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WARNING;  This post may offend many mental health professionals.  I am going to give my personal opinion and approach to OCD, which may go “against” what they have been taught.  However, I will provide my rationale for my thinking and then allow you to come to your own conclusions.

Obsessive-Compulsive Disorder (OCD) is a challenging and often debilitating mental health condition that affects millions of people worldwide. Characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions), OCD can severely impact a person’s quality of life. Traditional treatments, such as cognitive-behavioral therapy (CBT) or exposure response and prevention (ERP) therapy and medication, have proven somewhat effective for many, but they don’t work for everyone.  An emerging treatment, neurofeedback, offers a promising alternative for those seeking relief from OCD symptoms.

As a side note, I belong to a few Facebook Groups that are specific for those experiencing OCD.  Within these groups I have seen horrifying posts from people experiencing OCD symptoms coupled with major depression, high levels of anxiety, hopelessness, reaching out for help and even being suicidal.  People are screaming and seeking help, but are only told to live with it, take your medication and try therapy.  When I ask if anyone in the group has had (or heard of) using Neurofeedback as a treatment option, not a single person has responded with “yes.”  NONE!  To me, this is beyond frustrating!  People who suffer from OCD are one of the most underserved populations in mental health.  There are a few reasons for this, so allow me to explain my stance and what I can do to offer help to those in need.

FIRST:  OCD is a neurological disorder, based in the brainwave activity, that results in obsessive and compulsive thoughts or behaviors.  Again, this is based in neurology.  Trying to talk your way out of a brainwave and neurological condition just isn’t going to happen.  Trying telling someone to talk themselves out of a seizure or a heart arrhythmia and see how that goes. Thus, if the approach isn’t trying to fix or remedy the brainwave or neurological issue, then what (exactly) are they doing for you? 

SECOND:  Very few mental health professionals understand OCD, let alone understand what a neurological disorder is, why it happens and have little knowledge of how to treat it (other than “talk” at it and hope it goes away). They attend a conference or two and then just believe what they are taught (don’t question it) and then just give it a try hoping for the best.  

THIRD:  OCD is very costly to treat.  Many insurance companies will not pay for or reimburse for the coverage of mental healthcare treatment of OCD.  Why?  In my opinion it is clearly due to costs, nothing more.  OCD can be expensive due to the number of mental health treatment sessions, the amount of time it can take, etc.  Thus, they just don’t pay for it.  Many people are paying out of pocket (cash), selling or mortgaging their homes in order to pay for services in hope that they can find relief in some way.  So I try and give people a big financial break if possible.  People are paying $500 a day (or more) for treatment that involves 5 days per week (or more).  To me, that is a crime.

FOURTH:  Very little information is available on OCD and the treatments that truly impact a person’s life.  For the most part, if you search for OCD treatment you will find (mainly) two treatment options; medications and CBT/ERP therapy often referred to as “Exposure Therapy”.  Even those who “treat” OCD are not aware of how the neurological condition works and how to make sense of it while providing treatment.  They may admit it is “neurological” but then begin just doing what they were taught with little consideration.

FIFTH:  OCD is probably the most difficult and challenging mental health disorder to treat.  There are two main reasons for this.  First, it can be difficulty to identify the brainwave activity and where it is taking place in the brain.  So, it can take some sessions while monitoring the EEG to identify where the treatment must be focus.  Second, due to the first problem of identifying where to exactly focus the EEG treatment, the client can become (for obvious reasons) very fearful, not see any improvements and the compulsive or impulsive thoughts can become too problematic.  Regardless of what we do, I would say that about 25% of those seeing OCD treatment, while using neurofeedback, do not see results.  This number may seem high, but when 75% of the clients see massive improvements it is worth the effort.

Okay, having outlined these 5 things, allow me to expand and tell you why I believe Neurofeedback is a key component to treating OCD.

Understanding Neurofeedback

Neurofeedback, also known as EEG biofeedback, is a non-invasive therapeutic approach that trains individuals to regulate their brainwave activity. By monitoring brainwaves in real-time, neurofeedback provides immediate feedback to help individuals develop greater control over their brain function.

How Neurofeedback Works

The process begins with an initial assessment, where an EEG (electroencephalogram) is used to map the brain’s electrical activity. This brain map identifies areas of dysregulation, which are often linked to the symptoms of OCD. During neurofeedback sessions, individuals are connected to EEG sensors that monitor their brainwaves. They engage in a task, often involving a visual or auditory stimulus, and receive feedback (through changes in the stimulus) that encourages desirable brainwave patterns.

For example, if the goal is to increase alpha waves (associated with relaxation) and decrease beta waves (linked to anxiety), the feedback might be a video that plays smoothly when the desired brainwave patterns are achieved and pauses when they are not. Over time, this feedback helps individuals learn to modulate their brain activity, leading to symptom reduction. 

The Science Behind Neurofeedback and OCD

Research into neurofeedback for OCD is still evolving, but preliminary studies and clinical reports suggest significant benefits. OCD is often associated with hyperactivity in certain brain regions, such as the anterior cingulate cortex and the orbitofrontal cortex. Neurofeedback aims to normalize this activity, thereby reducing the compulsions and obsessions characteristic of the disorder.

In a study published in the journal “Clinical EEG and Neuroscience,” researchers found that neurofeedback training led to a reduction in OCD symptoms by targeting abnormal brainwave patterns. Another study in “Applied Psychophysiology and Biofeedback” showed that participants who underwent neurofeedback training experienced improvements in their ability to manage anxiety and reduce compulsive behaviors.  Neuroscience is catching up very quickly in terms of treating various mental health disorders, especially OCD.  Yet, we are still in the early stages of treating OCD effectively.

Advantages of Neurofeedback

Non-invasive and Drug-free: Neurofeedback does not involve medication, making it an attractive option for those who prefer to avoid the side effects associated with pharmaceuticals.

Personalized Treatment: Each neurofeedback protocol is tailored to the individual’s specific brain activity patterns, ensuring a customized approach to therapy.

Long-lasting Results: Studies indicate that the benefits of neurofeedback can be long-lasting, as individuals learn to self-regulate their brain activity over time.

Complementary to Other Treatments: Neurofeedback can be used alongside traditional treatments like CBT/ERP and medication, potentially enhancing overall efficacy.

Challenges and Considerations

While neurofeedback presents a promising option, it’s important to acknowledge the challenges and limitations:

Limited Availability: Access to neurofeedback therapy can be limited by geographical location and cost.

Need for Skilled Practitioners: Effective neurofeedback requires highly trained clinicians to interpret EEG data and how to use it properly.  

Varied Responses: Like all treatments, neurofeedback may not work for everyone, and more research is needed to understand why some individuals respond better than others.

Treatment Sequences:

Given all this information, it is my professional opinion that a client with OCD take the following steps to achieve the highest probably of finding relief from the symptoms of OCD they experience.

1.  Begin with Education about OCD.  Find the most information you can about it.  Find a therapist who can help educate you.

2.  Begin Neurofeedback and Mindfulness Training:  Find a therapist that will begin Neurofeedback and Mindfulness training for you.  Neurofeedback will target the brainwave activity while Mindfulness will help you be aware of mind/body connections, etc. 

3.  Once you have education and finished Neurofeedback and Mindfulness training, you can now begin ERP (exposure and response prevention).  In my opinion, ERP will work BEST if your brain is able to now manage it.  This is why I believe it is imperative to do Neurofeedback PRIOR to ERP therapy.  

Here is my logic on why I truly believe ERP treatment is more successful if the brain is ready to do it.  Again, OCD is a brainwaive issue, it is neurological.  Exposure therapy exposes you to the environment that MAKES YOU GO INTO FIGHT OR FLIGHT mode.  ERP believes, for the most part, that if you expose yourself enough to the fear (or whatever) that you will just become desensitized to it.  In many ways this may be true, but NOT so much for ERP with severe OCD symptoms.  Rather, let’s calm the brain down, get the brainwave activity normalized AND THEN attempt exposure.  Doesn’t this sound a bit more logical?  Well, research would show that I am correct.  My experience shows that I am correct.  Yet, you decide.

Conclusion

Neurofeedback represents a groundbreaking approach to treating OCD, offering hope to those who struggle with this persistent disorder. By teaching individuals to harness the power of their own brains, neurofeedback empowers them to break free from the cycles of obsessions and compulsions that dominate their lives. As research continues to unfold, neurofeedback holds the potential to become a mainstay in the therapeutic landscape for OCD, paving the way for a future where mental freedom is within reach for all.

If you or someone you know is struggling with OCD and interested in exploring neurofeedback, consulting with a licensed professional who specializes in this therapy is a crucial first step. With the right support and treatment plan, overcoming OCD is possible, opening the door to a life of greater peace and possibility.

Thank you and I hope this blog was helpful.

Aaron Nicolaides, PhD, LCSW

Therapeuo Health