD/Anxiety Disorders Program at the Mayo Clinic in Minnesota.
Dr. Abramowitz can be contacted at:
Phone: (919) 843-8170 Email: [email protected]
Websites: http://www.jabramowitz.com and http://jonabram.web.unc.edu/
What made you become interested in treating OCD?
When I was in graduate school I was assigned a person with OCD to work with in treatment and I learned how to use exposure and response prevention (ERP)… and it worked. A woman with terrible obsessions was basically cured of her OCD by facing her fears. I thought that was amazing and I became fascinated with studying OCD and anxiety disorders. I was as much interested in the scientific aspect of it (learning more and helping to develop our knowledge) as I was in using the scientific principles to help people get over these problems.
Why is it such a challenge to find a qualified OCD therapist in the 21st century?
Unfortunately, there are still relatively few training programs that really train therapists to do good ERP for OCD. It’s getting better, but most of the therapists out there still are not well trained. We cognitive-behavioral types (ERP is a form of cognitive-behavioral therapy; CBT) tend to hang out at universities and larger cities. We are the more scientifically-oriented types. We need more of us in the rural areas… but as I said, it is getting better.
What challenges do you see with patients while treating their OCD?
I think the greatest challenge is that the “cure” can seem worse than the “disease”. Doing good CBT is a huge challenge for patients and for many, it seems too daunting. So, I too often find myself having to really work hard to help people with OCD figure out how to get themselves into the frame of mind for doing ERP. Some of my research focuses on how to help people embrace and do this therapy more successfully.
I was reading your latest blog entry and noticed something called The Inhibitory Learning Model of Exposure. Is this used by therapists yet for treating OCD?
I think more and more people are understanding it, but the prevailing way people think about exposure is still the habituation model (emotional processing). Inhibitory learning approaches have some important implications for long-term outcome that therapists should be taking into consideration.
The word OCD has become a “cliché” term to label people who are clean, neat, organized, and anal retentive. How can we educate people about what real OCD is like?
Great point! The words “obsession” and “compulsion” have really lost their meaning. To make it worse, there’s also OC personality Disorder, which has a similar name, but isn’t really similar to OCD. I don’t know what to do about it except continue educational efforts through the media, etc. And even if it needs to be corrected, at least people are recognizing that something called OCD exists. That’s better than the alternative
There is still a stigma associated with being mentally ill in the 21st century. As a psychologist do you have any theories on how to stop this?
Indeed there is still stigma. Research shows that people are less likely to befriend people with psychological disorders, and that people incorrectly think these problems are associated with violence and aggression. Moreover, this stigma hasn’t changed very much over the past 20 years, which is strange since groups such as National Alliance for the Mentally Ill (NAMI), the American Psychiatric Association, and the National Institute of Mental Health (NIMH) have launched campaigns to de-stigmatize mental illness.
Unfortunately, these campaigns have focused on trying to “legitimize” psychological disorders like OCD by convincing people that they are “real” biological or genetic illnesses like cancer, diabetes, or the like. But they have failed,, and research shows that stigma gets worse (as does people’s views of themselves) when they think of problems like OCD as a “brain disease” (which it is not). In fact, there is not one biological test that proves OCD is biological/biochemical.
I believe that the stigma can be helped by promoting the idea that people with OCD (and anxiety disorders in general) are really just like everyone else except that they make some critical misjudgments about what’s dangerous (they overestimate risk) and their ability to cope (they underestimate their coping ability). The majority of the research shows that people with OCD are not “defective” or “damaged.”
Do you think doctors and scientists will find a “cure” for OCD?
Good question. I see it like this: OCD comes from normal experiences gone awry. We all get anxious sometimes–people with OCD become anxious when they don’t need to be. We all have strange thoughts from time to time–people with OCD fight these kinds of thoughts even though they are not harmful. We all behave in ritualistic ways from time to time– people with OCD use rituals to try to manage their anxiety over unwanted thoughts that aren’t dangerous. These types of rituals are excessive and unnecessary.
So, I don’t think we can ever make these things completely go away because they are normal to some extent. Rather, I think we’re doing really well if we can help people with OCD not to become so fearful over their intrusive unwanted thoughts, and not to use avoidance strategies and rituals to try to control their anxiety. Management rather than cure is probably what a successful outcome would be.
What are the latest theories regarding the cause of OCD?
We honestly don’t know what causes it. Biology/genetics/environment? Who knows? Think of it this way. To have a blizzard, you need cold air and moisture. Without both of these, you can’t have a blizzard. For OCD, you need some biological predisposition along with environmental/learning factors, too. And you probably can’t get OCD unless you have both factors at play. What exactly are those facts, and how much of each do you need to have? I don’t think we know at this point. I tell my patients not to focus too much on cause because treatments work regardless of what causes the OCD in the first place.
How large of a role does medication factor into the treatment of OCD?
There is some evidence the medications such as serotonin reuptake inhibitors (antidepressants) can be helpful. Drugs like Prozac, Anafranil, Paxil, and the like. But it’s trial and error. Some people respond well to these drugs while others don’t. The average response is about 20-40% improvement in symptoms. Personally, I recommend cognitive-behavioral therapy before trying medication.
I would like to thank Dr. Abramowitz for taking the time to do this interview. It was an honor to talk with him regarding OCD. Although OCD is not “curable,” it is treatable with the correct therapy. Medication has been proven to be useful, but treatment is essential to tame the OCD bully.
