Complementary and alternative medicine (CAM) interventions hold the promise of allowing the OCD sufferer to achieve reductions in medication, lower overall anxiety levels which contribute to obsessions and trigger compulsions, and address the myriad of lifestyle impairments experienced by people with OC-Spectrum disorders.
CAM techniques are usually benign when they are used in addition to, and not as replacements for, exposure and response prevention cognitive-behavioral therapy, which must remain the centerpiece of OCD treatment. It is a mistake to think that we must wait for replicated, double-blind, crossover research studies to validate CAM practices and procedures. For one thing, most of these practices are quite benign and well within the boundaries of the medical tradition of “first doing no harm”. For another, many CAM techniques do not lend themselves easily to the scientific method. Finally, and most importantly, in spite of increases in the National Institutes of Health budget for CAM exploration, funding is still seldom available to most CAM researchers. Thus, when it comes to Complementary and Alternative Medicine, if we wait for research we will be waiting, potentially, forever.
So what are some of the CAM practices which have been shown empirically (clinically) to have a high degree of safety and at least some degree to effectiveness in treating OC-Spectrum disorders? Our office has been able to obtain enough empirical and research data regarding each of the below CAM practices listed below to at least (1) determine relative safety and usage guidelines, (2) determine some potential for effectiveness for some persons beyond placebo-effect and (3) determine which practices or substances are helpful for which disorders.
The most common CAM area to be applied to OCD treatment includes herbs, supplements and other phyto-medicinal substances. The B-Vitamin Inositol, for example, has been studied both by Israeli and American scientists and found to be significantly effective for the relief of depression, anxiety and OCD. Since many folks with OCD experience comorbid depression and Inositol presents few if any side effects, it deserves a trial by anyone with OCD who, while not requiring strong pharmacological intervention, needs more assistance than psychological or behavioral techniques can offer.
Likewise Gamma-Aminobutyric Acid (GABA) deserves a top rating in OCD recovery. Taken with cofactors, which promote absorption by the brain, GABA acts much like a benzodiazepine tranquilizer to reduce anxiety levels. Like Inositol, GABA has few known side-effects making it a good choice for recovering OCDers who need anxiety reduction but are able to manage compulsive behaviors with exposure and response prevention therapy.
5-hydroxy-L-tryptophane (5-HTP) has received very little attention due to confusion about it’s downstream precursor L-tryptophane. L-tryptophane was studied in the 1970s and 1980s as an augmentation agent for OCD treatment. Unfortunately, a single tainted batch of L-tryptophane from the Orient caused a severe blood disorder in consumers and it was taken off the market by the Food and Drug Administration. 5-HTP, while molecularly close to L-tryptophane, has never had these so-called “peak x” problems. Because 5-HTP causes brain serotonin levels to rise is can have some of the effects (albeit weaker) as SSRI drugs. It must be used with caution since combining 5-HTP with other serotonergic medications can create an additive effect resulting in the rare, but potentially fatal, serotonin syndrome (the most dangerous symptom of which is out-of-control blood pressure).
The more popularly known South Sea herb Kava-Kava has similar action on GABA receptors in the brain. Like synthetic Benzodiazepine drugs, however, it can be psychologically habit forming and is not natural to the body like GABA or 5-HTP.
Hypericum Perforatum, or St. John’s Wort, has received scattered attention in the OC-Spectrum literature. It has been shown to be effective mainly for moderate depression, but can also impact anxiety. Hypericum acts on multiple neurotransmitters including serotonin and again has few side-effects as far as we know. It is not nearly as potent as SSRI drugs and is not a good bet for people with more than mild OC-Spectrum symptoms.
Other consumable CAM tools include Amino-Acid Complexes, Omega-3 Fatty Acids, B-Vitamin Complexes, N,N-Dimethylglycine, Valerian Root Extract, Passion Flower, Hops, Lemon Balm, and DHEA. Each has an interesting role to fill when used with the proper precautions and under medical supervision. The problem is finding a professional who is willing and knowledgable in phytomedicinals. Our web site at www.mindbodyconsult.com offers evidence-based descriptions of many different herbs, hormones and enzymes. Emerging research, however, continues to outpace even our best efforts to keep up to date in the exciting CAM arena.
Preferrable to consuming an outside agent, various mind/body techniques have been studied and found to be effective in treating depression and anxiety. Some of these in use by our clients include: Yoga, Centering practice, Guided Imagery, Tai Chi and Qigong, Eye Movement Desensitization and Reprocessing (EMDR), Thought-Field Therapy (TFT), Bright Light Therapy, Acupuncture, Hypnosis, Guided Imagery, Journaling, Magnetic Field Therapy, Cranial Electrical Stimulation (CES) and Mindfulness Mediation. All of these require some training, but many can be learned from a video or audio tape.
Personally I am very attracted to Qigong, a collection of hundreds of gentle breath-and-movement exercises. Qigong has been used for thousands of years in China as a method for increasing, refining and cleansing internal energy. Research studies have found it to have a variety of positive physiological effects such as increasing breathing capacity, reducing blood pressure, and lowering cholesterol. If we understand anxiety to be energy, it makes sense that techniques like Qigong would have a positive impact on anxiety driven disorders like OCD.
Cranial Electrical Stimulation (CES) has been shown helpful for achieving anxiety reduction without psychoactive drugs. CES involves the application of bipolar asymmetric rectangular waves of electrical energy to the brain through the cranium and or audiatory canal. CES has been approved by the FDA for the treatment of anxiety conditions and has been shown to raise brain serotonin levels as well as other neurotransmitters.
The application of magnetic fields in medical diagnosis and treatment is well-established. The use of rapid-cycling, pulsed magnetic fields (rTMS) is in the experimental stages for psychiatric disorders and early results are promising. Stationary, direct-current, low-frequency magnetic fields applied to the human body may yield similar results to rTMS with far less expense. Reputable dealers of monopolar magnets are now easy to find. (More complex magnet configurations are ineffective and more costly.) Placing the north (or negative) pole of a 450 to 1,500 gauss magnet on either temple is the standard method for treating anxiety and depression.
Acupuncture has a long history of use in traditional oriental medicine. We have had mixed success with acupuncture for anxiety, depression and compulsive behavior reduction. Neverthelss, this modality tends to be benign and experienced practitioners easier to find than in the past. Unless needles throw one into a panic state, acupuncture is worth a try when searching for non-drug pathways for OC-Spectrum healing.
Mindfulness meditation, guided imagery and hypnosis are all mainstays of any mind/body program. Guided imagery and hypnosis can be used as adjuncts to the desensitization process as well as in establishing an active relaxation response pattern of the parasympathetic nervous system. Mindfulness meditation is a powerful disruptor of obsessive ideation. In meditation the individual learns to detach from thoughts rather than being controlled by them – an obvious benefit for those of us who are plagued by mental obsessions and ruminations. Other forms of meditation, such as Kundalini offer more specific techniques of mood stabilization, anxiety reduction and OCD treatment.
Eye Movement Desensitization and Reprocessing (EMDR) was initially designed for use in accelerated information processing of traumatic life experiences. Brain imaging studies have found that EMDR stimulates portions of the limbic system of the brain, causing EEG patterns similar to REM sleep. EMDR has been used at our office as an adjunct to in vitro exposure exercises with significant anecdotal success.
Of obvious importance when approaching CAM practices is finding a qualified practitioner who familiar with both the cognitive-behavioral treatment of OC-Spectrum disorders and also knowledgable about CAM practices and procedures. It is wise to must proceed slowly and carefully, double-checking literature and looking carefully at the issue of interactive effects between CAM procedures themselves and between CAM procedures and other interventions such as prescription medications. Fortunately, there are an increasing number of web sites devoted to such issues and several publications (including a Physician’s Desk Reference for Herbal Medicines) that can be of assistance.
Researching and mastering Complementary and Alternative Medicine strategies can be a challenge. The payoff of increasing one’s “toolbox” of self-care resources for dealing with obsessions, compulsions and their impact on lifestyle is well worth the effort.
Christian R. Komor, Psy.D. is a clinical psychologist who combines 12 years of clinical experience treating OCD-Spectrum disorders 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 Grand Rapids, Michigan and Sedona, Arizona.