Paige, 19, battled severe OCD until she underwent an intensive four-day treatment to confront it. Photo / Anna Heath
At first, Christchurch teenager Paige couldn’t sleep without repeatedly checking the alarm on her phone. Eventually, it took over her life.
OCD – obsessive compulsive disorder – is often misunderstood as referring to people who are extremely clean, tidy and organised.
In reality, it’s a mental health condition that can manifest in different ways: compulsive checking, constant handwashing or cleaning for fear of contamination, repeatedly arranging items in a specific order, intrusive thoughts and many more.
“It started with something really simple, and then it asks more and more and more from you until it takes up a lot of your life,” Paige says.
‘Stuck in a loop’
Now 19, Paige struggled at university because she would repeatedly check whether she’d submitted assignments “for days” after their due dates.
“If I didn’t get an A, I would just end up in tears, because in my brain, it would lead to so many consequences.”
She couldn’t sleep at night because of the compulsion to check whether she’d turned her heater on or off. She couldn’t leave the house without checking the locks multiple times, or park her car without going back to make sure it was locked over and over.
“I couldn’t send a [text] message without having to ring my dad or my mum and check that what I’d said sounded all right. It seems like such a simple task to someone that doesn’t have OCD or doesn’t have that compulsion, but for me it just was so anxiety-provoking.”
Her parents have always been supportive, but Paige says in some ways that support enabled her to keep up her compulsions.
“They would check something for me, or they’d let me ring them to tell them I’d checked that things were off or that I’d locked something. But ... it just let it go on and showed my brain and my body that doing those things wasn’t safe.
“It was obviously hard for them as well, because they didn’t want me going through that. I’m sure that sometimes it was very frustrating, because I was just stuck in a loop all the time.”
Paige would compulsively check and double check her alarms, locks and text messages. Photo / Anna Heath
Living with OCD can be exhausting, as it gradually demands more and more time and energy to keep up the compulsions.
“It’s so tiring doing and trying to think about everything that you’ve possibly done,” Paige says.
“I would be studying and then I’d remember, ‘I shut the fridge an hour ago. Did I actually shut that properly? Did I check it? Did I check that I turned the light off?’”
Then she saw a new treatment for OCD would become available in New Zealand.
In January, Dr Bjarne Hansen, one of the founders of the Bergen four-day treatment (B4DT), travelled to Auckland from Norway with a team of psychologists to run a pilot of the treatment for 17 New Zealanders aged 18 to 25 living with OCD.
The Bergen treatment involves four consecutive days of intensive exposure therapy, with group sessions and one-on-one work with psychologists designed to help patients confront their OCD and give them the tools to take back control.
Paige flew to Auckland to take part in the treatment, and her experience features in a new TVNZ documentary Exposure.
And while the treatment was “nerve-racking”, she says it changed everything.
“When you’ve dealt with something for so long, and you’re going into a treatment that’s only four days long and then you’re just not going to have [OCD] anymore ... it was amazing that four days can change someone’s life.”
“It was about getting back what you wanted from your life, what was meaningful to you, what you wanted to be able to do again. That was really motivational. It was really helpful also being in that group and doing things independently as well. We had a shared experience, supporting each other.”
On screen, psychologists get Paige to practice control over her compulsions - for example, turning off light switches without going back to check them.
They explain that having OCD feels like having a cat scream at you to feed it. But the more you feed it by giving in to the compulsion, the more it demands from you. The less you feed it, the less powerful it becomes.
For Paige, the cat still screams sometimes.
“But I have a lot more control over what I do now.”
‘OCD thrives in secrecy’
Emma Chapman is a Christchurch-based child and family psychologist and clinical co-lead of charity Open Closed Doors, which was established to find a new intensive treatment option for OCD in New Zealand.
She says the Bergen treatment “seemed like an absolute no-brainer of a match for us”.
Here, there isn’t a culture of being in therapy long-term, and it can be difficult to access treatment for OCD, so the chance to give patients the skills to overcome it themselves was a huge drawcard.
“The research and the outcomes that they were showing in different parts of the world were another no-brainer; we wanted to go with something that worked really well,” Chapman says.
According to international data, about 90% of patients respond to the treatment and 75% have clinical remission. Participants in the Auckland pilot had an 87% response rate and a 70% remission rate.
Paige, 19, from Christchurch, started getting symptoms of OCD in her early teens. Photo / TVNZ
It’s estimated about 100,000 New Zealanders have OCD. But Chapman says it can be difficult to get a diagnosis because it “thrives in secrecy”.
“It can work on people’s big emotions of shame and distress, so it can be that people just aren’t able to talk about it.”
It can also be misdiagnosed or classified as anxiety. GPs, psychologists and psychiatrists can all diagnose OCD, in the public or private health system, but getting there can take time.
“We know from research [there’s] an average seven-year delay in getting a diagnosis, which is a huge amount of time when you look at development.”
Exposure response prevention, (ERP), a form of cognitive behavioural therapy that involves facing fears or triggers while choosing not to respond with compulsive or avoidant behaviours, is considered the gold standard treatment for OCD globally.
It’s available in New Zealand, but can be difficult to access, Chapman says.
“Sadly, we’ve seen that there haven’t actually been too many people that have received ERP, though they’ve had OCD for a long time and been in different services.
“It’s a really good intervention, it can just be lengthy. That’s tricky if you’re not in the public system, because you’re paying, and of course some people can’t pay at all.”
The Bergen treatment shares some similarities with ERP.
“The differences are that it doesn’t focus on the anxiety or the distress the person’s feeling. Instead of that, you’re focusing on what you want to do.
“One of the things [that helps it work] is a person’s willingness to break up with OCD. They really have to be at that point that they’re willing to just trust the process and go, ‘I’m done’, and really wanting to fully commit to that.”
Left to right: Dr Marthinus Bekker, co-clinical team lead at OCD charity Open Closed Doors, Dr Throstur Bjorgvinsson, participant Misha, B4DT co-founder Dr Bjarne Hansen, and psychologist Emma Chapman of Open Closed Doors.
Dr Throstur Bjorgvinsson, co-director of the OCD and Anxiety Programme of Southern California and an associate professor at Harvard Medical School, works with Hansen to take the Bergen treatment around the world, and was part of the team delivering the New Zealand pilot.
Bjorgvinsson has been treating OCD for more than 30 years and says the Bergen treatment works because it’s a “strength-based approach”.
“[We] focus on what makes you human, what makes you click, and we use all those strengths to engage with them and use all these little techniques, these metaphors like ‘Don’t feed the cat’.
“It’s really about living a life that’s not dictated by OCD – to crack the code, call the bluff, all the words we use to move on.”
He says the group component of the treatment is important, as it allows people to support each other, recognise each other’s progress and help reduce the stigma around OCD.
Most people don’t need extensive follow-up after completing the four-day treatment, he says.
“We do a 10-day, a month, three-month and six-month check-in, and if needed, we do a bit of a booster session.
“If they’re struggling or stuck, sometimes it takes just one or two sessions over the phone, one or two hours, and they’re back on track.”
Treatment costs between $6000-$7000 per person, Chapman says, adding the Rātā Foundation and Wayne Frances Charitable Trust helped fund the last treatment round held in Christchurch for those who would have been unable to access it otherwise.
Open Closed Doors’ goal is to get the treatment funded through the public health system.
“Our purpose has always been to train DHBs and public services in this treatment so that anyone with OCD in Aotearoa can have access to [it], if it is appropriate to them, and not be hindered by affordability or postcode.”
‘I feel like I have my freedom back’
For Paige, the weeks following the treatment were tough. But seven months on, she says, “I don’t even talk about OCD very much any more”.
“I literally never check [my alarm] any more. I don’t check my car, I don’t check the locks. I’ve had slip-ups, but we got told if you make a mistake, that’s totally fine. They even encouraged us to, one day, do the compulsions again, to show yourself that actually, you can just stop.
“Every time the cat screams, it’s your choice what you’re going to do. And you don’t have to feed the cat.”
She says the treatment has restored her trust and confidence in herself.
“Now I just feel like I have my freedom back. I can live my life again how I want to, and that is just an amazing feeling.”
But she wants people to know how debilitating OCD can be.
“A major misconception people have is that [people with OCD] are just tidy and clean and really organised. That’s just not the case with many people. Lots of people’s lives are stolen by what OCD gets them to do.
“We have this incredible treatment that’s now in New Zealand, and if there is anyone suffering from OCD, living with OCD, I definitely think it would be worth giving it a go to try and get your life back.”
Exposure screens at 8.30pm on TVNZ1 and TVNZ+ on Monday .
Bethany Reitsma is a lifestyle writer who has been with the NZ Herald since 2019. She specialises in all things health and wellbeing and is passionate about telling Kiwis’ real-life stories.
