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Fortunately, during my grad school training at Duke, instructors and supervisors emphasized the importance of asking, for each form of mental illness: which of the hundreds of possible treatments for this disorder is most strongly supported by the research evidence?
For OCD, this is a no-brainer: a form of behavior therapy called exposure and ritual prevention has outperformed other treatments (including meds) in virtually every relevant outcome trial ever published.















I'm with you--let's write a
I'm with you--let's write a tv spot about ERP!
Perhaps the new show Obsessed
Perhaps the new show Obsessed on A&E will help. It clearly states the CBT is the most effective treatment.
Thank you for your book
Dr. Ilardi, my apology for veering off subject, but I am thrilled I found your blog and just had to thank you for your new book The Depression Cure. It is helping me like nothing else has. I should probably be in therapy, but until I muster up enough energy to do it, the recommendations in your book will happily suffice.
I wrote a very nice review of your book on amazon yesterday. How nice to find your blog and tell you "face to face"!
Right now (having the fish oil supplement recommendation in practice), I am working on your eating recommendations such as getting canola oil, etc. out of my diet. I always thought canola oil was a good source of omega 3's. There's even DHA enriched canola oil out on the market now. Can you explain why it's not acceptable?
Thank you again for your book. To say it's saved my life is proably not an understatement.
Many thanks
Thank you for your thoughtful, insightful note. It's wonderful to hear how helpful you've found the book, and I wish you all the best as you work to reclaim the healing, antidepressant habits of the past.
As for canola oil . . . it's naturally a rich source of omega-6s (which we all get far too much of), but the DHA-enriched variety at least adds a little omega-3 to the mix (a good thing). On balance, I wouldn't worry about retaining it in one's diet.
Be Careful
You need to be very careful not to overly generalize. Some patients (e.g., many with Tourette's) have little to no control over their response to certain triggers. Behavior therapy may help them to avoid triggers, won't will likely not achieve remission. In that instance, the energy required from the patient to avoid triggers (without medication) could prove large, with the results continually demoralizing- so that a combination of behavioral therapy and mediation may be preferable.
OCD associated with Tourette's has a number of other nuances that may be best managed by a Tourette's specialist.
Reply
Thanks for the comments. In reply:
Obviously, caveats are always in order when we turn our attention to clinically challenging co-morbidities. But please note that:
1) The co-morbid OCD-Tourette's subtype you mention constitutes only a very small subset of all cases of OCD;
2) In the NIMH multi-site study I cited (Foa et al., 2005) - by far the best comparative outcome trial to date - there was absolutely no observed benefit, on average, in adding meds to the behavior therapy protocol;
3) Even in the co-morbid OCD-Tourette's treatment scenario you describe, treatment with meds alone (the typical default treatment for anyone with ocd) is presumably inferior to combined behavior therapy + meds.
Exposure Therapy for Treating OCD/Obsessions
Great article - many thanks. I had obsessions, phobias and panic attacks for over 20 years and when I finally decided to get healed found it extremely difficult to get a 'one way' approach. I just wanted to get on with it and found no-one was willing to tell me straight what to do so did lots of research and self-testing.
My psychiatrist diagnosed me with severe depression and complex OCD (although I couldn't identify any rituals to speak of).
My doctor, my psychiatrist and my counsellors were all very supportive but I have to say not a single one clearly advocated the exposure therapy approach although they did support me when I told them I was doing it regardless. Their main concern was that I take it easy as I had a bout of the immobilisation/disassociation response. Over a two to three year period I removed 27 obsessions (as one was cleared another would pop up from the past); 14 phobias and various other trapped emotional responses.
Took about 3 years and now and again I identify some other negative emotional experience that comes up from the past and I go into and 'exposure therapy' any new material - but all the major emotional problems have gone.
I think if enough work and effort are put in exposure therapy is 100% effective - has been for me in regard to a variety of emotional responses and intensities.
Dead fish-oil
OCD always comes with depression. Just because major symptoms are reduced to a minor scale doesn't mean they're cured or Depression has left. Chronic people must be on medicine. Are you really serious about fish oil? Sincerely,David
David, I use fish oil instead
David, I use fish oil instead of antidepressants. Back in the early 90's when Prozac became a household word, I used it, and afterward vowed to never go on antidepressants again. And I haven't.
David, fish oil in the right dose, works. Fish oil works wonders. The big pharma companies can't patent it and sell it to you for $120 a bottle. That doesn't make fish oil any less effective. Dr. Ilardi outlines in his book the proper way to use fish oil. I have followed the recommendations and in a short time I noticed a great improvement.
I hate to sound like a commercial for his book or fish oil, and I don't even know the doctor lest you think I am a "plant", but I am so grateful I wasn't a skeptic and bought the book and fish oil. I've also joined a church and am finding a sense of community that I was so hungry for. It is just wonderful. Obviously, depression is not just about fish oil, we need to work on healing ourselves, and sometimes it's just not fun!! But if I had to follow just one recommendation from his book, I would grab my bottle of fish oil!
Recommended Doses of Fish Oil
Fish oil is awesome, but I notice when talked to people that a lot of people think they have it covered when they take the 2 pills a day. Reality is, though, for someone with an inflammatory problem (and normal people, for that manner) the doses recommended by the US Institute of Medicine is pretty low.
Thanks for your kind response
Thanks for your kind response but I believe your fooling yourself. Sincerely,David
I'm surprised not to see
I'm surprised not to see cognitive behavior therapy in the article.
Agree
I have been undertaking a review of the exposure and ritual prevention methodology. Interested to see that you feel it performs well. Thanks for the article.
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