Abstract
Alongside concern about the physical health impacts of the coronavirus disease 2019 (COVID-19) crisis, public health officials have also raised concerns about the potential for massive mental health impact. This has led many to wonder, how are individuals with obsessive-compulsive disorder (OCD), and especially those with contamination fears, doing in the era of COVID-19? We present data from eight patients in our residential treatment program for OCD who were admitted prior to any COVID-19 restrictions and continued in treatment at the facility during the pandemic. Much like the general population, our patients varied in the ways they were impacted by COVID-19, yet the majority experienced improvements in OCD symptoms despite the context. This is not to downplay the many ways in which our patients were personally affected by COVID-19. Rather our patients’ relatively resilient responses mirror our program’s treatment model, which emphasizes exposure and response prevention (ERP) within the complementary framework of acceptance and commitment therapy (ACT). The intention of this article is to challenge the notion that by definition this population will fare worse than the general public or that ERP cannot proceed effectively during this time. In contrast, we underscore that effective OCD treatment can and should continue in the era of COVID-19.
Highlights
Coronavirus disease 2019 (COVID-19) was identified on December 31, 2019 and has become a global pandemic (World Health Organization, 2020) that has resulted in over 4 million positive cases and over 146,000 deaths in the United States alone (Centers for Disease Control and Prevention, 2020)
This has led many to wonder, how are individuals with obsessive-compulsive disorder (OCD), and especially those with contamination fears, doing in the era of COVID-19? Myriad articles written by popular press and professional organizations have speculated about this topic and offered suggestions (Anxiety and Depression Association of America, 2020; Fontenelle and Miguel, 2020; International OCD Foundation, 2020; Rosman, 2020)
COVID-19 provided opportunities or motivation to more fully engage in exposure (Patients 1, 2) or other treatment goals (Patient 3)
Summary
Coronavirus disease 2019 (COVID-19) was identified on December 31, 2019 and has become a global pandemic (World Health Organization, 2020) that has resulted in over 4 million positive cases and over 146,000 deaths in the United States alone (Centers for Disease Control and Prevention, 2020). At the broader societal level, it has been noted that COVID-19 has the potential for positive impacts on mental health and wellbeing, including increased time for exercise, healthy eating, family, and friends (Delgado, 2020) Given these mixed hypotheses about the impact of COVID-19 on the population we serve, we present both quantitative and qualitative data from eight patients in our residential treatment program. Their clinicians noted that the patient remained fully engaged in treatment despite these increased anxieties and spent more time thinking about how to engage in activities with meaning and enjoyment This patient presented with harm obsessions and contamination fears resulting in vomiting. The patient made good progress despite setbacks during stressful events and notably completed home-based exposures via a newly-developed virtual treatment program following discharge This patient presented with harm and contamination symptoms, including fear of bodily fluids and contracting disease. The patient mentioned feeling as though the social connection and activities provided through the program structure were helpful in managing symptoms
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