By Louise E. Marks, M.S., O.T.R., BCIA-EEG and Biofeedback
COCA Board of Directors-Public Awareness Chair
Published in the Colorado Applied Psychophysiology and Biofeedback
Association Newsletter, December 2002
The Colorado Obsessive Compulsive Association, COCA, a newly
formed non-profit organization, is dedicated to enhancing awareness of
OCD spectrum disorders, disseminating information on mainstream and complementary
treatments, and offering support to OCD sufferers and family members. On
November 18th in Boulder, COCA hosted an assortment of providers,
OCD sufferers, and family members for a public presentation on QEEG/Neurofeedback
and OCD. Daniel Hoffman, M.D., BCIA-EEG, reviewed current brain imaging
findings relevant to OCD (QEEG, SPECT, PET, LORETA), Kay Sheehan, MSW,
LCSW, BCIA-Biofeedback, presented information on EEG biofeedback as a treatment
modality and a case history. I gave an overview of OCD and mainstream treatments.
A video is available for purchase through COCA.
OCD Symptoms, Causes, and Mainstream Treatments
OCD can be an extremely disabling condition that robs a person of life
enjoyment and functionality. One in 50 adult Americans are afflicted by
irrational, intrusive, troublesome thoughts or images (obsessions) with
or without the need to perform ritualized behaviors (compulsions). The
common compulsions of washing and checking are performed to alleviate the
anxiety produced by the disturbing obsessions.
In the early 19th century, the French called OCD the doubting
madness. Today OCD continues to be referred to as the doubting disease,
because a person with OCD doubts his or her own senses and thoughts. Depression
is a frequent companion to OCD, as well as ADHD, and Tourette’s syndrome.
Body dystrophic disorder, eating disorders, trichotillomania (compulsive
hair pulling), hypchrondriais, and other anxiety disorders are also associated
with OCD. Seventy five percent of people who have OCD also report major
episodes of depression and 68 percent of people who are diagnosed with
Tourette’s syndrome also have OCD. Thirty percent of children and adolescents
diagnosed with OCD also have ADHD.
OCD is a neurobiological disorder with no single identified cause. Investigators
with brain imaging technologies have developed the hypothesis that OCD
involves a dysfunction in the neuronal loop running from the orbital frontal
cortex to the cingulate gyrus, striatrum (caudate nucleus and putamen),
globus pallidus, thalamus and back to the frontal cortex. Because serotonin
reuptake inhibitors and SSRI medications have offered relief for many cases
(40 to 60 percent), a neurotransmitter imbalance theory has also been hypothesized.
The role of an autoimmune response to strep infection is known to be
related to the onset of OCD symptoms in children (PANDAS, Pediatric Autoimmune
Neuropsychiatric Disorders Associated with Streptococcal Infections). Several
recent studies have shown that OCD sufferers have deficits with working
non-verbal memory. Using QEEG with OCD patients, Prichep et al found two
subtypes (excessive alpha and excessive theta) which responded to SRIs
differentially. Whereas 82.4 percent of the alpha subtype responded positively,
only 20 percent of the theta subtype responded positively. Robert Gurnee,
MSW, BCIA-EEG, QEEGT, is also finding OCD subtypes using QEEG. It is likely
that multiple causes of OCD will be found as OCD research progresses.
The current mainstream OCD interventions are education, cognitive behavioral
therapy (CBT), medications, and surgery. Many proponents of CBT insist
that exposure and response prevention behavior therapy (ERP) is the essential
component of CBT. Others, such as Jeffery Schwartz, M.D., favor a more
"mindful" approach. Schwartz developed a specialized OCD cognitive strategy
that can alter brain chemistry and decrease obsessions and compulsions.
Repeated studies have shown exposure and response prevention therapy
to be effective but have also pointed out its failings. ERP is refused
by 25 percent of OCD patients. Twenty percent of the OCD patients who opt
for this treatment drop out as a result of the stress it causes. Of those
who complete the therapy an average of 76 percent receive benefit and report
a 50 to 80 percent reduction in symptoms. Seventy six percent maintain
benefits at long term follow up, six months to six years. In other words,
of those who complete ERP, 52 percent obtain some long-term benefit.
Medications often have negative side effects, and surgery has obvious
drawbacks. Approximately 33 percent of patients receive no benefit from
medication or CBT. Despite major strides in the treatment of OCD, more
effective and user-friendly approaches are needed.
The Role of QEEG and Neurofeedback in OCD Treatment
Neurofeedback is emerging as a promising alternative or complementary
approach to treating OCD. Positive anecdotal reports are common at conferences,
workshops and on biofeedback Internet lists. Unfortunately, the only study
to appear in a medical literature search for QEEG/neurofeedback and OCD
is the NYU Prichep study. At the 2002 annual meeting of the International
Society of Neuronal Regulation, ISNR, Cory Hammond, Ph.D., presented two
cases he successfully treated with QEEG guided neurofeedback. Hammond used
the Yale-Brown Obsessive Compulsive Scale, Y-BOCS, Padua inventory, and
MMPI to track outcomes. At long term follow-up (13 to 15 months) positive
results were still holding. Hopefully, Dr. Hammond’s finding will be published
shortly.
If neurofeedback practitioners obtain positive results using EEG biofeedback
as a standalone or supplementary treatment for OCD, they owe it to OCD
sufferers to publish their findings and reach out to a larger audience.
I would also like to see biofeedback practitioners become acquainted with
the CBT variants that have shown merit, and consider integrating them into
their practices.
My hunch is that biofeedback and neurofeedback will aid in the cultivation
of what Schwartz calls "directed mental force". This mind-willed directed
force mediated through the frontal cortex serves as a buffer to the OCD
pathological brain circuitry. With repeated practice, the faulty wiring
is dampened and symptoms subside.
For additional information on OCD and treatments the reader is referred
to the following:
Organizations and Websites
Colorado Obsessive Compulsive Association COCA
Mental Health Center of Boulder County
1333 Iris Avenue
Boulder, CO 80304
General information and Boulder Support Group: 303-938-1360
To order video: Louise Marks, 303-546-6639
Obsessive Compulsive Foundation OCF: www.ocfoundation.org
The University of Florida Obsessive-Compulsive Disorder (UFOCD)Program:
www.ufocd.org
Stanford University Obsessive Compulsive Program: http://ocdresearch.stanford.edu
International Society of Neuronal Regulation: www.snr-jnt.org
Publications
Prichep LS; Mas F; Hollander E; Liebowitz M; John ER Almas M;
Decaria CM; Levine RH "Quantitative electroencephalographic subtyping of
obsessive-compulsive disorder" Psychiatry Research, 50(1): 25-32,
1993 Apr.
Baxter, LR, Phelps, ME, Mazziotta, JC, Guze BH, Schwarz, JM &
Selin, CE. (1987). Local cerebral glucose metabolic rates in obsessive-compulsive
disorder. American Journal of Psychiatry, 141, 363-369.
Expert Consensus Treatment Guidelines for Obsessive-Compulsive Disorder:
A Guide for Patients and Families, (1997) Journal of Clinical Psychiatry,
58 (suppl 4)
Amen, DG, Carmichael B. (1997). Oppositional children similar
to OCD on SPECT: Implications. Journal of Neurotherapy, 2(2), 1-7.
Brain Lock, Schwartz J. Harper Collins, 1996
The Mind and the Brain, Neuroplasticity and the Power of Mental Force,
Schwartz J. Harper Collins, 2002
Obsessive Compulsive Disorder in Children and Adolescents, Rapoport
J. American Psychiatric Press, 1989
The Boy Who Couldn’t Stop Washing, Rapoport J. Penquin Books,
1991
Getting Control, Baer L. Little, Brown and Company, 1991
Obsessive Compulsive and Related Disorders in Adults, Koran LM,
Cambridge, 1999
