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So a friend who's family member was asking about Paleo and OCD. The person with OCD has been doing low-carbish Paleo (50-100 grams carb/day) with supplements for 4 months (was doing Faileo before then ...) and certainly has helped with health and mood but still has old trauma from a family member's death in childhood from over 50 years ago ... The OCD person has done yoga and exercise but I feel everything has been tried except counseling/behavioral modification so I'm trying to convince them - this person accepts the diagnosis of OCD. I apologize for the length of the post but I'm a bit stumped so I'm grateful for your response/feedback.

I want to know success stories or people who've done any combo of treatments for OCD and how much improvement they've had. Also how long did it take you/them?

What did you or someone you know (patient, friend, family) do:

1) Behavioral Therapy- I've heard people can relapse so how frequently would one to do a booster dose? How long does therapy typically last with a psychologist - 1 to 6 months? Do you meet with the psychologist once a week, once a month - frequency?

2) Paleo

3) Drugs

4) Herbs/Supplements

It seems that CBT - cognitive behavioral therapy can be useful, and newer research suggests no difference between that and drugs (see the end of this post) so I'd rather not recommend this person go take drugs (as he tried Prozac in the past and it just turned him into a vegetable and caused weight gain) ... There is some bias as obviously psychologists can't prescribe drugs but psychiatrists can ..

On wikipedia a pretty lengthy article just an excerpt below: http://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder

Management

According to a team of Duke University-led psychiatrists, behavioral therapy (BT), cognitive behavioral therapy (CBT), and medications should be regarded as first-line treatments for OCD.[46] Psychodynamic psychotherapy may help in managing some aspects of the disorder. The American Psychiatric Association notes a lack of controlled demonstrations that psychoanalysis or dynamic psychotherapy is effective "in dealing with the core symptoms of OCD."[47]

Behavioral therapy

The specific technique used in BT/CBT is called exposure and ritual prevention (also known as "exposure and response prevention") or ERP; this involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior. At first, for example, someone might touch something only very mildly "contaminated" (such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school.) That is the "exposure". The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once (exposure) without going back and checking again (ritual prevention). The person fairly quickly habituates to the anxiety-producing situation and discovers that their anxiety level has dropped considerably; they can then progress to touching something more "contaminated" or not checking the lock at all—again, without performing the ritual behavior of washing or checking.[48]

Exposure ritual/response prevention (ERP) has a strong evidence base. It is generally considered the most effective treatment for OCD.[48]

It has generally been accepted that psychotherapy, in combination with psychiatric medication, is more effective than either option alone. However, more recent studies have shown no difference in outcomes for those treated with the combination of medicine and CBT versus CBT alone.[49]

More recent behavioral work has focused on associative splitting. It is a new technique aimed at reducing obsessive thoughts. The method draws upon the “fan effect” of associative priming:[50] The sprouting of new associations diminishes the strength of existing ones. As OCD patients show marked biases or restrictions in OCD-related semantic networks (e.g., cancer is only associated with “illness” or “death”, fire is only associated with “danger” or “destruction”),[51] they are encouraged to imagine neutral or positive associations to OCD-related cognitions (cancer = zodiac sign, animal, crab; fire = fireflies, fireworks, candlelight-dinner). First studies tentatively confirm the feasibility and effectiveness of the approach for a subgroup of patients.[52]

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5 Answers

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I've worked in the mental field and would definitely encourage him to give CBT/BT/ERP a try. I've seen it (alone or in combination with meds) do wonders for people who have had OCD for years. The frequency/length of treatment varies between patients and practitioners, but I'd say that the typical model is weekly 50-minute sessions. Sometimes therapists will intersperse regular sessions with longer exposure sessions, and they often taper sessions, so the client will come in less frequently as the end of treatment approaches. Booster sessions may be offered as needed (sometimes a person's symptoms can come back in a time of stress, and they just need a session or two to be reminded of the skills they learned before). CBT is a short-term treatment relative to, say, psychoanalysis, but the number of sessions will likely depend on a person's response to treatment. The CBT protocols tested in clinical trials are typically 10-15 sessions long. I see that you live in Boston. If that's where this person is, he'll have plenty of CBT practitioners to choose from. A decent place to start looking for a therapist is on the Association for Behavioral and Cognitive Therapies website (www.abct.org).

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The person with OCD is actually in Houston but great point - I recommended the ABCT website to this person. – Lady_Arwen Jun 22 at 19:21
The University of Houston has as Anxiety Disorder Clinic (uh.edu/anxiety/contact.htm) that offers CBT. I would guess that it's primarily staffed by doctoral students, which can make some people uncomfortable. If nothing else, though, it may be a good source for referrals in that area. – Chauncey Gardner Jun 22 at 21:32
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I think mental health diagnosis can often become self-fulfilling prophecies, and it's hard to get better because you identify yourself with the diagnosis; becoming a bad emotional cycle/rut. Honestly, the things that most help my OCDish tendencies are adding good carbs back into my diet, and regular acupunture treatments (biggest help by far). But like I said, I believe that paradigm shift in the way you view yourself and your issues is crucial to the treatment of any mental health issue. If you're looking for a good dicussion of this concept, I think Eckhart Tolle does a nice job of putting it into words in The Power of Now.

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Agreed, there are a few mental health practitioners in Seattle who have abandoned traditional talk therapy because it tends to just reinforce old hurts, and have moved in the direction of mindfulness meditation which leads to more spontaneous breakthroughs. I think Eckhart does a good job of creating a "how to" guide with "Power of Now" without the dogma that usually comes with meditation. I'd highly recommend it for someone with OCD because the symptoms are often a coping mechanism based on an avoidance of unpleasant feelings. If they can face the feeling without fear they can let go of it. – Happy Now Jun 23 at 19:14
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You might try EFT. I found it to be very effective. You can find it here: http://www.eftuniverse.com/

The manual is free and that manual is all that you need.

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 +100 Works for so many anxiety-related disorders. – Dragonfly Jun 23 at 2:36
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If this friend has OCD, then he (or she, you didn't specify) should have a look at this presentation by Dr. Mary Pickett. Don't let the title fool you; she does go into OCD in some detail later on in the talk, and even has a clinical case example.

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I've often seen B vitamin (particularly B-12) deficiencies as being implicated in OCD.

When I was vegetarian there were times when I would find myself trapped in repetitive thoughts or motions, sometimes for weeks at a time, it was maddening. Eating steak seems to have gotten rid of it.

If someone is eating a paleo diet now, but wasn't in the past there could still be malabsorption problems from damaged cilia in the small intestine, so even if they are eating organ meats they might not be able to get what they need from it. Before shelling out for therapy, I'd try a trial of B-12 shots, sublingual B-12, or sublingual B-complex to see if that has any impact.

Low carb could also exacerbate things depending on the part of the brain that is triggering the OCD. Dr. Daniel Amen talks about how different diets can help or exacerbate different mental health issues (warning he's a proponent of low fat diets, but I just ignore those bits, no reason to throw the baby out with the bathwater). He talked about people who have a tendency to over-focus, do so even more with a low carb diet, so some starchy tubers and bananas would be another thing to add to the diet and see if it helps.

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This person is very carb addicted and carb sensitive and was gorging on dried fruit, honey, and got hungry within 2 hours if just eating 2 bananas. Moderate and high carb caused horrendous physical symptoms and mood swings. This person is supplementing with B Comple as well as eating organ meats. – Lady_Arwen Jul 3 at 16:43
I think it is perfectly normal to get hungry every two hours when eating bananas, but yes it does sound from other symptoms that LC is the best bet here. I'm still worried about the B vitamins, just because they are being eaten doesn't mean the body is able to take them up if there is damage to the gut. Has this person ever had a brain MRI to really see what is going on under the hood? It might be helpful. – Happy Now Jul 3 at 22:19

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