An Interview With Dr. Shana Doronn of A&E's Obsessed

Practical Tips from an Expert for Getting the Most Out of Your OCD Treatment

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From 2009-2010, A&E hosted a reality show called Obsessed that examined the real-life struggles of people with anxiety disorders, including obsessive-compulsive disorder (OCD). Modeled after the network's popular show Intervention, this program followed people as they underwent cognitive-behavioral therapy (CBT) to reduce and/or manage their OCD symptoms.

In June 2009, I did an email interview with Obsessed's Dr. Shana Doronn, a licensed clinical social worker in Illinois and California and a doctor of psychology, about the basics of psychological treatment for OCD and some practical tips for getting the most of out treatment.

Doronn works as a psychologist at the UCLA OCD Intensive Treatment Program and also maintains a private practice where she specializes in the treatment of OCD and other anxiety disorders with an emphasis on exposure-response prevention therapy (ERP).

Types of OCD Treatment

When discussing the psychological treatment of OCD, CBT and ERP often come up simultaneously. Are CBT and ERP the same thing?
ERP is not the same thing as CBT. Many therapies are under the umbrella of CBT. ERP is a specific type of behavior therapy used in treating anxiety disorders such as OCD. ERP is exposing someone to that which they fear and not allowing them to engage in the desired behavior/compulsion. As a result, they are left to feel the anxiety and "sit with it" until the anxiety comes down by 50%.

How do you decide which form of treatment to use?
When someone is acutely ill and the compulsions are to the point that someone can't engage in talk therapy, there is no choice but to engage in ERP (usually in conjunction with medications).

Talk therapy or insight does not lead to behavioral change. Practicing via ERP is the only way to change. This is not to say talk therapy is irrelevant; I believe there is a place for it once the client is able to function in a healthier manner. At that time, I engage in cognitive restructuring. In less severe cases, there is more time for talk therapy but the bottom line is that exposure therapy is what helps someone eliminate their compulsions.

Successful OCD Treatment

What is the average success rate for treatment of OCD symptoms with CBT?
The success rate is very good; however, it depends on a number of factors including co-morbid conditions, properly executed treatment, client determination and ability to tolerate anxiety. When working at UCLA in the intensive out-patient treatment, the goal was to reduce symptoms by 50%. The program views treatment as a beginning and follow up with a therapist who specializes in OCD as necessary to maintain gains and further reduce symptoms. If a patient does not continue with treatment, after the program there is a high likelihood of relapse. There is no cure but there is effective treatment.

Although we know that psychotherapy is effective in treating OCD, it doesn't work for everyone. What do you think is the most important factor in determining whether CBT will be helpful for someone with OCD?
Client motivation is crucial and absolutely necessary. Families will bring their loved one into care, but if the patient does not want the treatment, it won't work.

Number of Sessions to Treat OCD

People with OCD understandably want relief from their symptoms. How many CBT sessions are usually needed to get good results and how long do these results last?
The number of sessions is really determined by the severity of the illness. For mild OCD, 5 sessions on an out-patient basis can work. Mild to moderate OCD (may take) 10 to 15 session and if someone's symptoms are more severe, I would recommend an intensive treatment program or meeting several times a week. The results last as long as the patient continues to practice at home. As patients improve and become fairly independent, I cut back on sessions and see how they do.

Obsessed's Similarity to Real Life

How similar is the therapy we see conducted on Obsessed to what you would do in your everyday practice?
What you see on TV is exactly what I do in my private practice. What you don't necessarily see are all the exposures leading up to the "BIG" one. I use a hierarchy of symptoms and don't start with the most difficult exposure. I love doing home visits and have always done them long before I participated in the show. I never need to make up an exposure as life happens and before you know it an exposure has been created.

Building on Progress in OCD Therapy

OCD is often considered a chronic illness that requires ongoing treatment. What advice do you have for people who may have recently completed CBT for OCD? How do they build on and maintain the gains they've made while in therapy? 
Practice, practice, practice! Do not stop exposure therapy! In time the exposure will feel a bit more natural. You want to stay on top of your game! Practice exposures and practice living and enjoying life. OCD tends to rob people of their humanity and they forget how to live, thus the need to practice living.

​Financial Concerns for OCD Treatment

Many people with OCD are unable to work and are concerned about their finances. How much does CBT therapy usually cost? If people can't afford the out-of-pocket costs associated with psychotherapy, what options are available?
Sadly, treatment can be very expensive and not all clinicians take insurance. I must admit that insurance companies don't pay very well and getting reimbursed is a pain beyond belief. Personally, I would rather do a sliding scale and not turn people away. For a true expert in OCD the price ranges from $120 to $300 per hour (at least in Los Angeles). I live in Illinois and the range is a bit different. Treatment programs can cost $20,000 if insurance doesn't pay. I do know that the many intensive programs such as UCLA's OCD Intensive Treatment Program take many different types of insurance.

Source:

http://drshana.com/about/

In your experience, what do clients find to be the most challenging aspect of undertaking CBT for OCD? What are some strategies they can use to get through difficult exposures?
The most challenging aspect is feeling the horrible symptoms of anxiety. Anxiety is brutally painful. My job is to prevent the compulsions which mean that my patient will feel pain. This is hard to watch but I know they will feel better sooner rather than later.

Most of us (OCD treatment providers) don't start with the difficult exposures thus the patient will experience a lower level of anxiety. They learn how to feel the anxiety without doing anything but FEEL and in time the symptoms go down (a process called habituation). Once they realize that the anxiety will lessen on its own, I then have my patients tackle a more difficult exposure.

What are the ingredients that go into an effective exposure exercise?
You need a trained therapist and a motivated patient. I try to prepare my patient as much as possible so they know what will happen. The key is not to bail out of the exposure too soon. Patients must rate their anxiety (0 to 100) and wait for the symptoms to come down by 50%. The exposure is then done repeatedly. If someone stops early and engages in a compulsion, the obsession will strengthen and the exposure for that situation is rendered useless.

How do you decide when home visits might be necessary to conduct exposure exercises?
I decide to do a home visit after doing exposures in the office is completed. Also, I go to the home if someone is practicing at home but still having difficulty. I like doing home visits as I get a better sense of that person in their home environment.

It is not always necessary it is just my preference.

Is there any evidence that medications designed to relieve anxiety interfere with exposure therapy? What do you typically say to clients who are taking anti-anxiety medications and who want to undertake CBT?
In order to engage in exposure therapy, the client needs to be able to feel their anxiety. If medications take all of their anxiety away, I can't really do the exposure. Most people will feel some anxiety on their medications so typically it is not a problem. It is problematic; however, if someone is on benzodiazepines to totally mask his anxiety. With that said, I try to work closely with the psychiatrist who is prescribing medications.

Family members often want to help but are unsure what to do. What advice do you have for family members who want to support a loved that is being treated with CBT for OCD? Should family members be actively involved in treatment or even attend sessions?
Family involvement is absolutely important. Typically family members want to be supportive and are often the ones giving in to the patients' anxiety.

Enabling a patient is essentially doing a compulsion for the patient and this makes the OCD worse. More often, a family member is just trying to help out. I find it necessary to get the family involved as they are the ones who are going to help with exposure therapy in the home.

For people who are interested in self-help, are there any books that you would recommend for people with OCD?
My absolute favorite books are Getting Control and Imp of the Mind and both are written by Lee Baer. Two of the best websites are Obsessive Compulsive Foundation and OCD Chicago.

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