Obsessive Compulsive Spectrum Disorders (OCSD) including OCD, Aspergers Disorder, Tourette’s Disorder, Hypochondriasis, Compulsive Hoarding, Trichotillomania, and Body Dysmorphic Disorder are chronic and often debilitating bio-psycho-social problems. We now believe these disorders are likely to be genetically hard-wired in the brain (in the case of OCD the cortical-thalamic-striatal pathway of the basal ganglia) and can be affected by personality factors, immune system changes and hormonal fluctuations. For most patients a variety of practices and procedures are needed in order to reduce intrusive obsessive thinking and compulsive behavior, heal depression and restore self-care, relationship and other life skills.
While a broad-based recovery program is essential, the core of OCSD recovery remains Exposure and Response Prevention (ERP), a form of cognitive-behavioral therapy in which the individual comes into contact with the thought, situation, person, or object they fear and remains in contact with the feared stimulus long enough for the brain to habituate to the stimulus. This is much like jumping in a cold lake of water and staying in the water long enough to become accustomed to it. Without taking the risk of exposure to feared situations it is impossible to really progress in the healing process. By doing so, on the other hand, brain imagery studies have shown us there is actual functional and structural healing the cortical-thalamic-striatal region of the brain – something that is impossible to produce through any other method – including medication.
Unfortunately, for many individuals with OCSD, obtaining qualified treatment assistance may be difficult or impossible. There are too many patients needing treatment and too few practitioners available to meet this need. In addition, simply starting treatment is often a daunting task for sufferers under siege by their obsessions. In 2001 the OCD Recovery Center started a Teleconferencing Cognitive Behavioral Therapy (TCBT) program to link OCSD sufferers in distant parts of the world with our clinic as well as to provide ongoing support for Teleconferencing Program and Housecall Program graduates. Since that time we have conducted hundreds of hours of TCBT with similar results to those obtained in the office. Now new research at the University of Florida at Gainesville confirms our experience that TCBT remission rates are similar to those obtained in face-to-face behavior therapy (Behavioral and Cognitive Psychotherapy, 37(4): 469-474, 2009). Researchers Turner, Heyman and Furth found that 70% of their teleconferencing patients achieved “remission” and maintained this over a 12 month period.
TCBT can be combined with the use of video if the patient and practitioner both have this available via the Internet. The practitioner can instruct the individual in the specifics of video conferencing if they are not familiar with “web-cam” technology. This can be easily accomplished in 10 to 15 minutes by all patients with access to a computer, the Internet and a digital video camera (less than $50 investment). We have found that videoconferencing is “the next best thing to being there”. Services such as MSN Messenger, Yahoo Messenger and Skype often include this service for customers. The addition of video allows the practitioner to see the physical objects and situations the patient is dealing with and even instruct the patient in specifics of the behavior therapy.
Patients often report that TCBT is more convenient and accessible than working in the counselor’s office. We have found that behavior therapy is most effective when conducted as close to the “epicenter” of the rituals as possible. This it makes intuitive sense that if the counselor is unable to actually come to the home of the patient, a telephonic visit may be the next best thing (and often times better than meeting in the counselors office). There are exceptions, however. Compulsive hoarders, for example, often seem to need the counselor to actually work with them in the hoarding environment.
Additional concerns or limitations to TCBT include obtaining insurance reimbursement for telephonic sessions and the legalities of practicing across State lines. The American Psychological Association has been working on these issues and such barriers to TCBT are being worked through.
A well planned Teleconferencing Program can be a wonderful opportunity to begin a recovery program or to jump-start an OC recovery process already underway. At the OCD Recovery Center we have found that any limitations of TCBT are far outweighed by the benefits obtained. OCSD sufferers no longer need to struggle alone in isolation.
Christian R. Komor, Psy.D. is a Board Certified clinical psychologist practicing since 1982 who combines 15 years of clinical experience treating Obsessive Compulsive Spectrum Disorders (OCSD) with discoveries from his personal recovery from OCD. Dr. Komor is the author of The Obsessive Compulsive’s Meditation Book (2000), OCD and Other Gods (2000), and The Power of being (1992). Dr. Komor is the founder of the OCD Recovery Centers of America based in Sedona, Arizona and Grand Rapids, Michigan. He has trained thousands of professionals around the US in optimal treatment methods of OCSD.