Understanding Obsessive-Compulsive Disorder: Debunking Common Misconceptions

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In this episode of “Roadmap to Joy,” Dr. Brad Riemann, who has a doctorate in clinical psychology and senior clinical adviser of Embark Behavioral Health, joins the podcast with Alex Stavros, CEO of Embark, to discuss obsessive-compulsive disorder (OCD) in teens and young adults and how parents can support their children. OCD is characterized by obsessions (unwanted thoughts, images, or urges) and compulsions (repetitive acts to neutralize obsessions). Common misconceptions include thinking that OCD is just an exaggeration of normal behavior and that excessive video game playing is a form of OCD. OCD is commonly misdiagnosed and often goes undiagnosed due to the fear of embarrassment and stigma. Family accommodation, where parents enable the disorder, can worsen OCD symptoms and reduce response to treatment. It is important for parents to have open and compassionate conversations with their loved ones if they suspect OCD. Seeking information from reputable sources like the International OCD Foundation can also be helpful. Telehealth has been found to be an effective treatment option for pediatric OCD, providing similar outcomes to in-person treatment.  

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The International OCD Foundation

Related Blogs:

Obsessive-Compulsive Disorder (OCD) in Kids, Adolescents, Teens, and Young Adults 

OCD and Autism: Similarities and Differences 

Related Videos:

Living with OCD | Embark Sessions 

What is Obsessive-Compulsive Disorder (OCD)? | Ask a Therapist 

Research Cited:  

Intensive Cognitive-Behavioral Therapy Telehealth for Pediatric Obsessive-Compulsive Disorder During the COVID-19 Pandemic: Comparison With a Matched Sample Treated in Person 

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Have a question for our experts? We want to hear from you! Submit your questions to: [email protected].

Guest and Host Bios:

Dr. Brad Riemann, Ph.D. is a Senior Consultant working with a variety of behavioral health companies and academic institutions to develop evidence-based treatment programming, measurement-based care systems, and standardized training protocols. He is collaborating with Embark Behavioral Health as consultant and clinical advisor. As the former President of Philanthropy, Research and Clinical Care at Rogers Behavioral Health, Dr. Riemann also served as Chief Clinical Officer and System Chief Operating Officer where he launched and developed the OCD and Anxiety Service Line with programming at the intensive outpatient, partial hospital, and residential levels of care. He has authored over 120 scientific, peer-reviewed articles on OCD and anxiety, and fifteen treatment manuals. Dr. Riemann has spoken both nationally and internationally on OCD and is a member of the Scientific and Clinical Advisory Board of the International OCD Foundation and the International OCD Accreditation Task Force. 

As the son of missionaries, Alex Stavros grew up in Peru working, playing and living alongside the troubled youth and desolate orphans of Lima’s slums. Alex’s childhood shaped his professional and personal aspirations. Prior to joining InnerChange Programs, Alex lived in California and was the Managing Partner of an investment fund, which he founded, focused on acquiring and leading mission-driven businesses. Prior to Lia Capital, Alex lived in Boston and was the Associate Director of Firm-Wide Operations – working directly for the President and COO – of Cambridge Associates, the world’s largest global investment advisory firm to not for profit organizations. Alex also has experience in public service having worked at the Overseas Private Investment Corporation, a U.S. government agency that mobilizes private capital to help solve critical, global social and poverty challenges. And he worked on the Capitol Hill in Washington DC for a Minnesota Congressman. Alex has also earned a Certificate of Public Management from Stanford University. And, while at Stanford, was a Rising Fellow at the Hoover Institution, a world-renowned public policy think tank. Alex loves the ocean and is a certified open water diver. He has served as a Board Fellow at one of the most enchanting Aquariums in the world, California’s Monterey Bay Aquarium. Alex spends his free time reading up on foreign affairs and international politics. Alex graduated with Honors from American University with both an Economic Theory and International Relations degree and he earned an MBA from Stanford’s Graduate School of Business. Alex is on the Board of Peruvian Partners, a nonprofit established to connect North Americans in a real and significant way with Peruvian families that live in abject poverty. Alex lives in Phoenix, Arizona and is happily married to his wife, Maria-Paz, who has the most important job in the world, raising their two beautiful children. 

About Embark Behavioral Health

Embark has been helping people overcome behavioral health issues that may be affecting their everyday lives for over 25 years.   

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The Embark team has some of the most compassionate and educated professionals in the industry. Its core purpose is to create joy and heal generations. Embark’s big hairy audacious goal is to lead the way in driving teen and young adult anxiety, depression, and suicide from the all-time highs of today to all-time lows by 2028. Exceptional treatment options, like short-term residential care, makes Embark the world’s most respected family behavioral health provider.   

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Transcript
Alex Stavros:

Welcome Dr. RAMAN to our podcast Roadmap to Joy.

Alex Stavros:

Thank you. I appreciate it. Alex, Dr. Brad Raman is Embark

Alex Stavros:

senior clinical advisor and as a member of our Clinical Advisory

Alex Stavros:

Council, he participates in clinical quality activities and

Alex Stavros:

makes recommendations to Embark on care, treatment and services.

Alex Stavros:

His extensive experience in mental health positions. Help

Alex Stavros:

them advise us on clinical curriculum practice guidelines,

Alex Stavros:

and specialty clinical programs such as obsessive compulsive

Alex Stavros:

disorders, Autism Spectrum Disorder, substance use disorder

Alex Stavros:

and eating disorders. Dr. Ramin really has an impressive resume.

Alex Stavros:

He has been specializing in OCD and OCD related disorders for

Alex Stavros:

over 35 years and is considered one of the foremost OCD experts

Alex Stavros:

and clinicians across the world. In fact, Dr. Freeman is widely

Alex Stavros:

regarded in the healthcare community for helping more

Alex Stavros:

people recover from OCD than any other clinician in America. One

Alex Stavros:

of the many areas we Embark have found alignment with Dr. Freeman

Alex Stavros:

is his significant contributions to measurement based care, and

Alex Stavros:

standardizations of care. He's a prolific researcher and serves

Alex Stavros:

as a member of the scientific advisory board of the

Alex Stavros:

International obsessive compulsive disorder Foundation,

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acting as expert consultant to the organization on research

Alex Stavros:

matters. And in fact, his research has been published in

Alex Stavros:

nearly 100 articles and professional journals, which is

Alex Stavros:

particularly impressive given.

Alex Stavros:

He is someone who is in the practice setting, not the

Alex Stavros:

research or academic setting. Suffice to say Embark is

Alex Stavros:

fortunate to have Dr. RAMAN as a clinical leader and partner.

Alex Stavros:

Welcome Dr. Raman.

Brad Riemann:

Thank you very much. I appreciate that Alex,

Brad Riemann:

and I'm, I'm so excited to partner with with Embark I mean,

Brad Riemann:

it's such a mission driven organization. And certainly,

Brad Riemann:

that's a real credit to you and your leadership team. So thank

Brad Riemann:

you. Thank you. Thank you, Dr. Raman. Well, you know, there's

Brad Riemann:

so much we could talk about, but what I would love to do is to

Brad Riemann:

focus this conversation on teens and young adults with OCD, and

Brad Riemann:

their family and parents that are looking for ways to support

Brad Riemann:

them. It's really a unique disorder, and very debilitating

Brad Riemann:

condition. There's also so many misunderstandings, as I'm sure

Brad Riemann:

you're gonna share with us, and it's very commonly misdiagnosed.

Alex Stavros:

And often parents will do things though well

Alex Stavros:

intended, that can enable the disorder as well. So it's great

Alex Stavros:

to be able to spend time with you to hopefully provide some

Alex Stavros:

content for parents to help their children who may be

Alex Stavros:

struggling with this issue. So maybe first off to lay the

Alex Stavros:

groundwork. How would you define OCD? At a more high level?

Brad Riemann:

Yeah. So OCD is characterized by obsessions and

Brad Riemann:

compulsions Alex and and obsessions are these unwanted

Brad Riemann:

thoughts, images or urges that generate high levels of anxiety.

Brad Riemann:

So some common examples might be the fear of becoming dirty or

Brad Riemann:

contaminated. By coming in contact with things in your

Brad Riemann:

normal daily environment or doubting whether you did

Brad Riemann:

something or did something correctly. Did I turn off the

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stove? do that math problem, right, Did I lock the door.

Brad Riemann:

compulsions, on the other hand, are some sort of repetitive act

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and, and typically, it is some sort of behavioral act that we

Brad Riemann:

can observe something that someone feels compelled to do to

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try to neutralize that unwanted obsessional fodder to get rid of

Brad Riemann:

the anxiety that it causes. So this might be something like in

Brad Riemann:

response to say, the fear of dirty becoming dirty and

Brad Riemann:

contaminated washing and cleaning over and over again.

Brad Riemann:

But compulsions can also be another thought. I mean, it can

Brad Riemann:

be something that we can't observe something that someone

Brad Riemann:

does silently in their own mind, again, in an attempt to prevent

Brad Riemann:

something bad from happening, or to get rid of that anxiety that

Brad Riemann:

is caused by that social thought. So it's important to

Brad Riemann:

think about it as really a two part problem obsessions and

Brad Riemann:

compulsions.

Alex Stavros:

That makes a lot of sense and providing a clarity

Alex Stavros:

on OCD isn't necessarily always something that's outward, and

Alex Stavros:

something that can be visible to others around you. And also,

Alex Stavros:

what I found interesting is a lot of examples you gave. I've

Alex Stavros:

dealt with myself and probably most people have dealt with

Alex Stavros:

themselves. The question is, you know, what are some of those

Alex Stavros:

common misconceptions with OCD and misdiagnosis where some

Alex Stavros:

people think they may have it or may think they don't have it is

Alex Stavros:

just because I have certain thoughts about something that

Alex Stavros:

may be stressing me out, doesn't necessarily mean that I have

Alex Stavros:

diagnoseable OCD. What have you seen in your work that are some

Alex Stavros:

of the most common misconceptions and what leads to

Alex Stavros:

misdiagnosis and how should people be thinking about it in

Alex Stavros:

terms of when are the those behaviors? Maybe something that

Alex Stavros:

more represents OCD than just typical thoughts and behaviors

Alex Stavros:

that people may have?

Brad Riemann:

Yeah, great questions. And, you know, there

Brad Riemann:

are some that really believe that OCD is a great, great

Brad Riemann:

exaggeration of the norm. You know, to your point, Alex,

Brad Riemann:

everyone has probably washed their hands from time to time

Brad Riemann:

when they just felt dirty. Everyone has gone back and and

Brad Riemann:

checked the door lock even though they were quite certain

Brad Riemann:

that they had closed that door and locked it. So some people

Brad Riemann:

again feel it's it's just a tremendous, but I do emphasize

Brad Riemann:

the word tremendous exaggeration of the norm. Point simply being

Brad Riemann:

as we go back to our 2.2 part definition obsessions and

Brad Riemann:

compulsions. The obsessional part Alec seems to be universal.

Brad Riemann:

I mean, everyone gets unwanted thoughts from time to time. And

Brad Riemann:

it just seems that again, this exaggeration of the norm where

Brad Riemann:

someone with OCD has so many of those thoughts, and does so many

Brad Riemann:

repetitive compulsions, whether it's checking, washing,

Brad Riemann:

counting, cleaning, whatever it might be, that it creates

Brad Riemann:

interference or disorder in their life. And then that's when

Brad Riemann:

someone like me says, Well, you have obsessive compulsive

Brad Riemann:

disorder. But again, to your point, everyone's you know,

Brad Riemann:

this, a lot of these symptoms kind of ring bells and say, you

Brad Riemann:

have done that from time to time. But you know, when your

Brad Riemann:

child or young adult starts to do, you know, starts to have

Brad Riemann:

these issues so much that it creates this interference in

Brad Riemann:

their life, you know, that's when it really is time to be

Brad Riemann:

thinking about getting an assessment and perhaps,

Brad Riemann:

treatment, but it is commonly misdiagnosed as you as you said,

Brad Riemann:

and the real error, I guess here is that just because someone

Brad Riemann:

does or thinks something over and over and over again, does

Brad Riemann:

not make it obsessive compulsive disorder. And, you know, like

Brad Riemann:

the media in lay people, you know, really kind of

Brad Riemann:

misunderstand that. And a perfect example, Alex is, you

Brad Riemann:

know, kind of excessive video game playing. You know, I've

Brad Riemann:

gotten phone calls from parents saying, oh, you know, Dr.

Brad Riemann:

Freeman, you're an expert in OCD. My son has OCD. I'm so

Brad Riemann:

sorry to hear that. What sort of symptoms he has, he cannot stop

Brad Riemann:

playing video games. And I'll say, Well, you know, I never say

Brad Riemann:

never, but chances are, that's actually not OCD. And they'll

Brad Riemann:

say, Well, I don't understand. He's thinking about them all the

Brad Riemann:

time. He can't stop playing them. It's the he can't go to

Brad Riemann:

school, it's interfering with the social life of the

Brad Riemann:

differences. Again, if we go back to the definition of an

Brad Riemann:

obsession, it's an unwanted thought, right? Whereas if you

Brad Riemann:

ask Johnny, do you like thinking about playing video games? He

Brad Riemann:

says, yep. And do you like playing video games? Yep. It's a

Brad Riemann:

problem. And it can be a serious problem. But in a way, it's

Brad Riemann:

almost kind of the opposite. And so the, again, the take home

Brad Riemann:

message is just because you think or do something over and

Brad Riemann:

over again, does that make it OCD? Great

Alex Stavros:

take home message and about on the flip side, in

Alex Stavros:

terms of kind of undiagnosed, OCD. So some people may think

Alex Stavros:

they have it, but it's not really there. How about those

Alex Stavros:

that are struggling and kind of day to day and may not be aware

Alex Stavros:

of how much it's getting in the way of their daily functioning

Alex Stavros:

work and relationships? And others may not be aware of it

Alex Stavros:

too, or perhaps are? How should we think about OCD? That's

Alex Stavros:

undiagnosed? Yeah.

Brad Riemann:

Great, great question again. You know, first

Brad Riemann:

and foremost, we got to keep in mind that people with OCD for

Brad Riemann:

the most part do have some level of insight into their symptoms.

Brad Riemann:

And as a result, they fear embarrassment. You know, they

Brad Riemann:

really are quite good at hiding their symptoms, even from their

Brad Riemann:

parents or their teachers or their spouse. You know, we've

Brad Riemann:

gone into the classroom and spoken to teachers, of course,

Brad Riemann:

after obtaining proper consent, and teach us a passion, we had

Brad Riemann:

no idea, you know, that Johnny had these problems, because,

Brad Riemann:

again, Johnny, he might be washing his hands like mad at

Brad Riemann:

home, but you know, he is not going to display the symptoms in

Brad Riemann:

front of his friends. And so he's kind of sweating bullets

Brad Riemann:

all day long at school. Because again, just this fear of

Brad Riemann:

embarrassment. So you have this tendency for people with OCD to

Brad Riemann:

not discuss this stuff, they tend to hide it, they tend to

Brad Riemann:

keep it to themselves. Most people who come into an OCD

Brad Riemann:

treatment program, for example, will say I've never met anyone

Brad Riemann:

else who had this problem. I've never been able to talk with

Brad Riemann:

someone else who has this problem. So there's this

Brad Riemann:

tremendous relief and kind of normalization, if you will, when

Brad Riemann:

patients do come in but so this is a problem that is common.

Brad Riemann:

It's also commonly misdiagnosed. And then there are many, many

Brad Riemann:

people who are suffering in silence because of again, this

Brad Riemann:

fear of embarrassment and not wanting to discuss This with

Brad Riemann:

friends, family, whatever, even to the point of not wanting to

Brad Riemann:

discuss it with their mental health care providers, so they

Brad Riemann:

might have engaged in mental health care. I've gotten calls,

Brad Riemann:

you know, Hey, doctor even Yeah, this is Dr. Smith, I have this

Brad Riemann:

patient who has OCD. I've been seeing them for three years.

Brad Riemann:

They just told me last night they have OCD. Well, what were

Brad Riemann:

you treating them for depression? So they were even

Brad Riemann:

afraid to admit this type of issue, even to their mental

Brad Riemann:

health care provider?

Alex Stavros:

And what kind of advice would you give? Or what

Alex Stavros:

would you suggest for those friends or family members? That,

Alex Stavros:

that think that somebody may be struggling with OCD, but they're

Alex Stavros:

not sure. Particularly it's, it's difficult, somewhat because

Alex Stavros:

of not only a stigma, but also fairly common in our society for

Alex Stavros:

somebody to say, Oh, I'm, I'm being a little OCD right now or

Alex Stavros:

stop being so OCD and we throw it around flippantly is, how can

Alex Stavros:

we have a more serious conversation with somebody and

Alex Stavros:

get over that stigma? To figure out if we should be trying to

Alex Stavros:

find more help for that family member for that child? Yeah,

Brad Riemann:

yeah. And to your point, I mean, it has become a

Brad Riemann:

little bit of a, you know, just a coined phrase that people kind

Brad Riemann:

of do throw out there. And, and it really, you know,

Brad Riemann:

unfortunately, woefully underestimates the pain and

Brad Riemann:

suffering that people with OCD go through. You know, at the top

Brad Riemann:

of this podcast, you had mentioned the, how disabling it

Brad Riemann:

can be, and the World Health Organization, or WHO has rated

Brad Riemann:

as it the 10th leading cause of disability in the world, Alex,

Brad Riemann:

and they're not just talking about behavioral health

Brad Riemann:

problems, they're actually talking about medical problems,

Brad Riemann:

such as anemia, and falls, all these things. OCD is in 10th,

Brad Riemann:

leading cause of disability so it's, it's very disabling, very

Brad Riemann:

impairing causes a lot of pain and suffering. And, you know,

Brad Riemann:

when, when a loved one starts to feel that maybe something's off,

Brad Riemann:

maybe they start to pick up on some of these symptoms, again,

Brad Riemann:

keeping in mind it's a two part problem obsessions and

Brad Riemann:

compulsions. If you start picking that up, you know, I

Brad Riemann:

think the best thing to do is to approach your loved one, have a

Brad Riemann:

conversation with them, you know, ask them if they're having

Brad Riemann:

issues. Hopefully, they would feel comfortable in confiding in

Brad Riemann:

their parent, or sibling or whatever it might be. The other

Brad Riemann:

thing that I would suggest, and you had mentioned the

Brad Riemann:

international OCD Foundation, their website is a tremendous

Brad Riemann:

wealth of psychoeducation material, I mean, that they they

Brad Riemann:

go into great length of what it is what it's not what to do, you

Brad Riemann:

know how to talk with a loved one? And, you know, certainly

Brad Riemann:

that's another thing that someone could do just even

Brad Riemann:

inform themselves a little bit, you know, hey, I don't know, is

Brad Riemann:

this OCD? Isn't it? Is it normal, you know, going there

Brad Riemann:

and reading up a little bit on some of the resources they have,

Brad Riemann:

can be very, very helpful. And then when talking with a family

Brad Riemann:

or friend, you know, perhaps even suggesting that they go on

Brad Riemann:

the internet, and there are other organizations as well.

Brad Riemann:

But, you know, the iocdf is really kind of that

Brad Riemann:

clearinghouse for information for patients and their families.

Brad Riemann:

Great.

Alex Stavros:

Appreciate that. We'll put a link to that those

Alex Stavros:

resources in the show notes. Can I ask you to maybe do a little

Alex Stavros:

bit of role playing? Sure. And you can assume either I'm your

Alex Stavros:

child or a friend. And you you observed pretty serious OCD

Alex Stavros:

behaviors, and you're not sure if I am. If I have been

Alex Stavros:

diagnosed, and maybe I am seeing somebody, but you feel like, I

Alex Stavros:

need to hear something from us, for us to be able to start to

Alex Stavros:

have a more serious conversation. Would you mind

Alex Stavros:

doing that as we think about parents, and, or a loved one or

Alex Stavros:

an older sibling? is they want to bring it up? They're not sure

Alex Stavros:

exactly what words? How do I bring it up? And how do I start

Alex Stavros:

that conversation? How would you do that? Maybe do that with me

Alex Stavros:

right now? Sure.

Brad Riemann:

Sure. Sure. Sure. Yeah, you know, and just to

Brad Riemann:

preface it, I mean, you know, there's really no right or wrong

Brad Riemann:

way of going about doing this, for the most part, I mean, you

Brad Riemann:

know, and if someone goes about this in a compassionate and

Brad Riemann:

empathetic way, you know, I think nothing but good things

Brad Riemann:

are gonna happen. No, maybe not immediately, but at some point,

Brad Riemann:

you know, that conversation is going to register with someone

Brad Riemann:

and they're going to realize that, you know, hey, you're,

Brad Riemann:

you're a trusted person who cares about me, but yeah, you

Brad Riemann:

know, I think that my suggestions more specifically,

Brad Riemann:

you know, you know, I would approach you Alex and just say,

Brad Riemann:

hey, look, you know, I was noticing that you were kind of

Brad Riemann:

getting stuck over there. And having trouble you know, with

Brad Riemann:

that door lock or, or I notice you you know, you were avoiding

Brad Riemann:

touch Everything's at the dinner table and then had to go and

Brad Riemann:

wash a couple of times during the meals. And, you know, and I

Brad Riemann:

don't know what's going on Alex, you know, I'm just doing this

Brad Riemann:

because I care about you. And it just seems like you were really

Brad Riemann:

struggling. So it's something up, you know, I mean, is there

Brad Riemann:

something going on? You know, I'm a person you can trust, I'm

Brad Riemann:

a person you can confide in, you know, I, assuming I'm a

Brad Riemann:

layperson, you know, I don't really know, you know, but I am

Brad Riemann:

aware of this condition known as obsessive compulsive disorder,

Brad Riemann:

and just a little bit I know of it, it seems like, maybe some of

Brad Riemann:

these things are relevant for you. But again, you know, please

Brad Riemann:

feel free to talk with me, whatever you say, I'll keep to

Brad Riemann:

myself, I won't share with your parents or, you know, unless you

Brad Riemann:

give me permission to do so. But, you know, I'm here for you.

Brad Riemann:

I can listen, I can try to help you in any way, shape, or form.

Brad Riemann:

I'm not trying to exaggerate what was going on. But it did

Brad Riemann:

seem like you were really struggling. And it just gave me

Brad Riemann:

a sense that this is kind of a something, you know, your

Brad Riemann:

parents had told me that you were kind of struggling with a

Brad Riemann:

few things. And, and you know, if nothing else, you maybe you

Brad Riemann:

could talk to some friends, your school counselor, but I'm always

Brad Riemann:

here for you, and we'll help you in any way that I can.

Alex Stavros:

Right, great, nice work, you know, I think it's

Alex Stavros:

part of it is, you know, like you mentioned is we can get in

Alex Stavros:

our own way, when we feel like we're trying to accomplish

Alex Stavros:

something like I'm trying to get you to do something or, versus

Alex Stavros:

just saying, I'm here to talk, I see you, I accept you, that

Alex Stavros:

allows that person to feel more comfortable. And it may be that

Alex Stavros:

they don't want to talk to you about it. But that experience of

Alex Stavros:

acceptance will allow them to talk to the person they did want

Alex Stavros:

to wasn't able to tell them those words, but they feel like

Alex Stavros:

I really want to tell this person. And because you helped

Alex Stavros:

me feel accepted in the situation. Now I feel

Alex Stavros:

comfortable telling them. And so I think it's a great way to

Alex Stavros:

engage with a friend or even even a child in that way as is.

Alex Stavros:

It's maybe maybe it's one of many conversations, maybe it's

Alex Stavros:

one and nothing comes up for a couple of weeks. And then they

Alex Stavros:

say, Hey, Dad, you were you brought that up? And you saw me

Alex Stavros:

during this break that I was doing this thing? Can we talk a

Alex Stavros:

little bit more about that? And exactly,

Brad Riemann:

yeah, and you don't need to be a trained

Brad Riemann:

mental health care provider to you know, to reach out and to

Brad Riemann:

show somebody compassion and empathy, right. And, you know,

Brad Riemann:

to your point to it may not have that immediate impact. They

Brad Riemann:

might get defensive, they might, you know, it might stress them

Brad Riemann:

out. But they're going to remember that you cared about,

Brad Riemann:

right. And in, like you said, a week later, two weeks later, a

Brad Riemann:

month later, you know, they they may let their guard down and

Brad Riemann:

have a conversation with you.

Alex Stavros:

So tell me a little bit about the

Alex Stavros:

environment, and maybe parenting, how much does the

Alex Stavros:

environment in parenting play, first of all, into the

Alex Stavros:

development of OCD in the first place? or to what extent are we

Alex Stavros:

born with it? And to what extent does that environment or

Alex Stavros:

parenting, make it better or make it worse?

Brad Riemann:

Yeah. Yeah. I mean, so Alex, I mean, we're all

Brad Riemann:

products of our past, right. And so, you know, parents have a

Brad Riemann:

tremendous impact on who we are and who we're not, and so forth.

Brad Riemann:

But OCD. First and foremost, we don't know what causes OCD,

Brad Riemann:

we're just really learning more and more about it each year. The

Brad Riemann:

evidence that comes out of research every year is pointing

Brad Riemann:

more and more to a neurobiological abnormality that

Brad Riemann:

appears to be at least in part genetically influenced. So when

Brad Riemann:

you're talking about parents, and you're talking about

Brad Riemann:

genetics, you know, obviously what that means is that at least

Brad Riemann:

in part, you know, this was passed on OCD tends to run in

Brad Riemann:

families, right? It does not appear, though, to be really

Brad Riemann:

kind of parenting in and of itself. And so for example, when

Brad Riemann:

you look at adoption studies, and so say you have someone who

Brad Riemann:

is adopted, who there's positive biological family history of

Brad Riemann:

OCD, and they're adopted into a family that is OCD, free, they

Brad Riemann:

are more likely to have OCD because of that biological

Brad Riemann:

influence. Vice versa is also true if your biological parents

Brad Riemann:

were OCD free and you're adopted into a family that is positive

Brad Riemann:

for OCD. You're not going to develop OCD, you can't really

Brad Riemann:

make someone OCD, so it does seem to be neuro biologically

Brad Riemann:

abnormality that's influenced at least in part genetically. But

Brad Riemann:

again, we are all products of our our past and influenced in

Brad Riemann:

the environments that we are brought up in but you know, the

Brad Riemann:

the biggest thing that seems to be involved with the parents.

Brad Riemann:

And you had mentioned this in some of your opening remarks is

Brad Riemann:

this concept of what we call family accommodation. And it you

Brad Riemann:

are absolutely right, it is always very, very well intended

Brad Riemann:

to begin with. None of us like to see our children or our loved

Brad Riemann:

ones in distress. OCD causes lots of distress. And so parents

Brad Riemann:

try to kind of run to the rescue of their children. So they start

Brad Riemann:

opening doors for their kids so that they don't have to touch a

Brad Riemann:

door handle that appears to be contaminated. They start trying

Brad Riemann:

to help them in other ways. And initially, it does allow Johnny

Brad Riemann:

to kind of sidestep their OCD and get on with whatever it is

Brad Riemann:

that they're trying to do get to their little league game on time

Brad Riemann:

type of thing. But what it ultimately does, those kind of

Brad Riemann:

fanned the flame of OCD, and it actually literally makes the

Brad Riemann:

severity of the OCD worse, and reduces the response to

Brad Riemann:

treatment, unless addressed. And so that is one way that

Brad Riemann:

unfortunately, families can kind of make the situation more

Brad Riemann:

difficult. But again, it's it's natural. I'm not saying I

Brad Riemann:

wouldn't do it myself, right, or you. We care about our kids. We

Brad Riemann:

love our kids. We don't want to see him in distress. But it has

Brad Riemann:

this kind of paradoxical effect, it has this kind of opposite

Brad Riemann:

negative impact on the OCD in the long run. So it has to be

Brad Riemann:

addressed in treatment.

Alex Stavros:

Yeah, that I think that's a great point of just,

Alex Stavros:

you know, well intended. And it's even when you have a child,

Alex Stavros:

for example, that struggles in in social situations, you you

Alex Stavros:

almost want to go and talk to them or pull them aside because

Alex Stavros:

you don't like to see them feel uncomfortable. Yeah. And so what

Alex Stavros:

would you say, if, as a family member, as a parent, if, in that

Alex Stavros:

case where we got to get to the baseball game, or we got to get

Alex Stavros:

to school on time, we're going to be late again, instead of

Alex Stavros:

accommodating, which they do instead?

Brad Riemann:

Yeah, great question. And, and it's not an

Brad Riemann:

easily answered one. I'll just say that right from the get go.

Brad Riemann:

But, you know, in the context of treatment, right. And so we've

Brad Riemann:

been talking about, you know, OCD being a two part problem

Brad Riemann:

obsessions, and compulsions. And in the treatment of choice, so

Brad Riemann:

the gold standard of treatment is something called exposure and

Brad Riemann:

response prevention. So it's a two part problem with a two part

Brad Riemann:

solution. So the exposure is geared toward the obsessions,

Brad Riemann:

the response prevention, as some people refer to it as ritual

Brad Riemann:

prevention, is targeting the compulsion. So again, two part

Brad Riemann:

prompt two part solution, if a if a family is engaged in that

Brad Riemann:

type of treatment, then their clinician, their provider, will

Brad Riemann:

be instructing them in kind of a series of steps to address and

Brad Riemann:

reduce accommodation. It's tricky, Alex, if you try to do

Brad Riemann:

this without being in that context of treatment, and let me

Brad Riemann:

tell you why, you know if that child is because is going to

Brad Riemann:

become quite dependent on that accommodation. And if parents

Brad Riemann:

were to just say, okay, look, you know, I listen to this

Brad Riemann:

podcast, it's Reman guy said accommodations bad starting to

Brad Riemann:

come out, we're just not doing it anymore, right? That's not

Brad Riemann:

gonna go so well. I mean, it could cause World War Three in

Brad Riemann:

the house, it could cause a tremendous rush of distress for

Brad Riemann:

that young one, because, again, they've become dependent on it.

Brad Riemann:

So it's something that, you know, I think families need to

Brad Riemann:

note has to be addressed, I would encourage them to reach

Brad Riemann:

out to a provider to try to get some assistance on kind of the

Brad Riemann:

step wise approach to reducing and ultimately eliminating that,

Brad Riemann:

but just pulling the rug out from under on probably is not

Brad Riemann:

gonna go so well.

Alex Stavros:

Yeah, great advice. How earlier you had

Alex Stavros:

mentioned about that colleague of yours that had been treating

Alex Stavros:

that client for three years and found out that they had OCD, how

Alex Stavros:

common are co occurring disorders, like depression with

Alex Stavros:

those OCD? And how should a parent think about treating

Alex Stavros:

these co occurring issues? is, should one be more important

Alex Stavros:

than the other should both be handled the same time? Should I

Alex Stavros:

be going to find an OCD expert, or should I find it depression?

Alex Stavros:

Expert? Sometimes they're the same. A lot of times, they're

Alex Stavros:

not or maybe there's other anxiety issues, or there could

Alex Stavros:

be substance use issues or eating disorder. Eating issues

Alex Stavros:

is how often do you find co occurring disorders and how

Alex Stavros:

should parents think about seeking help for their child?

Alex Stavros:

Yeah,

Brad Riemann:

great, great quote. And so comorbidity is the

Brad Riemann:

rule when it comes to OCD. But keep in mind, you know,

Brad Riemann:

behavioral health issues, do kind of cluster. So I mean, it's

Brad Riemann:

it's not just an OCD issue, it's pretty common for someone who

Brad Riemann:

has, you know, issues in one area of their life to

Brad Riemann:

potentially have it in another but pertaining to OCD,

Brad Riemann:

comorbidity is the rule meaning. Most studies find that children

Brad Riemann:

with OCD have about 60% of kids with OCD will have at least one

Brad Riemann:

additional diagnosis, the really common comorbidities in kids,

Brad Riemann:

ADHD, tic disorders, depression, as you mentioned, other anxiety

Brad Riemann:

disorders. So it is pretty common. And, you know, some of

Brad Riemann:

these things like the depression, Alec seems to be

Brad Riemann:

kind of secondary to OCD. In other words, as you learn more

Brad Riemann:

about OCD, it's not really a question as to why is somebody

Brad Riemann:

sad and feeling hopeless and helpless, it's a bad thing to

Brad Riemann:

have, right. And so I think quite naturally, it starts to

Brad Riemann:

pull people's mood down. So depression, for example, is

Brad Riemann:

commonly secondary to the OCD. And what I mean by that is, if

Brad Riemann:

you get into good treatment, if you are in treatment for OCD is

Brad Riemann:

really kind of you want high quality exposure and response

Brad Riemann:

prevention, but you also need the right dose of it. And I'll

Brad Riemann:

get back to that in a moment. But if you're getting high

Brad Riemann:

quality treatment for their OCD, and their OCD symptoms go down,

Brad Riemann:

the depression tends to go along with it more often than not, I

Brad Riemann:

mean, they're depressed because they're anxious, right. And so

Brad Riemann:

the good news is there as you you know, you can kind of get a

Brad Riemann:

little too for one, but some of these other things that you

Brad Riemann:

brought up are freestanding problems. And at times, there

Brad Riemann:

may be some treatment overlap, a clinician treating your OCD

Brad Riemann:

could maybe just pivot the treatment plan slightly to be

Brad Riemann:

able to address some of these other conditions. And then some

Brad Riemann:

of them may need some expertise that your OCD provider might not

Brad Riemann:

have. And so then there there may need to be, you know, a

Brad Riemann:

referral elsewhere. And the the order of that treatment also

Brad Riemann:

depends, I mean, again, if it's a primary OCD, that really means

Brad Riemann:

that it is the number one problem causing interference in

Brad Riemann:

your child's life, then that should be the priority. And

Brad Riemann:

these other things can, can can wait. Now, it also depends get

Brad Riemann:

back to the dose from for a moment, and we talk about dose

Brad Riemann:

of treatment all the time when we think about medication, you

Brad Riemann:

know, 20 milligrams of this versus 40 milligrams of this

Brad Riemann:

dose rarely comes up Alex when we're talking about psychosocial

Brad Riemann:

treatments, but there is truly a dosage effect for many

Brad Riemann:

behavioral health and addiction problems with OCD for sure. And

Brad Riemann:

what I mean by that is, you know, the, the more complex, the

Brad Riemann:

more complicated the OCD, and that is within OCD, also with

Brad Riemann:

comorbidity, right, I mean, you know, do they have other things

Brad Riemann:

going on, which we said is already the rule. It's how much

Brad Riemann:

good ERP how much high quality treatment do you need to get

Brad Riemann:

better, and there is this dosage effect. And many people because

Brad Riemann:

of that level of disability, remember, it's a 10th leading

Brad Riemann:

cause of disability, the world may need more than high quality

Brad Riemann:

one or two hours a week. So they may need intensive outpatient,

Brad Riemann:

which might be two, three hours a day, three to five times a

Brad Riemann:

week, they may need a day treatment program, they may need

Brad Riemann:

residential care, and that 24 hour support. Now, thankfully,

Brad Riemann:

you know, that is a small minority of these patients. But

Brad Riemann:

it is enough that obviously there are specialty OCD

Brad Riemann:

residential programs that in that case, they have they have

Brad Riemann:

enough time with this youngster to not only address the severe

Brad Riemann:

OCD, but these other comorbid problems as well. Yeah.

Alex Stavros:

So we had a you mentioned ERP, we have a as you

Alex Stavros:

know, Southern California outpatient clinic that offer OCD

Alex Stavros:

programs for teenagers in an IOP using ERP, which as you

Alex Stavros:

mentioned is the gold standard. And we also offer a virtual IOP

Alex Stavros:

OCD program also using ERP as as the gold standard. We once had a

Alex Stavros:

child who lived nearby one of our brick and mortar outpatient

Alex Stavros:

clinics and had enrolled in the OCD program, but can never get

Alex Stavros:

there. They just weren't able to leave the house. And so there's

Alex Stavros:

part of it in terms of there was this initial step and it didn't

Alex Stavros:

mean that that first step we couldn't even accomplish. So

Alex Stavros:

fortunately, we were able to enroll in the virtual program as

Alex Stavros:

a first step with the main goal of helping this young boy teen

Alex Stavros:

boy be able to leave the home first of all, to be able to

Alex Stavros:

transition to be to his near his Tom and accessible to be there

Alex Stavros:

in person and continue that treatment. You know, we we know

Alex Stavros:

that you recently co authored an article on the benefits of

Alex Stavros:

telehealth for pediatric OCD, I would love if you could share a

Alex Stavros:

little bit what you found in that study?

Brad Riemann:

Yeah, yeah, no, that's, that's, it's

Brad Riemann:

interesting. And you brought up a perfect example. I mean,

Brad Riemann:

sometimes, you know, whether it's a child or an adult, I

Brad Riemann:

mean, they're debilitated enough by this condition and their

Brad Riemann:

anxiety, that they're really not able to access care outside of

Brad Riemann:

their home. You know, COVID, obviously changed everything.

Brad Riemann:

And all of the programs that I had been associated with over

Brad Riemann:

the years, were always in person treatment. But we had to pivot

Brad Riemann:

very, very quickly, right. And within seven days, we

Brad Riemann:

transitioned, you know, literally over 1000, patients

Brad Riemann:

that were receiving intensive treatment in IOP, AND PHP, to

Brad Riemann:

telehealth because of the, you know, the pandemic, obviously.

Brad Riemann:

And we began to collect data immediately, because we wanted

Brad Riemann:

to make sure that this treatment was still effective. This study

Brad Riemann:

that you mentioned, that we published, really supports that.

Brad Riemann:

So to make a long story short. Now, again, this is primary OCD.

Brad Riemann:

In kids, and they're receiving three hours a day of treatment,

Brad Riemann:

a day or six hours a day of treatment in the day treatment,

Brad Riemann:

or partial hospital programs, the outcomes were basically

Brad Riemann:

identical. This treatment, when done in a high quality

Brad Riemann:

structured kind of protocolized or manualized, fashion, produced

Brad Riemann:

equal outcomes in these in these patients. The only difference is

Brad Riemann:

we needed two days longer for the telehealth IOP to get the

Brad Riemann:

same benefit, which was kind of an interesting little thing.

Brad Riemann:

It's not insignificant. I mean, especially if you're a payer, I

Brad Riemann:

mean, two extra days that there's a cost to that. But the

Brad Riemann:

bottom line is, is these kids got better equally telehealth or

Brad Riemann:

in person. Now, what I think will be fascinating, Alex, any

Brad Riemann:

kind of follow ups to those things? Is we also however, were

Brad Riemann:

aware that there were probably, you know, some young individuals

Brad Riemann:

who did not do as well, telehealth I mean, at the

Brad Riemann:

individual level, not at the group level with hundreds and

Brad Riemann:

hundreds and hundreds of patients. And there were

Brad Riemann:

probably people who didn't respond to telehealth, who would

Brad Riemann:

have responded to in person. And I think the the interesting

Brad Riemann:

thing would be to kind of find out what predictors, you know,

Brad Riemann:

would we be able to what kind of data could we collect from an

Brad Riemann:

individual who is considering treatment, and say, you know,

Brad Riemann:

what, Alex, based on your responses to this, you have a

Brad Riemann:

choice, you could do telehealth or in person, or based on your

Brad Riemann:

responses here, you know, you really need to do in person. And

Brad Riemann:

that ability to predict would be incredibly powerful. You brought

Brad Riemann:

up a perfect example of someone who could get geographic access

Brad Riemann:

to this clinic, but was too anxious. And the goal in

Brad Riemann:

treatment was to lower that to get him to come up with some, as

Brad Riemann:

you know, no matter how many clinics you have, say,

Brad Riemann:

California that you brought up, it's an enormous state. And you

Brad Riemann:

could still be four or five, six hours away from your nearest

Brad Riemann:

specialty clinic. And as a result, being able to plug in

Brad Riemann:

telehealth would be a huge advantage.

Alex Stavros:

Yeah, yeah. It's really a great, great study and

Alex Stavros:

great conclusion, given the issues of accessibility and

Alex Stavros:

realizing that the vast majority of teens who are struggling with

Alex Stavros:

OCD, vast majority do not have geographic access to high

Alex Stavros:

quality. That's right. IOP for specialized in OCD, or PHP using

Alex Stavros:

the gold standard of ERP, it's the vast majority don't have

Alex Stavros:

that. So knowing that there are these telehealth options, that

Alex Stavros:

when done right, can provide similar outcomes.

Brad Riemann:

Yeah, yeah. And to your point, I mean, even though

Brad Riemann:

it's such a common problem, and it's such a treatable problem,

Brad Riemann:

the vast majority of sufferers do not have that geographic

Brad Riemann:

access. In obviously, you were mentioning the programs that

Brad Riemann:

Embark is opening up that's welcomed, right, I mean, in

Brad Riemann:

other words, the the demand exceeds the ability to provide

Brad Riemann:

and these new programs are going to open up access to a lot of

Brad Riemann:

young people who need care.

Alex Stavros:

You mentioned how treatable disorder is can you

Alex Stavros:

share a little bit more that can provide some hope for if there's

Alex Stavros:

a teenager young adult watching this podcast or for a parent?

Alex Stavros:

What are some of those statistics or some of your

Alex Stavros:

experience around when when treatment is done? Well

Alex Stavros:

standardized and with protocols and, and using ERP with

Alex Stavros:

experienced clinicians? How treatable is it? Yeah,

Brad Riemann:

In my opinion, Aleks, honestly, it's the most

Brad Riemann:

treatable psychiatric problem we have, when treated properly and

Brad Riemann:

properly being again defined as the right kind of treatment

Brad Riemann:

delivered in a high quality care, and then the right

Brad Riemann:

quantity that we're talking about that dosage effect, right.

Brad Riemann:

And so plugging somebody into the appropriate level of care,

Brad Riemann:

the majority of people with OCD can benefit from high quality

Brad Riemann:

ERP just one or two hours a week. But then there's a subset

Brad Riemann:

of patients who just have to have more than that, I mean,

Brad Riemann:

it's just the dose isn't high enough. And so then this is

Brad Riemann:

where the IOP has come into play. In some cases, even those

Brad Riemann:

partial hospital programs or PHPs, provide six hours and then

Brad Riemann:

of course, residential for thankfully, the minority of

Brad Riemann:

patients. But again, it is a fairly large number because of

Brad Riemann:

how common the problem is, but it's very, very treatable. Just

Brad Riemann:

some examples. You know, the the overall kind of success rates

Brad Riemann:

that one will read about in the field 80 to 85% of people who

Brad Riemann:

will engage in this treatment, respond to care and get

Brad Riemann:

significantly clinically meaningfully better. In my

Brad Riemann:

world, you know, 90% of our IOP patients responded, 81% of our

Brad Riemann:

residential patients responded. And that's interesting, because

Brad Riemann:

these residential patients were considered treatment refractory,

Brad Riemann:

you know, they were considered patients who were were not able

Brad Riemann:

to get better from treatment. And it's all about the dose

Brad Riemann:

piece, right, they just didn't have enough dose of it. And once

Brad Riemann:

given that proper dosage, they got better. The reality of

Brad Riemann:

though is this, you get out of it, what you put in it, and this

Brad Riemann:

is not a treatment, Alex that one can benefit from, passively.

Brad Riemann:

This is not something that one can absorb, but it is one that

Brad Riemann:

you have to be an active participant in. And as a result,

Brad Riemann:

you know, when you hear things like 85%, or 90%, or whatever it

Brad Riemann:

might be, you know, there are patients who do put in effort

Brad Riemann:

who don't respond, nothing's perfect. But the vast majority

Brad Riemann:

of patients who don't respond are unfortunately, either

Brad Riemann:

unwilling or unable to really do the work that they need to do it

Brad Riemann:

is against something where, you know, it is an active engagement

Brad Riemann:

in this treatment. But if people do that, they get better.

Alex Stavros:

You mentioned about the doses and and levels

Alex Stavros:

of care. Something that's so important to be able to provide

Alex Stavros:

that as simply having a continuum of care were starting

Alex Stavros:

at that lower level of care. And maybe that one or two hours a

Alex Stavros:

week is able to address the issue. But if it's not, we want

Alex Stavros:

to move to that three hours a day, three times a week. And if

Alex Stavros:

that doesn't work three hours a day, five times a week, then

Alex Stavros:

five, six hours a day, and RTC being able to step up. And

Alex Stavros:

that's good, just good health care, good health care system

Alex Stavros:

where we intervene at the lowest level of care, possible, least

Alex Stavros:

invasive, try to get that to work. But if it doesn't, we can

Alex Stavros:

quickly step up so we can nip nip it in the bud and then step

Alex Stavros:

them back down, it's less expensive, less invasive, that

Alex Stavros:

continuum of care is really important for delivering good

Alex Stavros:

outcomes.

Brad Riemann:

And as you point out, both up and down. In other

Brad Riemann:

words, you know, if somebody is in a residential program, you

Brad Riemann:

know, as you know, Alex, the goal is not to get them symptom

Brad Riemann:

free. It the goal is to get them to the point where they're, you

Brad Riemann:

know, responding to care that they don't need 24 hour support

Brad Riemann:

anymore. And then if they go right back into outpatient, if

Brad Riemann:

they go from that to one hours a week, that's kind of a big thud,

Brad Riemann:

if you will, and, and and to your point in, in medicine, in

Brad Riemann:

a, you know, general medical surgical world, you know,

Brad Riemann:

there's these step downs. And that's exactly what we have to

Brad Riemann:

build in our world. And, and so it's, it's being able to ratchet

Brad Riemann:

it up if they need more dose, but then it's that stepping down

Brad Riemann:

as well. And in the key here, to your point, Alex, is that even

Brad Riemann:

if someone has tried what they believe is truly high quality

Brad Riemann:

ERP, you don't want to throw the ERP baby out with the bathwater,

Brad Riemann:

so to speak. You don't want to sit back and say, Well, we tried

Brad Riemann:

that and it didn't work. It could be again, that the dose of

Brad Riemann:

the treatment you're receiving did not match the severity and

Brad Riemann:

the complexity of what you needed.

Alex Stavros:

Yeah, yeah. And I love that you brought up the

Alex Stavros:

kind of general health care as you don't see people going to

Alex Stavros:

get knee surgery and then being sent home without a brace or any

Alex Stavros:

physical therapy wouldn't go very well and they have follow

Alex Stavros:

ups with their doctor but often that happens in our mental

Alex Stavros:

health care system for you. There's they'll end up in a

Alex Stavros:

hospital or even a residential treatment center and then

Alex Stavros:

afterwards discharged, and haven't seen improvements and go

Alex Stavros:

straight home. It's as if you had knee surgery, and you go

Alex Stavros:

straight home with no physical therapy. That doesn't mean the

Alex Stavros:

knee surgery. What wasn't effective, as long as you didn't

Alex Stavros:

do the proper continuing, continuing care needed,

Alex Stavros:

developing more of that. If I'm a parent, and I'm looking for a

Alex Stavros:

therapist, because it may be the one to two hours, or maybe you

Alex Stavros:

have been doing the one or two hours, but it's not working. And

Alex Stavros:

so I want a higher dose. So I'm looking for an IOP, or the PHP,

Alex Stavros:

partial hospitalization program, therapeutic day treatment

Alex Stavros:

program, or even RTS C. Now I'm a parent, what should I be

Alex Stavros:

looking for? What should I be Googling, what type of

Alex Stavros:

treatments exist? What type of programs are there out there?

Alex Stavros:

And how can you guide me a little bit into making sure that

Alex Stavros:

it is high quality and that I know that we likely are going to

Alex Stavros:

get the right dosage, the right interventions and treatments

Alex Stavros:

that are the most effective?

Brad Riemann:

Yeah, those are great questions. I mean, in

Brad Riemann:

again, in the OCD realm, you know, the thing that you are

Brad Riemann:

looking for is exposure and Response Prevention, or again,

Brad Riemann:

sometimes referred to as exposure and ritual prevention.

Brad Riemann:

It's the same treatment, ERP, nonetheless, that is the key

Brad Riemann:

ingredient you're looking for. You don't want to just find

Brad Riemann:

someone who says they treat OCD. You don't want to find someone

Brad Riemann:

who says they use evidence based treatment, evidence based

Brad Riemann:

treatment, Alex's. That is this idea that research has found

Brad Riemann:

this treatment to work for this condition. But when we think

Brad Riemann:

about evidence based treatment, we also have to make sure Yeah,

Brad Riemann:

but that clinician can apply that evidence based treatment to

Brad Riemann:

patients just as well as that study did, right. So you know, I

Brad Riemann:

can, I can say I do these things. But that doesn't mean I

Brad Riemann:

really know what to do. And so you got to do your homework,

Brad Riemann:

most people spend more time picking out the person who's

Brad Riemann:

going to tile their bathroom than they do their mental health

Brad Riemann:

care provider, unfortunately, you know, right, Alex, and so

Brad Riemann:

you got to do your homework, you have to do your due diligence,

Brad Riemann:

and you want to make sure that they do this. You want to ask

Brad Riemann:

them, how many patients with OCD have you treated? How many have

Brad Riemann:

you treated successfully? You know, if they're starting to use

Brad Riemann:

some of the jargon, ERP, obviously, or exposure work or

Brad Riemann:

exposure hierarchies, and that's just the big master list of all

Brad Riemann:

of the exposures that that this young person with OCD is going

Brad Riemann:

to have to do that starting to ring some bells. But you know,

Brad Riemann:

ask questions, I mean, be informed. This is important.

Brad Riemann:

And, sadly, there are not that many people who specialize in

Brad Riemann:

this, we did mention the international OCD foundation

Brad Riemann:

before they do have a tab, find a therapist, I'm assuming

Brad Riemann:

parents could reach out to Embark in Embark would also

Brad Riemann:

steer people in the right direction. I mean, obviously,

Brad Riemann:

you might have a program that could help them in the vicinity

Brad Riemann:

that they live, or you could direct them elsewhere. But it

Brad Riemann:

takes a very specific kind of intervention to be effective.

Brad Riemann:

And in the end the dose to your point.

Alex Stavros:

Speaking of dose, can you discuss a little bit the

Alex Stavros:

role of medication and treat OCD? What? What are the

Alex Stavros:

considerations? And What should parents know about medication?

Alex Stavros:

OCD? Yeah,

Brad Riemann:

so So there are medicines that have been found

Brad Riemann:

to be helpful Alex and treating OCD. These medicines all come

Brad Riemann:

from a subset of antidepressants that affect a brain chemical

Brad Riemann:

called serotonin. The good news we mentioned before that, you

Brad Riemann:

know, like, for example, depression is a common comorbid

Brad Riemann:

condition. So if you have a youngster with OCD, who is also

Brad Riemann:

depressed, these medicines kind of give you a little bit of a

Brad Riemann:

double whammy or a two for one, you know, you're kind of helping

Brad Riemann:

nudge that depression along as well as the OCD. These medicines

Brad Riemann:

provide somewhere between 25 and 30% symptom reduction in the

Brad Riemann:

average patient. Some people get much more production than that

Brad Riemann:

some people unfortunately, get none. But on average, you can

Brad Riemann:

expect about a 25 to 30% symptom reduction, which could be the

Brad Riemann:

difference between being able to go to school or not, or being

Brad Riemann:

able to go to work or not, or being able to engage in social

Brad Riemann:

relationships or not. The medicines are rarely enough in

Brad Riemann:

and of themselves. In ERP is really again, considered the

Brad Riemann:

gold standard. So there was an expert consensus study done many

Brad Riemann:

years ago that I participated in and the consensus of the expert

Brad Riemann:

OCD community was that everyone with OCD should get exposure and

Brad Riemann:

response prevention, some should get exposure and Response

Brad Riemann:

Prevention Plus medication. Great.

Alex Stavros:

Thank you. As you'd mentioned earlier, it's

Alex Stavros:

the 10th leading cause of disability and there are

Alex Stavros:

millions of people in United States who are affected by OCD.

Alex Stavros:

So a lot more common than people know. In fact, my guess is some

Alex Stavros:

people may be surprised to know that Cameron DS and Leonardo Di

Alex Stavros:

Caprio and Justin Timberlake are all living with The OCD. And I

Alex Stavros:

share that just to open up a question around awareness and

Alex Stavros:

stigma. What would you recommend? And what advice would

Alex Stavros:

you give? What steps can individuals take to raise

Alex Stavros:

awareness about OCD and reduce that stigma? and advocate for

Alex Stavros:

better understanding and support? Yeah,

Brad Riemann:

no one, as you pointed out, I mean, there's

Brad Riemann:

been many famous people over, over the centuries, and

Brad Riemann:

certainly even currently, that have that an and I do think,

Brad Riemann:

Alex, that that does help, especially young people, I mean,

Brad Riemann:

you know, if you look up to athletes, or movie stars, or

Brad Riemann:

musicians and, and, you know, it just, it does normalize things.

Brad Riemann:

And I think, you know, to fight stigma, that is what you have to

Brad Riemann:

have is normalization. You're not crazy, you're not weird. You

Brad Riemann:

have a medical condition. Right? And, and we unfortunately,

Brad Riemann:

separate out mind from body. This is a medical condition, as

Brad Riemann:

I said, every year we get more and more evidence that it is

Brad Riemann:

truly a neurobiological issue, a medical issue. And, you know, I

Brad Riemann:

think that that's the key, I mean, it just realize that there

Brad Riemann:

are many people out there with this condition, some famous,

Brad Riemann:

most not but many people with this condition. And then I think

Brad Riemann:

just that the hope of treatment, I mean, you know, I think, you

Brad Riemann:

know, knowing that there is effective care out there, and

Brad Riemann:

that there is hope. And there is help, also, you know,

Brad Riemann:

dramatically reduces all that fear and stigma as well.

Alex Stavros:

Love the overarching message of of hope

Alex Stavros:

that particularly that evidence that this is one of the most

Alex Stavros:

treatable of behavioral health conditions. What else would you

Alex Stavros:

leave parents and others and the family or community or friends

Alex Stavros:

who have a loved one? who's struggling with OCD? Any, any

Alex Stavros:

parting thoughts, or comments you'd want to share with them?

Brad Riemann:

Yeah. You know, it is common. It is very

Brad Riemann:

debilitating, unfortunately. And it rarely goes away on its own

Brad Riemann:

Alex again, I never say never, but it really doesn't, it's

Brad Riemann:

going to take intervention medication, ERP or a combination

Brad Riemann:

of the two. And if anything, it tends to continue to kind of

Brad Riemann:

exacerbate over time, right. So in youth, it tends to kind of

Brad Riemann:

continue to escalate, then somewhere in you know, young

Brad Riemann:

adulthood, late 20s, maybe around 30. For most, it tends to

Brad Riemann:

plateau off, but it's plateauing off at a pretty debilitating

Brad Riemann:

level, right. And so, you know, it is common, it's debilitating,

Brad Riemann:

it's not going to go away on its own. And there are resources to

Brad Riemann:

help. And you're just going to have to, again, kind of roll up

Brad Riemann:

your sleeves and find the right provider. The good news is, as

Brad Riemann:

you know, there are more and more trained providers every

Brad Riemann:

year. There are more and more intensive programs every year,

Brad Riemann:

still not nearly enough. And then to your point, if you don't

Brad Riemann:

have geographic access, you might be able to plug into a

Brad Riemann:

good telehealth program. And the good news is insurance tends to

Brad Riemann:

support these programs. You know, they insurance understands

Brad Riemann:

OCD, and understands how debilitating it is and and

Brad Riemann:

understands it's not just a whim or a phase that Johnny's going

Brad Riemann:

through. And if anything, it's going to get worse. And so they

Brad Riemann:

do support treatments and including intensive treatments.

Brad Riemann:

Great.

Alex Stavros:

Well, thank you, Dr. Raman. So much for your

Alex Stavros:

time. We're really grateful for your clinical leadership and

Alex Stavros:

clinical expertise. And we love that we're partnered together

Alex Stavros:

and working together now as your partner Embark team on on

Alex Stavros:

developing more comprehensive and even higher quality and more

Alex Stavros:

accessible treatment interventions and programs. And

Alex Stavros:

thank you again for your time today. We appreciate Thank you.

Alex Stavros:

Thank you all for listening to today's podcast. It was great to

Alex Stavros:

have Dr. Freeman on to talk about OCD. We appreciate you

Alex Stavros:

following liking and sharing this episode. You can go to

Alex Stavros:

where you can find our podcasts or our YouTube channel to follow

Alex Stavros:

and we look forward to seeing you on the next one.