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432 OCD Treatment in 2025: Updates in Research, Treatment & the Future (with Dr Jon Abramowitz)
00:50:51
In this episode, Kimberley Quinlan and Dr. Jon Abramowitz explore the current state of OCD treatment in 2025, highlighting what’s working, what challenges remain, and how the future of personalized, evidence-based care is evolving.
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- [00:02]
A
Welcome to your Anxiety Toolkit podcast where I bring you all the virtual hugs and practical strategies to help you face your fears and live each day with courage and compassion. I'm Kimberly Quinlan, a licensed therapist and anxiety specialist and today we are talking all about OCD treatment, where it stands in 2025, what we know, what we're missing and what needs to change what. Whether you're struggling with anxiety, ocd, panic, perfectionism, this podcast is your space to learn science backed tools to help you build a life you love where you feel confident even with fear on board. I am so honored to be joined by Dr. John Abramowicz, one of the leading voices in the field of OCD research and treatment. In this episode, we're talking about the big picture and the current landscape of OCD care, from the progress we've made in evidence based treatment to the myths that still cause harm and the barriers that continue to keep people from getting the help they need. So let's dive in. Welcome so much, Dr. Jon Abramowitz.
- [01:12]
B
Thanks, Kim. Thanks for having me. It's an honor to be here. I'm flattered that you picked me to have this conversation with, so I look forward to it.
- [01:22]
A
Oh, I needed you for this episode. Truly I do. Like, I'm all, I'm very happy to say when I'm out of my league, and I was out of my league in trying to do this on my own. So let's jump in immediately to what would you say is the current state of OCD treatment in 2025? Meaning what are we doing well at? What do we need to do better at? What are your thoughts?
- [01:49]
B
Yeah, that's a great question. I think, you know, well, clearly we're in a much better place than we were, you know, 20 years ago, even 10 years ago, I think in the field of OCD exposure and response prevention, ERP is more than ever recognized as the gold standard treatment that we have. There's growing awareness of this treatment in the OCD community. More, more clinicians are getting trained to do research, supported exposure and response prevention. There are online resources, there's the IOCDF International OCD foundation has wonderful conferences and training. So there's expanding access for clinicians, for professionals in the field, for how to work with folks who have ocd. But I will say that, you know, there are still some, some gaps. Many people are still misdiagnosed. I see people, you know, every week in our clinic at University of North Carolina or in my own little private practice who, you know, they've been told they have OCD and, and they don't, or they were told they had something else and they really have ocd. So even by mental health professionals, still people are being misdiagnosed. They'll go years without realizing that they have OCD or that there are actual treatments. But that's getting better. We're doing better about that. I think even among trained therapists, there's still hesitancy for some folks to do good, thorough exposure therapy. Especially I think with like taboo obsessions, existential themes where you have to do imaginal exposure. There's still some, you know, discomfort around doing that. And I still think that we need more research and tailored approaches for, for diverse populations and comorbid presentations. Right. People that, you know, our studies, we have lots of studies, lots of research, decades and decades and it's still accumulating. But the people who are included in these studies tend to be of certain populations and there are other populations that tend not to be included in these studies for different reasons. Maybe we can talk about that. White folks tend to be included in a lot of the studies that we do and we don't have a lot of studies on diverse populations. And we're starting to. That's starting to change. But we can always do better.
- [04:22]
A
Yes, thank you for mentioning that, because I think that that is a really important point. Okay, so here is where my lack of knowledge comes into play and this is where you're amazing knowledge comes in. So let me just pause for a second. As someone who is a sufferer and they go to read the research, how would they determine what is good research versus not so great research? I mean I. On social media, I'm constantly seeing, oh, this new research article has shown that blah, blah, blah is good for. It could be something like supplement or herb or you know, tap your head, whatever it might be. How might complete newbie. In the area of actually getting to the research, how would they determine what is quality research?
- [05:15]
B
Wow, that's a great question. Because it's really hard.
- [05:19]
A
Yeah.
- [05:20]
B
In this day and age with social media, with just. It's. It's so easy to communicate things to different people, often in echo chambers. A poorly done study can look just as factual as a really rigorously done study, depending on, you know, where it gets posted or who posts it or what they say about it. And you've got to know, like research methods. Take a class in research methods. But of course, no, you know, not everyone can do that. Understanding that studies need to include more people, the more participants or subjects you have in a study, the better. So if you're just basing your results on 10, 20, 30 people, that's not as good as if you have 100, 150. Right. And you can tell me if you want to get into the specifics. But there are different types of research design. So in some studies, you have a group of people and everybody knows the therapy that they're getting. And there's not a blind. They're assessed before treatment, and then they're assessed at the end of treatment. And that's one what we would call an open trial study, which can be really helpful, but not as good as what we call a randomized controlled trial, where you have groups of people with large numbers of people who are randomly assigned to receive one treatment or the other, or a drug or a placebo, and people who are rating these patients in the study, they don't know what treatment the person's getting, so they're not biased. Oh, I want the drug to do well, so I'm going to give this person a higher score because I know they. Right. So you don't have that in randomized controlled studies. If you are one of the people that, you know, Kim, that you were talking about someone who's really interested in consuming the research, you want to go, you know, maybe go online and read about research methods and read about what makes certain studies better than others. Because you and I both, we know, we go on social media and you see, you know, this person is saying, look, there's a new study on this new treatment, and it worked for 10 people. Well, you got to take that with a grain of salt because, you know, there's a problem. We want lots of people in a study before we can say that it works. Yeah, yeah, but you get the idea.
- [07:47]
A
I actually could literally spend an entire episode you teaching us that. Because I think that is the key here. Okay. The reason, actually, I bring that up and I'll tell the story, is I use ChatGPT quite a lot for work. And my assistant, who is amazing and knows a lot about ocd, was telling me she was writing something up, and she always checks her work. And she was like, you will not believe ChatGPT quoted an article and a journal. And she's like, it's not a thing. It's not even there. It's not even a thing. And I love ChatGPT and I rely on it for many things. But it took her extra time to check the, you know, cross the T and dot the I. And I thought that was so Fascinating. It completely created its own journal article that never existed.
- [08:34]
B
So it's interesting because that's called hallucinating. Right? AI can hallucinate. There's a. There's a term for that. Yeah. ChatGPT is great when you have a difficult email to write to someone and you want to make sure that it comes across professionally or whatever. But when it comes to doing science, I'm not sure ChatGPT is what, you know, is where you want to go.
- [08:54]
A
Yeah, first.
- [08:55]
B
Yeah. Google.
- [08:56]
A
No, I just thought it was hilarious. We always check anything that we do and, you know, recess and site. But I just thought that was so fascinating that it chewed out some random study that was never done. That being said.
- [09:09]
B
Yeah, I've heard of that happening before.
- [09:11]
A
Oh, my gosh. Tell us about the research. When I started Business City Therapist, we already had the meta analysis.
- [09:19]
B
Yeah.
- [09:20]
A
How often are these meta analysis being done? What is the new research for ocd? What are the shifts that we understand based on the research? Can you give us an update? Give us a news update?
- [09:34]
B
Yeah. So let's define for folks who might not know, what is a meta analysis? Because it sounds really scary. Meta. Right. What researchers are doing when they do a meta analysis is they're taking all of the studies in a particular area, let's say all of the studies evaluating ERP exposure and response, prevention versus, you know, a control treatment or versus medication. And all they're doing is they're tallying up the results. They're going to the results, and they're saying, you know, what was the Yale Brown, the Y box score at pretest for this group and at post test, and then at pretest for the other group and at post test. And let's take all the studies that have used the Y box and let's kind of put them all into one big analysis so that we can see across all the studies, 30, 40, 50 studies, probably more than that. You know, how effective is this treatment? Or how effective is one treatment versus the other? And these have been done. I actually, one of my very first publications in 97 was a meta analysis, one of the first meta analyses of OCD research. We've come a long way since then. We only had, like a handful of studies. Now we've got, you know, many, many studies. I don't know how many offhand, but, like on the order of like 50. And these have been done. And time after time they show the same results that we know that ERP works and it works well and it works overall at post test. So after you know, 16 sessions or so. And then we know that once people stop doing ERP and they, they're followed up six months, a year later, that overall the gains tend to be kept. People get better and they stay better. Now, as I'm sure we'll talk about, not everybody, and even in the best case scenario, the OCD is never cured or like gone completely. But this is the best treatment and our meta analyses tell us that. So that's very clear. We do have more studies that are coming out in the last couple of decades, kind of building on what we know already. And I'm encouraged by some of the studies showing what we can do with acceptance and commitment therapy. So act, and it feels really promising for how we can use ACT and exposure and response prevention together for some people, maybe we can get more out of using act. Not for everyone. We actually did a study some years ago now showing that overall, when you added ACT to erp, the results were exactly the same as when you didn't include act. Oh yeah, but we knew that individual patients, some of them clearly needed act. If they, our clinical observation was like, if they were in the ERP only group, it wouldn't have been helpful. And there are other people, you know, because ACT is very abstract. There are other people that didn't like the ACT and they might have done better in the other group, which is one of the limitations of large studies is that you're looking at averages, but like that's the best that we have right right now. So I'm encouraged overall with the use of ACT to help people kind of build a life worth living, right while they're learning how to approach their fears. I'm encouraged by some of the newer control studies that are now coming out on inference based CBT or icbt. And people are starting to wonder about how that might complement or enhance kind of traditional erp. And there are some folks in the field that are like, no, no, this is a separate thing altogether. And then there are other people who think, well, you know, really there are more similarities than differences, or there are some similarities. Let's see how we can build a treatment together that incorporates the best of both worlds. So I'm encouraged to hear about some research looking at that, the ICBT research, the vast majority of it. And I had a student who's just working on a meta analysis of that now for one of his assignments for his PhD training. And we're going to publish this, a large review of the, of the literature. A lot of the research on ICBT is conducted by the same people who invented the concepts, who invented the therapy. And that can introduce biases. So we really want to look for independent groups to see if they can replicate the results that the folks who invented the therapy, you know, it's not surprising that they would find that the therapy works since they invented, they have a horse in that race. But we want to see research done by folks who haven't invented the therapy and who are less, they're less like invested. Yeah, that's a great word. They're less invested in what the results are. Well, so I was also going to raise some concerns on the neuroscience side as well, the biological side. And one of the concerns that I've had over the decades, I've been in the field since the 90s, we've been spending millions, probably billions on imaging studies, studies of the brain, studies of genetics to try to understand what's the disease in ocd, what exactly is going on biologically in folks who have OCD. The problem is that since 1988, when Prozac came out, we're still using the same biological treatments, SSRIs. All of this money to help us understand has not helped us really one bit when it comes to biological treatments. Every once in a while we hear about, you know, something, oh, it's a different neurotransmitter or it's this. But then the, you know, whatever enthusiasm there is starts to fade. What we have seen is kind of the commercialization of these fast fixes things like poorly delivered ketamine or surgeries like deep brain stimulation. And these things are nice. And I'm not saying they haven't helped people because I've met folks who swear that they did ketamine treatment, they feel better, they did deep brain stimulation and they feel better. So I'm not denying that they can be helpful. But they're very experimental. We don't know about their long term effects. We don't know about, you know, and, and no one would say that they are first line treatments and they're heavily peddled by big pharma and other for profit companies that are also very invested in, you know, making money and maybe don't necessarily have people's best interests as their priority. So I, I worry about that. People want quick fixes. Oh, let me just have this surgery and then I, I won't have to have anxiety anymore. It's just doesn't work that way. So I'm, I'm rambling, but go ahead. You were going to say something.
- [16:37]
A
No, you're not. Rambling. I have like a million questions. Okay. So going back, let's summarize and you can correct me if I'm wrong. So we have a lot of evidence based on meta analysis that ERP seems to be the shining star.
- [16:52]
B
Yeah.
- [16:53]
A
They're now doing more and more research to see what are good, like, supplements to that, like, how can we make it better?
- [17:03]
B
It doesn't work for everybody. It's not a panacea. Okay, so how can we make it better? In our lab, we're doing research to try to optimize erp rather than throwing ERP out.
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A
Yes.
- [17:13]
B
Where we want to, which is a terrible idea. We want to optimize it. How can we make it better? So, you know, we've tested various ways to do that, one of them being with act.
- [17:22]
A
Yeah. What about dialectical behavioral therapy? Is there any research to show that that is helpful for particularly folks with emotional dysregulation, so forth?
- [17:34]
B
There's some evidence that I'm not up to date on that. It can be helpful for folks who have problems that are primarily focused on emotion dysregulation. But as far as OCD goes, there's just no reason that DBT would be helpful for ocd. I think there's like one or two studies of it, not terribly well conducted, and there's just no conceptual what we understand about how OCD works. There's no reason that DVT would be.
- [18:02]
A
Used even as a supplement.
- [18:04]
B
You know, I guess one of the ideas is it can help people to kind of rein in their anxiety when they're doing erp. But on the other hand, we want folks to learn that they can manage anxiety now. So, you know, I guess individually, and maybe we can talk about individually tailored treatments later on. But if there are folks who have OCD and they have problems with severe emotional tissue dysregulation, maybe pulling in some DBT could be helpful, but I wouldn't do by itself.
- [18:32]
A
Yes. Yes.
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B
Yeah.
- [18:34]
A
Okay. So this is really, really helpful. And let me just ask one more question about that is let's sort of talk, go back to the icbt just because that's where I get a lot, a lot of questions. And I have done trainings, I've read a lot of the research, but I still, again, always happy to say I'm not the best person is, say the research that they have done by the people who develop it. There seems to also be some people who are trying it with other conditions in which it hasn't been studied on. So if. Let's say we know that there are like obsessive compulsive related disorders. If something is really good for ocd, could we make the assumption it's then good for like body dysmorphic disorder or specific phobias or so forth? How, from the research perspective, do they determine what will help additional disorders?
- [19:35]
B
I mean, there should be research on it right there. In an ideal world, we'd have studies showing that it's effective. And I think that's one of the problems with the way we group OCD with these other disorders. Body dysmorphic disorder, hair pulling, skin picking, things like that, they don't all work like OCD works.
- [19:55]
A
No.
- [19:56]
B
In the ICBT language, icbt, they look at that as being specific to ocd. And inferential confusion is something that's specific to ocd. So, and I'm not an CBT expert, but I think that folks who are would say, yeah, it hasn't been tested and it's really supposed to be for ocd. Ocd, the inferential confusion is what sets OCD apart from some of these other problems.
- [20:21]
A
Okay, good, good. What are some misconceptions, whether that be from the research or clinically, that you see in general among therapists and sufferers that you think really needs to be corrected? You know, in this year, meaning, like, we're in 2025, let's start the year off, you know, the best foot possible as a clinician, as a sufferer, what misconceptions do people need to be aware of?
- [20:50]
B
Yeah, you know, the same old, same old stuff that OCD is just about hand washing or just about being neat. We know that it's not. And so it would be great if more people were educated about all the different ways that OCD can present. And OCD is not being quirky or cute. There's nothing cute about, about ocd, but it still kind of gets made fun of. I was at a, went to see a comedian over the weekend and they were telling jokes about ocd. Oh man, it was really cringy to hear that in 2025, like a progressive comedian was still telling jokes about that and that, that people with OCD should just stop worrying or learn to relax. That's, you know, that's of course doesn't. Doesn't work. So I think those are some of the main misconceptions. I think there's some misconceptions among therapists too. A common one is that erp, especially like imaginal exposure, where you're having people lean into their obsessional Thoughts that. That's risky and. Or unethical or something like that. And. Right. I think that's. Well, that is a myth. That is absolutely not. Not true. The reality is that OCD can show up in, you know, lots of deeply distressing and nuanced ways. And we as therapists want to help people. We want to meet them where they are. We want to help them to be courageous while also being compassionate and empower them to be able to learn how to, you know, lean into and do better about having these unwanted thoughts that they. That they have.
- [22:24]
A
And it's great that you brought that up because again, my inbox is pretty commonly filled with. For our private practice, people who have said, and this is where I wanted your. You to give us sort of the science is. They. They understand the science is on our side when it comes to erp, but maybe they've had a bad experience. And so that they assume that their bad experience means that ERP as a whole isn't for them.
- [22:56]
B
Yeah.
- [22:57]
A
Or erp, let's say in many cases, they'll say they felt like it was too aggressive. Erp and that they feel like that for that reason, they don't ever want to go back to even trying erp.
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B
Yeah.
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A
What would be your thoughts coming as a clinician and as a researcher, in terms of navigating that as a clinician, you know, as. Okay, so I'm a clinician. Someone comes to me and says, I never, ever, ever want to do ERP again. I had the worst experience. Talk to me about what you would say.
- [23:32]
B
Yeah, I would want to know specifically, you know, what was that worst experience? Unpack that for me. What happened? What was the therapist doing? What was it like for you? What. How did they set up the exposures? Some therapists kind of. They look in the book and it says, have them face their fears. And they come in, in session one, oh, you got to touch the floor, you got to touch the toilet. You got to do this, you got to do that without any sort of education on the front end. People who are well trained, they know that you need to explain the rationale for ERP and get the person's buy in and go gradually and do it with compassion. It's not just sitting here saying, touch the floor now, you know, don't wash your hands. But it's working with, you know, working with the person. And usually when someone says that to me, there are a handful of answers that I know the. And when I kind of say what you say. Right. Like, well, tell me about or what I, what I suggested. Tell me about, you know, what was that experience like? I know that there's going to be a handful of things that the person's going to say that kind of, I guess, relates to that bad experience. The therapist kind of went too fast. The client wasn't ready. Maybe someone else was pushing them into, my mom is making me do this. Right. The patient didn't understand why they were doing exposure. They were just told, you got to face your fears and that's it. And not only does that make the experience miserable, but it doesn't work that way.
- [25:08]
A
Right.
- [25:08]
B
So they, they just, you know what I find? And I have very rarely had that experience where someone works with me and they say I can't do it. I have had it, but I work very hard and I encourage therapists to work very hard to take time to set up the exposure, do some of that education on the front end. I tell the students that I supervise. I was having a conversation about this yesterday. I want the clients on the edge of their seat saying, so when are we going to get to this exposure stuff? Right. And if you do that, you won't have folks saying this was the worst experience ever.
- [25:46]
A
Yeah, I agree. I say to my staff that we can, we want to kind of be a bit like a sales team for erp. We want them to understand the benefits first and help not sell them in a sleazy way, but sell them on the benefits, sell them on the life that they will have. Going back to just the research, because this is a question I have had for a while, is when they do a meta analysis of erp, they're doing a study on a manualized type of treatment. How much of that manualized treatment involves that psycho education component? Because again, like you could say, oh, I'm practicing using erp, it's the gold standard. But if you're not using it in a super effective way, or maybe you are going in when it comes down to that research, how long are they spending on setting up?
- [26:42]
B
Yeah, different manuals, different programs have different amounts of that. But you're bringing up a good point, which is that those studies that are done, they are based on manuals. And not only that, they're based on supervision by, you know, like experts. Ed Nafoa. Right. Marty Franklin, people like that who are like the world's experts. They're supervising the therapists in these studies. But most of us are not getting that kind of supervision. Right. We should be using treatment manuals or at least informed by treatment Manuals, but most of us are not. So those studies, while they. They're good, I mean, that's the gold standard way to do the therapy for sure, but it's also a little bit more one size fits all. And in the real world, it's not one size fits all. In the real world, people come in with, you know, comorbid depression or they failed treatment before or. And so even though those studies and those meta analyses are the best evidence that we have right now, they're not. They're not perfect. Science is the best that we've got, but it's not perfect.
- [27:51]
A
Yep. So simply put, too, if someone came to you and said, yeah, and this. I see this a lot, particularly in the. In the clinical world, they'll say, okay, that's great. ERP is the gold standard. But I've seen in my practice that EMDR is better, or I've gotten better results from, you know, their own experience.
- [28:17]
B
Yeah.
- [28:18]
A
What do we do with that?
- [28:20]
B
Well, we have to be skeptical, again, not to deny anyone their private experiences as. As a therapist. But that's not the same thing as science. That's an anecdote. An anecdote is your personal experience. And again, it can be very worthwhile and very helpful. But that's not the same thing as. We have 10 studies showing that EMDR works for OCD with hundreds and hundreds of people with OCD, you know, as participants. When I'm a therapist, I mean, and I'll. I can't even say that the therapy that I'm doing is helping my own patients. I'd like to think that it is, but I'm not in the position to say that, because what if. What if I'm working with, you know, a person with OCD and at the same time that they're doing ERP with me, maybe they just got into a great relationship, met someone special, and. And they feel really good, and they want to impress that person, and they don't want to be embarrassed with OCD stuff, so they stop doing their rituals. Right. Maybe I didn't have anything to do with that. Maybe they were talking to a good bartender who, you know, who talked them out of their ocd. Maybe they were taking a medication that also helped. As a therapist, I can't be sure that what I'm doing is really helping. Now, that's not to say that if you're a therapist out there or if you're a person with OCD out there, that your therapist can't help you or that you can't help Your patients. I'm not saying that at all. I think we do a lot of good work. And when we do therapy that's based on research, there's a really good chance that we are helping people to make changes. But just in terms of the logic and the science of it, I can't sit here and tell you that the patients that I'm working with are getting better because of me. It's not a randomized controlled trial. I'd like to think that they are. Similarly, my patients can't say, oh, Dr. Abramowicz made me better, because they. Maybe they're on a medication. I've had lots of. Lots of people. They've been on medications for 10 years, never done, you know, CBT, never done exposure therapy before. They come in, we do some exposure for a few weeks, and they say, oh, what do you know? The medication just kicked Right. After 10 years. So we're, you know, people, human beings, we're just not that good at attributing cause and effects. Yeah, right. Whether we're really smart clinicians, whether we're people with OCD who are also really smart, our brains are. We're not able to deduce cause and effect that way. Now, I know a lot of people are listening to this, and they're saying, what are you talking about? I know my therapist helped me, or I know that I helped my. And I'm not saying you're wrong, but scientifically, those are called anecdotes, and that's not the same as a randomized controlled trial. So back to your example. If I treat a few people with EMDR, or if I treat a few people with some new therapy that I think works for ocd, just because those people tell me they're getting better, I can't say for sure that it worked. Another thing would be maybe some of those people, they want me to like them. I'm the therapist, so they're not going to tell me they're not doing better. They want to impress me. Right. They're paying money for therapy. And we know that there's something called cognitive dissonance. And when you invest in something by paying money for it, that alone can make you feel like it's working. They're placebo effects.
- [31:58]
A
Yeah.
- [31:59]
B
And our brains are just not good enough to be able to parse that out through individual anecdotal experience. So that's all I'm saying.
- [32:07]
A
I love it. Maybe I'm making things too complicated here, but one of the things, as a clinician and this Is a, I think a really cool conversation I've had with other clinicians is that the treatment that works is often related to the relationship between the client and the therapist.
- [32:28]
B
Oh yeah.
- [32:30]
A
And I've even had clients, let's say they've been through multiple really good therapists in my area and then they come to me and they start to get much, much better. And they'll say, you were the one who fixed me. But I have two problems with that. Number one, I truly believe that people hearing the same thing over and over by from different people has a massive impact on. I believe that I do much better after hearing being told the same thing a couple extra times to where I'm like, okay, if three people I really trust believe this, I'll be on board. I also believe that sometimes it is that relationship. So what are your thoughts on that in terms of more scientific perspective?
- [33:16]
B
So in the area of research called psychotherapy, outcome research, where we evaluate treatments, we pay a lot of attention to the specific and the non specific effects of therapy. What does that mean, the specific effects? Let's say, let's take erp, we're talking about that. The specific effects of ERP are the effects of specifically facing your fears and reducing your rituals. And you know, there's a theory about how that works, extinction theory, behavioral theory, inhibitory learning theory, you know, habituation. There are theories about how that specifically works and there's a lot of scientific data suggesting that those are correct. And it does work that way. A lot of experiments looking at that. But when you're, like you were pointing out, when you do therapy, there are these non specific effects too. The relationship that you have with someone, someone who cares, someone who you've met with every week for several months and you get to know them as the patient, client, you've got expectations. I'm going to a therapist, they're supposed to know what they're doing, they're going to help me. I have hope, I'm going to work hard at it. I invest a lot of time and effort and money into it. So I'm going to feel like I should be getting my outcome. So I'm going to be looking for positive effects. Those are non specific effects because they are present in any therapy that you do, whether it's erp, emdr, act, I, cbt, those nonspecific effects are always there. The specific effect is whether you're doing erp, icbt, act, emdr, you know, whatever, that's the specific effects. In psychotherapy outcome research. We worry a lot about confusing the specific and the non specific effects. So if, if I do a study and I want to show that ERP works, I've got to control for those non specific effects. Otherwise I can't say that that the improvement was due to just the ERP alone. Which is why we do placebo controlled studies. That's why. So a non specific effect of taking a drug is that is the placebo effect. You know, you're taking a medicine and.
- [35:31]
A
Right, right.
- [35:32]
B
And that contributes to feeling more positive. And so that's why drug studies have a placebo control because that kind of washes out any effect that's due to the non specific placebo effect. So if people get better from the drug relative to the placebo, the difference is attributed to the drug per se. Because both conditions had the placebo, you.
- [35:56]
A
Come full circle on explaining what those effective studies are. So that's very helpful.
- [36:01]
B
Yeah, it's harder in psychotherapy research.
- [36:04]
A
Yeah.
- [36:05]
B
Right. Because like, what's the treatment that we're going to use? What's the control treatment for something like erp? Well, people have done things like just education about OCD or stress management training, something that we don't think would be all that helpful. But there have been studies or relaxation training, there have been studies where the relaxation group does just as well as the ERP group. Right. So what does that mean? That means that when you respond to erp, there's a hefty chunk of that that is due to the non specific effects. You have this relationship, there's compassion, there's working together, there's collaborative empiricism where we're working together and learning stuff. And you know, as a proponent of erp, not because I invented it, because I sure didn't, but because I've seen that it works in lots of scientific, you know, studies and in clinical experience. But I still have to be honest and say there are also important non specific placebo effects. And that's the case with any psychotherapy. Yes. Yeah.
- [37:16]
A
That is so cool to know.
- [37:18]
B
Cool stuff.
- [37:19]
A
Yeah. So. So really if we were to round this out, the erp, we have research and please correct me as I go here, I'm paraphrasing if we, we start with erp, really that's the meat and cheese of this. Right? Like that's where it's at. And then there are these things that we can do as clinicians to improve the outcomes. A quality relationship, really solid psychoeducation, where they have a buy in, they understand what they're going to do, they Understand why they're motivated to do that. We have supplemental treatments depending on where they are in their life stage. Act, like you said, maybe some mindfulness or, you know, we've talked about medication, icbt, what, whatever. But is that how you would build this out?
- [38:16]
B
I think all of those things can be factors and it's different for every person. So I mean, I think that the research is plenty clear that there is specific effects of doing erp. There's specific effects of doing act, There are specific effects of doing icbt. There have been enough studies to show that, you know, those make a difference in terms of ocd, you know, you know, changing OCD symptoms, but especially for erp because it is a challenging therapy. You know, you got to have that, that relationship, you got to have those nonspecific effects. They, they play off each other. And you know, clinicians who are doing this with clients, you gotta have that trust and that relationship to get them to do good erp. And when you're doing good erp, you develop that relationship even better. So it really kind of, they, they work together in, in tandem. And I think that's one of the important reasons that this therapy works so well.
- [39:19]
A
Great. What about the folks who are doing it on their own? Yeah, they're, they're doing it through a, a manual, a workbook, an online course. What non specific. I can't get my words right on how you describe it so beautifully. Like what can they do if they went to the research, they're going to pick erp. What can they do to squeeze out the most out of it if they are doing it on their own?
- [39:48]
B
It's, it's challenging. I would say getting social support, having a buddy who's going to walk you through doing it is going to help you. I think that's how you can get as much of that non specific stuff that you would get when you're working with a therapist. I think also if you're doing this alone, you know, it's really easy to do ERP incorrectly because if you have ocd, the inclination is to avoid. Right. Rather than approach. That's what OCD is all about. So having someone there to kind of, you know, help you to get through that and give you lots of encouragement and praise and be your cheerleader, be your coach, you know, that's what the non specifics are all about.
- [40:30]
A
Right. That's really, really cool and good to know in 2025. Is there anything that you, or maybe even in your research that you're actually doing, like where Are you excited? What's exciting you in regards to treatment? Like, tell me a little bit about what we can look forward to moving forward with OCD treatment.
- [40:53]
B
Yeah, I think we need to have more personalized treatments that take more factors into account before we just jump in and do a therapy. OCD is so heterogeneous. In other words, the saying is you've met one person with ocd, then you've met one person with ocd, right?
- [41:12]
A
True.
- [41:13]
B
I've seen probably thousands of people with OCD in my work and no two of them are exactly the same. Some of them are really similar, but no two are exactly the same. Just because, you know, that just shows you the environmental impact, the impact that the environment has on ocd, that it's just everyone grows up a little bit differently in different experiences and we're built a little differently. So we need to personalize our treatments too. And we have wonderful manuals for the treatments that can be helpful. But OCD is not one size fits all. And I see unfortunately lots of therapists that are trying to fit every patient into this treatment manual and put them in boxes. And so I want to see more research on personalizing treatment. What are the client specific factors that should dictate do we use erp, do we use act, do we use medications before we just jump in with a treatment? Well, I'm an ERP therapist, so I just use erp. I'm an ICBT therapist. I just use ICBT for everybody. Like we're just stamping out widgets. People with OCD are not widgets to be stamped out. So I think that's an important thing. Personalizing and understanding what is going to predict what treatment people are going to respond to. We are just scratching the surface with that. I think we need better early detection of ocd, particularly in kids and teens. I'd like to see more research on that. I am biased, but more research on perinatal ocd. OCD that starts in pregnancy and postpartum, not only among the women who are having the babies, but also their partners. Partners, because we know that, you know, dads and partners do develop OCD when, around the time that their partners are given birth. That responsibility of having a kid, this is not just about hormones. Right. This is about responsibility changes. So we need more research on that, more research on lesser known aspects of ocd. And I'm going to plug a paper that we just finished in our lab on existential obsessions. We went to the literature and we scoured the literature. They're like Five papers that even mention like philosophical obsessions, existential obsessions about like, you know, what's the nature of reality or am I a real person or what's my real personality. There's so little of this. So we just wrote an overview paper. Hopefully it'd be published at some point in the next six months or so. That kind of lays out, you know, here's what we know, here's what we don't know, and, and here's the field that's ripe for research. So if folks are listening and they want ideas for their dissertations. Getting into to this area because it's I think because of like social media and we're comparing ourselves to other people and you go on social media, everyone seems to like have it made and they've got it figured out. But you know, no one really has it figured out. I don't even know what that means. So it's right for obsessing about. So anyway, that's another area that I'd love to see more research. I'd like to see more research on like digital stuff. How can we use digital tools for assessment and treatment of ocd? I don't think it's going to replace good ERP where you're working with a therapist, but. And two more things, I guess I'd like to see more family based approaches that, you know, like empower loved ones to be part of the solution without like accommodating. We don't have enough of that now and then. Also I think we need a more diverse and inclusive field that's going to, you know, bring in different perspectives to actively address whether it's barriers to care or the way that OCD presents in different cultures. I think we need much more of that too.
- [44:58]
A
Oh, we need so much of it. I love it, I love it.
- [45:01]
B
I feel, there's a lot.
- [45:03]
A
I feel empowered after this conversation because I do. Number one, thank you. I feel like I wanted someone to come in and teach me a lot of this. I knew, but I love sort of.
- [45:14]
B
Getting, you know a lot about this stuff.
- [45:16]
A
I do. But I, I love this stuff. I love understanding the research piece of it. Like I said, you talked about the non specific factors and I think that's so interesting. So thank you, thank you, thank you, thank you.
- [45:30]
B
So it's fun to nerd out about.
- [45:32]
A
Oh my God. I feel totally nerded out right now. It's so.
- [45:35]
B
I'm a geek for all this.
- [45:36]
A
I know, I'm like loving it. Tell us where people can hear more about you Your research, your books. Because we didn't talk about, like, your many, many, many books. Tell me.
- [45:48]
B
So. I'm a professor at the University of North Carolina, and you can read about our research online. I think it's un. If you search. You know, John Abramowicz at UNC. I have a. My own website, jabramowitz.com, where I have lots of free stuff on there. If you're a clinician, if you're a person with ocd, you can download all sorts of stuff that. That you can use. I have published a number of books and things like that. Some are for clinicians, some are for folks with ocd, some are for people who live with folks with OCD families. My latest one is called Living well with ocd. And this is for people who have gone through, like we were saying before, treatment doesn't help everyone. So what do you do if either you're not at a place where you're ready to start therapy or. Or maybe you've tried it and you're having a hard time, or you just haven't. You haven't gotten to where you want to get with therapy. Living well with OCD has lots of strategies for how to manage OCD symptoms, how to navigate work, school, dating, intimacy, all the above, family. A lot of stuff on family and relationships. So, you know, I've got a book called the Family Guide to Getting over ocd, which obviously is for families. And my main workbook is called Getting. Getting over ocd, a title that I don't love. But I don't know, I kind of go back and forth. You don't get to pick the titles of your books when you publish. The publishers, they want to sell books, right? Let's be honest. They would get mad at me if I'm saying this.
- [47:19]
A
Oh, I had the same issue with my book. They wanted to say something about curing ocd, and I had to be like, we couldn't come to a compromise here, please.
- [47:28]
B
I mean, I'd love for people to get over ocd, but I think there are a million better titles for a book like that. But nevertheless, I always appreciate positive feedback from folks about, you know, about books. So if you do check one out, drop me a line or write a review or something like that. Only if you like it. If you don't like it, then, yeah, you know, don't. No, I'm kidding you.
- [47:46]
A
Reviews are so good for authors. Really, it's so helpful for. If you get anything from a book, do leave a review. Since writing a book, I now Leave a review for every book I read because.
- [47:57]
B
Changes your perspective.
- [47:58]
A
Yeah, it totally does. I know you've just given me where people can get in touch with you, but I have one more question, if you don't mind.
- [48:05]
B
Yeah.
- [48:05]
A
Is there a place to go for the good research articles?
- [48:11]
B
Yeah. So there's something called Google Scholar. It's free, it's part of Google. And I think you just type in Google Scholar on Google and it'll take you there. And you can type in meta analysis, OCD or, you know, latest studies on act, you know, and. And it will show you. You might not be able to get the full text of. Of all the articles that you want. It just depends on certain journals make them available. But you can often read the abstract, which is supposed to give you a good idea of. Of stuff. And you can. You can write to authors. I get emails all the time. Hey, you know, I wasn't able to get your study on OCD and depression. Can you send me a PDF? And I'm more than happy to do that. Yeah. Because, you know, we want to disseminate this stuff. You know, we want more than like three people to read our articles.
- [49:02]
A
Absolutely. I cannot thank you enough. This has been so good. I loved it. I. I could listen to you for hours. So thank you, thank you, thank you.
- [49:12]
B
I could talk with you for hours.
- [49:13]
A
I know. Is there anything you want to add? Is there anything you feel like we didn't do a great job of really covering, or any final words you want to leave?
- [49:22]
B
I think there's hope for the future. I think clients with ocd, people with OCD are courageous. The students that are learning about OCD that I train, that I see at conferences, they're curious. This is a passionate community, the OCD community. And I can't give enough of a shout out to the International OCD foundation, iocdf, who really takes such a wonderful leadership role worldwide. They're based in the us, but it's really worldwide in terms of organizing this community. And, you know, every time someone shares their story of having OCD or working with someone, with treating someone with ocd, and I hear about how folks are, you know, approaching, leaning into their fear instead of running away from it. It just reinforces how much, you know, how much hope that we have where we can really help people to reclaim their lives. And, yeah, that gives me a lot of hope.
- [50:17]
A
Me too. Thank you so much. Thank you so much again. This has been so wonderful.
- [50:22]
B
You bet, Kim. Thanks for having me.
- [50:26]
A
Please note that this podcast or any other resources from CBTSchool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day and thank you for supporting CBTSchool.com Sam.