OCD Alternatives

July 4, 2016 Written by JP    [Font too small?]

Obsessive-compulsive disorder (OCD) is a relatively common condition which involves cyclical and unreasonable thoughts. Those living with OCD often engage in rituals to calm their exaggerated or unfounded compulsions and fears. The severity of OCD varies among individuals. For some, it manifests in rather innocuous ways such as the avoidance of specific clothing, foods or locations. On the other end of the spectrum, certain people find that OCD can be quite debilitating. A prevalent example is an excessive desire for cleanliness and/or fear of germs. In the most severe cases, the entire course of one’s life can be dictated by an insatiable “need” to follow certain rules in order to create the impression of control and order.

A form of cognitive behavioral therapy known as exposure and response prevention (ERP) is the gold standard of conventional OCD care. It isn’t a quick fix, but it has been shown to offer significant benefits when compared to pharmacological interventions, including the use of antidepressant medications. In treatment-resistant cases of OCD deep brain stimulation may be employed. However, as you might imagine, an invasive procedure involving the brain carries a rather alarming list of potential side effects. But, worry not! Several alternative and complementary practices have demonstrated promise in reducing OCD symptoms. If you or someone you love is struggling with OCD, I encourage you to consider the following therapies in addition to the medical options listed above.

OCD Alternative #1: Yoga – A pilot study appearing in the June 2016 edition of the International Review of Psychiatry reports that as little as two weeks of yoga practice decreased symptom scores in a group of 17 OCD patients. Previous, longer-term trials, have also found positive outcomes in adults utilizing kundalini yoga. These interventions not only improved quality of life, but also decreased the need for antidepressants.

OCD Alternative #2: Mindfulness – The medical literature features several papers supporting the benefits of mindfulness training for OCD. Before and after evaluations using the Yale-Brown Obsessive-Compulsive Scale reveal that mindfulness is helpful in limiting “intrusive unwanted thoughts” by assisting “thought-action fusion and suppression”. In the scientific research, up to eight mindfulness classes were employed to instruct the volunteers. These days, mindfulness can easily be learned using apps and various online resources. A popular example is the app Head Space (link).

OCD Alternative #3: Aerobic Exercise – At least three peer-reviewed studies have revealed an important role for exercise as an adjuvant and/or primary therapy for OCD. The latest trial, published last year in the journal Cognitive Behavior Therapy, found that combining cognitive behavioral therapy (CBT) with exercise far exceeded the anticipated benefits of CBT alone. What’s more, anxiety and negative mood were minimized and the benefits were maintained over a six month follow up period.

If additional support is required, I think EMDR (eye movement desensitization and reprocessing) looks promising. I like this therapy because it generally isn’t a long, drawn out process. Typically, a few to several sessions is all that’s needed. More information about EMDR can be found here: (link). Another alternative, that is highly preliminary, but encouraging, is the use of a specific probiotic strain called Lactobacillus rhamnosus GG – commercially sold under the product name, Culturelle. A mouse study from 2014 determined that this healthy bacteria safely diminished OCD-like behavior as well as fluoxetine (Prozac).

The upside of all the candidates featured today is that they present numerous “side-benefits”, rather than side effects. Adding any or all of these options to your health care routine will likely result in upgraded cardiometabolic, digestive and immune function. Enhanced quality of life and sleep can reasonably be anticipated as well. All good things! Now, all you have to do is apply what you’ve learned. Go to it!

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 – A Systematic Review of the Clinical Effectiveness and Cost- (link)

Study 2 – Cognitive Effects of Deep Brain Stimulation in Patients with (link)

Study 3 – Designing & Validation of a Yoga-Based Intervention for obsessive (link)

Study 4 – Randomized Controlled Trial of Yogic Meditation Techniques (link)

Study 5 – Clinical Case Report: Efficacy of Yogic Techniques in the Treatment (link)

Study 6 – The Use of Mindfulness Practice in the Treatment of a Case (link)

Study 7 – Is Mindfulness-Based Therapy an Effective Intervention for (link)

Study 8 – The Effects of a Mindfulness Intervention on Obsessive-Compulsive (link)

Study 9 – The Use of Mindfulness in Obsessive Compulsive Disorder (link)

Study 10 – A Pilot Test of the Additive Benefits of Physical Exercise to CBT (link)

Study 11 – Acute Changes in Obsessions and Compulsions Following Moderate- (link)

Study 12 – A Pilot Study of Moderate-Intensity Aerobic Exercise for Obsessive (link)

Study 13 – Comparison of Eye Movement Desensitization and Reprocessing (link)

Study 14 – An Integrative Model for the Neural Mechanism of Eye Movement (link)

Study 15 – Desensitizing Addiction: Using Eye Movements to Reduce the (link)

Study 16 – Obsessive-Compulsive-Like Behaviors in House Mice Are (link)

Study 17 – Probiotics: An Update (link)

Study 18 – No Evidence of Harms of Probiotic Lactobacillus Rhamnosus GG (link)

Meditation and Yoga Positively Modulate Brain Activity

Source: Anc Sci. 2015 Apr;2(1):13-19. (link)

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Posted in Alternative Therapies, Exercise, Mental Health

7 Comments & Updates to “OCD Alternatives”

  1. JP Says:

    Updated 07/04/16:


    J Complement Integr Med. 2016 Jun 23.

    Effect of integrated Yoga and Physical therapy on audiovisual reaction time, anxiety and depression in patients with chronic multiple sclerosis: a pilot study.

    BACKGROUND: Multiple sclerosis (MS) is characterized by a significant deterioration in auditory and visual reaction times along with associated depression and anxiety. Yoga and Physical therapy (PT) interventions have been found to enhance recovery from these problems in various neuropsychiatric illnesses, but sufficient evidence is lacking in chronic MS population. The aim of this study was to assess the effect of integrated Yoga and Physical therapy (IYP) on audiovisual reaction times, depression and anxiety in patients suffering from chronic MS.

    METHODS: From a neuro-rehabilitation center in Germany, 11 patients (six females) suffering from MS for 19±7.4 years were recruited. Subjects were in the age range of 55.45±10.02 years and had Extended Disability Status Scores (EDSS) below 7. All the subjects received mind-body intervention of integrated Yoga and Physical therapy (IYP) for 3 weeks. The intervention was given in a residential setup. Patients followed a routine involving Yogic physical postures, pranayama, and meditations along with various Physical therapy (PT) techniques for 21 days, 5 days a week, 5 h/day. They were assessed before and after intervention for changes in audiovisual reaction times (using Brain Fit Model No. OT 400), anxiety, and depression [using Hospital Anxiety and Depression Scale (HADS)]. Data was analyzed using paired samples test.

    RESULTS: There was significant improvement in visual reaction time (p=0.01), depression (p=0.04), and anxiety (p=0.02) scores at the end of 3 weeks as compared to the baseline. Auditory reaction time showed reduction with borderline statistical significance (p=0.058).

    CONCLUSIONS: This pilot project suggests utility of IYP intervention for improving audiovisual reaction times and psychological health in chronic MS patients. In future, randomized controlled trials with larger sample size should be performed to confirm these findings.

    Be well!


  2. JP Says:

    Updated 07/04/16:


    Behav Res Ther. 2016 Feb;77:86-95.

    Internet-delivered acceptance-based behaviour therapy for generalized anxiety disorder: A randomized controlled trial.

    Generalized anxiety disorder (GAD) is a disabling condition which can be treated with cognitive behaviour therapy (CBT). The present study tested the effects of therapist-guided internet-delivered acceptance-based behaviour therapy on symptoms of GAD and quality of life. An audio CD with acceptance and mindfulness exercises and a separate workbook were also included in the treatment. Participants diagnosed with GAD (N = 103) were randomly allocated to immediate therapist-guided internet-delivered acceptance-based behaviour therapy or to a waiting-list control condition. A six month follow-up was also included. Results using hierarchical linear modelling showed moderate to large effects on symptoms of GAD (Cohen’s d = 0.70 to 0.98), moderate effects on depressive symptoms (Cohen’s d = 0.51 to 0.56), and no effect on quality of life. Follow-up data showed maintained effects. While there was a 20% dropout rate, sensitivity analyses showed that dropouts did not differ in their degree of change during treatment. To conclude, our study suggests that internet-delivered acceptance-based behaviour therapy can be effective in reducing the symptoms of GAD.

    Be well!


  3. JP Says:

    Updated 07/04/16:

    Cogn Emot. 2016 Apr 4:1-10.

    Acute aerobic exercise helps overcome emotion regulation deficits.

    Although colloquial wisdom and some studies suggest an association between regular aerobic exercise and emotional well-being, the nature of this link remains poorly understood. We hypothesised that aerobic exercise may change the way people respond to their emotions. Specifically, we tested whether individuals experiencing difficulties with emotion regulation would benefit from a previous session of exercise and show swifter recovery than their counterparts who did not exercise. Participants (N = 80) completed measures of emotion response tendencies, mood, and anxiety, and were randomly assigned to either stretch or jog for 30 minutes. All participants then underwent the same negative and positive mood inductions, and reported their emotional responses. Analyses showed that more perceived difficulty generating regulatory strategies and engaging in goal-directed behaviours after the negative mood induction predicted more intense and persistent negative affect in response to the stressor, as would be expected. Interactions revealed that aerobic exercise attenuated these effects. Moderate aerobic exercise may help attenuate negative emotions for participants initially experiencing regulatory difficulties. This study contributes to the literature on aerobic exercise’s therapeutic effects with experimental data, specifically in the realm of emotional processing.

    Be well!


  4. JP Says:

    Updated 09/02/16:


    Complement Ther Med. 2016 Aug;27:25-9.

    Evaluation of the efficacy of Withania somnifera (Ashwagandha) root extract in patients with obsessive-compulsive disorder: A randomized double-blind placebo-controlled trial.

    BACKGROUND: Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder that is causally linked to dysregulation of the serotonergic system. The aim of this study is to investigate the efficacy of Withania somnifera (W. somnifera) root extract as an adjunct therapy to standard OCD treatment.

    METHODS: Thirty patients with a confirmed diagnosis of OCD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria participated in this randomized double-blind placebo-controlled trial and were randomly assigned to the treatment group (W. somnifera extract, 120mg/day; n=15) or the placebo group (n=15). All patients were under treatment with Selective Serotonin Re-uptake Inhibitors (SSRIs), and were instructed to take 4 capsules of the extract or placebo per day, preferably after meals, for a period of six weeks. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used in order to assess the severity of OCD symptoms at baseline and at the end of the trial. Statistical analyses were performed using SPSS software and Y-BOCS values were presented as median and range (Min-Max).

    RESULTS: Comparison of the change in Y-BOCS score during the course of the trial revealed a significantly greater effect of W. somnifera (26 (14-40) [pre-treatment] versus 14 (4-40) [post-treatment]; change: -8 (-23 to 0)) versus placebo (18 (11-33) [pre-treatment] versus 16 (10-31) [post-treatment]; change: -2 (-4 to 0)) (P<0.001). The extract was safe and no adverse event was reported during the trial.

    CONCLUSION: W. somnifera extract may be beneficial as a safe and effective adjunct to SSRIs in the treatment of OCD.

    Be well!


  5. JP Says:

    Updated 07/01/17:


    Iran J Psychiatry. 2017 Apr;12(2):134-141.

    Efficacy of N-Acetylcysteine Augmentation on Obsessive Compulsive Disorder: A Multicenter Randomized Double Blind Placebo Controlled Clinical Trial.

    Objective: Glutamate is considered a target for treating obsessive-compulsive disorder (OCD). The efficacy and safety of the nutritional supplement of N-Acetylcysteine (NAC) as an adjuvant to serotonin reuptake inhibitor (SSRI) for treating children and adolescents with OCD has never been examined.

    Method: This was a 10-week randomized double-blind placebo-controlled clinical trial with 34 OCD outpatients. The patients received citalopram plus NAC or placebo. Yale-Brown Obsessive-Compulsive Scale (YBOCS) and Pediatric Quality of Life Inventory (PedsQL™) were used. Adverse effects were monitored.

    Results: YBOCS score was not different between the two groups at baseline, but the score was different between the two groups at the end of this trial (P<0.02). The YBOCS score of NAC group significantly decreased from 21.0(8.2) to 11.3(5.7) during this study. However, no statistically significant decrease of YBOCS was found in the placebo group. The Cohen's d effect size was 0.83. The mean change of score of resistance/control to obsessions in the NAC and placebo groups was 1.8(2.3) and 0.8(2.1), respectively (P = 0.2). However, the mean score of change for resistance/control to compulsion in the NAC and placebo groups was 2.3(1.8) and 0.9(2.3), respectively. Cohen's d effect size was 0.42. The score of three domains of quality of life significantly decreased in N-Acetylcysteine group during this trial. However, no statistically significant decrease was detected in the placebo group. No serious adverse effect was found in the two groups.

    Conclusion: This trial suggests that NAC adds to the effect of citalopram in improving resistance/control to compulsions in OCD children and adolescents. In addition, it is well tolerated.

    Be well!


  6. JP Says:

    Updated 08/19/17:


    Psychiatry Res. 2017 Aug;254:232-237.

    Vitamin B12, folic acid, homocysteine and vitamin D levels in children and adolescents with obsessive compulsive disorder.

    Obsessive compulsive disorder (OCD) is a complex disorder with a poorly understood aetiopathogenesis. One carbon metabolism that includes vitamin B12, folic acid and homocysteine has been investigated in many psychiatric disorders like OCD. In recent years, vitamin D has also been considered to contribute to many of these psychiatric disorders. In this study we investigated whether vitamin B12, homocysteine and vitamin D play a role in the aetiology of paediatric OCD. With this aim we compared 52 children and adolescent OCD patients with 30 healthy controls. The participants were tested for vitamin B12, folic acid, homocysteine and vitamin D levels and were evaluated with a sociodemographic form, state-trait anxiety inventory 1 and 2, Kovacs Depression Inventory and Yale-Brown Obsessive Compulsive Scale (Y-BOCS). As a result we found significantly lower levels of vitamin B12 and vitamin D and higher levels of homocysteine in the patient group compared to control group (p values for all three scores were <0.001), whereas there was no significant difference between groups in terms of folate levels (p=0.083). This demonstrates that one carbon metabolism and vitamin D deficiency can play a role in the aetiology of OCD.

    Be well!


  7. JP Says:

    Updated 03/13/19:


    J Psychiatr Pract. 2019 Mar;25(2):156-170.

    Mindfulness-based Cognitive Therapy for Obsessive-Compulsive Disorder: A Pilot Study.

    BACKGROUND: Cognitive-behavioral therapy (CBT) is the first-choice intervention for obsessive-compulsive disorder (OCD); however, a notable proportion of patients either do not respond to treatment or relapse after CBT. Mindfulness-based treatment has been suggested as an alternative or complementary therapeutic strategy for OCD. However, only a few studies have focused on its application in clinical samples.

    OBJECTIVE: To evaluate the impact of a new treatment, called “Mindfulness-based Cognitive Therapy for OCD.” It is an 11-session manualized group intervention that integrates elements of CBT, mindfulness, compassion-focused therapy, and acceptance and commitment therapy.

    METHODS: The program was delivered to 35 patients with a primary diagnosis of OCD.

    RESULTS: Participants demonstrated good adherence to the intervention. There was a significant reduction in mean total score on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS-TS) (P<0.001; Cohen d=-0.72). One third of the participants (n=13) showed at least a 25% reduction on the Y-BOCS-TS, and 40% of the sample (n=14) were assigned to a lower Y-BOCS severity category after treatment. Significant changes were also found in depression (P<0.001; d=-0.80), worry (P<0.001; d=-0.79), alexithymia (P<0.01; d=-0.41), dissociation (P<0.05; d=-0.46), and general psychopathology (P<0.001; d=-0.58). Repeated measures linear mixed models showed that OCD symptom reduction was associated with an increase in mindfulness skills, in particular on the acting with awareness (P=0.006), nonjudging (P=0.001), and nonreactivity (P=0.001) facets.

    CONCLUSIONS: Overall, these findings are promising and they suggest that randomized controlled studies be conducted to test the effectiveness of this new treatment program for this challenging and disabling mental disorder.

    Be well!


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