snowbear

Absolutely. Independent studies (note: pleural) are needed, so we're a long way off using it 'routinely' or 'rolling it out across the NHS', but based on the studies available at this time I believe it's worth further investigation and cannot be dismissed out of hand. Hi peeps. I'm fine thank you. Just popped by and the title of the thread caught my eye so thought I'd respond. I hope you are both well.

I saw this article recently: Deep transcranial magnetic stimulation in OCD It does appear they found some benefit BUT -the numbers in the study are very small (99 patients) -and the benefits were only measured at the end of the 6 week treatment and again one month later. (short term gain only, no proof of lasting improvement.) My feeling is it could be an area of potential treatment as a second or third line option for those who haven't responded to at least 2 attempts at CBT, with or without medication. It needs further research on bigger numbers before rolling it out across the NHS, but perhaps should not be ruled out as an option in the right circumstances. Very important to this study was that they triggered OCD thoughts/fears just before applying dTMS and they made the trigger specific to each person. That clause means this cannot ever become an alternative to CBT, only ever an adjunct to it or a later treatment after CBT has been explored and the individuals fears identified. It may also transpire to be only a short-term improvement which fades or disappears in the medium term. My gut feeling is that the best way to use it may be between courses of CBT. I can see from a functional point of view how it could work by activating OCD thoughts and then disrupting the neural circuitry to weaken the connections which maintain OCD, so the theory is sound. So... -the person would have initial CBT to identify their specific obsessions and compulsions and work on these in the normal way - if they failed to respond to 2 courses of CBT each of minimum 12 weeks (6 weeks is too short for resistant OCD who are the proposed target patients) and possibly with different therapists or a standard therapist followed by one more experienced in treating OCD - then add in dTMS - then repeat CBT while the brain plasticity has been temporarily increased by dTMS. In my opinion this step is likely to prove vital to longer term full recovery and maintenance of any improvement. Based on all of the above, I would cautiously accept dTMS as an option in some cases, but would not wish to see it invested in as a treatment for OCD before investing a great deal more in much needed numbers of qualified therapists. I surprised myself by concluding that it can't be ruled out as an option once more is known about the long term results (side effects, complications and duration of improvement.)

This is so perfectly worded it deserves repeating. I'd pin it permanently and put it in gold letters if I could. Extremely well said, Gemma.

Hi Gemma, welcome to the forum. PMDD will improve when you stop have monthly hormone fluctuations (reach the menopause.) If you have a hysterectomy but your ovaries are conserved it's possible you won't get full relief from the PMDD until a few years after the op when you go through a natural menopause. Some improvement may come from the relief of being without periods, but your body will still have some hormone fluctuation so you could have some residual symptoms (though they might be less severe.) If the ovaries are removed at the same time as the womb and you are relatively young, you'll be put on oestrogen replacement therapy (HRT), In that case your hormone levels should be much more stable and your PMDD will rapidly improve. As OCD is one of your PMDD symptoms then it too should lessen. Regarding the You Tube video you saw, I suspect the doctor was referring to how some women suffer depression after a hysterectomy; either because they weren't ready to accept the end of their reproductive ability, or sometimes when the operation includes bilateral ovary removal - this induces an immediate menopause with severe menopausal symptoms. Of course that's treatable with HRT in most cases. If it was me I wouldn't hesitate to have the hysterectomy and I'd expect to see an improvement in my mental health, not fear a worsening of it. If in doubt, discuss it again with your gynaecologist or GP before deciding. Whatever you decide, I hope it goes well for you.

Decided to stop by the forums, came across this and felt compelled to sign in and comment. Yay! This is fabulous news Bruce. I'm so pleased you are making positive changes. These first steps are exactly what you need to change surviving into thriving. I'm proud of you for engaging with therapy again and sooo pleased to see you moving forward. Good on you, keep it up!! To be brutally honest, Bruce, there have been times when I thought getting you to go back to therapy was an insurmountable task. Yet you've made that move! Things always feel difficult before you tackle them, but once you get stuck in it gets easier and easier. With hindsight you'll look back and realise that going through what you thought was impossible is actually far easier than waiting to start it, fearing failure if you try. Will pop by again soon for an update.

Dying/suicide is viewed as the ultimate escape. Having these thoughts on a daily basis just means you're very unhappy with how things are and in desperate need of a change. CHANGE doesn't require any kind of escape. Change comes from standing your ground while doing things differently. Even the smallest difference in how you do things can have a huge knock-on effect with a very positive outcome. What are you going to do differently today, Bruce? And tomorrow? Set yourself small daily challenges to build up the habit of making changes and before long things will be very different (better).

1. Absolutely. I would neither expect nor accept non-evidence based treatment. 2. Not as a first line option, no- never. Any discussion of non-evidenced based treatments should be reserved for those who have failed to respond to the evidence based treatments and even then only treatments which have some evidence of efficacy (though inadeqate to qualify as 'evidence based') should be considered, with the pros and cons openly discussed in some depth. Fuller understanding by the patient is required when considering treatment which is not fully evidence based. 3. I don't think so. Unless the patient raises the option of a non-based treatment when it may be necessary to explain why they aren't being offered this and why treatment A is better. 4. I think a reasonable understanding of any treatment offered is essential for it to be efficacious. Mental health treatments are about changing how you think. That can't be achieved without patient understanding and cooperation. It's not like surgery where you can chop out the dysfunctional/diseased part whether or not the person understands what is being done. Particularly with CBT it is helpful for the sufferer to be to recognise which bits of their therapy are cognitive and which are behavioural. The idea is we become our own therapists so learning from the outset when you're doing C and when you're doing B is essential. Then later you can apply the correct self-therapy. If you don't undrerstand which is which when you do it with a therapist then you'll always need the help of a therapist to progress (and be reliant on the therapist offering the correct/most suitable/personalised combination while you are treated 'blind'. I can'yt imagine a single case likely to be successful at changing how a person thinks if they are blindly unaware of what they are trying to achieve and the processes they need to use to get themselves there.

Had to have my say! Howevert I forgot to put on the survey that, despite my criticisms, on-the-whole the current guidelines are reasonably fair and comprehensive.

You're free to believe whatever nonsense you want to believe. You're free to feel nonsense guilt if you want to. You're free to believe your OCD and conclude these thoughts aren't nonsense. But hopefully there's enough normal thinking going on to convince you to take a chance on it being nonsense so you dismiss both the thought and the guilt without further ado. Only you can choose what you want to believe and what you want to feel. If you do choose to believe your nonsense thoughts and beat yourself up with guilt, only you will suffer. Your mum won't be affected either way, same as her current illness hasn't been influenced by your crazy magical thinking (obsessive thoughts.) Do you really want to do this to yourself?

Perhaps the confusion your comment caused will act as a reminder that sarcasm and jokes don't come across well in a written format, Paradoxer?

There's where you need to be doing some cognitive work, Dave. A drop of urine on your leg means nothing. It isn't significant at all, needs no action, not even washing it off let alone a full body shower. Work on changing the meaning you give to your obsessions.

You won't like my answer, Orwell, but I would be doing you a disservice not to say it. You get over it by letting it go. I know it feels like 'righteous' anger, that you feel totally justified in being angry, that you feel you are in the right and they were in the wrong. That may be true, but thinking like that only fuels the anger and damages your physical and mental health. Thinking like that doesn't change the past, doesn't make them change, doesn't bring justice - and it never will. So you have to make a decision. How long are you going to hold onto this position of 'being right' and staying angry? A day, a year, a lifetime? You can hold onto it as long as you want. Feel like this to your dying day if you choose. But what a waste of your life. Or you can choose to let it go. Choose to move on. How? Change how you think about it. Instead of thinking, 'Letting it go means letting them get away with it' change the meaning you put on it. 'Letting it go means I can be happy and well again.' It takes a bit of work and determination not to keep punishing yourself with anger (in lieu of being able to punish them) but with perseverance you will get there. Like forgiveness, letting go of anger is about YOU, not them. It's about choosing how you want to feel. It's a mindset; nothing to do with justice, nothing to do with 'letting them off the hook'. Just an uncomplicated choice of how you want to think about it and the meaning you choose to give it.

Wonderer is quite right that OCD will latch onto things we fear. However looking for links between what's happened to you and what OCD themes you have is potentially misleading. A lot of therapy time can be wasted exploring 'links' that are irrelevant to fixing either the trauma or your OCD. The only true 'link' is how you respond to stress/anxiety. The way you think rather than what you think. The actual link will be that you make a particular kind of interpretation when given a certain kind of experience. Learn to recognise 'This is how I think when I'm exposed to stress, this is the way I tend to interpret things when I'm anxious'. Changing that response to a better one is how to overcome OCD, not exploring themes or events from your past. It's not what's happened, but how you responded, how you thought about it and interpreted it, which matters.

Just a reminder to everybody that seeking advice about aspects of your OCD via PM from any one individual is not recommended. Remember that we're forum users sharing personal experiences, not therapists formulating someone else's therapy plan. Comparing one OCD case directly to another because it seems similar is fraught with the danger of misconception, misinterpretation and therefore giving misleading advice. Far better to share any concerns or questions on the open forum which has the advantage of multiple inputs and people to step in if the advice starts to go off the rails. There are several reasons why people can feel uncomfortable sharing information 'openly' on the forum, but there are ways around this. Questions can be posed in general terms and personal information can made a little less specific (or even totally abstract) so the point comes across without 'giving too much away'. Sparklemango, have a think about how you might word your concern so you are comfortable with it. I don't know what SIAD stands for, but maybe if you choose to post again you could enlighten us?