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When they see that no illness has resulted from viewing the tissue, the therapy can progress to a more provocative exposure, like touching the tissue, and so forth, until they overcome their unrealistic fear of contamination. For especially fearful patients, this therapeutic approach is often combined with a medication that counters depression or anxiety.
One silver lining of the pandemic is that it may have allowed more people to get treated remotely through online health services. “With telemedicine, we’re able to do very effective treatment for patients, no matter where they may live in relation to the therapist,” Dr. Lack said. “Without ever leaving central Oklahoma, I can see patients in 20 states. Patients don’t have to be within a 30-mile radius of the therapist. Telemedicine is a real game changer for people who won’t or can’t leave home.”
For highly impaired O.C.D. patients for whom nothing else has worked, the latest option is transcranial magnetic stimulation, or T.M.S., a noninvasive technique that stimulates nerve cells in the brain and helps to redirect neural circuits that are involved in obsessive thoughts and compulsions.
“It’s as if the brain is stuck in a rut, and T.M.S. helps the brain circuitry get on a different path,” Dr. Lack explained. As with exposure and response prevention, he said, T.M.S. uses provocative exposures, but combines them with magnetic stimulation to help the brain more effectively resist the urge to respond.
In a study of 167 severely affected O.C.D. patients at 22 clinical sites published in May, 58 percent remained significantly improved after an average of 20 sessions with T.M.S. The Food and Drug Administration has approved the technique for treating O.C.D., though many insurance companies are not yet offering coverage.
Where can I get help?
Bradley Riemann, a psychologist at Rogers Behavioral Health System in Oconomowoc, Wisc., said his organization, which has 20 locations in nine states, relies on treatment teams that include psychologists, psychiatrists, nurses and social workers to provide both outpatient and inpatient treatment for O.C.D. patients as young as age 6. Too often, Dr. Riemann said, parents inadvertently reinforce the problem by clearing a path so that their child can avoid their obsessive fear and resulting compulsive response. For example, they might routinely open doors for a child fearful of contamination.
The nonprofit International O.C.D. Foundation, based in Boston, can help patients and families find therapists and support groups for those struggling with the condition. A message can be left at 617-973-5801.
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