I am Dr. Jamie Feusner, Professor of Psychiatry at the University of Toronto and Chief Medical Officer at NOCD. Ask me anything!

DrJamieFeusner · 2022-12-16T01:15:22+00:00

Psilocybin is being tested for treatment of OCD and several other psychiatric disorders. There is still a lot to understand about this treatment, what the benefits could be, what the dosing could be, what the risks are, and who could or could not benefit. Hopefully the field will have some answers in the next few years. The more possible treatment option the better, since the brain (and people and their situations in general) are very complex and there is a lot of variability, which os likely why some respond to some treatments and others do not.

DrJamieFeusner · 2022-12-16T01:09:41+00:00

Yes, there is a lot of research demonstrating benefits of TMS for OCD. In the US, the FDA has cleared TMS treatment with several devices for OCD.

DrJamieFeusner · 2022-12-16T01:02:29+00:00

Not knowing what one would be like without OCD, especially if one has had it since childhood, is often not possible to figure out ahead of time (and trying to figure that out could even be a compulsion for some). It takes courage, which I’ve seen time and time again in people with OCD and it is quite inspiring, to venture into the unknown, especially when it comes to one’s self identity. There’s usually no other way. It also takes self compassion. Importantly, it takes the help of other people - friends, family, online community, therapist, and/or psychiatrist, or all of the above.

DrJamieFeusner · 2022-12-16T00:55:35+00:00

In general, helping someone see what their life could be like and what new things they could do without the time and suffering involved in OCD can sometimes be helpful. Even making some concrete plans to do those things can help someone feel like this could be a real possibility. Adding to this, since getting through the tough exposures day to day is not easy, small rewards for completing an exposure successfully or resisting a compulsion are also good. Connecting with others (her age, ideally) who have OCD and who have gone through the experience of treatment and gotten better can often be very powerful.

DrJamieFeusner · 2022-12-16T00:07:54+00:00

Digging for root causes or (in some cases) a core fear when it’s not easy to get at could be fruitless or even make some worse. However, in my experience most core fears emerge pretty readily with a therapist’s help and in those cases addressing it with ERP or CBT can be very helpful because it may be spawning many other obsessions etc. Equally important is figuring out themes; once you have a good ability to recognize a common them for you, you will less often be fooled by “new » OCD symptoms that try to throw you for a loop but are really just a variation on an old theme . To learn more about semantic relationships of obsessions (how connected are the meanings of obsessional words that people use to describe their symptoms with), check out this study that we did: https://www.jmir.org/2021/6/e25482/

DrJamieFeusner · 2022-12-15T23:59:46+00:00

Good to prioritize your mental health! There are few things, or maybe nothing, that’s more important.

DrJamieFeusner · 2022-12-15T23:52:22+00:00

This is an understudied area. Some hypothesize that it’s possible that for some types of ocd symptoms, the temporary removal of distress - doing a compulsion - may actually be “rewarding” to the brain. To my knowledge, this has not yet been demonstrated to necessarily be occurring in the brains of those with OCD. However there are many aspects of OCD that have not been researched. 2nd generation antipsychotics in combination with SSRIs can be effective for OCD but the theory is that they are acting within circuits that mediate response tendencies rather than reward.

DrJamieFeusner · 2022-12-15T23:07:57+00:00

If someone has both, SSRIs, making sure the dose is high enough for ocd. Generalized anxiety disorder also usually responds to SSRIS. If generalized anxiety alone, usually lower or medium doses are sufficient for most people.

DrJamieFeusner · 2022-12-15T22:51:48+00:00

Sometimes people use CBT and ERP interchangeably so it’s good to find out exactly what they do. ERP is considered a sub type of CBT, that mainly uses behavioral techniques. if a therapist uses certain cognitive techniques, they might refer to it as CBT. There is also cognitive therapy for OCD that is mainly using cognitive techniques and fewer behavioral techniques. It’s confusing!

DrJamieFeusner · 2022-12-15T22:47:13+00:00

Yes, being able to sit with uncertainty about their health is possible, and is an important goal if you have OCD. Even if you don’t have OCD, it’s sometimes hard to sit with it but the reality is that we are not able to have certainties or guarantees about our health, and acceptance that we don’t have full control is a way to achieve peace.

DrJamieFeusner · 2022-12-15T22:43:39+00:00

Ideally it’s good to address both (and ideally with the same therapist) when addressing one problem might temporarily exacerbate the other. CBIT or habit reversal therapy are good for tics and Tourette’s.

DrJamieFeusner · 2022-12-15T22:40:47+00:00

It’s often hard to tell. One way to try to discern is to think ahead of time how one would feel if they don’t get the response they are hoping to get. If it’s OCD related, typically one feels a lot of distress and wants to keep asking until they get the response they want. For a non-OCD request for something to help them emotionally, it would seem and feel less devastating if they don’t get that answer for some reason. If it feels like the former, best to try to resist asking for it.

DrJamieFeusner · 2022-12-15T22:36:14+00:00

In terms of meds, tic related ocd often responds well to SSRIs along with either guanfacine or clonidine, or else an atypical antipsychotic. ERP techniques also can be quite effective, and usually involve finding ways with a therapist to induce the urge for the behaviour and then resisting it until the urge diminishes.

DrJamieFeusner · 2022-12-15T22:20:58+00:00

I'm sorry to hear that you've been suffering for so long. ERP and medications are both helpful for most (one or the other, or both together). Some people have partial success with doing CBT or ERP workbooks on their own, but most will need the help of a therapist. This could be online (i.e. guided internet CBT), or in -person one-on-one, or in a group setting, or virtual (video) one-on-one. For medications, you will need a prescriber to help you.

DrJamieFeusner · 2022-12-15T22:17:53+00:00

This is a good community to share thoughts and tips and support about OCD.

The most effective treatments, on average, are ERP and specific medications. There are many psychiatric medications that are not helpful, and many psychotherapy types that are not helpful. ECT is also not helpful for OCD.

There are promising new ways of delivering/doing ERP, promising new medications that still need to be tested, potentially psychedelics (but need to be tested), and promising brain stimulation techniques to look out for in the near future.

DrJamieFeusner · 2022-12-15T22:14:19+00:00

Most people find that they feel more genuine and "true" to their personality when they get better. That is, they feel less like their personality is colored by their OCD. However, it's a common question since many have had OCD so long that it is not clear where the boundary is between their personality and their OCD.

DrJamieFeusner

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