Throughout my research, one theme has continued to emerge: exercise has powerful effects that can be used for treatment of various psychological impairments.
While my current research focuses largely on healthy populations, I am most interested in the therapeutic effects exercise can offer individuals with clinical diagnoses and challenges. As such, I am always excited when I come across research that applies a therapeutic exercise regimen to a new patient population.
Recently, I came across a study that examined the used of aerobic exercise in treatment of Obsessive Compulsive Disorder (OCD).
Obsessive Compulsive Disorder (OCD) is a psychological disorder characterized by the “presence of recurrent obsession and / or compulsions that are time consuming and cause marked distress/ and or impairment” (Rector, Richter, Lerman, & Regev, p.328). According to the National Institute of Mental Health, OCD affects around 1% of the U.S. population with about 50% of those affected demonstrating severe cases. The average age of onset is 19 years of age.
While therapy and medication successfully provide symptom reduction and often allow the inflicted individual to live a more normal and less interrupted life, in many cases individuals with OCD continue to demonstrate residual symptoms in spite of their other treatment forms. Given this, researchers were interested in whether exercise could offer additional relief to combat these residual symptoms of OCD.
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Can Exercise Remediate the Residual Symptoms of OCD?
The aim of the present study was to examine whether the addition of an aerobic exercise regimen to Cognitive Behavioral Therapy (CBT) and medication could remediate the residual symptoms of OCD related to obsessions, compulsions, depression and anxiety. The researchers hypothesized that, given the previous research on the beneficial effects of exercise on psychological disorders such as depression, individuals with OCD would also experience symptom relief from engaging in aerobic exercise.
Participants with OCD were recruited for participation in the study. Because the test was concerned with the effects of aerobic exercise, it was desired that the participants not be active exercisers before the intervention. As such, patients were not eligible for included in the study if they were currently involved in an exercise regimen including moderate to strenuous exercise more than 2x per week.
All participants completed measures of fitness, symptom presence / severity, anxiety and depression both pre and post intervention. During the initial fitness test, the participant’s target HR was established based on his or her maximal level of exertion. They were instructed to work out at moderate to vigorous intensity so as to reach this established HR range. All participants were equipped with HR monitors so as to be able to keep track of his or her workout intensity. Interestingly, participants were given freedom when it came to the type of workout he or she completed. The only condition was that it had to be an aerobic workout lasting 45-60 minutes. Participants engaged in aerobic exercise using the treadmill, elliptical, and bicycle. Below is an example of the typical prescribed exercise session.
For the duration of the study, participants engaged in CBT on a weekly basis coupled with the 12-week aerobic exercise program. In line with the fundamentals of Cognitive Behavioral Therapy (CBT), sessions aimed to empower the participants with cognitive strategies that helped normalize intrusions, target obsessional appraisals, and test alternative interpretations of such intrusions. Two cohorts completed the study. The first cohort received CBT from a senior level clinician with 20-years of experience treating OCD with CBT. The second cohort was treated by two post-doctoral fellows with substantial CBT experience but less experience working with OCD. In this way, there was no standard control group.
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Overall, the exercise intervention successfully contributed to improvements in almost every measure (with the exception of anxiety which demonstrated no significant change). Symptom severity related to obsessions, compulsions and depression demonstrated statistically significant improvements following the exercise intervention.
In an effort to understand and plan for future feasibility of such a program, the researchers were also interested in whether the level of experience of the clinical psychologist administering the CBT played a role.
When investigating the effects of clinical experience, they found no significant difference between the groups. Both cohorts demonstrated improvements in the same scales suggesting that the two post-doctoral fellows were just as effective as the experience CBT clinician. This is a positive outcome because it suggests that this therapeutic combination can be more accessible to more individuals as it is not directly dependent upon clinician experience.
Fitness Level Findings
Interestingly, the improvements in symptom severity did not appear to be related to an increase in physical fitness as level of physical fitness remained stable from pre to post testing. This may suggest that an individual with OCD can reap the psychological benefits of exercise before he or she experiences changes in fitness level.
While the study had its flaws, the findings are very promising. I am always enthusiastic about research that utilizes exercise as a therapeutic treatment for mental illnesses. This study provides yet another example of an area of psychological dysfunction where exercise can make a meaningful difference.
Future research should consider using a more standard control group so as to more effectively measure differences in the treatment course. Additionally, while the freedom to choose one’s workout was an interesting choice, future research should conduct studies in which a specific workout type is prescribed. In this way, we can start to tease out the workouts that may work best for reducing symptoms of OCD.
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Rector, N.A., Richter, M.A., Lerman, B. and Regev, R. (2015). A pilot test of the additive benefits of physical exercise to CBT for OCD. Cognitive Behavior Therapy, 44(4), 328-344.