Therapy program helps patients short circuit obsessive-compulsive behaviors

June 1, 2013



A pregnant Jennifer Noetzel knew she needed serious help managing her obsessive-compulsive disorder when she insisted her husband exchange all the gifts she had received at a baby shower for the exact same ones.

Noetzel, 33, feared she had contracted toxoplasmosis, a parasitic disease that can be spread by cats, and was sure the gifts were contaminated. The friend who hosted Noetzel's baby shower had an outdoor cat.

While toxoplasmosis generally causes a mild, symptomless illness in people with healthy immune systems, it is risky during pregnancy because the parasite may infect the placenta and unborn baby.

"Even though there was no evidence the cat had toxoplasmosis or that the gifts were contaminated, I was convinced otherwise. I felt I was protecting my baby," said Noetzel, who delivered her son Joshua in October 2011. "When I got home from the shower, I started scrubbing everything the gifts might have touched in my house. Throughout my pregnancy I worried excessively about the health and safety of my baby."

Jennifer Noetzel with son Joshua.

After Joshua's birth, Noetzel became paralyzed with fear that she would somehow harm the baby. That fear, she says, grew out of having been sexually abused as a child. She wondered if breast-feeding was OK. What about touching him when she changed his diaper? Was she being inappropriate?

"I got super anxious and really started freaking," she said. "That's when I realized I needed intensive help. I had to be able to take care of my baby and be there for him."

Facing down fears
A therapist referred Noetzel to the Alexian Brothers Center for Anxiety and Obsessive Compulsive Disorders at Alexian Brothers Behavioral Health Hospital in Hoffman Estates, Ill. The hospital is run by Alexian Brothers Health System, which operates five Catholic hospitals in the northwest suburbs of Chicago.

The goal of the Center for Anxiety and Obsessive Compulsive Disorders, which is led by clinical psychologist Patrick McGrath, is to help people with anxiety and obsessive-compulsive disorders learn to handle their anxiety disorders and manage future stressors.

Rather than encourage clients to avoid their anxiety — which tends to be a short-term fix — therapists at the center help clients face their fears by immersing them in anxiety provoking situations.

"Most therapists only work on changing how people think and feel about their anxiety," said McGrath. "We use cognitive-behavior therapy and exposure and response prevention to change behavior.

"When it comes to an anxiety disorder, behavioral change is the ultimate measure of whether or not a person is still anxious," he continued. "By confronting the events that cause the anxiety rather than avoiding them or continuing to seek reassurance, a person can learn to face their fear and handle it. That way, the anxiety decreases."

McGrath explained learning to face one's fear and changing behavior comes "slowly and gradually. It is not a flooding experience."

Risks and rewards
The center has been operating for six years. It treats between 300 and 500 patients annually, all of whom receive therapy on an outpatient basis. In the "day hospital" program, patients typically spend up to six hours a day in treatment Monday through Friday, for four to six weeks. There is an evening and weekends option for patients who work during the week. "Most of the time, people take a leave of absence from their job or school because of the intensity of their anxiety," said McGrath. "The program is really designed for people who are disabled by their anxiety."

Noetzel spent 12 weeks driving 50 minutes each way, five days a week to get the help she needed. She says insurance paid for the bulk of her treatment, though she was responsible for an $88 daily co-pay. "It was pricey, but it was worth it. In my case, it took longer because I was dealing with two major OCD issues — contamination and intrusive thoughts about harming my baby," she said. "I needed to learn coping techniques for both."

As part of her therapy, Noetzel had to list her fears and rate them on a scale from 1 to 10. With her contamination issues, she assigned a "3" or "4" to things like touching door handles, drinking from water fountains and pressing elevator buttons and a "10" to her worst fear — Joshua contracting toxoplasmosis and dying, a fear that lingered for her after her son's birth.

"You start with the low numbers and work your way up the hierarchy, exposing yourself to your fears until you realize you can survive them," she explained. "You confront your fears so that you do feel extremely anxious. You go through the anxiety, not around it. I came home exhausted every night."

Repeat exposures
McGrath says the hierarchical list not only details what a patient is afraid of, but also provides themes about the fear. For example, some patients fear confronting a certain anxiety could lead to excessive sweating, panic attacks or worse, death. Therapists then develop exercises, called exposures, to address each fear, having patients practice them multiple times until the anxiety decreases.

"We want people to learn their worst case scenarios do not happen, or if they do, then they can handle them," said McGrath.

To cope with her complex emotions related to changing Joshua's diaper, Noetzel used an anatomically correct doll. "At first I couldn't change the doll's diaper at all. Then I could take the diaper off but only with the doll on its stomach," she explained. "I brought baby wipes, diaper rash cream and diapers with me each day. Eventually, I could change the diaper but only with the baby's face down. I did that for two or three days over and over. Then I turned the doll over and started changing the baby doll face up. I did that exposure for eight or nine days, until my anxiety level kept going down and down to the point where my goal was to go home and change Joshua once, then more and more."

These days, when Noetzel gets anxious about changing Joshua's diaper, which she sometimes does, she practices diapering the doll. "I still am sometimes anxious changing Joshua's diaper," said Noetzel. "I know mentally I'm not being sexually inappropriate but my OCD tells me something different.

"What helped so much was hearing (at the center) how common this is," she continued. "As a new mom, you're like what the heck? I love my baby. What's wrong with me? To hear that they see this behavior all the time was huge."

Like Noetzel, Sharon Nutter, 43, who sought treatment at the anxiety center for two weeks last year, knows her obsessive compulsive disorder will never completely be gone. "But through the exposures, and group and individual therapy, as well as the right meds, I now have the tools to manage my anxiety and have a much better grip," she said. "Fear no longer cripples me."

Adds Noetzel: "I have my life back now and my son has his mom back. I've even been in a house with outdoor cats, and it wasn't that big a deal."

Anxiety disorders are common, but few seek treatment

  • Anxiety disorders are highly treatable, yet only about one-third of those suffering receive treatment.
  • Anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.
  • People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders.
  • Anxiety disorders include obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, and specific phobias, among others.

— Source: Anxiety and Depression Association of America

Using virtual traumatic experiences to reduce war's emotional consequence

For the past few years, the Center for Anxiety and Obsessive Compulsive Disorders at Alexian Brothers Behavioral Health Hospital has been working extensively with recent war veterans dealing with post-traumatic stress disorder, using a three-dimensional virtual reality simulator.

Dubbed "Virtual Iraq," veterans taking part wear goggles and headphones and use a joystick to negotiate roadside bombs and snipers to simulate their war experiences and work through trauma.

"By slowly exposing them to the sensations that trigger their anxiety, the simulator helps them to overcome fears of loud noises and stressful situations and they learn to handle them without anxiety or panicking," said Patrick McGrath, director of the Center for Anxiety and Obsessive Compulsive Disorders.

"That helps reduce symptoms like insomnia and flashbacks."

The center received a $97,500 grant from the Illinois Department of Veteran Affairs in 2009 to buy the simulator and provide counseling for veterans and their families and diagnostic screening to differentiate between post-traumatic stress disorder, traumatic brain injury and depression — three conditions affecting these veterans.

McGrath says these efforts, along with serving people who often feel hopeless, support the hospital's mission. "We can offer people who have suffered so long with anxiety disorders therapy that truly works," he said. "We say to people, if you are afraid, we can teach you to handle your fears so that you can not only manage your life, but enjoy it as well."

— Ellen Futterman

Copyright © 2013 by the Catholic Health Association of the United States
For reprint permission, contact
Betty Crosby or call (314) 253-3477.

Copyright © 2013 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.