Over the last few months, I have read a number of stories from people who have been unable to find good therapy in their own country and as a result looked at other options. One particular method I have noticed quite frequently is the rise in online cognitive behavioural therapy, which is done using a webcam connection. This has allowed people from all over the globe to access treatment from a recognised OCD specialist. I spoke to Tom Corboy, Executive Director at the OCD Center of Los Angeles, who told me more…
Since doing my research into OCD I’ve noticed a lot of people have sought help from the OCD Center of Los Angeles in the UK via the internet. How is this done?
Online therapy is exactly the same as face-to-face treatment, the only significant difference being that the therapy occurs over the internet. There have been scores of studies on phone and online therapy, and they have consistently found this approach to treatment to be as effective as face-to-face treatment. One study even found online treatment more effective, mostly because the treatment was viewed by study participants as being easier to access than face-to-face treatment.
It’s also worth noting that Cognitive Behavioural Therapy (CBT), which is the evidence-based treatment of choice for OCD, is particularly well-suited to being conducted online. CBT for OCD uses a structured treatment protocol that is easily adapted to online treatment. Our OCD therapy program uses two structured treatment manuals that every client receives, and which are central to treatment. Conversely, traditional psychoanalysis focuses on a largely unstructured treatment approach that is not conducive to online treatment.
Is it easy to diagnose someone with OCD over the internet?
In most cases, there is no significant difference in assessing someone online, as opposed to doing so face-to-face. Regardless of whether an assessment is conducted online or face-to-face, the diagnostic criteria are the same. And we use the exact same diagnostic questionnaires when doing online assessments.
Think of it this way – when we are assessing someone in our office, we are doing four things: we are looking at them, asking them questions, listening to their answers, and giving them specific questionnaires related to OCD. We do the exact same four things when conducting an assessment online.
Why do you think people from international countries are seeking help from the OCD Center of Los Angeles, rather than their own country (particularly UK)?
We have treated hundreds of clients online, with most of them being from the UK, Canada, and Australia. The primary reason that people seek out treatment online with our center is that there is such a shortage of therapists who know how to appropriately treat OCD. We receive calls and emails every day of the week from individuals around the globe who are suffering with OCD, yet are unable to find therapists who know how to appropriately treat them.
The main reason this problem persists is that there is a lack of effective training about OCD and its treatment. I can say from personal experience that graduate school training for the treatment of OCD in woefully inadequate.
There are three additional factors in why we receive a disproportionate amount of inquires for online treatment from the UK, Canada, and Australia. First, like the US, these countries all have English as their primary language.When someone with OCD does not speak English fluently, there is obviously an additional barrier to treatment at our centre. Second, all three of these countries have developed economies in which a significant number of people have the financial resources for therapy. And third, psychotherapy is more culturally acceptable in these three countries than in some other countries. We receive fewer enquiries from people in other countries for one or a combination of these three factors.
Can you give a full diagnosis to international people, so that they can go to their GP and say “this is what I’ve been told” – or is it not as simple as that?
Yes, we can do that, but generally speaking, their GP would not have the training to provide appropriate treatment. Or worse, their GP may dispute the diagnosis because he/she doesn’t understand that OCD is far more than just compulsive hand washing (which is the average ununiformed person’s idea of what OCD is).
But again, this lack of clinical understanding is hardly the exclusive province of therapists in other countries. Many mental health care providers in the US are equally ignorant about OCD and its appropriate management with evidence-based treatment.
I have found a lot of people don’t recognise that OCD can be thought-based (Pure OCD) and instead think it is largely hand washing, checking etc – would you agree with this and why? Do you think it is a misunderstood illness?
Yes, the sad truth is that most people, including most mental health professionals, do not understand that OCD is more than just repetitively washing hands or checking stove knobs. I think there are a number of reasons for this gap between the reality of OCD and the understanding of this condition by the public and the mental health community.
First, the mass media does a terrible job of covering OCD. In a 90-second TV news clip, it’s just easier to show hand washing than it is to explain and show the subtleties of what is colloquially known as “Pure OCD”. And because it is easier, that is generally what the mass media presents.
Second, there are now so many celebrities who use media (including social media) to expound on the minutiae of their personal lives, and in so doing, they often misrepresent what OCD is. Hardly a week goes by that there isn’t some misinformed celebrity talking about how they are “so OCD” because they like to keep a clean house. And because celebrities get such a ridiculous amount of attention by the media (again, including social media), these sorts of comments are then sent around the world at warp speed via the internet. And third, as I noted above, graduate school programs generally do a dreadful job of training professionals to treat OCD.
Would you say people with Pure OCD have a harder time dealing with their symptoms than those with physical symptoms such as hand-washing?
Some clients have a more difficult time with the more cognitive symptoms of so-called “Pure OCD”. That said, Pure OCD is no more difficult to treat than hand washing and other more well-known symptoms of OCD. The key is finding a therapist who specialises in treating OCD.
What do you find works better for Pure OCD sufferers – the cognitive side of therapy or the behavioural therapy?
There is no reason to separate cognitive therapy and behavioural therapy. I like to think of them as two sides of the same coin. At our centre, we use both “Cognitive Restructuring” (the main cognitive technique for OCD) and “Exposure and Response Prevention” (the main behavioural technique for OCD) with virtually all of our clients struggling with OCD. We also have a strong emphasis on mindfulness and acceptance techniques that are commonly described as the “third wave” of CBT (cognitive therapy and behavioural therapy being the other two waves).
It is also worth noting here that so called “Pure” OCD is a common colloquial term, but it is misleading, for there is no such thing as “Pure” OCD. I have yet to meet a client with Pure O who wasn’t doing significant amounts of compulsions. These compulsions are often less obvious than hand washing or door checking, but they are compulsions nonetheless.
Repeatedly asking for reassurance is a compulsion. Spending hours in online chat rooms reading about a particular flavour of OCD is a compulsion. Avoiding certain people, things, or situations is a compulsion. And mentally reviewing your thoughts is a compulsion.
All of these things belie the notion that those suffering with Pure O don’t have compulsions. Pure O is just OCD, and it responds well when treated with cognitive and behavioural tools, especially when mindfulness and acceptance training are added to the treatment.
What would be your one bit of advice to people who are suffering with intrusive thoughts?
If I had to reduce treatment advice for Pure OCD to one rule of thumb it would be this: Accept the existence of your unwanted thoughts, and challenging their accuracy and importance. That doesn’t mean accepting that your unwanted thoughts are “true” or “meaningful”. It means accepting that they exist in your consciousness, while at the same time challenging their importance with CBT, rather than buying into the idea that they are a legitimate manifestation of your character or intent. Intrusive, unwanted thoughts in Pure O are just fictions created by your mind, and they don’t deserve your attention or your belief.