Transcriber: An Nguyen Reviewer: Aijia Yang
Let me tell you about Sam.
Sam, he’s a 12-year-old who lives in a lovely red wooden house
two hours away from here in the other side of the field
in a little village called Rakvag.
Sam lives with his mom, his dad, and his little brother.
Sam’s mom is an accountant and Sam’s dad is a carpenter.
Sam is a natural at cross country skiing.
And his free time, he likes doing crafts.
So recently, he did this wooden clock.
When I saw it, I was very impressed.
He really is handy.
On the weekends, he likes joining the local football club
and on Fridays, he and his dad like to gather together and they like to make
their very special meal, the special Friday taco.
Recently, Sam became more and more concerned with that.
At the beginning, his parents were very happy.
Imagine having a child who is so tidy and so clean.
Total jackpot.
But then when his little brother would try to hug him and touch him,
Sam would get very upset.
“He’s trying to test me with dirty hands”, he would say.
So then Sam started washing his hands
three times, six times, nine times
until it felt right.
You see, Sam has this idea that,
If he did an activity in the wrong mindset,
something terrible could happen to his parents or to his little brother.
For example, when he was at home,
he would go to the toilet and he would go out of the toilet again
and then in again and then out,
sometimes three, sometimes six times.
Normally multiples of three until it feels right.
There was a symptom that was very specific to his house
and wouldn't happen anywhere else.
But there were other symptoms,
for example, when he was in the street,
he would need to avoid to step on the lines in the floor.
At some point this became more and more of a problem.
He would try to make up excuses not to join the school trips.
And on the weekends when he should be playing football with his local team,
he just wasn’t ready for playing the matches.
Before each match, he will become so and so stressed
that he will start doing more rituals and more repetitions.
And his coach just couldn’t trust that he would be ready to play.
The situation became unbearable.
Sam has ...
O
C
D
Obsessive compulsive disorder.
In the year 2016, Sam was my patient,
and we would meet every week in the center of Trondheim.
The idea behind Sam's treatment
is that I will teach him what is OCD and then together would make a list
with all of those rituals that Sam needs to do.
Then we both organized those rituals.
At the top of the list, we would put those rituals which are the easiest
and then to the harder and the harder and the harder
Easiest to break. Harder to break.
This therapy.
Main concept is that I should expose Sam
to break with his rituals to stop doing so.
The therapy has been used since the 80s with psychologists all over the world.
This is called
CBT.
Cognitive behavioral therapy.
The idea
behind cognitive behavioral therapy is that our thoughts, your everyday ideas,
have an impact on how you feel, your emotions, your feelings,
and those emotions have an impact on your behavior,
what you choose to do, how you behave and is also again against your thoughts,
but also the other way around.
In Sam’s treatment, I would expose him to not to do his rituals,
and I would prevent his natural fear reaction.
During this period,
we always ask the parents to please join us in the sessions.
At least one of the parents, most of the sessions.
This way Sam’s parents could help me helping Sam.
Today, Sam is coming to my office at 12 o’clock in the morning.
In order to do so, Sam has to wake up at seven in the morning. So did his dad.
In fact, it would be his dad the one driving Sam from Rockfork
a few hours away from Trondheim
to my office.
In order to do so, Sam’s dad have to ask for a day off at his job.
Sam would miss one day at school.
When Sam woke up, he was so concerned
about the possibility of being late that he went to the bathroom
and started going in and out from the bathroom.
Three times. Six times.
He later told me he did this nine times this time.
They will need one hour to get ready and two hours more to drive
from Rakvag to Trondheim,
in addition to more time because they have to cross the field with a ferry.
When I spoke to Sam later at 12:00, he was telling me, “You know,
when I was in the car, I had this very strong urge to check
that the doors in the car were properly locked.
But he didn’t.
And this is what I called success.
Good job, Sam.
The year is 2017.
Sam is not my patient anymore,
but recently I was going for a walk in the center and I met his mom.
And she was looking the most relaxed than I’ve seen her in a very long time.
I spoke to her
and she told me very happily how Sam now can give hugs to his little brother
as many times as he wants.
That’s not an issue anymore.
And in fact, he’s now joined in all sorts of activities in school.
And then with this glimpse of pride,
she told me very happily how,
“You know it was Sam the one to score the goal in the last weekend’s match.”
We are very proud of Sam.
And we are also very proud of 70 percent of all of the patients
that finish this treatment, that get rid of their OCD.
In the year 2017,
the team I’m working with was very, very busy.
They were developing and thinking
how can we do this CBT better and more modern to the one we are having, right?
So let me introduce you
to
ECBT.
Enhance cognitive behavioral therapy.
I’m going to tell you everything about ECBT.
The idea is that it’s enhanced with technology tools.
But first, I’m going to tell you about my new patient.
Her name is Alice.
Alice lives in Frosta, a few hours away from Trondheim.
She loves sailing and she loves running.
But I’ve been told although she gets straight A’s in Math,
she also has OCD.
In the year 2017, we started treating Alice with ECBT.
We did this with the help of an app that Alice could download
and install on her phone.
In this phone, Alice has a list with all of her symptoms.
And in between sessions, every every week,
she receives tailored exercises that she needs to do
in order to get over her OCD.
When she makes those exercises.
she sends back feedback, letting us know how hard was it for her
to do the exercises from 0 to 10.
In the same app, she also has access to psycho-educative videos
that her but also her parents can watch anytime they want.
These videos are made by professionals who know very well what OCD is,
and she can learn what is OCD, which are the most common symptoms,
how OCD impacts in your life and your parents, and how do we treat OCD?
In addition to that, we were using video calls.
Remember Sam?
Sam was living in Rakvag and he would lose a whole day of school
and his dad would need to ask for a day off
in order to drive him to Trondheim.
Well, with Alice, this is not an issue anymore.
She can just grab her phone and do a video call
and we can have an online meeting.
I remember Sam, he had this very specific symptom that would happen in the bathroom.
He would need to go in and out,
but this would only happen at home and nowhere else.
Well, if Alice has a symptom that is similar,
and then she can call me with video calls using her phone,
and she can show me where it happens.
Maybe her home, the school, the playground.
I can “online” be with her.
I can help her to get her exposed to break with her OCD symptom.
When I started doing therapy with Alice,
we were talking about how would we do this.
We decided that
maybe in the first two sessions we would have face to face in Trondheim
and maybe the rest of the sessions could be online.
But if any week Alice decided that she preferred in fact to come to my office,
that’s not a big issue.
She just needs to let me know, and I will be happy
to welcome her in my office.
The point of ECBT is that we can adapt to whatever the patient needs.
In the year 2020,
we are having so many patients.
Most of our patients are between 7 and 17 years old,
and they all live scattered in the county of Trondelag.
Do you guys remember what happened in March 2020?
From March 2020 to October 2021,
more than one year and a half past.
The government strongly asked for us to reduce physical contact to a minimum.
Do you guys know what I’m talking about? So we were lucky to have ECBT.
We have experience using a light therapy for more than three years
and we have the tools in place to keep treating OCD online.
The point of ECBT is that it adapts to the needs of our patients,
but also adapts to the needs of our world in pandemics.
My team that I work with has been working with this for five years now, maybe more.
And it's been a total journey.
We have been gathering these data and we have been analyzing it.
And now we are publishing in scientific journals.
And this is very important.
The goal is to be able to offer a treatment
that is scientifically sound to our patients.
In addition to that, there is this new project,
which is an online health platform,
there is now being developed in Mid-Norway and we are going to be part of it.
The ECBT project will be in this online platform.
You know, some patients may need five sessions to get rid of their OCD.
Other patients may need 15, and that's perfectly OK.
Our point is to give the patients what they need
and to redistribute their resources in the smartest way.
Our point is to help children like Sam or Alice to get rid of their OCD.
However, whenever and wherever it happens.
Thank you.
(Applause)