Obsessive Compulsive Disorder
A letter from our OCD Director regarding Covid-19.
We know you are receiving a steady stream of emails and news about the COVID-19 pandemic. Given information overload, we wanted to send you a quick note to let you know that the PCH OCD and Anxiety Clinic remains here for you and your family. Read More...
A letter from Christopher Mulligan, LCSW; Director of the PCH OCD & Anxiety Clinic
We know you are receiving a steady stream of emails and news about the COVID-19 pandemic. Given information overload, we wanted to send you a quick note to let you know that the PCH OCD and Anxiety Clinic remains here for you and your family. During this period of unprecedented uncertainty and anxiety, PCH continues to be a trusted leader in mental health care.
As we have all learned through the ongoing medical briefings, people with pre-existing medical conditions are the most vulnerable to COVID-19. What is also true is that people with mental health challenges, particularly OCD and anxiety, are vulnerable to being psychologically overwhelmed by the pandemic.
At the core of OCD and anxiety is a profound experience of uncertainty and threat. This experience is manifested in a variety of ways, including existential fears about the safety of the self and the safety of loved ones.
Also, ALL of us are experiencing anxiety in the face of this crisis and there is nothing wrong with you for having that experience. However, we all need coping skills and support to best be able to manage our anxiety and not become frozen in our fears. We are also able to provide support and coping skills for anyone feeling enhanced stress and anxiety during this time.
COVID-19 can be viewed as a “super trigger” – provoking endless thinking about what might happen in the form of “what if” problem-solving. We are accustomed to solving problems and difficulties in brilliant ways. However, this ability can lead us to thinking in situations where thinking does not work. Our capacity to problem-solve can create infinite “what if” scenarios that have no resolution. The more we imagine and evaluate, the more anxious we become during times of great uncertainty and threat.
How We Work With OCD and Anxiety at PCH
At PCH we work with OCD and anxiety using a combination of exposure therapy, Cognitive Behavioral Therapy, and Acceptance and Commitment Therapy. Exposure therapy has long been considered the gold standard for OCD and anxiety treatment. Exposures involve confronting anxiety triggers in order to break down avoidance patterns, decrease ineffective thinking, and eliminate compulsions.
How We are Working with OCD in Relation to COVID-19 at PCH Treatment (and How We Are A UNIQUE RESOURCE)
Utilizing state-of-the-art telehealth services, we are conducting individual, group, and family sessions with licensed clinicians who specialize in OCD and anxiety. Additionally, we offer telehealth exposure sessions. PCH is a unique resource due to the fact that we provide one-on-one support and guidance during exposures with our highly trained exposure “coaches.”
Through PCH Connected, we have introduced a three day per week Telehealth program for OCD and anxiety. This program features individual and group sessions as well as exposure work conducted through a telehealth portal. For more information, please contact our admissions team at 888.724.0040 or fill out a contact form on our website at www.pchtreatment.com.
We hope this email finds you safe and well and we want you to know PCH will remain available to you as a source of support throughout this period and beyond.
Christopher Mulligan, LCSW
PCH Treatment Center is one of a handful of residential programs in the country that offers an evidence-based approach to treating Obsessive Compulsive Disorder (OCD). PCH has a stand-alone OCD Treatment Program that features Cognitive Therapy, Exposure and Response Prevention, OCD specific group therapies and medication management. PCH has a separate staff of doctoral and masters level therapists who specialize in OCD and anxiety related problems. PCH clients who enter the OCD program also have all the resources and treatment modalities available in our other programs, including psychodynamic therapies, over 100 groups per week and participation in the PCH Family Program.
Our OCD Program
The PCH OCD and Anxiety Clinic recognizes that this disorder is a serious and debilitating neuropsychiatric condition that requires a highly specialized and comprehensive treatment approach. In order to overcome and restore quality of life in persons with OCD, treatment needs to be individualized to meet each person’s specific symptoms and the functional impairment that those symptoms cause. At PCH, a personalized treatment plan is developed and employed that addresses each client’s unique OCD presentation. PCH Treatment Center offers an empirically supported core OCD program that relies on Exposure and Response Prevention (ERP), the gold standard therapeutic approach for Obsessive Compulsive Disorder. ERP is then supplemented with Cognitive Therapy, another treatment of choice for OCD and anxiety-based disorders, alongside 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 that frequently accompany Obsessive Compulsive Disorder. Mood disorders (depression or Bipolar Disorder), psychological trauma and personality issues frequently co-occur with OCD. In fact, Rachman proposed that depression may provide an avenue though which the disorder develops, suggesting that depressed mood may amplify the misappraisal of intrusive thoughts. Each client works with a team of experienced doctoral-level therapists and residential counselors trained in the delivery of ERP. The treatment team provides continuous support and guidance in a safe and supportive milieu for those clients who require the most immersive OCD treatment with residential option due to the severity of their condition. PCH also offers a 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 team also includes a psychiatrist for the pharmacological management of OCD and related disorders.
Typically, the entire family is affected due to the nature of the disorder and the behavioral accommodation family members develop over time to cope with their family member’s OCD. Accordingly, family involvement is an integral part of the Obsessive Compulsive Disorder treatment program at PCH.
- 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
Who is the Director of the PCH OCD and Anxiety Clinic?
Christopher Mulligan is a Licensed Clinical Social Worker with 26 years of clinical and administrative experience. He received a BA from Sarah Lawrence College and an MSW from the University of Southern California. He is currently an adjunct professor at the USC School of Social Work where he teaches assessment methodologies and theories of human behavior. Over the past two and a half decades, Christopher has designed and implemented comprehensive treatment plans for children, teens, and adults challenged by complex developmental and psychiatric disorders including PTSD, ADHD, Bipolar Disorder, Autism, Anxiety and Depression, OCD, Tourette’s Syndrome, Eating Disorders, and behavioral addictions. Christopher has also worked with teens transitioning to and from residential treatment and is experienced in divorce and custody mediation for families with special needs children.
What is Obsessive-Compulsive Disorder (OCD)?
Obsessive compulsive disorder (OCD) is a disabling and chronic neuropsychiatric condition characterized by distressing, intrusive thoughts (obsessions), and/or repetitive, ritualistic behaviors (compulsions). Individuals with the disorder 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 also central features of the disorder, as individuals with Obsessive Compulsive Disorder display an impaired sense of knowing. Overestimation of danger and an inflated sense of responsibility are additional features of the disorder. Some clients are also concerned with fears of shouting obscenities in public. OCD sufferers struggle with the disorder for an average of 15 years before they tend to find an effective treatment. This is due in part to the limitations of conventional therapeutic approaches and the scarcity of therapeutic resources for OCD clients and their families.
What are the causes of obsessional thinking and compulsions?
Thought-action fusion (TAF) is a cognitive mechanism that appears to underlie many OCD obsessions. TAF refers to the tendency OCD clients 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 Obsessive Compulsive Disorder 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 clients 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 clients employ to mentally reverse or avert perceived catastrophic events.
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 clients 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. Clients 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 clients with severe OCD may have limited insight into their obsessions, displaying delusional beliefs and overvalued ideas.
What causes OCD?
Although much has been learned through the research of OCD, pinpointing the specific origins of the disorder has still proved to be largely unsuccessful. However, through neuroscientific studies, it has been found that there are clear neurobiological differences between the brains of individuals diagnosed with Obsessive Compulsive Disorder and those without the diagnosis, primarily noting imbalances in neurotransmitters, such as dopamine, serotonin, and glutamine. Neuroimaging studies show consistent changes in specific areas of the brain which are associated with OCD. Like many psychological disorders, OCD derives from a combination of causes including a biological template (temperament and personality type), genetic predisposition, and environmental causes (psychological trauma, neglect, parenting issues).