Discovering ways to improve treatment: Rogers researcher awarded grants for OCD research

Rogers’ first prime federal award funds perinatal OCD research, IOCDF grant funds work into non-fear-based OCD

Knowing how powerful tailored approaches to OCD treatment can be, associate research psychologist at Rogers Research Center, Rachel Schwartz, PhD, wants that option available to everyone.

“My passion, and a large reason I got into this work, is to help the people who are currently not benefiting from existing treatments, as powerful as they are,” Dr. Schwartz says. “Still, so many folks are in need of treatment that works for them. Much of my research has been geared toward trying to figure out how we can better serve them by modifying treatments to better suit their needs.”

Two major research grants spearheaded by principal investigator Dr. Schwartz are helping make that work possible.

NIMH grant funds research into perinatal OCD

A grant awarded to Dr. Schwartz from the National Institute of Mental Health (NIMH) marks Rogers’ first federal grant as a prime awardee, providing more than $100,000 over two years for research into perinatal OCD.

People with perinatal OCD, meaning during or after pregnancy, are often difficult to study because as a vulnerable population, they are excluded from clinical trials, Dr. Schwartz explains.

“But that doesn’t stop these folks from showing up for treatment in the real world, like at Rogers,” Dr. Schwartz says. “So how can we leverage the data we have spanning decades to answer some of our burning questions?”

Those questions include what kinds of treatment patients with perinatal OCD receive, how well they work and are tolerated, and whether the treatments should be adapted.

This research is in collaboration with the University of Pennsylvania, with Erica Weitz, PhD, as co-Principal Investigator along with Dr. Schwartz.

IOCDF grant awarded for non-fear-based OCD work

Dr. Schwartz also received a $50,000 grant  from the International OCD Foundation (IOCDF) to fund work to develop and pilot test a treatment protocol for forms of OCD driven by emotions other than fear or anxiety, including disgust and incompleteness, or feeling “not just right.” The prestigious Michael A. Jenike Young Investigator Award will provide funding for Dr. Schwartz’s project titled “Nothing to fear: Developing and piloting treatment and training procedures for non-fear based presentations of obsessive-compulsive disorder.”

As OCD was traditionally thought of as an anxiety disorder, Dr. Schwartz says, it is not surprising that the first line treatment — exposure plus response prevention — was designed to address fear and anxiety more so than symptoms driven by other emotions.

“Historically, we have thought about OCD in terms of the ‘what’ of symptoms, like having washing OCD or checking OCD, but it is really important to also think about the why,” she says. “Because someone might perform washing or checking compulsions for any number of reasons – may it be fear, disgust, or “not just right” feelings —  and that should inform how we tailor treatment.”

Keeping that in mind, potential treatment modifications include providing greater guidance for clinicians in how to assess and design exposures that elicit non-fear emotions and changing the length of treatment, how it is offered, and the types of learning treatment emphasizes. For example, Dr. Schwartz says since disgust and incompleteness may be learned differently from fear, treatment for non-fear-based OCD may be enhanced by adding elements that are not typical of exposure therapy, such as positive stimuli, relaxation and distraction, and strategies from other therapies.

In the case of disgust OCD, Dr. Schwartz explains that “instead of treatment that gets a patient into a state of disgust and works to bring it down over time, what we might do is conjure the feeling of disgust and add something positive, such as relaxation, photos of cute animals, or even new information, to facilitate a different type of learning about a stimulus. When OCD is driven by emotions other than fear, many of the traditional emphases of exposure therapy just don’t apply, like testing feared outcomes or seeing that distress naturally habituates.

“It may be that we need to be focusing on different kinds of learning altogether—like helping patients get back to their core values and the things that make life worth living.”

The IOCDF research grant begins in September.