If you’re one of the members of the Facebook group of OCD FREE INDIA you must have come across various posts created by a lady named Carol Edwards, in addition to her valuable and helpful comments in innumerable posts of the others. Besides the Indian support group on Facebook, she plays the role of one of the chief admins in The Ways of the Force group. Not only that, she is determined to help one Indian at a time in the recovery from OCD for free of cost. I am very thankful to her that she agreed to share her precious time with us and her insight on OCD. Brothers and sisters, I, Gourav Kundu, on behalf of OCD FREE INDIA, welcome the renowned psychotherapist Carol Edwards ma’am to this exclusive interview series.
NOTE: The following conversation is presented before you as it took place between me and Carol Edwards with minimal minimal editing of a few words.
Namaste ma’am. I am so much obliged that you agreed to a part of this series. As many of us already know about your contribution to the online OCD support community but only a few know about your journey to this point. Can you please share your experience in this field with our readers: like how long have you been in this field and what inspired you to become an OCD therapist?
–First, namaste Gourav, and thank you for inviting me to do this interview. In answer to your question, I first obtained a certificate in counselling in 1994 which is when I first became interested in this type of work. What inspired me at the time was seeing problems associated with alcoholism and chronic anxiety in my family. It was later that I identified obsessive-compulsive disorder and related conditions that to-date shows a genetic link on both sides of my family.
2.) Besides the virtual space do you also provide your service in the real world, if yes, may we know the location?
—Yes, I work as a freelance coach in and around my hometown in England and provide individuals and families with a CBT format for working on cognitive change. This includes the exposure-response prevention model with a relapse prevention blueprint for maintaining gains following recovery.
3.) Since you’re a member of various online support and self-help groups, have you ever come across any Indian OCD therapist who practices in India?
—I recently came across a counsellor named Sunil Punjabi. He asked me to do an interview for his OCD group. I’d been asked before and had turned these down (with regret) because I was practising overcoming a social anxiety issue and speaking in public or in front of a camera online. I was surprised that Sunil didn’t just leave it there and even more surprised that he offered to give me some sessions to help me with this, and the result was that I did a live interview with him which was successful. This has opened new doors for me. I definitely recommend his services.
4.) These days the clash between ideas and theories keeps on happening, not only in India but all around the world. Some people claim to have recovered from OCD without taking any medicines while others are in favour of medicines. May we know what is the role of allopathic medicines in overcoming this disorder and can therapy alone do the magic?
—Yes, there will always be a clash of ideas but for the most part, I go along with the tried and tested theories that work. So in terms of medication, my view is that largely selective serotonin reuptake inhibitors (SSRIs) target the brain’s chemistry for reducing symptoms by up to 60%. Once medication reduces the symptoms for people who have moderate-severe OCD (which can take up to six weeks, sometimes a little longer) then CBT/ERP therapy is generally more effective as the active part in treatment, and in correcting the brain parts responsible for OCD. Whilst medication and therapy are the suggested requirements for reaching recovery goals for more severe symptoms, either one of these therapies is offered as a first option for mild symptoms with one or the other being included if needed.
5.) What is your opinion on emerging alternative treatments for OCD like cognitive drill therapy, rTMS, hypnotherapy, herbal medicines, homoeopathy etc? Since many people are afraid and cautious of the side effects of allopathic medicines they tend to follow other ways. May we know if one should really consider investing in aforesaid treatments?
—My first opinion is to stick with the tried and tested methods. That said, everyone’s chemistry is different, and so I keep an open mind and do review new theories when they emerge.
- I like cognitive drill therapy for the fact it holds some of the traditional cognitive and behavioural methods; but the downfall for me is the actual drilling because I’m not entirely satisfied that this changes the brain parts responsible for OCD, so biologically I have my qualms about the long-term benefits with this method, but again it’s a formed opinion so I could be wrong.
- With rTMS, while this is an approved treatment in the UK, the National Institute for Health and Care Excellence (NICE) found that while rTMS is safe, there is insufficient evidence for its efficacy so far. Since my thoughts fit with bio-behavioural treatments, I would be in agreement, and until efficacy results are on a larger scale.
- I’m not keen on hypnotherapy but this is an opinion so no offence to those who practice it. I studied hypnotherapy, it was one of my modules for my CBT diploma but it didn’t fit with my bio-behavioural approach for correcting the brain parts responsible for OCD, and so I don’t integrate this model into my treatment approach.
- As far as my knowledge stretches my concern with herbal remedies is that they don’t reduce the symptoms seen in obsessive-compulsive disorder on a biological level opposed to allopathic medicines, which do.
- According to the National Health Service (NHS) in the UK, it says there’s been an extensive investigation of the effectiveness of homoeopathy as an alternative treatment for mental health or any other condition such as cancer. I’m in agreement with the NHS in that there’s no good quality evidence that homoeopathy is effective as a treatment for any health conditions.
- With respect to homoeopaths, health and safety are an issue for; for example, it’s still not fully clear what causes OCD so any substances being ingested as a treatment method despite given in diluted measures, for me, raises concerns.
6.) What methods do you use to treat OCD patients and what is the success rate of a particular method or technique that you have used on OCD patients so far?
—I use cognitive behavioural therapy (CBT) in the first instance to help restructure maladaptive thoughts and behaviours. I find this works well as a foundation for preparing for exposure response prevention (ERP) – this has a person face their obsessional fears in which they resist all compulsions. The goals are habituation to one’s fears with remission being the main goal or much-reduced symptoms. I’m also in favour of mindfulness, motivational interviewing and allopathic medicine.
7.) People keep on asking this question, IS OCD curable, or about a permanent cure for OCD?
—Personally, and as someone who acquired OCD from a young age and now in remission, I don’t view any treatment methods as a permanent cure for OCD; instead, I see treatment being able to restore someone back to a healthy life before OCD, just like a person who is restored back to a healthy life following successful cancer treatment. I’m in remission from both with no symptoms following remission from cancer, but I live knowing (not consciously) that the symptoms could return, although not necessarily. Similarly, my remission from OCD means I live a life like a non-OCD person; I get intrusive thoughts like a non-OCD person and let them come and go like a non-OCD person and I don’t give into rituals anymore. So this for me is a “cure” which I call remission or recovery. I may at some time in my life develop a full-blown relapse, but I might not either. For the most part, I don’t fear OCD symptoms returning; and if they did I would draw on the CBT and ERP models and practice what worked best for me during recovery. My advice to anyone in recovery would be to have a copy of a relapse prevention blueprint for maintaining gains achieved in therapy.
8.) Can you suggest some resources (books/online media) for those who know about someone close, suffering from OCD?
–It might be fitting to tell you about my “OCD Learn and Recover” course which is a 3-part programme that is suitable for teens and adults and which is also available to relatives to learn about the CBT/ERP model for OCD – this can help them work with their loved one with my support. There are also free sites that offer simple-to-follow self-help guides for understanding and treating OCD – you would just need to Google something like “free OCD guides”. Also, OCD workbooks can be helpful such as the mindfulness one by Jon Hershfield for treating OCD. Online groups can be a source of support where fellow sufferers (and their families) can be there for one another and where admins can help people locate outside help, such as referring them to the IOCDF or in the UK, OCDAction and locating CBT professionals.
9.) If someone is close to a person suffering from OCD what would be your message to them?
—My message would be to first understand that they are dealing with a disorder that causes problems for the sufferer (and those around them), not the person themselves whose causing problems for themselves and their families. I would further advise finding the resources that will help them understand OCD, what it is and how it is treated. My course can help with this, and this comes with the added benefit of having a coach (myself) there on hand when needed; and there are lots of other courses too, or books and documents, all of which can give someone the tools they need to help the person close to them. One helpful book that I recommend too is “Loving Someone with OCD” by Karen J. Landsman et al.