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New partnership may help treat obsessive-compulsive disorder

Clinicians will now have greater access to the most current training on obsessive-compulsive disorder, thanks to a partnership between two mental-health organizations.

On Tuesday, Massachusetts General Hospital’s Psychiatry Academy and the International OCD Foundation announced that they will develop new training programs to help clinicians assess and treat OCD and related disorders, which can be debilitating for some people.
According to the Anxiety and Depression Association of America, obsessive-compulsive disorder affects 2.2 million Americans, or about 1 percent of the population. Some studies have found prevalence rates up to 2 percent, but those results have been called into question based on their methodology.
“OCD is one of those conditions that has gotten so overused in general conversation that it's important to distinguish the disorder from its sometimes common casual use,” said Dr. Matthew Rudorfer, psychiatrist and director of the National Institute of Mental Health’s Somatic Treatments Program. Rudorfer is not involved in the development of the training program.
“People will joke,‘you’re so OCD, ’ ” Rudorfer said. “It’s perfectly okay if you like to line up your shoes in your closet. Now, on the other hand, if you spend all day rearranging your shoes and you refuse to leave your house because they don’t look perfect yet, that’s something else.”
The past 30 years have seen a major evolution in the way OCD is diagnosed and treated. Before the 1980s, OCD was considered rare and the primary treatment was psychoanalysis.
“The psychoanalytic theories were very interesting hypothetically, but were never really able to be translated into useful treatment for OCD,” Rudorfer said.
A revolution came in the form of new medications, specifically clomipramine, an anti-depressant that inhibited the re-uptake of serotonin. The brain chemical serotonin maintains mood balance and transmits impulses between nerve cells. The control of serotonin levels has been shown to help people with depression and with anxiety disorders like OCD.
Clomipramine and, later, selective serotonin re-uptake inhibitors, commonly known as SSRIs, proved effective in treating most people with OCD.
“The history of the field Is that it was really only well into the second half of the 20th century that we really had effective medications, and that really changed everything,” Rudorfer said. “As we've found with many mental disorders, the combination of medication and behavior therapy is very powerful. They work very well together and that's probably the treatment of choice for most people.”
Behavior therapy works by helping patients recognize problem behaviors and develop new habits.

The IOCDF has been running a behavior-therapy training institute for more than 20 years, but the demand is ever-increasing.
“Unfortunately, the type of therapy used for OCD is not the type of therapy that many professionals learn in graduate school,” said Dr. Jeff Szymanski, a clinical psychologist and executive director of the IOCDF. “So, unfortunately for many individuals with OCD, mental-health training is still lagging behind. A primary goal of this partnership is to help disseminate this information and fill that training gap.”
Szymanski has partnered with Dr. Sabine Wilhelm, who is chief of psychology and director of the OCD program at Massachusetts General, as well as vice-chair of the IOCDF’s scientific and clinical advisory board.

Together, they are developing interactive online courses comprised of videos, self-assessments and moderated discussion boards.
Mental-health and medical professionals will use the mobile-friendly, on-demand content to develop a personalized cognitive behavioral model for patients with OCD, apply skills to treat the different OCD system sub-types and manage treatment-interfering behaviors.
The IOCDF and Massachusetts General plan to develop more online courses for OCD-related disorders, such as body dimorphic disorder, hoarding disorder and bodily-focused repetitive disorders.
“The fact that we have good treatments now means that it's recognized more. In terms of training to have clinicians be aware of the latest is certainly only a good thing,” Rudorfer said. “We know a lot more than we used to but there's still plenty of dots to connect. I think that keeping up with the latest is only a good thing.”
The courses are currently in development. A formal launch date has not been announced.