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pch-blocks-largePCH Treatment Center is one of a handful of programs in the country that offers an evidence-based approach to treating Obsessive Compulsive Disorder (OCD). Under the directorship of Dr. Flavio Marenco, PCH has constructed a stand alone OCD Residential Treatment featuring Cognitive Therapy, Exposure and Response Prevention and medication management. This behavioral approach differs from the PCH General Program, which is centered around a psychodynamic model. There are many outside residential treatment centers that “treat” OCD, but very few offer this evidence-based model. PCH clients who enter the OCD program, however, have all the resources and treatment modalities available to them from our other programs, including psychodynamic therapies; they also participate in the PCH Family Program.

Our Program

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The Obsessive-Compulsive Disorder OCD Residential Treatment Los Angeles at PCH Treatment Center is predicated on the assumption that OCD is a serious and debilitating neuropsychiatric condition that requires a highly specialized and comprehensive treatment approach. In order to overcome the disorder and restore quality of life in persons with OCD, treatment needs to be tailored to each person’s specific symptoms and the functional impairment those symptoms cause. Dr. Flavio Marenco is the director of the PCH Treatment Center OCD Program. Dr. Marenco is a licensed psychologist who specializes in the treatment of OCD, Hoarding Disorder and other anxiety-based disorders. He completed his post-doctoral clinical training at UCLA, which included three years in the OCD Intensive Treatment Program at the Resnick Neuropsychiatric Institute and Hospital. At PCH Treatment Center, a personalized treatment plan is developed and employed that addresses each patient’s unique OCD presentation. Under Dr. Marenco’s guidance, PCH Treatment Center offers an empirically supported core OCD program that relies on Exposure and Response Prevention (ERP) which is the gold standard therapeutic approach for OCD. ERP is supplemented by Cognitive Therapy, another treatment of choice for OCD and anxiety-based disorders and pharmacological management (medication) as appropriate.

In addition to these cognitive and behavioral staples PCH integrates cutting-edge complementary interventions to address co-existing psychiatric conditions frequently accompanying OCD. OCD typically affects the entire family due to the nature of the disorder and the behavioral accommodation family members develop over time. Thus, family involvement is an integral part of the treatment program at PCH. The client with OCD works with a team of experienced doctoral-level therapists and residential counselors trained in the delivery of ERP. The OCD treatment team provides continuous support and guidance in a safe and supportive milieu for those OCD patients who require the most immersive treatment with residential option due to the severity of their condition. PCH also offers an OCD Day Treatment Program for those who can benefit from a stepped-down version of the immersive program and for those who are ready to transition to a less acute level of care. The PCH Treatment Center OCD team also includes a psychiatrist for the pharmacological management of OCD and related disorders.

Services provided

  • Comprehensive psychological assessment and treatment plan
  • Exposure and response prevention (ERP) treatment
  • Cognitive therapy (CT)
  • General education about anxiety and OCD
  • Tailored education about individual symptoms and management
  • Family discussion and education about OCD
  • Integrated follow-up and relapse prevention plan
  • Relaxation skills using multicomponent strategies including mindfulness practices, muscle-relaxation, guided imagery, slowed breathing training and neurofeedback.
  • Complementary treatment modalities for co-occurring psychological issues

What is Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is a disabling, chronic neuropsychiatric condition characterized by distressing, intrusive thoughts (obsessions), and/or repetitive, ritualistic behaviors (compulsions). Individuals with OCD report obsessions that include preoccupations with dirt or germs, worries that something harmful may befall them or others, fearing that a routine behavioral act such as locking the door or shutting off the stove was carried out incorrectly, as well as concerns with order and symmetry. Additionally, obsessions can present in the form of aggressive impulses and violent images of a sexual, religious, or blasphemous nature. Uncertainty and pathological doubt are central features of the disorder, as individuals with OCD display an impaired sense of knowing. Overestimation of danger and an inflated sense of responsibility are additional features of the disorder. Some patients are also concerned with fears of shouting obscenities in public. OCD sufferers struggle with the disorder for an average of 15 years before they find effective treatment. This is due in part to the limitations of conventional therapeutic approaches and the scarcity of therapeutic resources for OCD patients and their families.

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What are the causes of obsessional thinking and compulsions?

victoria_216Thought-action fusion (TAF) is a cognitive mechanism that appears to underlie many OCD obsessions. TAF refers to the tendency OCD patients have to believe that thoughts are equivalent to actions, so that having a blasphemous thought would be as sinful as committing a blasphemous act, or that the thought of a loved one having a car accident would make the accident actually occur. In an effort to alleviate the anxiety produced by the obsessive thoughts and to prevent the feared consequences associated with them, individuals with OCD perform such compulsions as washing and cleaning, checking, counting, ordering, and praying. Some compulsions are carried out to relieve an internal experience of not feeling right or okay rather than reducing anxiety. Additionally, some patients carry out rituals in an effort to feel complete or to relieve the sense that something remains undone. Neutralization is a common mental compulsion that OCD patients employ to mentally reverse or avert perceived catastrophic events.

Is Hoarding a part of OCD?

Hoarding Disorder (compulsive hoarding) appears to affect between 20% to 30% of OCD patients. Frost & Hartl proposed a comprehensive model of hoarding based on three main features: “(1) the acquisition of, and failure to discard a large number of possessions that appear to be useless or of limited value; (2) living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed; and (3) significant distress or impairment in functioning caused by the hoarding.” Compulsive hoarders typically develop emotional attachment to seemingly worthless objects and confer sentimental value to possessions acquired without the presence of a memorable experience. Additionally, compulsive hoarders tend to believe that their possessions will have functional utility in the future, and discarding them would preclude their use when needed. Compulsive hoarding has been associated with impaired executive functions and memory deficits, leading to poor categorization and organizational skills.

How is the diagnosis of OCD made?

In order to meet the diagnostic criteria for OCD, symptoms must be severe enough to cause marked distress or impairment in everyday functioning and last more than one hour per day. Many OCD patients report multiple obsessions and compulsions that they recognize as extreme and senseless, which often lead to feelings of shame and fear of “going crazy”. As a result, they often report a sense of helplessness and they attribute their inability to control their thoughts and behaviors as a sign that they are weak or flawed. Patients appear particularly troubled when they experience images or impulses that they consider immoral or abhorrent, such as those associated with incest or rape. Obsessions of causing harm to others almost invariably involve such vulnerable targets as children, the elderly, and persons with disabilities. Some patients with severe OCD may have limited insight into their obsessions, displaying delusional beliefs and overvalued ideas.

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What causes OCD?

While the etiology of OCD is unclear, its underlying neurobiology is associated with faulty neurocircuitry involving the basal ganglia, thalamus, and frontal cortex. Positron emission tomography (PET) studies have shown hypermetabolism in the orbitofrontal cortex, caudate nucleus, and anterior cingulate gyrus. Dysregulation of the OCD circuit composed of the orbitofrontal cortex and its projections to the basal ganglia have been shown to disrupt the brain’s capacity to regulate thoughts and behaviors, leading to obsessions and ritualistic compulsions symptomatic of OCD. Successful pharmacological and behavioral treatment of OCD has been shown to normalize activity in frontal areas and basal ganglia. Cognitive deficits associated with OCD have been identified during a Stroop task showing impairment in the inhibition of irrelevant information. Such impaired cognitive inhibition may allow more intrusive thoughts into consciousness, which then become harder to ignore. Additionally, attempts to suppress intrusive thoughts typically leads to more intense and frequent cognitive intrusions. Enright and colleagues (1995) suggest that OCD patients who have difficulties inhibiting irrelevant information may be more likely to forget or disbelieve what they do, making them prone to repetitive and checking behaviors. The common mental compulsion of neutralizing the perceived threat of a thought mentioned earlier is another form of thought suppression that has been hypothesized to increase obsessions through rebound of intrusions.

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What other psychological problems co-occur with OCD?

The onset of OCD occurs before the age of 25 in 50-65% of patients, peaks at age 20, and develops before age 35 in more than 85% of patients. It tends to be chronic as evidenced by 43 to 68% of adolescents still meeting diagnostic criteria 2 to 7 and 9 to 14 years after treatment. OCD is often associated with other psychological disorders, with major depression as the most common co-occurring disorder. In fact, Rachman (1997) proposed that depression may provide an avenue though which OCD develops, suggesting that depressed mood may amplify the misappraisal of intrusive thoughts. Additionally, OCD has been found to be comorbid with substance abuse, eating disorders, bipolar illness, psychotic features, and personality disorders. Additionally, trichotillomania (the compulsive urge to pull out one’s own hair) and Tourette syndrome may co-occur with OCD.

How is exposure and response prevention (ERP) used to treat OCD?

OCD Treatment LA

OCD poses a significant public health burden due to its prevalence and the financial cost associated with it. OCD affects 2-3% of the US adult population, with an estimated 3.3 million Americans suffering from the disease (NIMH, 2000). OCD was considered a treatment-resistant disorder until the relatively recent development of pharmacological and psychosocial interventions that have greatly improved prognosis. The first line psychosocial treatment and gold standard for OCD is exposure and response prevention (ERP), a subtype of cognitive behavioral therapy. Randomized controlled studies have shown that ERP is superior in its efficacy for OCD when compared with therapies such as progressive muscle relaxation and anxiety reduction techniques. ERP has also shown greater efficacy than pharmacological agents such as clomipramine. ERP induces physiological habituation through exposure to fear-evoking scenarios, as well as modification of maladaptive beliefs through discussions about risk, uncertainty, and overestimation of danger associated with OCD. Habituation is achieved through in vivo and imaginal exposure while patients are instructed to resist from engaging in the compulsions they typically use to reduce their anxiety. Extinction occurs by blocking the negative reinforcement of the rituals, as patients habituate to the anxiety-producing stimuli. Additionally, exposure exercises serve as behavioral experiments aimed at testing a patient’s beliefs and as such they function to modify maladaptive cognitions associated with OCD.

Embedded in ERP are discussions before and after exposure exercises aimed at helping patients realize that anxiety naturally declines without the execution of a ritual, and that the feared consequences are not as catastrophic as anticipated, providing corrective information about risk and feared stimuli, and resulting in habituation within and between exposure sessions. While ERP leads to habituation and reduces anxiety and fear, it is not designed to prevent obsessions from occurring, requiring cognitive reappraisals of their underlying maladaptive beliefs. For example, OCD patients misinterpret intrusive thoughts to mean that they will be responsible for the harm they may cause to themselves or others if they do not engage in rituals to prevent them. In the course of therapy patients learn to reframe their appraisals of inflated responsibility and to give up the compulsions that seek to neutralize them. Additionally, they are taught that intrusive thoughts are normal occurrences rather than signs of character flaws, and that it is the misappraisal of normal intrusive thoughts that leads patients to develop clinical obsessions. The efficacy of ERP is well established in the literature, with studies showing that patients receiving ERP experience an average symptom reduction that exceeds 50-60%. However, many patients who report a partial reduction of OCD-related obsessions and compulsions continue to experience clinically significant symptoms that impair their functioning and quality of life. Additionally, some patients do not appear to respond to treatment, while others are unwilling or unable to tolerate ERP exposure exercises and drop out of treatment.Lack of compliance with exposure assignments to be carried out outside the treatment setting (homework) limits the efficacy of ERP and its generalizability to contexts that are relevant to the patient’s functioning. Patients completing exposure exercises alone often discontinue exposures prematurely before extinction of anxiety has occurred, thereby reducing treatment efficacy.

What other treatment modalities are used for OCD?

OCD treatment Los Angeles- ERP can be enhanced with complementary interventions that have additive or synergistic effects to augment the efficacy of ERP and to address its shortcomings. Mindfulness-based strategies have been implemented in contemporary approaches to the treatment of mental disturbances. In the psychology literature mindfulness refers to the awareness that emerges by training attention to focus on moment-to-moment experience acceptingly and non-judgmentally. Bodhi described mindfulness as ‘bare attention’, the practice of removing our conditioned emotional reactions, judgments, and conceptual overlays (Bodhi, 2006). Mindfulness-Based Stress Reduction focuses on cultivating mindfulness as a mediator of positive outcomes, and has been shown to reduce emotional disturbance and foster well-being in diverse clinical populations. Mindfulness facilitates the cultivation of moment-to-moment awareness by training individuals to focus their attentional resources on present experience. As such, it might counteract the future-directed nature of worry associated with OCD and other anxiety disorders and provide an alternative way of responding to anxiety-provoking stimuli.

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