This summer, we’ve been in a personal story series, and I’m taking a brief break from that Today. I had a guest that I was really excited to have come on the podcast and we tried two different occasions and it just didn’t happen and didn’t follow through. So I thought I would take some time to talk about my response to the International OCD Foundation’s new treatment guidelines and recommendations.
They just put these out at the beginning of June and it’s a big shift from what they had previously. So I wanted us to talk through that and just give you my response and my thoughts on it. Hello and welcome to Christian Faith, an OCD with Carrie Bock. I’m a Christ follower wife and mother licensed professional counselor who helps Christians struggling with OCD get to a deeper level of healing.
When I couldn’t find resources for my clients with OCD, God called me to bring this podcast to you. With practical tools for developing greater peace, we’re here to bust through the shame and stigma surrounding struggling with OCD as a Christian, sharing hopeful stories of healing and helping you replace uncertainty with faith.
I’m here to help you. Let go of the past and future to walk in the present abundant life God has for you. So let’s dive right into today’s episode. When this episode comes out, I’ll actually be on my way to the international OCD Foundation Conference in Chicago for the first time, and I’m super excited because I.
My best friend lives in Chicago, so we will also be hanging after I’m done conferencing. Previous to this June, if you had looked up the I-O-C-D-F website, international OCD Foundation, we’re just gonna shorten it throughout this episode. If you had looked at their website, you would’ve seen that they were really promoting ERP saying it’s the gold standard.
It’s what we have as far as evidence-based care. That’s exposure and response prevention. If you’re new to OCD lingo or new to the show, we’ve definitely talked about that before. They had a section on their website about ICBT, but basically it said we really need further research and we still recommend that you do ERP.
They had sections about medication for OCD. It’s quite a comprehensive website. If you’ve never been on there, I definitely will link the treatment guidelines in the show notes so that you can go through and read them yourself. Before we dive in, I wanna just highlight why a website like this is so important when people are googling about OCD treatment or help for OCD.
Obviously, the IOCD F’S website is going to come up pretty high. There are a lot of people that are just finding out, they’ve been diagnosed with OCD, they’re going online, they’re searching, okay, well, what do I need to do now? Maybe my therapist has said, Hey, I think you have OCD, but that’s not something that I really treat or know much about.
Maybe their therapist is well-versed in OCD, but this individual is really savvy and wants to be educated. Hopefully we’re all like that. We wanna know and understand our treatment options and what’s available out there. We also have to look at this from a social, political standpoint and financial standpoint.
Let’s be savvy here and know that this is a nonprofit organization that is being sponsored by various business entities. As a result, if we have an organization that’s being majority funded by programs, treatment centers, et cetera, that are promoting exposure and response prevention therapy, of course.
The I-O-C-D-F is going to be promoting ERP. That just makes sense. And so we need to go in this with eyes wide open and understand that while they may be saying this is based on clear cut research, but we all know that can’t be the only driving force behind these treatment recommendations. Research on OCD in my opinion is imperfect at best.
Because these are very complex cases, often with multiple diagnoses. In addition to OCD and clinical presentations are going to depend on whether or not an individual is highly sensitive. We’ve talked about that on a previous episode. Whether or not a person has experienced certain attachment features in their upbringing, I’ve talked about rigid upbringings in a prior episode as well.
While we take research into consideration, we also have to, as a therapist, take into consideration the human being that is sitting in front of us and understanding their story so that we know how best to meet their needs. So let’s get into the guidelines. In the beginning, they talk about how OCD is treatable, and it says, while there is no one size fits all treatment plan for people living with OCD, that’s good that we admit that there are many first, second, and third line approaches that can get individuals on a treatment journey so they can thrive.
And I think that in terms of ICBT, that we might disagree with some of this first, second, and third line approaches because obviously there are first line approach that they outlined here is, as you guessed it, exposure and response prevention medication and combining ERP and medication treatment.
According to the I-O-C-D-F, exposure and response prevention is the most proven, effective first-line therapy for OCD in adults, children, and adolescents. It’s interesting they say this therapy fosters long-term relief from OCD symptoms and builds resilience against anxiety. Then why do I have so many people that are coming to my practice saying, yeah, I’ve done ERP, I’ve kind of gotten what I can out of it.
Or, yeah, I’ve done ERP, but the results didn’t last, and I’m slipping back into old behaviors. I. Or it just doesn’t seem to be fully effective for me, based on my own experience of treating people with OCD and the people that are walking through my front door. I think a lot of them would question that sentence about long-term relief from OCD symptoms.
Then they have a section, this is interesting to me on adjunctive treatments. It says you can add these to improve your response. So adjunctive treatments or other medications or therapies that are added onto first, second, or third line treatments, they can enhance outcomes, but are not meant to replace primary therapies because they have not been found to be effective as a standalone treatment for OCD.
I would agree with that. Under here they have acceptance and commitment therapy. I think there are definitely pieces that we can gain from acceptance and commitment therapy really talks about what does it look like to move towards your values. Very much the acceptance piece as mindfulness. Really allowing the thoughts to be there without having to do something about it and act on them.
They also have dialectical behavioral therapy or DBT. This can be particularly helpful for individuals who have intense emotions and have a hard time managing those emotional experiences. Usually that results from attachment disruption. In childhood or some type of anxious attachment that has developed mindfulness based therapy, which of course is gonna be super helpful for just becoming more aware of how OCD works so that you can catch it before you automatically give into a compulsion.
That’s where mindfulness can be really helpful. It’s just learning to kind of. B, with what’s already here. With a sense of awareness and acceptance. Like, Hey, this is the deck of cards that we are dealing with right now. Instead of, A lot of times what we do is try to ignore, shove things away, neutralize in OCD.
Under adjunctive medications, they explain basically that if you don’t respond well to an SSRI medication alone, you can add a typical anti-psychotic. These are obviously much stronger class of medications that you would want to talk with your doctor about and find out about side effects, et cetera.
Just because someone is prescribed an anti-psychotic medication or an anti-convulsant medication, which they also lift on here, obviously does not mean that they’re having psychotic symptoms. It is just used in a different way, just so we’re not scaring anybody out there or making you think that we’re saying that people with OCD are psychotic.
That is not what we are implying here. Now in the second line treatments they have, if first line options fail, if first line treatments don’t relieve symptoms or cannot be tolerated, second line therapies offer alternative approaches. And interestingly, they put acceptance and commitment therapy in here, which I find bizarre because they just listed it as an adjunct treatment.
So which is it? Is it an adjunct or is it a second line treatment? There are little tabs under each of these, so then if we click on inference based cognitive therapy, it says, inference based cognitive behavioral therapy. ICBT is a specialized treatment for OCD that focuses on identifying and resolving inferential confusion.
A reasoning process that fuels obsessional doubts through tailored sessions. ICBT helps you recognize and resolve the tricks OCD uses to make obsessional doubts feel real and reasonable. ICBT is evidence-based, bing, bing, bing. That means it’s been researched and found to be effective. Has shown significant success in reducing OCD symptoms.
Cbts body of evidence for OCD continues to grow, meaning just because it’s a newer treatment on the scene doesn’t mean it’s inferior to ERP. ICBT has not been studied for children and adolescents, so that is a key factor here. If you have a child or an adolescent that is dealing with OCD, I think it can be much more challenging for them to grasp onto some of these concepts.
I think if you had an older adolescent, they probably could grasp onto ICBT pretty quickly and understandably. That would depend a lot on their severity level that they’re dealing with, as well as their developmental level and emotional level. So each person has to be kind of looked at differently, obviously, but I think that this is possibly why they would put ICBT as a second line treatment option.
Due to, they’re looking at the range of OCD and a lot of people getting diagnosed as a child and adolescent. And obviously those people need treatment that is very relevant and so if that’s why they put it in the second line of therapy, I’m actually okay with that. But we do at least feel like that ICBT is getting looked at more now as an option because of how they put this in here.
Especially in terms of this line of cannot be tolerated if first line treatments don’t relieve symptoms or cannot be tolerated. We have a lot of people out there that just really are terrified of exposure and response prevention, or they feel like it will butt up against their Christian belief systems being required to do these imaginal exposures, and so it’s nice.
To have this listed here as a second line option for them saying, Hey, this is available to you. It doesn’t have to be exposure and response prevention or bust. And I’ve talked with other therapists who have been to the I-O-C-D-F conferences in the past many years ago, and they said it was almost a little cultish about how into ERP they were, and they said it was.
Kind of like almost to a, a bit of a creepy level. I think hopefully some things have shifted and changed since then, since that was many years ago. I also want to just point out and congratulate, applaud people that you guys don’t know. And who have been working so hard behind the scenes to really get the I-O-C-D-F to recognize ICBT as a valid treatment.
And so I am so thankful they are obviously much more research minded and valued. Than I am who are able to go in and say, Hey, we do have this research. It’s been done over and over. We can show that this treatment is effective. We have a large community of therapists now that are using this treatment and seeing success with their clients.
I. Will you please offer this to people as an option who are so desperate in such a high rate of suffering, who need help and need hope? And that’s what we’re here for. We’re not here to bash ERP. If it works for people and you feel comfortable doing it, and you’re at a place where you can do it and do it successfully with a trained clinician, then by all means, please go pursue your healing journey in any way that you need to.
And I’m a hundred percent on board with that. I’ve had people leave me to go do ERP and like I hope they soar and thrive. Like I’m not offended by that by any means. That’s okay. Everyone has to do between them and the Lord, what they feel like is right for them. Now, also, under the second line treatment options, they have metacognitive therapy, which I was really interested in seeing.
Now remember, this is an international foundation, which is really cool because it means that even things that aren’t very popular in the US but are working super well in other parts of the world are being recognized. And I would even put ICBT in that category because it’s relatively newer to the us.
This past year I participated in a two day training for metacognitive therapy, and it was an online training. I could be super wrong about this point, but I believe it was the first metacognitive therapy training for a therapist in the US and it was done by a psychologist named Pia Callison. Hopefully I’m saying her last name, right?
I can’t remember because they kept just referring to her as PIA in the training. She wrote a book for laypeople called Live More Think Less, overcoming Depression and Sadness. This is on my reading list. I would like to get a hold of this, but I wanted to give it to you in case you wanted to look more into metacognitive therapy.
There is also a treatment manual written by Dr. Adrian Wells. That I started and haven’t finished yet. It’s called metacognitive therapy for anxiety and Depression. If you have not heard of metacognitive therapy, I’ll give you the brief overview, but understand that this is coming from a novice. The therapy.
Essentially what metacognitive therapy says is that we all have these thoughts that come into our mind, but we all deal with them in different ways. And if we grab a hold of those thoughts and we really chew on them, ruminate on them, worry about them. Do some type of compulsion in response to the thought.
They call this the cognitive attention syndrome. Metacognitive therapy says that the problem is not really your thought. The problem is what you do with your thought. So they teach something called detached mindfulness, and they use an analogy like having trains that are coming and going, right, and you can choose which train.
You want to hop onto, if you’re at a train station now, you might have a train that’s going east and you really wanna go west. Well, if you hop on that East train, it’s gonna take you way out of the way of where you want to be. Metacognitive therapy has different activities that you do with clients where they will essentially just learn to detach from the thoughts that they’re having In my very novice practice of metacognitive therapy.
What I have seen it be most helpful for is for clients who are dealing with a secondary depression in addition to their OCD. I find it incredibly effective for depression because sometimes we go through things in our life and like it does stink, and cognitive behavioral therapy is like, Hey, let’s reframe that thought and make it better.
Okay, you’re lying in a hospital bed with a broken leg, but now you have more time to read that you’ve always wanted, I mean, whatever it is, you’re trying to constantly in cognitive therapy for depression, trying to look at your circumstance a different way. And metacognitive therapy would just say, okay, so you’re lying in a hospital bed.
You can detach from that thought. You don’t have to focus on it, or you don’t have to change it. You don’t have to make it better. You don’t have to ruminate about it. You can literally do nothing with that thought. And then the theory behind metacognitive therapy is that your brain will be responsible for the self-regulating process.
Essentially, if I get out of the way of having to quote deal with all of these thoughts, then my brain will be able to relax and regulate and be okay. It’s super hard. I’m just gonna say that for the clients that I’ve used it with, it takes a lot of practice. It does take intentionality to be able to let thoughts go because that’s not typically what we do, especially for Christians.
We often feel like we have to pounce on thoughts. I’m gonna do an episode about this in the future. About taking thoughts captive and like, what does that really mean for us? How do we apply that in a practical sense with OCD? Because that’s something that I hear a lot of Christian clients talk about. I will say that when I went through the training for metacognitive therapy, there was something in my life that I was really stuck on.
It was a thought that was true, but the thought was causing me to be really angry. And as I practiced some of the metacognitive techniques on myself and with like kind of a practice therapist, we were practicing on each other throughout the two days. I will say that something just release within me. It was incredible.
So I know that there are pieces of this. That can be helpful and work. But I also feel, uh, still very novice, almost like, kind of like I’ve run out of parlor tricks to use and I would love to pursue additional trainings in metacognitive therapy because I do think there are pieces of it that can be useful.
And as I’ve said, this is something that’s being used in Europe. I think it originated in Denmark. I’m not really sure. Just know that metacognitive is another therapy that is out there for you, but you may have a little bit of a challenge finding someone in the US who does it. If you are in Europe, you might have a little bit of an easier time under second line treatments, they also mention space, which we’ve had as a previous episode as well.
So supportive Parenting for Anxious Childhood Emotions is what space stands for. It’s an acronym. The cool thing about space is that you as the parent can do this. Even if your child or adolescent is digging in their heels, they’re refusing to go to therapy, or maybe you take ’em to therapy and they’re like not talking to their therapist or they’re just saying, I’m not doing this.
You as the parent can get this training in space and really be supported on how to respond to reassurance seeking how to reduce accommodation, how to be really compassionate and empathetic, while also at the same time not doing things that are gonna feed the OCD in your child or adolescence. So I love that they put space on here because I think it’s a great option for parents.
So just moving down the treatment recommendations, we then get to third line treatments. So for severe or treatment resistant OCD. Third line treatments are advanced options for individuals who haven’t found success with first or second line treatments, including combinations of the various types of therapies.
And these are reserved for severe treatment-resistant cases and require close clinical oversight. So they have transcranial magnetic stimulation. TMS. By the way, we are still looking for a guest, so if you know a guest who’d like to come on and talk about TMS, that’s definitely something I wanna explore more on the show, as I believe more insurance companies are paying for TMS.
Now, TMS originally was used for treatment resistant depression. So if your depression is super, super bad as a result of OCD, and you’ve tried various medications, typically in order to do TMS, you have to quote, like fail out of so many medications. Next in line we get to emerging treatments, experimental.
Some treatments show early promise, but require much more research, psychedelics and IV ketamine therapy supplements, and pharmaco genomic testing. PGX. I personally disagree with PGX because I’ve seen in a couple different cases where it’s actually backfired and people have been taken off of medications that were helpful for them to be put on something.
Supposedly that’s better for their based off of their genetic testing. That’s just my personal experience. Take it with a grain of salt and then we get down to little section on pans. Pandas, I’m not gonna talk through that. Then treatments to avoid ineffective or potentially harmful. I mean, that’s a very strong wording.
I-O-C-D-F. It’s important to avoid treatments that lack scientific evidence. These therapies have not been proven effective and may delay access to evidence-based care. So they have ineffective psychosocial treatments. EMDR what? Hypnotherapy, psychoanalysis, psychodynamics, psychotherapy, et cetera. What’s interesting is that the EMDR has a link, and if you click on the link is actually a more balanced article.
One of the co-authors is someone I know from the ICBT community, Bronwyn Schroer, who uses EMDR and ICBT to treat co-occurring PTSD and OCD. If you click on the link, it does give you a much more balanced point of view to say. EMDR for OCD specifically doesn’t have a large body of research and most of that research being done in adults now I know because I have taken trainings from them that add dej.
Sorry if I mispronounced your last name, and Suzy Matheson have something called the Flash Forward technique that they use for OCD. I think the argument is that this is glorified exposure therapy because you are having people imagined their worst case scenarios and then processing that as a traumatic memory.
Now, I will say that odd and Suzy, who are researchers in the Netherlands. They’re super incredibly brilliant. I’ve taken a couple of their trainings and I probably honestly could go through them again and get something more out of them. They are also pioneers of what’s called EMDR 2.0, which focuses on working memory taxation versus just the bilateral stimulation.
Hopefully I’m not getting too nerdy for some of you I know we also have some therapists that listen to this podcast as well. Essentially, EMDR 2.0 just adds another layer and sometimes can help people process through things if they’re getting stuck. So it’s something that I have incorporated into my practice, and I do think that because people who struggle with OCD have so much going on in their brains.
Sometimes they benefit when they are processing trauma. They benefit from that EMDR 2.0 approach. So you could also argue odd and Suzy are seeing people in the Netherlands who are in intensive treatment therapy programs and probably have a pretty high level of distress that they’re dealing with. I think it might be hard to differentiate.
Are they benefiting from EMDR 2.0 or are they benefiting from really the flash forward technique? Is this just glorified exposure therapy? So flipping back to the I-O-C-D-F website where they’re talking about EMDR and they’re saying, okay, it’s not evidence-based for a standalone treatment. I would agree with that, but it still could be recommended as part of an overall treatment plan.
To treat trauma slash PTs in co-occurring OCD and PTs d. They also say that we could benefit from more research, so that webpage is much more balanced than saying ineffective or potentially harmful. I think that that’s very harsh and that that’s very unfair for people who might benefit from EMDR as part of their treatment process.
I have sat with many client who has processed the onset of their OCD because that was truly so traumatic for them. They did not know they were going through OCD. They did not know what was happening to them. They might have thought they were going crazy. They had an intense high level of. Fear. It was a very dark time in their life, and even just being able to go through EMDR surrounding that situation has been so healing for so many people, and I think that’s why it hurts my heart a little bit that I-O-C-D-F would deter people from getting EMDR therapy who might really benefit from it.
I’m not saying it’s going to solely cure your OCD. It’s super helpful in terms of dealing with childhood woundings in terms of dealing with traumatic events that may be exacerbating OCD symptoms. I see that all the time. So for someone who just lands on this website and sees potentially harmful and then right under it, EMDR, that’s really gonna deter quite a few people from getting it.
They also have brain spotting on here. And then they have ineffective medical treatments. The reality is that getting effective, helpful treatment for OCD is super challenging, and we have to rewind and say that back in the 1960s, which is not that long ago, this was considered an untreatable disorder. So we have come a long, long way, and I think we still have a long way to go.
There’s more research that can be done, more research that probably needs to be done. Even though for me, I am not the biggest fan of research. I would much rather have people come in. I kind of know who my ideal client is that I work well with, and I will try some things out with them. And if it doesn’t work, we’ll try something else.
If I consistently see something not work for people, I just pull it out of what I offer. I don’t even offer it anymore, and I’ve been doing that for years and it has worked super well for me and I’ve been able to help a lot of people. I’m thinking of somebody that I have right now that really had a long course of exposure therapy and medications.
A course of EMDR treatment for some early childhood trauma and woundings, and then I’m working with this person on ICBT right now, and it’s just been so interesting to see that this person has hope again. They have hope of getting better. They feel like this treatment really makes sense to them, and they’re like, okay, I’m getting it.
And I feel like I’m able to start seeing some progress and I’m putting some pieces together that I wasn’t able to put together before. And one of the reasons that exposure wasn’t helpful for this person was that they just weren’t able to tolerate it. So they would try to expose themselves, but then it was like they couldn’t move on the hierarchy ladder.
They got to a point where things just became too much and became like their nervous system was just getting super triggered. The whole reason that I’m here, that I’m speaking into this space and even talking about this stuff is because I want people to know that there’s hope. That no matter how low you feel like you are right now, no matter how badly you feel like you’re struggling, that there are these different treatment options.
And you know what? If you find a therapist and you guys just don’t jive, let’s keep it real. Sometimes that happens and I’m gonna do an upcoming episode at some point on terminating. In therapy, like kind of ending a therapy relationship. And it can really be challenging sometimes. And so I hear that, especially if you feel like, you know, this person just doesn’t get it because they don’t share my faith.
We’re now at a point where we have over 175 episodes for you guys to listen to. That can hopefully help you on your OCD journey if you’re interested in ICBT or think that might be a good fit for you. You can check out Christian’s Learning I ccbt over at care bach.com/training. I also do MDR and I ccbt intensives.
For those of you who really feel like you have trauma in the way of being able to. Get the help that you need with OCD and really just need a wraparound approach. OCD Warriors, you are amazing individuals, so tough and so strong, and continuing to fight even though you’ve had some really hard or really low points in this process.
I want you to know that I see you and want to continue to support you guys any way that I can. Until next time, may you be comforted by God’s great love for you. Christian Faith and OCD is a production of By the Well Counseling. This podcast is for informational purposes only, and should not be a substitute for seeking mental health treatment in your area.
