OCD Growing Children

As a psychologist, I am fascinated by how the brain develops

when children grow from babies into adults

and why sometimes things don't follow the typical pattern -

when they lack the usual social skills,

when they struggle with learning,

and when their anxieties mean

they can't deal with the daily pressures of the world around them.

Over the last 50 years, neuroscience has begun to unlock a new understanding

of how the brain works

and what happens when it develops differently.

So it's like, constantly, a voice in my head saying, like,

"You have to do it or you'll get ill."

It's like there's someone standing there telling me to do it.

In this film, I want to look at one of the most common teenage anxiety disorders -

Obsessive Compulsive Disorder, OCD,

through the eyes of the families affected by it.

It's one of the very characteristic aspects of OCD,

that some people call it the secret problem or the hidden illness.

To investigate what causes it, how it affects the brain

and see how it can be treated.

I think it did go through a depressive period cos you used to

get suicidal thoughts, as well, with that.

I mean, thinking, you know, it's best just to end it now, almost.

I was so scared that he was going to do something.

I just knew then...we, we've got to get some help.

The world can be a dangerous place.

There are lots of things that can cause us harm.

Children are born with a defence mechanism

which they use to help them learn what is safe.

Fear is actually good for us -

without it, we'd have no sense of danger.

But we have to learn how to control our fears and anxieties.

If we don't, they can take over and ruin our lives.

Anna is 16 and she suffers from OCD, Obsessive Compulsive Disorder,

an extreme form of anxiety.

She is terrified that anything she touches will contaminate her

and cause her harm.

I went to London yesterday

and one of my friends was ill as well, which didn't help,

because I was sort of trying to avoid, like, being with him

to catch what he had.

Even if it was catchy, I don't even know.

I had to go out for lunch, to, like, a sandwich place,

which I don't usually do,

because sandwiches involve someone touching bread or food or whatever it is, but I did that.

Even though I couldn't eat it, like, out of the bag,

I had to hold it in the bag to eat it and it was quite awkward.

'As a child psychologist, I see families affected by OCD.

'It's a common childhood anxiety disorder.'

Sufferers have constant intrusive, obsessive thoughts

that compel them to commit repetitive compulsive behaviours

that they believe will reduce their anxiety.

And a lot of my friends getting jobs, as well,

which made me realise that, like, it's kind of annoying

that they can get jobs but I can't,

cos who is going to want to employ someone that can't touch anything?

And also, at school, I had to get my friend to do up my shoelaces

because I couldn't touch them.

Then my other friends started having a go at me

and saying I was being lazy and stuff.

'This is Anna stroking Gabbie.'

I have just slept for the past two hours

because it's just so exhausting,

trying to fight, like, the compulsions all the time.

And if you think about Anna as a young girl,

is there a time when you thought that something was developing in her differently?

The only time the anxiety showed was probably a couple of years ago

where she suddenly sort of panicked when we arrived at school

and she didn't want to get out of the car and...so that's how it started.

You know, she wasn't having masses amount of time off

because I knew that actually being at home didn't really help anyway, even if I had let her stay at home.

Well, no, cos in a way that doesn't...doesn't help you sort of confront what is the actual fear.

No, no.

Everyone has anxieties and phobias.

One of mine happens to be spiders.

I know it's irrational

and I know that I shouldn't be afraid, but I am.

And every time I even think of a spider,

let alone see one, I can feel my heart rate go up.

I start to sweat and my mouth goes dry.

It's what we psychologists call the fight or flight response.

So, once and for all, I want to conquer this fear.

She might move, mightn't she, because she's alive?

She could move, she could move at any moment, yeah?

I am going to make her move now. I am going to make her move onto this hand.

She'll stay there. Here she comes. If she walks up my arm, don't worry.

Is there anybody who would like to have a try? Yeah?

-You'll have a try.

-But make it quick.

-I will.

'Fear and anxiety are actually good for you.'

Are you sure she's not agitated?

No, no way at all. She's very relaxed in my hand.

'They are powerful and primitive human emotions

'that have evolved to alert and protect us from danger.

'As long as we learn how to control them.'

That's enough, that's enough.

'Because I now know the spider won't hurt me,

'I should be able to curb my fear.'

Brilliant, well done.

Time out. Really, really good. Really good.

We can do this.

..people throw them at me.

'Some people have such an extreme response to anxiety

'that is so overwhelming that it completely takes over their minds,

'to the extent that it can ruin their lives

and those of the people around them.'

I'll tell you when that happens...

'It is as if they have a fear of fear itself.'

You've got her. Look, well done.

You've got her on your hand.

Now, I am going to take her off.

Here she comes, straight back on to me.

I want you all to give yourselves a round of applause. It's brilliant!

APPLAUSE

Fantastic.

OCD is one of the most common anxiety disorders in growing children.

It affects just over 1% of people in the UK every year

from any race, creed, class or gender.

Sufferers have intrusive obsessive thoughts

that can cause extreme anxiety

that then compel them to repeatedly perform compulsive behaviours

aimed at reducing that anxiety.

These compulsions can include excessive cleaning,

repeated checking or extreme hoarding.

In Anna's case, she washes her hands, often dozens of times a day.

Anna, can you, um, explain your OCD to me?

Um... It's mainly about, like, a fear of getting ill,

so a fear of germs and stuff, mainly.

So I wash my hands a lot, I don't touch things.

And do you know why you developed that fear?

Not sure.

-But you, you...

-It sort of happened.

-But you worry that you might get ill?

-Yeah.

Do you know what sort of illness?

Just any kind of... Well, illnesses you can catch,

but just any kind of illness.

When it's at its worst, what's it like?

Um... Well, I just can't touch anything,

I just wash my hands all the time.

My hands get quite cracked and dry...

And...yeah.

How's it for you, do you really understand it?

Uh... Sort of, but there're some things I don't really understand,

like why I'll do one thing but not something else.

While we all worry about getting ill and avoid germs where we can,

Anna's obsessive thoughts are irrational in the extreme.

Have you been ill recently at all?

-No.

-Oh.

I'm not really sure why I'm scared of getting ill.

Hm, but it's the, it's the thing that you fear the most.

Yeah.

So it's just like constantly a voice in my head saying, like,

"You have to do it or you'll get ill."

It's like there's someone standing there telling me to do it.

-Come in, Laverne.

-OK.

If you just take a seat on that stall there, that's great.

'Dr Adam Perkins of King's College, London,

'is an expert on the psychology of fear.

'He has a test that can measure how well we respond to threats.'

Cos the hypothesis is that the more intense you defend yourself,

the more anxious you are.

So you're the green dot and you are chased by the red dot.

The harder you push the joystick,

the faster the green dot goes.

OK? So if pop your headphones on, we'll get underway.

'The joystick runway test is designed to simulate the anxiety

'anyone might feel by being chased.

'The player's anxiety level should rise

'as the dots come closer together

'and peak if the green dot is not driven away fast enough.'

'Anxiety has evolved as a defensive response.

'As long as you survive to have kids,

'that's how natural selection works.'

To make your survival count, you have to produce kids

and so, the...if being anxious means that when there's a blood bubble

coming out of your baby's nose you think,

"Oh, something's going on here,

"I'm...I'm worried, I think I'll go to the doctor",

then, your baby will have more of a chance of surviving.

'Most animal species of all kinds

'have some kind of threat withdrawal mechanism,

'so if you tap a snail on its shell, it'll curl up into the shell.'

So there's been a long evolutionary pressure,

a selection pressure on animals to get away from a threat.

The more complicated the animal, the more abstract it seems to become,

so a snail doesn't really get anxious about the meaning of life.

Once you get up to primates, great apes, humans,

that's really when you start getting proper angst.

-And you've got my results there. Can you tell me how I did?

-Yep.

You're significantly lower in your threat responsivity than average.

You are just not as bothered as our average female participants

by the threat that was chasing you in the task.

'Like most people I am able to control my anxiety.

'But, for Anna, her obsessive fear of getting ill has taken over her life.

'Over the last few months,

'Anna has been keeping a detailed diary about her OCD -

'how many times a day she washed her hands to alleviate her anxiety.'

So if we look at one of the days, just, just take... Well, just take the first one, we come to...

Between seven o'clock and ten o'clock and it's a week day, so probably you were at school...

-Yeah, yeah.

-You tell me.

Um...between 10am and 1pm,

I washed them once, but I used hand gel twice.

Then, between one and four I washed them once, but used hand gel three times.

Between four and seven, I washed my hands 12

times and used hand gel once.

Then, between seven and ten, I washed my hands 11 times.

Right. So, all in all, ten, 13...

..30... About 35...

-37 times that day.

-Yeah. 37, yeah.

That's quite a lot, isn't it?

Yeah, that was less than I do it now.

-That's less than you do now?

-Yeah.

So how often do you think you wash your hands now?

Uh... Between about 40 and 50.

-So it's gone up?

-Yeah.

-Quite a lot.

-Yeah.

Anna has her own bathroom,

so much of her hand washing is hidden away from the rest of the family.

We didn't sort of notice, it was harder to tell

because she's in her room, which a lot of teenagers are.

So we don't know what she's doing in there

but, obviously, there were times when we'd be hammering on the doors.

And also other times when we'd go out,

you've still got to wait for Anna.

-So, actually, yeah. You do lose your patience sometimes.

-Yeah.

Anna knows that her anxiety is irrational

but it doesn't stop her having the obsessive thoughts.

That's one of the effects of OCD -

that sufferers can't get these intrusive thoughts out of their heads.

My hunch is that there...

there's another trait to do with your capacity to be imaginative

and visionary and you're not fully anxious

unless you're not only sensitive to threat,

but also you've got this kind of abstract mindset

where you tend to think a lot about stuff that isn't happening.

If you've got both of those, you probably will end up

being what we would call a highly neurotic or highly anxious person.

The kind of person who may then end up having to have psychiatric help.

-At the back of my head I'm thinking, "You don't need to do it."

-Mm-hm.

Like, "You're not going to get ill from touching a door handle."

But then, there are still stronger voices in my head saying,

"No, you will, you need to go and wash your hands."

The latest hypothesis is that the brain systems that control defence,

that have evolved over, you know, millions of years to keep us safe,

these systems are just overactive.

A combined team of scientists from the University of Oxford

and the Institute of Psychiatry in London

is doing some pioneering research into how the OCD brain works

and, in particular, in teenagers.

They are performing brain scans on children with and without OCD

between the ages of 12 and 18

to try and pinpoint which areas of the brain

are affected by the condition.

Well, the main question was, em,

how does the brain of children with OCD develop?

Because we know a fair amount about the brain in adults with OCD,

eh, but very little about the children with OCD.

What we are going to do is a very brief scan,

just to start the planning.

This will probably be one of the more comprehensive studies

that...ever been done anywhere on, eh,

the structure of the brain in young people with OCD.

This is an MRI scan.

It's a structural scan of the brain, giving you highly detailed pictures

of the grey and white matter

that composes the brain.

Here you can see the...skull here...

You can see the fluid-filled spaces here,

and the grey, which is obviously the darker areas

and the white matter tracts here.

This is the first scan.

And what we did find is that, actually, particular areas of the brain,

the basal ganglia, were different.

Some of the areas specifically were enlarged.

And the actual connections between these two parts of the brain,

the striatum and the fronter... frontal areas, were actually altered.

We don't really understand the, the reasons for this.

But we know the, eh, the brain takes several decades to mature fully,

perhaps...in, eh, until people are 25 or so, or 30 even.

Eh, so there's a dynamic process.

And we're trying to understand what happens during development.

If you want to have a look at some...

As the scans from this research are fully analysed,

they are producing some extraordinary three-dimensional images

of a key area of the brain thought to be affected by OCD -

the basal ganglia.

The blue and green areas represent

how much bigger it is in people with OCD.

The basal ganglia is really

a crucial part of the brain.

Not to say that other parts of the brain are not crucial,

but it is very important for a couple of reasons.

One of them is that it really has connections

to almost everywhere in the brain.

And it has control over many functions in the brain.

One of the most important functions is decision-making,

shifting from one task to another, for example.

-So key for OCD sufferers?

-Yes, absolutely right.

In addition, this study has uncovered some interesting results

concerning the connectivity of the brain

and how it may also differ in people with OCD.

Now, these orange-looking regions are an area that has higher connections

in subjects with OCD with the very front of the brain.

The suggestion is that parts of the brains

of teenagers with OCD, like Anna,

are not only bigger but are working overtime

as they process all the intrusive obsessive thoughts.

And, in terms of physical contact,

I mean, how does it impact on ordinary cuddles and getting close?

-Well, you probably wouldn't let us touch your hands, would you?

-No.

-You don't really like me touching your face.

-No.

But then if, you know,

she wanted me to do her make-up for her prom and everything,

she'd let me do it.

And have you tried yourself to stop?

Yeah, but I can't do it.

When you've tried, what happens?

I just get too anxious and I can't do it.

Anna has been in an out of treatment since she was 14.

She is also on medication to reduce her anxiety,

but nothing has proved successful so far.

The Maudsley Hospital, in South London,

currently has the only national specialist clinic for young people with OCD.

The treatment they offer has proved remarkably successful.

With the permission of a family and the psychologists,

they have agreed that I can observe and record

a session of treatment for this film.

We are going to be

spending five days together...

'One option offered by the Maudsley

'involves an intensive 5-day therapy

'for teenagers and their families in Cognitive Behavioural Therapy, CBT.'

I think it's, um, quite surprising, really,

how the OCD has taken control

in such really quite a short space of time,

because it's only just over a year

since he started with the irrational thoughts.

So Jon, take me through some of the entries?

Yeah, I mean, this one here,

"Going to wake up in the night and do bad to someone."

That was one of the really severe ones that I saw

that really made me worry and anxious.

Unlike Anna, Jon's OCD is characterised by obsessive irrational thoughts

in which he thinks he has harmed someone,

even though it is something he has never done.

It would come to the point where you couldn't sleep at night

and you'd sort of want to lock your door and, you know, make it so you couldn't do anything.

But even then, you would still think that wouldn't be enough,

cos you'd still have the thought and you'd still worry about it afterwards.

Jon lives with his family in a small village in Devon.

He is 17 and has just started sixth form.

Carol, what was Jon like as a, as a baby, as a little boy?

Just a normal, everyday little boy.

Looking back, when would you say,

"Actually I can see something was shifting,"

in terms of how Jon was.

When he was about seven, I would say,

because Jonathan has always wanted to be top of the class,

to be a perfectionist.

In hindsight, I think I realised cos, when Jon was about seven,

we went to the doctor because he couldn't stop thinking.

And that's what Jon had said.

And that's what he told me - "Mum, I can't stop thinking."

Well, that's an incredible statement.

Mm. Now, obviously, he couldn't articulate that it was OCD,

we wouldn't have known it was OCD.

And his headmaster in primary school said,

"He constantly needs reassurance",

and so I just thought, "Oh, he's just a little bit anxious.

"It'll pass, just leave it, forget about it."

And I realise now that, actually, I think,

that was the start of the OCD.

Unlike people suffering from psychosis,

Jon doesn't hallucinate or have delusions

or hear voices compelling him to do things.

His OCD means he suffers from extreme anxiety,

an obsessive fear that he has or will harm someone.

And he just can't get these intrusive thoughts out of his head.

When he was really bad, last year, we were really worried,

we were worried that he was going to commit a crime.

Cos at its very, very worst, Jon was having to ask his father

to take him back to locations where he thought he may have done something

and check that he hadn't actually committed a crime.

I mean, that must have then raised your anxiety

-to such an extent that you were in it with him.

-Exactly.

I was so scared that he was going to do something.

I just knew then we, we've got to get some help.

'One of the most distressing aspects of Jon's OCD

'is that neither he nor his family realise

'that his imaginary obsessive thoughts will never be acted out.'

We sometimes like to think of...OCD

as a bit of an over-sensitive car alarm,

because if you think of a car alarm, that's a safety device, isn't it?

And when it goes off, when someone's actually trying to steal the car,

-that's really helpful, isn't it?

-Yeah, yeah.

But if a car alarm goes off when someone just walks past it,

or a leaf falls on it, it's sort of like a really helpful safety system

going off at the wrong time.

'The treatment method used by the Maudsley is known as

'Exposure and Response Prevention.

'It involves teaching Jon that his anxiety WILL reduce

'after sufficient exposure to any threatening situation.

'A key tool for Jon to learn is how to rate his own anxiety levels.'

-Sometimes, it's easier to start with the extremes.

-Yeah, yeah.

So if we think of a zero out of ten.

Can you think of a situation, Jon, where you feel really chilled

and don't feel any anxiety at all?

'Start with holidays, probably.

-'Holidays?

-Yeah.'

'Jon can then use this anxiety rating system

'to monitor his own progress as the treatment continues.'

-Could be a car accident or something like that?

-Yes, yeah.

Great, so that's an excellent list.

And this just hopefully exemplifies the fact that we don't always

feel the same amount of anxiety.

'The other key element of this treatment is to teach Jon

'how to block his urge to compulsive behaviour,

'to stop him constantly checking whether he has harmed anyone.'

So where's the best place to break this vicious cycle, at what stage?

Uh... I would say just after the feelings,

so before you can actually do that behaviour. Yeah.

We all have disturbing thoughts from time to time,

but they are usually easily dealt with.

The problem for Jon is that his obsessive imaginary thoughts

are constant and, apparently, unavoidable.

It does sound as if there are moments when the thinking really takes over

and it must be almost as if you want to shut down thinking,

you know, you don't want to think at all.

Well, it's all, like, based around obsessive thoughts.

I mean, a lot of people think of OCD as, you know, hand washing,

cleanliness, ritualising... But it's not all about that.

It's, a lot of it is obsessional thoughts on their own,

so it's, you know, worrying about certain things,

whether you might cause harm to someone,

whether they might cause harm to, harm to you

or whether anything might happen.

So when you came in, in June,

you were excessively checking over your shoulder

to make sure you hadn't harmed somebody by pushing them

-or stabbing them.

-Yeah.

-Are you still doing that?

-Yeah, yeah.

-OK.

When Jon's OCD is at its worst,

sometimes, he can't even leave the house.

It's cos that I knew that would trigger the fear off, almost.

I remember I wouldn't look at people

cos you'd think that would, might trigger off a, you know, a thought.

-But could things be triggered in the home?

-Yeah, definitely.

I remember I used to have this, you know,

these intrusive thoughts of thinking I'd get up in the night,

maybe sleep walking, and do some, do, go outside the house

and do some things to other people, even when you knew you didn't do it.

I got to the point of thinking,

"I'd rather just strap myself into bed with a belt almost",

to reassure yourself you haven't done anything.

And, through that period, I didn't get much sleep at all.

'A key part of the treatment will be to teach Jon

'that, despite what he thinks, he does not represent a risk to anyone.'

Are you still avoiding being near knives at work

in case you stab someone?

Um... Not so much at home as such,

but you can still get the intrusive thoughts sometimes, such as in work.

And are you still having intrusive violent images

followed by a thought that if you have this image,

then, it must be true?

Um... Yeah, it's sort of like you get the images and then you think

cos you've had that image, it sort of thinks, you know,

"That must have happened." So, yeah.

Yeah, so that's still troubling you.

You could be sitting up in your bedroom and then you'd have that thought.

Yeah, exactly. And I could sort of call it, even today, I call it spiking,

-where it...it just goes straight into your mind and that's it.

-Right.

And a lot of the time, straight from then, the anxiety grows.

Day two of Jon's intensive treatment

and he's been sent out on the streets to test his OCD alone,

to help him understand that, despite what he thinks,

he represents no risk to others.

Isobel, I wonder, can you take me through your explanation of OCD?

Really, very honestly, the point we are at in understanding,

which is that we don't know the cause of OCD,

but we do have some clues from research.

One of the clues, for example, is that this is quite a biological illness.

So it's not, for example, caused by the way you bring up your children.

OCD can occur in any kind of family, any race, any background, any class.

So, you know, it's very biologically driven.

It's actually quite genetic, so doesn't explain all of it,

but it does tend to run in families.

And I guess it's only been in the last 20-30 years,

we've really got strong evidence for how treatable OCD is.

Normally, when Jon walks down a crowded street,

his OCD compels him to check behind him continually

to see whether he has harmed anyone.

Amita and Holly are trying

to get him to resist this compulsive behaviour.

And, thinking about Jon, you know,

he's come with sort of this obsessional component to his OCD

-where, you know, he feels flooded by the thoughts.

-Yes.

And how he can really, you know, manage them himself.

And, I think, in some ways, he's managing it on his own.

He's not really, but it feels as if he is.

How did it go?

Um... I, lowest I went to was a three,

highest it went to was a six,

-but that was only for a short time.

-OK.

We've got a very good talking treatment - Cognitive Behaviour Therapy -

and what that means is helping the person with OCD

identify the rituals that they're doing,

or the things that they're not doing sometimes because of their OCD,

and teaching them that, actually, with practice,

they can do those things, even though it involves getting anxious.

OK. So do you want to tell us a little bit about what happened?

-Yeah.

-It sounds like you resisted at least twice.

-Yeah, um... On two occasions, I did look.

-Yeah.

-About eight occasions when I wanted to, but resisted it.

-Fantastic!

What Amita and Holly are trying to do is habituate Jon to his fears,

get him so used to them that they are no longer fearful.

So it's actually a lot about learning that anxiety is a normal emotion

that we all have in various circumstances,

that it's sort of artificially heightened if you've got OCD.

And, although it's unpleasant,

the sort of fight and flight and fear reaction that they're experiencing

doesn't mean they have to take it seriously.

They don't have to do anything. They can just sit there

and experience the anxiety

and wait for it to go away on its own, which it does.

-It's one thing us saying, Jon, that these are just tricks of OCD...

-Yeah, yeah.

..but what we need to help you do is collect evidence to say,

"These aren't fact, these are OCD..."

Yeah, to control it.

-"..playing some nasty tricks."

-Yeah.

When Jon's OCD was at its worst,

he kept a diary in which he detailed his obsessive thoughts

and rated his anxiety when he had them.

He agreed to share it with me.

The date where I got it really bad - 15th of August.

And it's sort of dates like that, you can still remember today.

-I mean, I know it got bad on the 15th of August.

-So what does it say on here?

-Oh, stuff like, er...

"I thought I'd deleted someone's coursework at school," or "poking someone in the eye" or something.

I used to think, you know, "What happens if you blinded someone with a sharp object,

"waking up in the night," thinking, er...

"killed or done something to someone,

"buried someone in the garden" or something.

It was completely ridiculous stuff but, up here, it was just all real.

It's almost as if you were living in a parallel world where things were happening.

Even when you could see they weren't, but it's all up here.

You know, I put down chronology

of what happened when it was getting bad.

I was putting down stuff.

You've got little sort of flow diagrams.

Yeah, I was doing stuff like that.

This goes right up until March this year, you know,

dates of how bad it would get from, you know, one being...

And you're rating it, are you?

Yeah, so one would be normal, ten would be really bad,

and it got to points where I'd rate it at nines.

So what does nine feel like?

Nine's really bad, sort of really stressed out.

I mean, it would get to points where you'd come home from school

and you would go straight to sleep or you'd go straight to bed

because you felt that ill.

-A sort of depression.

-Yeah, I think it did go through a depressive period,

cos you used to get suicidal thoughts, as well, with that.

I mean, thinking, you know, it's best just to end it now almost.

That, to me, says that your mind was just exploding at some level.

Yeah.

Yeah, you did... It got to the point where you felt these...

You actually thought you were doing these things

and at times you thought, you know, "Why don't you just hand yourself in", almost.

-If OCD's saying you're going to do something...

-Yeah.

You know, you're going to hurt somebody,

why don't we just really go for it? If OCD thinks that's going to happen, just up the risk.

-Are you up for that?

-Yeah, that will be OK.

Fantastic.

Jon lives in a very rural part of Devon

and often needs to travel by train.

One of his most regular obsessive intrusive thoughts

occurs whenever he uses a station.

As he waits on the platform,

he thinks that he will push someone under a train.

So what if say, I or Holly, whoever, stood right in front of you

-and we stood right on the edge and we just stood there.

-Yeah.

-And trains are coming and going.

-Yeah.

What would OCD be saying to you?

It would be like saying, you know, "Push them", and stuff,

"and start harming them", and...

And then, what shall we do when we're at the station,

how far do you want to...

I was going to say "Push it", but you don't want to say push.

Um... Yeah, you could go, do as much as you want, really,

to see how anxious you can get in that situation.

-Test it out.

-Yeah.

To really test Jon's OCD,

Amita and Holly have decided to take him to a local train station,

to prove to him that he has no intention of harming anyone.

-It must be a dangerous situation, but it's just a trick.

-Yeah, yeah.

And I wonder, actually, if you were to do it,

why would I be standing in front of you

and letting you put your hand on my shoulder

-if I honestly believed that you would do something?

-Yeah, yeah.

So what would you rate your anxiety at now?

It's gone down a bit. A six, maybe.

Yeah! Fantastic! So that's a bit of habituation, isn't it?

You're kind of... Your body is getting used to it.

-You know, we don't stay at that high level of anxiety for long.

-Yes, yes.

Let's look at the time.

I think it's coming at 20,

I think it comes at 15 this one.

-TANNOY:

-The train now approaching platform four is the...

Yeah.

-Well done.

-Well done, Jon.

-Really well done.

-Well done!

-Yeah.

-Fantastic!

Well, I'd say the obsession got, like, a lot more...

And how anxious did that make you feel when the obsession got so intense?

What number did it go up to?

I'd say an eight.

-And I'm alive!

-Yeah.

-Yeah! Well done!

-Yeah.

'It seems to me that this is a really important moment in Jon's treatment.

'He's got Holly and Amita with him giving him the confidence to realise

'that actually, he isn't going to push anybody,

'that actually, he is in control.'

And, I think, because he's gained that confidence,

he'll realise that this is the first step,

the first quite big step forward in his recovery.

OK, so, for starters, I am going to set you up with the...

'Scientists at the Department of Experimental Psychology at Cambridge University

'have been studying how OCD relates to typical brain function

'and, in particular, how the obsessive thoughts

'and the compulsive behaviours, the O and the C, are related.'

You're going to tell us how you feel about the different stimuli...

'The research tested subjects suffering from OCD

'and those without OCD

'on a task which looked at their tendency to develop habit-like behaviour.

'Volunteers were taught how to avoid a mild electric shock

'by pushing a pedal with their foot.

'Their fear response was monitored

'via changes in their skin conductance their sweat.

'After 30 minutes, the electrodes were removed

'and they were asked to perform the same task,

'but without the danger of being shocked.'

When I disconnect it, you can incorporate that knowledge

and update your fear response accordingly.

Also, your skin response reflected that you managed

to inhibit your fear response as well

and you learnt that this stimulus is no longer threatening.

'When Claire tested the OCD subjects,

'their response tended to be very different to mine.'

They confirm with me that they can no longer be shocked,

but, still, when that stimulus comes on the screen,

you see they still, um, have an anxious fear response to it.

Claire's initial results appear to suggest

that rather than being the direct outcome of their obsessive thoughts,

the repetitive compulsive behaviours of teenagers like Jon are habits.

Maybe these obsessions, which can form an...an awful,

a large part of the overt symptoms of the disorder,

are maybe not so critical to its maintenance.

And that, in fact, it may be an underlying propensity

towards compulsive habitual behaviour that actually leads it.

Claire believes the reason why people with OCD develop obsessive thoughts,

is that it's the human brain filling in the gaps

to justify their compulsive behaviours.

You know, everybody has anxieties, don't they?

And everybody has these thoughts or feelings

about what they might need to do,

but actually I know, sometimes, when I have those thoughts,

I can calm myself down in order to, you know,

not have that thought any more or not act on it.

I think it's really critical to know

that these disturbing intrusive thoughts that OCD patients have

are no different in content from normal intrusive thoughts, as it were,

that most people experience at one point in their life or another.

And maybe the key to it is these compulsive repetitive habits

that keep these obsessions alive,

that fuel them, that force you to ruminate on them,

and that also, um, as we've shown, preserve your anxiety.

Claire's research appears to confirm

the potential of the treatment method used at the Maudsley

in that it shows if OCD sufferers like Jon stop their compulsive behaviour,

the feared consequences don't happen

and their anxiety will come down of its own accord.

I think it's very important that,

if you go through one round of exposure and response prevention that it works,

that you really try and apply that in every other domain.

So the idea is that if you, if you prevent doing the response,

while your anxiety gets high initially,

it will gradually decline,

and then, it will stop this vicious cycle

of reinforcement of these avoidance responses.

It's day three of Jon's intensive treatment course.

Holly and Amita have decided to increase the challenge to his OCD

'by confronting him with one of his biggest anxieties - knives.'

I know that OCD in the past has made you feel a bit nervous

about being around knives and things like that,

-and I know that it used to make you avoid using them.

-Yeah, yeah.

One of Jon's most frightening obsessive thoughts

is that he believes he will harm someone, stab them with a knife.

Even a close friend.

So, Jon, we've got your friends here this afternoon, Sophie and Harry.

I'm just wondering,

what do you think it must be like for Jon to have OCD?

I think it's very difficult, um,

I think he struggles a lot, um,

because I feel like he wants to talk about it a lot,

but doesn't really know how to.

And Jon's, you know, he said he's held back a little bit

in terms of how much he tells you...

You know, he's allowed to keep things to himself if he wants to,

I don't tell everybody everything.

He already feels different enough

with being diagnosed with the condition,

so I think it's important to stay how you've always been.

OK. So we've got two types of knives here, as you can see.

We've got a knife that you might use to eat your dinner

-and then we've got a bit of a sharper knife here.

-Yeah.

And, actually, I was just wondering, Jon, having them here,

has that increased your anxiety a little bit?

Yeah, and it's already, like, already today it's a lot higher, the anxiety,

than it was yesterday. So, yeah.

Probably at a nine.

And, again, just to remind you why we are doing things.

We are going beyond normal everyday life here, aren't we?

-We are really doing an extreme task to prove OCD wrong.

-Yeah.

'There is extensive clinical and research evidence

'that people with OCD do not behave violently.

'This is why Holly and Amita can have absolute confidence

'that there is no chance Jon will harm anyone.'

Last summer, I could really see

how much it had taken over his life.

Everything, even on Facebook talking normally and casually,

that it would enter the conversation

and he'd be worried about something

and you could really see how difficult it was for him

and how much it was taking up.

-So you felt something was bubbling, in a way?

-Yeah, yeah.

So I wonder whether we could do a really quick thing here,

-just in preparation.

-Yeah.

Just kind of...just holding it.

-Do you think with us here, would that...

-Yeah.

-Would that do anything to your anxiety?

-Not really.

I can tell I'm getting a bit hotter.

So I wouldn't say it's a great anxiety,

but you can tell it's just sort of changed a bit.

What if I came and sat nearer to you? Would that be OK?

That's OK. Yeah, go on, then.

I'm...a bit hotter again.

-I can see it in your cheeks, Jon, actually.

-Yeah.

Your cheeks have gone a little bit redder

-so that's a bit of a physical sign, isn't it...

-Yeah.

..that it's getting a bit trickier?

Yeah, so I wouldn't say it's a great leap,

but you can just tell that it keeps sort of making it a bit more intense,

that anxiety level. Definitely. Yeah.

-I'd say about a seven...

-A seven?

-Yeah.

-Yeah, so it's gone up.

-Could you direct it towards Amita?

-Yeah.

Hold it with a tighter grip? It could be as close as you want.

'Amita and Holly know from experience

'that Jon's intrusive obsessive thoughts,

'his fear that he might stab someone with a knife,

'are totally without foundation.

'They are fears created by his anxiety.

'So the purpose of this challenge is to prove to Jon

'that he has nothing to fear from holding a knife,

'that, in reality, he has no intention of harming anyone.'

OK, so let's just sit as we are now for a minute,

and see what happens to that anxiety.

But what are you learning about this situation?

-So you have had that knife in your hand for a few minutes now, Jon.

-Yeah.

I mean, it's sort of like the obsessive thought is still there,

so you definitely get these mental images.

But the anxiety isn't so great.

So I wonder whether once you get a bit more evidence

that actually it's just the worry.

'I remember he used to say,'

"Oh, I feel like such a monster."

And I know that now he's told people

and it's kind of getting itself sorted and he talks about it,

that he feels better.

'With this challenge, Amita and Holly have finally shown Jon

'that he is no risk to anyone,

'even with a knife in his hand.'

When the knives came out this morning,

-I was thinking... You know, we are really going to use knives, you know?

-Yeah.

'The way we do therapy is to really push it to the extremes'

to really prove that what OCD's saying is not going to happen.

Well done. Fantastic!

-'He's a real thinker, isn't he?

-Yeah, he is.'

He's in that moment of thinking,

"Well, what is it that's really making me have these compulsions, you know,

"these thoughts and these compulsions?"

'I think so, I think he's been very open with us.

'He's aware that the more he tells us,

'the better position we are in to fight the OCD

'and I think it's incredibly hard for him to do that.'

And yet, he really wants to get rid of this,

so he's sort of taking the plunge and doing that.

And I think this is the way to really prove OCD wrong,

is that, you know, without having us there...

-Here he is!

-Hi, Jon!

-Hiya!

-All right?

-Mm-mm.

HE CHUCKLES

I was wondering if part of what you were doing was

really trying to help him to see

that we are not going to give any weight to these thoughts.

'But I wasn't sure that he could really see that,

'because he is so obsessed with them.

'I think that's really common at this point in treatment,

'because they are so powerful, so persistent, so intrusive and frequent.

'And it's only once we keep doing these tasks

'that he can challenge them and the heat,'

kind of the heat will come out of it

and he might find them a bit easier to kind of think about them

in the way that we do.

-And the trick is to do nothing with those thoughts.

-Yeah.

So, the weekend, how was it?

-Not that good, to be honest.

-OK.

Jon has been given a break from his treatment

so he can practise some of the techniques he has learnt on his own.

But, over the weekend, he seems to have taken a step backwards.

It's the weekend, it's Saturday evening...

Um... Yeah, OCD's taking quite a big toll, to be honest,

with, like, the obsessive thoughts.

Not exactly physical anxiety but just, like, really low in general.

I remember talking about, the other day, about, you know,

the obsessive thoughts being like a mental battle, like...I don't know.

HE SIGHS

Sort of played its toll.

And just makes you feel generally really low and sort of...

I mean, you wake up and you feel pretty sad,

and you go to bed and you feel pretty sad.

It's almost like the OCD is, like, shouting at you

and it's the only thing and it's always at the forefront of your mind,

-so everything else sort of goes below it almost.

-Yeah.

And when you are, like, in a conversation with someone,

you are not really in that conversation

-cos you're still just thinking about these thoughts that just go around, around, around.

-Yeah.

Take it, then.

'It's one of the very characteristic aspects'

of OCD that it's...

Some people call it the secret problem or the hidden illness,

that it remains hidden for a long time

before it's detected or diagnosed,

and sometimes that's because the individual's very embarrassed about it.

And it's also because it does blur into normality

and so, it can just creep up at home

and what could be just a normal bit of childhood behaviour,

before people realise it, it's become daily

and it's become prolonged, and it's become distressing.

The compulsions you always felt you could deal with somehow

and they weren't as strong as just having the thoughts though,

and that's probably the worst bit.

'You can't do anything without something coming into your head

'and that causing anxiety.'

Can you explain, you know, the process that somebody

who...who's really struggling with OCD is going through?

One of the themes that often comes out

is that they're just very preoccupied and distracted all the time

by thoughts that keep popping in to their head.

And it can be the smallest trigger that can make, for example,

the specific fear come into their minds.

So, almost relentlessly, thoughts are just...

almost, like, we sometimes call them um, you know, mental hiccups almost.

Their mind is just popping out another worry, you know.

Have I got germs on me?

Is that blood on that table? Do I need to wash my hands?

It's sort of...the tools work with the compulsions,

but they don't help with, like, the thoughts themselves.

Jon's making great progress with stopping his compulsive behaviour,

but he still doesn't seem to be able to get his obsessive thoughts out of his head.

At one time, this would have been tackled through psychoanalysis.

I would actually specifically say

that psychoanalysis doesn't help at all.

And, in fact, there's even some evidence that it may make OCD worse.

The whole premise of psychoanalysis is looking into the past,

looking into past experiences and patterns

and trying to understand how they shape the present and the future.

And trying to do that with somebody with OCD

can actually make them EVEN more obsessive.

SHE CHUCKLES

-You just get really fed up with it.

-Yeah.

Cos it's like you can't really live, sort of, in the moment

cos you are always thinking about other things

It's quite distracting.

Yeah. You're sort of, it's never sort of... It doesn't hardly ever let up.

A young man of his age should be able to go out without worry,

should be able to see his friends.

His mind is in turmoil and that's why he is exhausted.

People of his age shouldn't worry, you know, he should be carefree,

but the way he is at the moment, it's all internalised.

And it shouldn't be. He shouldn't be worrying about contamination.

He shouldn't have to be worrying all the time.

It's not normal, is it? It's not normal behaviour.

The following day, Amita and Holly

decide that they must get Jon out on the streets again

to concentrate on beating his compulsive behaviour

and to overcome his obsessive thoughts.

So let's just sit here

and let's just kind of watch people go by.

And that's why exposing yourself to these fears is so important,

-because you get desensitised.

-Yeah.

The potency goes from the thoughts

-and you can kind of deal with them a little bit easier.

-Yeah.

-So let's have another go.

-Yeah.

-And I'll go ahead.

-Yeah.

And so, think of these things again.

And I won't be there...

And drop all of those rituals.

-Good to go?

-Yeah, go on, then.

-OK. I'll see you back there?

-Yeah, see you in a minute.

The goal of Jon's treatment

is to get him to focus on his obsessive thoughts,

to help him become de-sensitised to them on his own

without anyone to reassure him.

Jon's treatment is nearly over and he seems to be back on track,

but what he now needs to do is start fighting OCD on his own.

It's all very well here in London with Holly and Amita,

but how will he cope when he gets back home?

So what sorts of things could you have a go at practising

whilst you are in school?

Like not checking back if you get an obsessive thought.

Like not checking to make sure it hasn't happened.

-Just doing the opposite. That's the golden rule.

-Yeah, yeah.

-Do the opposite to OCD.

But what's the end goal?

By dropping these rituals, what are we trying to do?

-Stop the compulsion of asking others to help you.

-Yeah.

So what you are actually saying is

no matter how bad his stress level is,

I'm still to resist helping him.

Is that what you're actually telling me?

-It's hard, isn't it?

-Yeah.

-Yeah, I think so, and I think Jon agrees, don't you?

-Yeah.

Although you know it's not going to be easy at times,

that's what's going to get rid of the OCD, isn't it?

-We think you've done really brilliantly, Jon.

-Yeah.

-It's a tough few days, isn't it?

-Definitely.

So soon as you walk out of this door, Jon, you start fighting.

You start using all those tools,

things will come up just even walking out going to the car.

So final day,

what do you think might happen over the next few weeks?

I think his confidence will increase and his ability to fight OCD

and I think he will be able to beat it.

There is no reason why he can't have a life without OCD.

Jon, how are you feeling now?

Yeah. Um...tiring, but it's sort of...

It's quite optimistic about the future

and I've got these tools to cope with when times get bad with OCD.

And, Carol, you're the one that's sort of

up close and personal to it, really.

What are you feeling at the moment?

He's very determined and I know he's going to make it.

I just know. No, this is it.

Anna has been suffering from OCD since she was 14.

Because of her fear of contamination,

she can't visit the local surgery for a check-up,

so the doctor has to come to her.

Would I be able to check your blood pressure, do you think?

Dunno.

Can I do it on your upper arm, and perhaps through your clothing,

-as far as the blood pressure's concerned, that would be easier.

-Yeah.

Most people will recover with treatment from their local NHS,

but Anna is still trying to find the right treatment for her OCD.

Her mother Karen wants her to be referred to the Maudsley's specialist clinic.

Is that the sort of place that you can refer her to?

I probably can make a referral to the Maudsley, certainly.

You've already been seen by a local psychiatrist

and there's not been any improvement.

-Righto, so cheerio, then.

-Yeah.

All right, I won't shake hands.

HE LAUGHS

And to feel sort of more ordinary, as, you know, like your friends,

what do you think would need to happen?

Just to not cover my hands up, not wash my hands as much,

-to be able to, like, touch things.

-Mm-mm.

And not worry about getting ill or things like that.

I had a couple of spikes this evening.

Spikes just like the thoughts that come straight into your head

without you really thinking about it.

I mean, if I was to give it a scale out of ten on the anxiety,

I would say six, but it's manageable at the moment.

A few weeks after his intensive treatment in London,

one of Jon's psychologists, Amita,

has come to meet him at home to monitor his progress.

-Hi!

-Hello!

-Hello.

How's the last week been since...?

Um... It's been quite good.

There's been sometimes when it's been a bit, you know, the anxiety's gone up.

-But, most of the times, you've been able to control it...

-OK.

Yeah, quite well.

And how have you been able to control it?

Um... Just by not doing the compulsions that go along with it, really.

At the end of his treatment in London,

Jon was asked to do homework,

certain tasks to keep challenging his OCD.

In particular, he was told to go to unfamiliar places on his own

and resist any urge to do any compulsions.

Yesterday, I said I was going to be trying to go down to a place

that I don't, haven't been on my own because of the OCD,

and that's down to the woods over there.

OK, so, I mean, I have come down to this end of the village before.

HE LAUGHS

But never on my own.

And I think, it's always...

with OCD, it's always sort of been certain areas you know

you don't want to go because you know you will trigger it.

And this is probably one of the places

where I would not have dared go down a year ago.

So... I mean, at the moment, if I had to rate the anxiety out of ten,

I would score it about four.

So I am going to see what's going to happen, really,

over the next 24 hours, just see whether the anxiety gets worse

or whether you feel better for doing it.

I did want to put it off but, now doing it,

you know, it sort of shows you you can overcome these things

even when OCD is telling you not to do it.

And the army of sheep are there on the horizon again.

HE LAUGHS

Do you feel a bit more confident about fighting OCD

compared to two weeks ago?

Um... Yeah, I think there's definitely, sort of, you can...

you're getting into a routine of doing things, I fear.

Yeah, I really noticed a change in you.

You probably don't notice it as much,

but I've noticed a real change in, kind of, the tone.

But we'll just take it as it comes.

-If we feel you need further input, we'll definitely support that.

-Yeah.

The key to Jon's treatment is that he has to keep

challenging his OCD, on his own,

using all of the techniques that he's learnt.

He has already made some amazing progress.

He now feels much less anxious around the home.

And when he goes to train stations,

he can now control his obsessive fear about pushing someone under a train.

The treatment is beginning to transform his life.

-The more you keep facing these situations then, eventually, OCD will give up.

-Yeah.

But I think, on the whole,

my sense is that you are a bit more in control

-compared to when I saw you two weeks ago.

-Yeah.

I think you've really used what you've learnt in sessions here

and that really shows, so just keep going.

-Yeah.

-Fantastic.

With the right treatment and the commitment and determination of all those involved,

OCD can be treated.

According to the Maudsley Hospital's latest figures,

84% of their patients saw significant improvement or full recovery.

It doesn't happen overnight, but OCD can be cured.

To find out more about OCD

and to separate fact from fiction,

go to...

..and follow the links to the Open University.

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