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Treatment options for OCD

Many people who experience OCD symptoms never seek treatment, perhaps because symptoms can come and go and they can vary in severity over a lifetime.

With OCD, getting treatment early on is usually the best course of action. Outcomes tend to be more successful with early intervention and appropriate care.

Outcomes are also better Trusted Source when treatment is provided by an interdisciplinary healthcare team. This can include doctors, psychologists, psychiatrists, psychiatric nurses, and pharmacologists who work together to create a treatment plan that meets your individual needs.

Most people with Obsessive Compulsive Disorder suffer from both obsessions and compulsions. “Obsessions” are thoughts, mental pictures, or impulses that are upsetting but that keep coming back. “Compulsions” are actions that people feel they have to perform to keep from feeling anxious or to prevent something bad from happening.

Common obsessions include fears of getting a disease, fears of hurting someone, fears of forgetting to do something, and fears of doing something embarrassing or immoral. Compulsions are also called “rituals.” Common compulsions include excessive washing or cleaning, checking, repeating actions, hoarding and putting objects in a set pattern.

Most people with OCD know that their fears are not completely realistic at least some of the time. They also feel that their compulsions do not make sense. However, they find themselves unable to stop. Cognitive-behavioral ocd therapy has been demonstrated by research to help people manage and overcome obsessive-compulsive disorder.

PSILOCYBIN AND OCD

Research supporting psilocybin’s use in treating OCD

Despite a paucity of clinical trials investigating the anti-obsessional effect of psilocybin,

converging evidence from a number of sources, as well as an array of possible

mechanisms of action, lend support to its plausibility as a treatment. Although a

considerable number of user reports on the internet - and one critically acclaimed stand-

up comedy show, developed and performed by an OCD patient - attest to the efficacy of

psilocybin, their comparatively low evidentiary weight preclude their exploration here.

In a rodent model of OCD - marble burying behavior - Matsushima and colleagues

(2009) studied the effects both of psilocybin, and a solution of powdered Psilocybe

argentipes, in mice. While both synthetic psilocybin and the mushroom solution were

recorded to reduce marble burying without reducing general locomotor activity, this

study bears three points worthy of consideration. Firstly, compared to psilocybin, a

much smaller dose of mushroom extract was required to produce significant effects on

marble-burying, suggesting a partial therapeutic role for other components of P.

argentipes. The other psychoactive alkaloids found in the Psilocybe genus, baeocystin

and norbaeocystin, may exert independent effects, or interact with psilocin in an

‘entourage effect’. Secondly, other work investigating psilocybin in rodent models has

failed to detect any therapeutic benefit. Psilocybin produces no change in a rat model of

depression (Jefsen et al., 2019), despite strong antidepressive action being repeatedly

found in human trials. Further research is required to account for this difference, but it

may be that antidepressive action requires cognitive or psychological abilities lacking in

rodents (e.g., the perception and processing of awe or meaning), whereas anti-

obsessional effects are mainly driven by direct pharmacological mechanisms. Finally,

any proposed pharmacological model of the reduction of marble-burying should aim to

go beyond a simple account of agonism at one receptor, since P. argentipes did not

produce a proportional dose-response relationship, displaying instead an inverted ueffect..

The important thing is that most of the positive changes that occur after well-planned psilocybin therapy by a psychotherapist occur after the session. And during the session, a person just feels all the usual attributes of a trip, such as hallucinations, changes in the nature of the flow of thoughts, changes in attitude. Again, these feelings are not the end goal of therapy, but its side effect, as if we were considering top nootropics for the long term. Therefore, taking psilocybin for the sake of glitches is like accelerating a plane so that the engine roars louder.

An important point that will be repeated several times in the text: just because something causes a boost in neuroplasticity, this does not mean that a person will have a positive effect. And this is not necessarily evidence that the therapy was successful. For neuroplasticity to have a therapeutic effect of psilocybin in addiction, it must help a person become more adaptive, develop skills or feelings that will help him function more effectively in life.

The material also touches on the topic of how the conditions of a psilocybin trip affect a person. How does the condition change if therapy is carried out with closed or open eyes, do phases with closed and open eyes alternate, and does music play during the procedure? Moreover, depending on what kind of music was played during the procedure, how a person will feel a few days, weeks and months after a course of psilocybin therapy depends. Which already offers effectiveness at the level of what CBT psychology offers.

The doغیر مجاز می باشدe, types of psilocybin and the number of psilocybin sessions are also important. Even one psilocybin trip can improve your mood in the long term. But most clinical studies use two doses, very precisely spaced apart. And all the auxiliary factors: closed/open eyes, music and the work of the sitter are extremely important.

So whether you are interested in participating in or setting up a clinical trial using psilocybin, or are interested in psilocybin for other reasons, this information is critical to understand.

Disclaimer 2: At the time of writing and publication of this material, in 2023, psilocybin is still a banned substance in most countries of the world. Unless, in the state of Oregon, psilocybin was approved for therapeutic use for certain diseases: namely, to get rid of depression and several forms of addiction. So in Oregon it is more or less decriminalized, but not legal. But in general, psilocybin and other psychedelics are still considered illegal. Possession and sale of psilocybin is punishable by law. Do not use psilocybin without government approval or in violation of the law.

The reason for writing/translating the material is that I believe that with this knowledge, you will be able to draw your own conclusions about what psilocybin mushrooms are and what role they can play in human life.

Diagnosis

Your health care provider will want to determine whether other conditions may be causing your anxiety or if you have social anxiety disorder along with another physical or mental health disorder.

Your health care provider may determine a diagnosis based on:

Physical exam to help assess whether any medical condition or medication may trigger symptoms of anxiety

Discussion of your symptoms, how often they occur and in what situations

Review of a list of situations to see if they make you anxious

Self-report questionnaires about symptoms of social anxiety

Criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

DSM-5 criteria for social anxiety therapy disorder include:

Persistent, intense fear or anxiety about specific social situations because you believe you may be judged negatively, embarrassed or humiliated

Avoidance of anxiety-producing social situations or enduring them with intense fear or anxiety

Excessive anxiety that's out of proportion to the situation

Anxiety or distress that interferes with your daily living

Fear or anxiety that is not better explained by a medical condition, medication or substance abuse

Care at Mayo Clinic

Our caring team of Mayo Clinic experts can help you with your social anxiety disorder (social phobia)-related health concerns

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Treatment

Treatment depends on how much social anxiety therapy disorder affects your ability to function in daily life. The most common treatment for social anxiety disorder includes psychotherapy (also called psychological counseling or talk therapy) or medications or both.

Psychotherapy

Psychotherapy improves symptoms in most people with social anxiety disorder. In therapy, you learn how to recognize and change negative thoughts about yourself and develop skills to help you gain confidence in social situations.

Cognitive behavioral therapy (CBT) is the most effective type of psychotherapy for anxiety, and it can be equally effective when conducted individually or in groups.

In exposure-based CBT, you gradually work up to facing the situations you fear most. This can improve your coping skills and help you develop the confidence to deal with anxiety-inducing situations. You may also participate in skills training or role-playing to practice your social skills and gain comfort and confidence relating to others. Practicing exposures to social situations is particularly helpful to challenge your worries.

First choices in medications

Though several types of medications are available, selective serotonin reuptake inhibitors (SSRIs) are often the first type of drug tried for persistent symptoms of social anxiety. Your health care provider may prescribe paroxetine (Paxil) or sertraline (Zoloft).

The serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor XR) also may be an option for social anxiety disorder.

To reduce the risk of side effects, your health care provider may start you at a low dose of medication and gradually increase your prescription to a full dose. It may take several weeks to several months of treatment for your symptoms to noticeably improve.

Diagnosis

Your health care provider will want to determine whether other conditions may be causing your anxiety or if you have social anxiety disorder along with another physical or mental health disorder.

Your health care provider may determine a diagnosis based on:

Physical exam to help assess whether any medical condition or medication may trigger symptoms of anxiety

Discussion of your symptoms, how often they occur and in what situations

Review of a list of situations to see if they make you anxious

Self-report questionnaires about symptoms of social anxiety

Criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

DSM-5 criteria for social anxiety therapy disorder include:

Persistent, intense fear or anxiety about specific social situations because you believe you may be judged negatively, embarrassed or humiliated

Avoidance of anxiety-producing social situations or enduring them with intense fear or anxiety

Excessive anxiety that's out of proportion to the situation

Anxiety or distress that interferes with your daily living

Fear or anxiety that is not better explained by a medical condition, medication or substance abuse

Care at Mayo Clinic

Our caring team of Mayo Clinic experts can help you with your social anxiety disorder (social phobia)-related health concerns

Start Here

Treatment

Treatment depends on how much social anxiety therapy disorder affects your ability to function in daily life. The most common treatment for social anxiety disorder includes psychotherapy (also called psychological counseling or talk therapy) or medications or both.

Psychotherapy

Psychotherapy improves symptoms in most people with social anxiety disorder. In therapy, you learn how to recognize and change negative thoughts about yourself and develop skills to help you gain confidence in social situations.

Cognitive behavioral therapy (CBT) is the most effective type of psychotherapy for anxiety, and it can be equally effective when conducted individually or in groups.

In exposure-based CBT, you gradually work up to facing the situations you fear most. This can improve your coping skills and help you develop the confidence to deal with anxiety-inducing situations. You may also participate in skills training or role-playing to practice your social skills and gain comfort and confidence relating to others. Practicing exposures to social situations is particularly helpful to challenge your worries.

First choices in medications

Though several types of medications are available, selective serotonin reuptake inhibitors (SSRIs) are often the first type of drug tried for persistent symptoms of social anxiety. Your health care provider may prescribe paroxetine (Paxil) or sertraline (Zoloft).

The serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor XR) also may be an option for social anxiety disorder.

To reduce the risk of side effects, your health care provider may start you at a low dose of medication and gradually increase your prescription to a full dose. It may take several weeks to several months of treatment for your symptoms to noticeably improve.

At the first stage, the person denies what happened. On the second, he realizes what happened and experiences strong emotions (fear, horror, anger, sadness). On the third, he accepts what happened and adapts. If after the second stage a person does not move on to the third stage and gets stuck in the trauma, he develops PTSD.

In the acute period (the first month after the traumatic event), a crisis psychologist works with the client. For example, if we are talking about shock due to physical trauma, being in a military conflict zone. And the trauma therapist gets involved later.

The psychologist’s task is to help the client live through the second and third stages. To do this you need:

Inform the client. Tell him that his condition is a normal reaction to a traumatic situation. Recommend books, talk about PTSD. It is important that the client understands what is happening to him and that it can be dealt with.

Work with the individual holistically. It is important not only to remove the symptoms of PTSD and work out the cause, but also to explain to the client the importance of a healthy lifestyle. Help him maximize his personal potential.

Provide social support. Communication with a psychologist already provides a powerful base, but it is important that other people also support the client. This could be friends, family or therapy groups.

Help the client individually reassess the traumatic experience. Direct processing of trauma.

PTSD Treatment Plan

1. Establishing contact. The specialist needs to determine the client’s motivation and mood, his attitude towards therapy, himself and the psychologist himself. Set up for work: talk about PTSD, therapy, talk through the client’s fears and anxieties.

The goal of therapy is to help the client feel in control of life, accept experience, and take responsibility. At the beginning, it seems to him that the future is doomed, and the pain will never go away. The psychologist’s task is to set the client up for work. To do this, at the stage of establishing contact, you can ask questions:

What helped you cope at that moment?

What has kept you going all this time?

What you went through is terrible, but can you say that it made you stronger?

What resources did you see in yourself then, and do you see now?

What would you say to someone who has experienced something similar?

In the work, you can ask questions from three groups: establishing contact, collecting information about the injury, maintaining the client’s confidence. It is important to move at a pace that is comfortable for the client to avoid retraumatization.

2. Working with emotions. The psychologist needs to help the client release repressed feelings and emotions. And also ask the client’s loved ones to support the experience of emotions, and not try to distract him.

3. Processing traumatic memories. The psychologist’s task at this stage is to work through the trauma using psychotherapy methods.

In addition, the psychologist must remember that a person may have several traumas, and they may overlap each other. And the subjective perception of a traumatic situation is different for each client. There cannot be a universal algorithm in PTSD therapy; in this article we have analyzed the basis of the work.

Augmented therapies: psychedelic substances, scientific evidence (Henrik Jungaberle)

Augmented therapies combine therapy and the taking of psychedelic substances. In Germany, the development of this emerging technique is supported by the MIND Foundation, which participates in scientific studies, organizes an international congress and trains doctors. A request is even underway for doctors in training to be able to experiment with these psychedelic substances themselves. It must be said that the clinical results of this innovative treatment look promising, particularly for the treatment of recalcitrant depression. Explanations from Dr Jungaberle, director of the MIND Foundation.

We created this non-profit organization five years ago to support research, scientific communication and continuing education for doctors and psychotherapists. For two years, OVID Clinics has provided a clinical setting in which we can treat patients.

We are probably the first organization in the world, in the field of psychedelics, whose work is entirely based on scientific evidence. We consider psychedelic treatments to lie exactly at the intersection of medicine and psychotherapy. And we want to bring this form of therapy to the heart of international medicine.

What is augmented psychotherapy?

We have a certain conception of psychedelic therapy, and it differs from that defended, for example, by Stan Grof 1 in the 1960s and 1970s. We believe that psychedelic therapy is a very particular form of psychotherapy. But here, the medical perspective joins the psychotherapeutic perspective.

The pharmaceutical product used is special because it generates particularly profound experiences in patients, and this requires a framework. This framework, which we believe to be rigorous, beneficial to patients and also ethical, is called psychotherapy.

What does “increase” mean? This is what psychiatrists know when certain medications are potentiated, generally by another substance. For us, this means that psychotherapy and psychedelics influence each other in their effects.

This may not be easy to imagine for someone who usually only works in organic medicine, but it's actually easy to explain: The effect of psychedelics depends on environment and attitude interior of the person who absorbs them. This means that there is an increase in this direction.

Conversely, this also means that the effect of the therapy depends on the psychedelic. This, for example, enormously influences the relationship between therapist and patient. It can accelerate the establishment of the relationship or even strengthen it.

American researchers from the Johns Hopkins School of Medicine believe that psilocybin therapy reduces symptoms of major depressive disorder four times more successfully than antidepressants. Psilocybin is a psychoactive substance found in magic mushrooms that causes an altered state of consciousness.

As outlined in their paper in JAMA Psychiatry, the researchers conducted a small pilot trial of psilocybin therapy in 27 people aged 21 to 75 who had been experiencing major depressive disorder for the past two years.

Participants in the experiment were randomly divided into two groups: 15 volunteers were assigned to psilocycin therapy, and another 12 were placed in a control group, which was supposedly delayed treatment. The experiment lasted a month, during which time the participants stopped taking antidepressants.

Volunteers were given two gelatin capsules with psilocybin (20 and 30 milligrams), the break between sessions lasted two weeks. Participants in the experimental treatment also attended psychotherapy sessions.

To assess the severity of depression, scientists used the Hamilton scale, which consists of 21 points. They are completed by the clinician during an interview with the patient and allow symptoms to be identified.

The experiment showed that after a month of psilocybin therapy, 71% of volunteers experienced a reduction in symptoms by 50% or more. According to study author Allan Davis, it is four times more effective than traditional antidepressants.

The next step is to conduct a phase two trial with a large number of volunteers. Additionally, the long-term effects of psilocybin therapy need to be studied.

American researchers reported the success of the second phase of clinical trials of combined individual and group psilocybin psychotherapy for the treatment of major depression in cancer patients. A report on the work was published in the journal Cancer; a separate publication in the same publication is devoted to the study of the subjective perception of such treatment.

Depression often accompanies cancer; clinically significant manifestations are observed in one out of three to four patients. At the same time, the traditional approach to treatment, including psychotherapy and the prescription of antidepressants, is often not effective enough. Because of this, psychedelic psychotherapy, including the use of psilocybin, is of great interest, which in clinical trials has repeatedly demonstrated high effectiveness in the treatment of major depressive disorder, post-traumatic stress disorder and other mental disorders.

The open-label (non-blinded) phase 2 clinical trial, conducted by Sunstone Therapies CEO Manish Agrawal and colleagues from several US research centers, included 30 cancer patients (average age 56 years). For two thirds of them, one to four years have passed since diagnosis; in 53.3 percent the disease was metastatic and inoperable. Among oncological diseases, breast cancer predominated (33.3 percent), as well as leukemia and lymphoma (26.7 percent). All participants suffered from major depressive disorder without moderate or severe psychotic features (HAM-D score 18 or more). They were not taking antidepressants, antipsychotics or medical cannabis at the time of recruitment.

After interview, assessment, and screening, each participant was assigned to an individual therapist and completed two orientation sessions that included information about psilocybin therapy. They then participated in weekly therapy sessions for eight weeks with 25 milligrams of synthetic psilocybin. In these sessions, the drug was administered to three to four patients at a time, who stayed in adjacent rooms of a community cancer center alone with their therapist for 4.25 hours, and then came together for 3.75 hours for group support and integration of the experience.

The dynamics of depression severity during therapy were assessed using the MADRS scale. At the eighth week, it decreased by an average of 19.1 points (p < 0.0001) compared to baseline. Sustained response to treatment was observed in 80 percent of participants; exactly half achieved complete remission of depressive symptoms in the first week, which persisted throughout the study. No serious side effects were recorded. Some patients complained of moderate and transient nausea and headache. Laboratory tests and ECG were without abnormalities. The participants did not show suicidal tendencies.

To determine the acceptability of combined individual and group psychotherapy using psilocybin for patients, the authors conducted semi-structured interviews with patients in a separate study; 28 people took part in them. In general, patients rated this approach positively in terms of both effectiveness and safety. Group sessions, on the one hand, increased their sense of security and preparedness, on the other hand, generated feelings of connectedness and community that helped to enrich and deepen everyone’s personal experience.

A recent study by Israeli scientists found that the mushroom extract may demonstrate superior effectiveness compared to chemically synthesized psilocybin, especially in stimulating neuroplasticity and promoting the development of new connections between nerve cells - a very important property. This breakthrough opens up potential applications for treating depression, PTSD and schizophrenia. The study results were published in the journal Molecular Psychiatry.

In work led by researchers Dr. Tsuri Lifshitz and psychiatrist Prof. Bernard Lehrer from Hadassah Hebrew University Medical Center, with the participation of graduate student Orrom Shahar and Dr. Alexander Botvinnik, the scientists found that a mushroom extract containing psilocybin may have more potent and long-lasting effects on synaptic plasticity in the brain. compared to chemically synthesized psilocybin.

Millions of people around the world suffer from mental disorders, and many patients remain refractory to existing pharmaceutical treatments. Alarming statistics show that 40% of people suffering from depression find no relief from currently available medications, a similar trend among people with OCD.

Moreover, with approximately 0.5% of the population suffering from schizophrenia, there is an urgent need for innovative solutions tailored to those who do not benefit from existing medications.

Preliminary study results shed light on the discrepancy in effectiveness between psilocybin-containing mushroom extract and chemically synthesized psilocybin. Notably, the extract increased levels of synaptic proteins associated with neuroplasticity in key brain regions including the frontal cortex, hippocampus, amygdala, and striatum.

Metabolomic analysis also revealed notable differences between the mushroom extract containing psilocybin and ocd chemically synthesized psilocybin. The extract demonstrated a distinct metabolic profile related to oxidative stress and energy production pathways.

These findings open up new possibilities for the therapeutic use of natural psychedelic compounds, offering hope to those who have found little relief in traditional psychiatric treatments. As demand for innovative solutions continues to grow, psychedelic drug research represents a critical avenue for the development of novel and personalized medicines.

Additionally, Western medicine has historically favored the isolation of active compounds rather than the use of extracts, primarily to achieve better control over doغیر مجاز می باشدes and the onset of known effects during treatment. The challenge with extracts has been that in the past it has not been possible to consistently produce an accurate product with a consistent composition. In contrast, ancient medical practices, especially those that attributed therapeutic benefits to psychedelic medicine, included the use of extracts or whole foods, such as consuming the entire mushroom.

The main problem with natural extracts is achieving a stable composition, especially in plants, but mushrooms are unique in this regard. The composition of fungi is influenced by their growth environment, including factors such as substrate composition, CO2/O2 ratio, light exposure, temperature and microbiological environment. Despite these factors, controlled cultivation makes it possible to “tame” the mushrooms and obtain a reproducible extract.