New OCD study: Deep brain stimulation effects on patients

People with Obsessive Compulsive Disorder (OCD) suffer from obsessions, compulsions, or both. Obsessions are intrusive thoughts which cause anxiety and distress. To neutralize these thoughts, people with OCD may have compulsions which prevent or reduce anxiety: “repetitive (mental) acts, such as hand washing, ordering, checking, counting, or praying.”

Patients have a very strong need to complete their compulsions, which take on a ritualistic importance. About 50-60% of patients find results with cognitive behavioral therapy (CBT), where individuals challenge their brain patterns and behavior; in this case, whenever a compulsion arises, patient directly confront their need to complete it.

For those individuals who aren’t helped by CBT, there is another type of therapy — deep brain stimulation (DBS). Patients have electrodes implanted in their brains “which give a continuous electrical pulse to modulate specific brain areas.” DBS began as a treatment for movement disorders, like Parkinson’s Disease. Some studies reported that patients with OCD who had DBS therapy felt decreases in anxiety, panic, and fear, whereas others found the exact opposite. Researchers in this article published in PLOS One called for a more thorough examination of a “broad investigation of all changes in experiences–not only those that are measured by standard psychopathological and functional scales,” as well as patients’ attitude toward DBS.

Researchers studied 18 individuals with OCD, which consisted of 10 women and 8 men. Participants were interviewed anywhere from 6 to 91 months after DBS treatment: some individuals had completely recovered from their OCD by the time the interviews were conducted. Interviewers spent anywhere from 1 to 3 hours with the participants. Researchers coded responses based on keywords.

Most participants said that they felt less anxious, more hopeful, and had experienced perspectives they previously had not. These participants also said they felt more self-confident and expressive toward others. In terms of their social interactions, most comments were also positive, with participants saying they felt they had more time for their social lives, less dependency on others, and more engaged and interested.

Researchers commented, “Not only the participants and their (social) life world changed, so did the way in which they interacted with the world and with others… In other words, their mode of engagement changed.” Members of the study felt increased concentration and flexibility in behavior and thinking. All of the participants had some compulsions remaining, but the need to complete the soothing actions was less burdensome and were less stressed when performing them.

Finally, participants commented on receiving DBS. For most, DBS was the last resort for treatment for OCD. Many were worried about the negative reactions from others. Some participants felt as though DBS had not helped them overcome their compulsions as much as they would have liked. Out of 18 members of the study, 14 felt significantly more free after treatment; they were no longer tied down (as much) by their compulsions. This new freedom allowed participants to “re-orient their lives,” which for some includes rediscovering their sense of self — who they are, what they like to do on weekends, what they want to do.

It is noted very heavily that researchers suggest using DBS with some other form of therapy (medication, CBT, etc). With the effectiveness of DBS for patients with OCD, it is important to test DBS for other debilitating disorders. In terms of DBS treatment, more clinical studies may be needed to determine specific markers for DBS working for the patient. While much of its results are still unexplored, it is essential that researchers evaluate patients’ experiences as well as clinical practice.