Myth-Busting OCD with Dr Brakoulias

We’ve recently had the pleasure of working alongside Professor Vlasios Brakoulias, a consultant psychiatrist internationally recognised for his work with people living with Obsessive-Compulsive Disorder (OCD). ??

We sat down with Dr Vlasios Brakoulias to find out about how he approaches digital treatments in the management of patients presenting with OCD.????

What were your biggest concerns about digital mental health treatments (for OCD) and how did you overcome them????

I wasn't too concerned about digital mental health as I saw this as an advancement considering many patients living with Obsessive-Compulsive Disorder (OCD) delay treatment due to feeling embarrassed or reluctant to engage in therapy. My own reluctance to use an online service was related to the assumed "hassle" of having to prescribe patients internet-based therapy.

Fortunately, THIS WAY UP made it very simple. It's basically a three-step process - 1. Login into the website 2. Enter the patient's first name and email address 3. Select the treatment program and press "send".

I guess that this was my biggest concern, but once I had made a start I realised just how easy it is and how useful the treatment program is for patients. ??

How do you discuss OCD when you speak to GPs????

When speaking to GPs I emphasise the common symptoms of OCD as OCD can present in a variety of ways and can easily be missed. I also emphasise the impact that OCD can have on patients and their families as it can often be trivialised, seen as a "bad habit" or as something that people can "snap out of". Often patients have suffered since childhood and have been too embarrassed or reluctant to seek help. If a patient presents with symptoms of OCD, this is an opportunity that cannot be missed. The patient should be promptly diagnosed and referred for evidence-based treatment, which is either exposure and response prevention (a psychological treatment) or high dose serotinergic antidepressant therapy (this requires talking with your doctor).???

Do you speak differently when you discuss OCD with other health professionals, such as Psychologists, Allied Health, and Nurses????

The key points are similar:??

1. That OCD is a distressing and disabling disorder that should be treated promptly with evidence-based therapies.??

2. That the disorder should not be trivialised.??

3. That we should be asking patients if they have OCD, i.e. screening for the common symptoms like handwashing, checking, intrusive thoughts, as well as symmetry and ordering.??

Finally, we should ensure that patients are receiving Exposure and Response Prevention Therapy. Unfortunately, too many patients are seeing psychologists or counsellors for their OCD and not receiving exposure and response prevention therapy. They may receive mindfulness, or are being taught relaxation strategies, but they are not given active tasks that make them face their fears, that make them anxious, and that help them to overcome their symptoms. So, I need to emphasise that patients should be given exposure tasks. I also need to emphasise the importance of involving the family or carers where possible. Family members or carers also need to have the importance of exposure tasks explained to them. No one wants to see their loved ones in distress, but by doing things for the person living with OCD, family members or carers could be unintentionally adding to the problem. Family members or carers need to understand how to best support the person living with OCD by recognising OCD, and by encouraging the individual to persevere when distressed and complete their exposure tasks, knowing that experiencing distress is part of the road to recovery. While exposure therapy can be unpleasant, it’s the most evidence-based approach method that leads to recovery. ??

Is there something you have a particular interest in, in regards to OCD?????

I am particularly interested in prevention and early intervention for OCD. Patients often report OCD symptoms from primary school years that then become particularly problematic in high school. By the time that patients get help for their OCD, often 10 years have passed and the person living with OCD may have already had time off school, deteriorating grades, missed social opportunities, missed work or educational opportunities, had their symptoms impact on their relationships and had a blow to their self-esteem. In the meantime, symptoms can become more ingrained and difficult to treat. Although we need to do more work in the area of prevention and early intervention, it makes sense to be able to diagnose people earlier and to get them the help they need before the disorder starts having such a big impact on their life and wellbeing.

The THIS WAY UP program may be a useful first step to getting help, particularly when there may be long waiting lists for psychologists and psychiatrists who have expertise in treating OCD. ?

Can you give us your top tips for clinicians to support in the management of OCD????

1. Remember that obsessions are recurrent and distressing thoughts, images or impulses. Recurrent images tend to be violent or sexual and very difficult to talk about. This can lead to a misdiagnosis of a psychotic disorder.???
2. Remember that OCD very rarely occurs as a single diagnosis. Comorbidity is the rule rather than the exception. So, ask for comorbid depression and anxiety disorders.???
3. Although recovery is estimated to occur in less than 10% of patients, more than 60% will have a reduction in the severity of their symptoms. Never give up too early and always try to instil hope and empower the person living with OCD.
4. THIS WAY UP's online treatment program can provide a good starting point to getting help. ? ?

THIS WAY UP’s clinically-proven OCD treatment program teaches the practical strategies for managing obsessive thoughts and compulsive urges (including repetitive behaviours and/or mental rituals). ?The treatment program delivers best-practice, evidence-based CBT for OCD. It was developed by our specialist Anxiety Disorders Clinic team at the Clinical Research Unit for Anxiety and Depression (CRUfAD). From our clinic to yours - it’s an effective treatment you and your clients can trust.