Putting OCD on blast: Highlights from the 2024 IOCDF Online Conference
This blog is all about my experience at this year’s International OCD Federation’s annual online conference where thousands of therapists and people living with OCD and OCD-related issues gathered to learn, teach, and provide one another support.
First: a bit of history! The IOCDF was started in 1986 as a grassroots support group for and by people living with OCD. It’s grown into an internationally recognized hub of resources for people with OCD, their loved-ones, and mental health professionals. There are a lot of mental health organizations out there, but what makes the IOCDF especially cool is that their conferences incorporate mental health professionals and people living with OCD and their loved ones. This is a powerful mix.
These are huge events filled with speakers, workshops, discussion groups, and education. Attendees can learn about the latest research, pick up new tips, and sharpen their skills. For me and my practice here in Denver, Colorado, it’s an event I look forward to every year. I especially love meeting new colleagues and sharing my passion for this work with other dedicated practitioners.
This year’s conference featured over 80 sessions! Below are some highlights from just a few of the sessions I attended. (Some of this may be geared toward providers working in the field more than to clients. If you are curious about anything you read here, feel free to e-mail me, and I’ll be happy to begin a discussion with you.) At the end of this blog I’ll share my reflections on the experience at the conference overall. So read on! We’re putting OCD on blast.*
*These notes should not be considered therapy or a replacement for therapy. If you think you have OCD, please reach out to a licensed clinician to discuss your options for treatment.
Some Sessions I Attended at the Conference:
Is This Really OCD? … A session on spotting issues that look like OCD, but aren’t. Expertly presented by Marla Deibler, PsyD, ABPP; Ilana Cohen, MD; Renae Reinardy Spiry; and Jon Hershfield, MFT.
“We will be like detectives together.”
I often say to clients, “We will be like detectives together.” We look for clues, collect evidence, come up with hunches, and we don’t stop until we solve the mystery!
This informational session took a curious and investigative approach to symptoms that seem like basic OCD on the surface, but that—after a functional analysis (looking at the function, effects, and context)—may be determined as coming from other causes. Determining if intrusive, unwanted thoughts or repetitive behaviors are OCD-driven is vital if we hope to help a person find relief from these disruptive and disturbing symptoms.
Many clinical presentations and mental health issues only mimic the thoughts and behaviors of OCD. Fortunately, when a therapist is armed with a working knowledge of these presentations and has the wisdom to “tease them out” through standardized measures and nuanced clinical interview, clients can feel confident that they are focussing on the issues that will help them move along on their journey to wellness and recovery.
Takeaway: Effective treatment relies on therapists staying well-versed diagnostically, staying flexible, taking our time, and being ready to refer to specialists when things go beyond our scope of practice.
2. When ERP Comes Up Short… A session covering strategies to get us unstuck when the path seems blocked. Expertly presented by Jonathan Abramowitz, PhD; Katy Higgins Neyland, PhD; and Bronwyn Shroyer, LCSW.
ERP is often called “the Gold standard” of OCD treatment.
Exposure and Response Prevention is considered by many to be “the Gold standard” of OCD treatment. A 2019 meta-study estimates 50-60% of people who complete ERP treatment show significant symptom reduction (Law & Boisseau, 2019). That’s fantastic for those in the 60%, but what about the other 40%? And what about the folks who are getting some relief, but then get stuck on a particular obsession?
The thoughtful therapists in this session reviewed therapeutic modalities that can help stuck clients make breakthroughs. They discussed interventions and tools from ACT (Acceptance and Commitment Therapy) and DBT (Dialectic Behavioral Therapy). I consider myself an ACT therapist, so this was exciting for me. I also have some training in DBT which I’ve seen be enormously helpful to dedicated clients and HSPs—highly sensitive people. Perhaps most exciting was Bronwyn Shroyer’s eloquent introduction to I-CBT (Inference-based Cognitive Behavioral Therapy), an up-and-coming protocol for treating OCD that I use in my office here in Denver.
3. Discussing Medication… A session on empowering clients in their decisions about medication. Presented by Kim Rockwell-Evans, PhD; Alie Bernard Garza, LCSW; Stacy Greeter, MD; and Carly Samach.
Image created by Stacy Greeter, MD, et al.
Proving that presentations can be inspired, silly, and still incredibly useful, these presenters gave us an awesome STAR WARS themed talk complete with music and memes (oh the memes!), and they even dressed up in costume. Using examples of how Obi-Wan would speak to his therapy clients about medication, or how Dr. Yoda would consult with a therapist, we learned about the undervalued—yet critically important—process of empowering clients to make informed and meaningful decisions about medication. We also discussed ways to help prepare clients for the discussions with their doctors, and how we ourselves can collaborate across disciplines to help set them up for success.
Takeaway: Interdisciplinary collaboration—therapists working with doctors—is an important, often overlooked part of treatment. We have a meaningful role helping clients make values-based decisions about medicine, supporting them through the transitions, advocating on their behalf, and empowering them to advocate for themselves.
4. Unified Protocol… A session outlining a transdiagnostic approach to OCD treatment. Presented by Peter Aston, PsyD; Michael Upston, LCSW; Sony Khemlani-Patel, PhD.
People do not always fit neatly into boxes,
The DSM-5 categorizes all the mental health conditions that licensed therapists treat or help manage. These categories are created so that scientists and doctors can study mental illness with integrity using the scientific method. Sometimes a diagnosis can even be empowering to a client, other times stigmatizing. For a clinician, diagnosing can be focussing, but it can also be limiting. People, their feelings, their behaviors, do not always fit neatly into boxes, and there are many common mental processes present across different diagnoses. When we approach mental health with an adaptable, humanist stance, therapists are more agile and affective at addressing the full person in our work.
Takeaway: Rigidly adhering to diagnoses in assessment and treatment planning can cause us to miss important clinical information. Being flexible and open-minded allows us to pivot with the needs of the client. “A good therapist is a chef, not a cook.”
5. “All In Your Head”… A session about internal rituals, those mental processes which often go unnoticed and which are so important to identify and address. This was a fascinating conversation presented by Charles Mansueto, PhD and Charles Mansueto, PhD
Internal rituals take place in the mind.
This was one of my favorite sessions of the entire conference. The presenters discussed the colloquially-termed “Pure ‘O’” or “Purely Obsessional” presentation of OCD. “Pure O” is put in quotes because it is most certainly not without the compulsive component. The nickname can be misleading, but it can also inform us as to where the compulsions or rituals take place. They take place internally, in the mind. Treating OCD with primarily internal compulsions (Pure ‘O’) takes finesse and creativity. (It’s one of my favorite parts of the work.) It also must be teased apart to determine if the compulsory thinking is obsessional in nature or ruminative (as in Depression) or worrying (as in Anxiety). There is nuance here, but—good news—with some care and dedication, we can pick it apart and help put a person get back in the driver's seat of their own life.
Takeaway: My favorite moment in this session was hearing this tip on determining the difference between general anxiety and OCD: “People often share their worries and anxieties with others, but they generally keep their obsessions to themselves.” So, if you’re wondering which it might be, think about the last time you chatted about these thoughts with your friends.
6. “Imagination Station”… A workshop teaching the finer points of creating imaginal exposures in ERP. This was superbly taught by Julia Hale, LICSW; Jayme Valdez, MA, LMHC; and Allison Solomon, Psy.D.
When we teach people Exposure and Response Prevention (ERP), it is often useful to use a technique called imaginal exposures. (If you’re unfamiliar with how ERP works, here is a nice boring article from the super-smarties at McClean Hospital in Massachusetts.) In very short terms, ERP is a methodical, evidence-based program aimed at decreasing your reaction to obsessive thoughts using a mechanism called habituation. Think: watching the same horror movie over and over until you’re board of it and it doesn’t scare you anymore. The client starts small—with the easy stuff—and builds their way up to the most scary stuff.
Watching the same scary movie over-&-over until it gets boring = exposure.
Imaginals—or imaginal exposures—are often necassary because the thing we are obsessing about is not something we can go and create, or get, or do (as we would do with a traditional exposure). In these cases we create a written script detailing the story of the obsession, and then we practice reading that story to ourselves while resisting the urge to disengage, flee, or do some ritual to get rid of the anxiety. Then, like watching The Exorcist for the 40th time, we get super board of the story, and it no longer has control over us and our lives.
Takeaway: Lots of great tips in this session. A gem among them was the importance of folding ACT (acceptance and commitment therapy) directly into the creation and the content of the imaginal script. Connecting to values—the why— sets folx up for success.
Overall thoughts.
OCD is bigger than just “hand washing.” And it’s definitely not a joke—as in “Oh, I’m so OCD”. OCD can wreck lives and wreak havoc on families. And there are many serious issues related to the diagnoses of obsessive compulsive disorder—related issues like hoarding, panic, body dysmorphia, skin-picking. Whatever form it takes, OCD is an insidious, at times monstrous thing to experience, and the people who face it and do battle are among the bravest people I have ever met. A mentor of mine once said they like treating OCD because they get to see people engaging in courageous acts all day long. This conference is full of courageous people doing courageous acts.
The IOCDF is one of those rare groups that really delivers on their mission and more. They provide a hub of community support, education, and activism for people living with OCD and for professionals treating OCD. But the IOCDF doesn’t exist without the courage of those people facing up to their OCD every day. So my ultimate gratitude goes to them.
If you are living with OCD, or one of the related issues listed above, please understand that you are not alone, that there is no shame, and that seeking help can be the most powerful action you ever take for yourself and for everyone you love. Reach out to me with questions or visit the IOCDF to find resources.
Sources:
Law C, Boisseau CL. Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: Current Perspectives. Psychol Res Behav Manag. 2019 Dec 24;12:1167-1174. doi: 10.2147/PRBM.S211117. PMID: 31920413; PMCID: PMC6935308.
