Obsessive-compulsive disorder (OCD) is an anxiety disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions).
The repetitive behaviors, such as hand washing, checking on things, or cleaning, can significantly interfere with a person’s daily activities and social interactions.
OCD often begins in childhood, adolescence or early adulthood. Afflicting some 2.2 million Americans, OCD is equally common in men and women and across social classes and ethnicities.
Michael Likier, Ph.D. is here to discuss OCD its symptoms and treatments.
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Obsessive Compulsive Disorder and Effective Treatment
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Michael Likier, PhD, ACT
Before joining Summit Medical Group, Michael Likier, PhD, was a psychologist for the Seton Hall University Student Counseling Center in South Orange, New Jersey, where he continues to serve as an adjunct professor in the Professional Psychology and Family Therapy Program. His previous positions include Employee Assistance Counselor at Corporate Counseling Associates and Career Counselor at JP Morgan Chase Career Services, both in New York City, and Senior Substance Abuse Therapist for Sobriety Through Out Patient in Philadelphia, Pennsylvania. In addition, he has been an adjunct professor and lecturer for Drexel University, Union County College, New York University, and Mercy College.Learn more about Behavioral Health and Cognitive Therapy Center
Transcription:
Obsessive Compulsive Disorder and Effective Treatment
Melanie Cole (Host): Obsessive-compulsive disorders or OCDs are an anxiety disorder group in which people have recurring unwanted thoughts, ideas, or sensations, obsessions if you will, that make them feel driven to do something repetitively. Those are the compulsions. My guest today is Dr. Michael Likier. He’s a psychologist with Summit Medical Group. Welcome to the show. Tell us a little bit about OCDs. What are they? What causes them, and how do you recognize if you have one?
Dr. Michael Likier (Guest): OCD stands for obsessive-compulsive disorder. Essentially, OCD is a disease of uncertainty. People who suffer from OCD need to know what is going to happen. They need to be able to protect themselves from imagined catastrophic consequences. The things in the environment, either external or internal, will trigger imagined catastrophic consequences. They may see something dirty. They may have a thought. When they have these thoughts or they see these things and they trigger this deep fear, what they want to do is reduce the fear, and they do things to hopefully reduce the fear, which are these compulsions, these thoughts or other kinds of behavior that are designed to alleviate the anxiety. Both the obsessions and the compulsions tend to be unrealistic or excessive and will interfere with the quality of people’s lives. Most people who have OCD may not correctly label it, but they tend to know something is wrong. They tend to know what they’re thinking and what they’re doing is not right, is not healthy. People around them see them doing these things, and they know these things are weird—typical things, going back and checking locks or washing hands repetitively or going in and out of doors or touching things in certain ways, behavior that most people will consider odd or out of place or excessive.
Melanie: Normally, you have thoughts. If you’re a parent, you have fears that something bad will happen to your child. When do those normal worrying or fears transfer to become something more serious?
Dr. Likier: To the extent that the actual content of the fears that people with OCD have may not be different at all to the fears that you or I have, but it’s the quantity, it’s the intensity, it’s the frequency of the fears that interfere with their ability to engage in work, engage in social relations to have peace of mind. That’s when it becomes problematic.
Melanie: What can you do about it if you’re a hand washer or a hoarder or one of those people that double check the lights on the stove all the time repetitively? It can really affect your quality of life. What do you do for it?
Dr. Likier: Fortunately, there’s good treatment available. Every mental health provider knows how to treat this well. So if you or someone you love has OCD, you want to screen out these therapists to see how they worked with people with OCD before. Have they had specialized training in treating OCD? You want to know someone who does cognitive behavioral therapy or some behavioral therapy for obsessive-compulsive disorder. And the treatment is very effective. It’s empirically validated for those who were trained to do it. There is a high success rate in dealing with a condition that’s really painful for the person who has it, but there is good treatment available.
Melanie: What is some of the treatment like? Does it involve medication? Is it long hours of therapy? What’s the treatment like? How difficult is it, doctor, to stop one of these behaviors?
Dr. Likier: It’s challenging to do. With good therapy, it’s very doable. Medication. When I see someone who comes in for OCD, I usually start without medication. I usually start a protocol, cognitive behavior therapy protocol for obsessive-compulsive disorder. It has several steps. I’ll do a thorough assessment, and then I will educate the person about what obsessive-compulsive disorder is. People with OCD tend to get caught up on the content of their obsessions or the content of their compulsions, and what we do, very briefly, is come to some agreement that what they’re worrying about is not the problem. It’s the way that they worry about it which is the problem. You give them a good education about what OCD is and then we go into how the pattern of OCD works. If they’re afraid of something, there’s a misappraisal of the threat—again, if I don't wash my hands, something bad is going to happen to somebody else. Again, that high anxiety. And then I engage in a compulsive behavior to reduce the anxiety. By engaging in that compulsive behavior while temporarily reducing the anxiety, it robs the person of the correct experience to see that the thought they’re having about it is incorrect. What we encourage people to do is exposures to what they’re afraid of, to practice touching something dirty and not doing the compulsion. What we do to help them do that is we do some motivational interviewing where we get into what has OCD robbed you of, what has OCD taken from you in terms of our peace of mind, in terms of your ability to work, in terms of your ability to function in your role as a wife or a husband or employee or a friend. What has OCD done to your time? What has OCD done to your ability to sleep? All these things we get people really hyped up about look at what OCD has done to you. Then we go and we fight back. We develop scripts. We tell them to imagine OCD as almost like an entity that lives inside of you and it feeds off your compulsions. The more you do the compulsions, the stronger OCD gets. It’s a game that OCD plays. OCD sets the rules and OCD wins when you do those compulsions. We get people hyped up and get them motivated to go against that, to experience the temporary anxiety, to be willing to have the short-term pain of anxiety for the longer-term quality of life to not be trapped, to not be almost enslaved by this disorder.
Melanie: Wow, fascinating. And that exposure, that response that you’re trying to elicit, can we rewire our brain to say that’s just my obsession, this is just my brain, I’m not going to pay attention to it? And if we’ve worked with you and you’ve gotten us to think differently, does it last, or is it something that will keep entering our thoughts for the rest of our lives?
Dr. Likier: Well, it definitely goes down. It may stay. The obsessions may stay, but we encourage people not to worry about the obsessions. We don't try to make the obsessions go away. We try to make the compulsions go away. That’s what we really focus on. By making the compulsions go away, the obsessions tend to die down over time. We tend to be less afraid of them. We tend to know that they are not real, that they don’t have – they’re real because they’re there, but they don’t have a real correlate in objective reality. There’s no real relationship between whether or not I wash my hands and whether or not my son or mother is going to die. So by putting them in their place, they become less painful, and over time, they become less and less anxiety provoking. People do relapse. We do relapse prevention and education as part of the treatment. But this is all doable with a provider, with a practitioner that knows how to do it.
Melanie: In the last few minutes, doctor, if you would, give your best advice and tips for helping a friend or a family member that suffers from OCDs and why they should come see you at Summit Medical Group.
Dr. Likier: Well, if anyone is suffering from OCD or you know someone who is suffering from OCD, you know how painful it is. You know how it robs you of your quality of life in so many different ways. Many people who have it often try to hide it because they know it’s weird. They know it’s weird what they’re doing, and they’re embarrassed, in a way. They don’t want to talk about it, and they can’t imagine that there’s help for them. Maybe they’ve been to therapists that don’t know how to treat it or maybe have been to a doctor who has only given them medication. So let them know that you understand the pain that they’re in, and let them know that there is treatment available. It’s not a very long treatment. I’ve had successes in, I don’t know, half a dozen sessions. More typically, we’re talking somewhere 12 to 20 sessions, which is maybe a big number but not so big for someone who has been suffering for so many years. We have a treatment. We have technology. We have medication which could be helpful as well. Just let people know that I know you’re suffering and I know there is a way out, and Summit Medical Group would be one very good place to get this kind of treatment.
Melanie: Thank you so much for such great information. You’re listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.
Obsessive Compulsive Disorder and Effective Treatment
Melanie Cole (Host): Obsessive-compulsive disorders or OCDs are an anxiety disorder group in which people have recurring unwanted thoughts, ideas, or sensations, obsessions if you will, that make them feel driven to do something repetitively. Those are the compulsions. My guest today is Dr. Michael Likier. He’s a psychologist with Summit Medical Group. Welcome to the show. Tell us a little bit about OCDs. What are they? What causes them, and how do you recognize if you have one?
Dr. Michael Likier (Guest): OCD stands for obsessive-compulsive disorder. Essentially, OCD is a disease of uncertainty. People who suffer from OCD need to know what is going to happen. They need to be able to protect themselves from imagined catastrophic consequences. The things in the environment, either external or internal, will trigger imagined catastrophic consequences. They may see something dirty. They may have a thought. When they have these thoughts or they see these things and they trigger this deep fear, what they want to do is reduce the fear, and they do things to hopefully reduce the fear, which are these compulsions, these thoughts or other kinds of behavior that are designed to alleviate the anxiety. Both the obsessions and the compulsions tend to be unrealistic or excessive and will interfere with the quality of people’s lives. Most people who have OCD may not correctly label it, but they tend to know something is wrong. They tend to know what they’re thinking and what they’re doing is not right, is not healthy. People around them see them doing these things, and they know these things are weird—typical things, going back and checking locks or washing hands repetitively or going in and out of doors or touching things in certain ways, behavior that most people will consider odd or out of place or excessive.
Melanie: Normally, you have thoughts. If you’re a parent, you have fears that something bad will happen to your child. When do those normal worrying or fears transfer to become something more serious?
Dr. Likier: To the extent that the actual content of the fears that people with OCD have may not be different at all to the fears that you or I have, but it’s the quantity, it’s the intensity, it’s the frequency of the fears that interfere with their ability to engage in work, engage in social relations to have peace of mind. That’s when it becomes problematic.
Melanie: What can you do about it if you’re a hand washer or a hoarder or one of those people that double check the lights on the stove all the time repetitively? It can really affect your quality of life. What do you do for it?
Dr. Likier: Fortunately, there’s good treatment available. Every mental health provider knows how to treat this well. So if you or someone you love has OCD, you want to screen out these therapists to see how they worked with people with OCD before. Have they had specialized training in treating OCD? You want to know someone who does cognitive behavioral therapy or some behavioral therapy for obsessive-compulsive disorder. And the treatment is very effective. It’s empirically validated for those who were trained to do it. There is a high success rate in dealing with a condition that’s really painful for the person who has it, but there is good treatment available.
Melanie: What is some of the treatment like? Does it involve medication? Is it long hours of therapy? What’s the treatment like? How difficult is it, doctor, to stop one of these behaviors?
Dr. Likier: It’s challenging to do. With good therapy, it’s very doable. Medication. When I see someone who comes in for OCD, I usually start without medication. I usually start a protocol, cognitive behavior therapy protocol for obsessive-compulsive disorder. It has several steps. I’ll do a thorough assessment, and then I will educate the person about what obsessive-compulsive disorder is. People with OCD tend to get caught up on the content of their obsessions or the content of their compulsions, and what we do, very briefly, is come to some agreement that what they’re worrying about is not the problem. It’s the way that they worry about it which is the problem. You give them a good education about what OCD is and then we go into how the pattern of OCD works. If they’re afraid of something, there’s a misappraisal of the threat—again, if I don't wash my hands, something bad is going to happen to somebody else. Again, that high anxiety. And then I engage in a compulsive behavior to reduce the anxiety. By engaging in that compulsive behavior while temporarily reducing the anxiety, it robs the person of the correct experience to see that the thought they’re having about it is incorrect. What we encourage people to do is exposures to what they’re afraid of, to practice touching something dirty and not doing the compulsion. What we do to help them do that is we do some motivational interviewing where we get into what has OCD robbed you of, what has OCD taken from you in terms of our peace of mind, in terms of your ability to work, in terms of your ability to function in your role as a wife or a husband or employee or a friend. What has OCD done to your time? What has OCD done to your ability to sleep? All these things we get people really hyped up about look at what OCD has done to you. Then we go and we fight back. We develop scripts. We tell them to imagine OCD as almost like an entity that lives inside of you and it feeds off your compulsions. The more you do the compulsions, the stronger OCD gets. It’s a game that OCD plays. OCD sets the rules and OCD wins when you do those compulsions. We get people hyped up and get them motivated to go against that, to experience the temporary anxiety, to be willing to have the short-term pain of anxiety for the longer-term quality of life to not be trapped, to not be almost enslaved by this disorder.
Melanie: Wow, fascinating. And that exposure, that response that you’re trying to elicit, can we rewire our brain to say that’s just my obsession, this is just my brain, I’m not going to pay attention to it? And if we’ve worked with you and you’ve gotten us to think differently, does it last, or is it something that will keep entering our thoughts for the rest of our lives?
Dr. Likier: Well, it definitely goes down. It may stay. The obsessions may stay, but we encourage people not to worry about the obsessions. We don't try to make the obsessions go away. We try to make the compulsions go away. That’s what we really focus on. By making the compulsions go away, the obsessions tend to die down over time. We tend to be less afraid of them. We tend to know that they are not real, that they don’t have – they’re real because they’re there, but they don’t have a real correlate in objective reality. There’s no real relationship between whether or not I wash my hands and whether or not my son or mother is going to die. So by putting them in their place, they become less painful, and over time, they become less and less anxiety provoking. People do relapse. We do relapse prevention and education as part of the treatment. But this is all doable with a provider, with a practitioner that knows how to do it.
Melanie: In the last few minutes, doctor, if you would, give your best advice and tips for helping a friend or a family member that suffers from OCDs and why they should come see you at Summit Medical Group.
Dr. Likier: Well, if anyone is suffering from OCD or you know someone who is suffering from OCD, you know how painful it is. You know how it robs you of your quality of life in so many different ways. Many people who have it often try to hide it because they know it’s weird. They know it’s weird what they’re doing, and they’re embarrassed, in a way. They don’t want to talk about it, and they can’t imagine that there’s help for them. Maybe they’ve been to therapists that don’t know how to treat it or maybe have been to a doctor who has only given them medication. So let them know that you understand the pain that they’re in, and let them know that there is treatment available. It’s not a very long treatment. I’ve had successes in, I don’t know, half a dozen sessions. More typically, we’re talking somewhere 12 to 20 sessions, which is maybe a big number but not so big for someone who has been suffering for so many years. We have a treatment. We have technology. We have medication which could be helpful as well. Just let people know that I know you’re suffering and I know there is a way out, and Summit Medical Group would be one very good place to get this kind of treatment.
Melanie: Thank you so much for such great information. You’re listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.