Dr. Jacobi has an extensive practice background in the treatment of anxiety disorders in the United States and Canada and has conducted research related to obsessive-compulsive disorder (OCD) as it relates to children and their families.

He previously trained under Bradley C. Riemann, PhD, who is the clinical director of The OCD Center at Rogers Memorial. Dr. Jacobi completed his doctorate under the direction of John Calamari, PhD at Rosalind Franklin University of Medicine.

He is a member of the International Obsessive-Compulsive Foundation (IOCDF), the Anxiety Disorders Association of America (ADAA) and the American Psychological Association (APA). Dr. Jacobi has presented to numerous clinical and academic audiences.

Thirty therapists from across the country visited Rogers Memorial Hospital June 11-13 for The Behavioral Therapy Training Institute (BTTI). BTTI is a three-day course on cognitive-behavioral therapy for the treatment of OCD and OC-spectrum disorders sponsored by the International OCD Foundation. The faculty members included two of Rogers Memorials’ own clinical staff. Pictured are (from left) Cheryl Carmin, PhD, Karen Cassiday, PhD, Bradley C. Riemann, PhD, David Jacobi, PhD, Patrick McGrath, PhD, and Alec Pollard, PhD.

Bradley C. Riemann, PhD, Clinical Director of the Obsessive-Compulsive Disorder Center and Cognitive-Behavioral Therapy Services at Rogers Memorial Hospital, will be giving no less than seven talks at this weekend’s Anxiety Disorders Association of America Annual Conference. The 2010 conference is held March 4 through 7 in Baltimore.
Riemann will be speaking on the ongoing development of research projects based on data collected by Rogers Memorial Hospital, as well as addressing the conference on the subject of differential diagnoses in the upcoming DSM-V.

Rieman will be part of a discussion group looking at the DSM-V’s impact on practice and research, along with Jonathan Abramowitz, PhD, University of North Carolina at Chapel Hill; Katharine Phillips, MD, Alpert Medical School of Brown University; Dan Stein, MD, University of Stellenbosch; Roberto Lewis-Fernández, MD, New York State Psychiatric Institute/ColumbiaUniversity; Simon Rego, PsyD, Montefiore Medical Center; and, Reid Wilson, PhD, AnxietyDisorders Treatment Center.

Riemann, along with Shawn Cahill, PhD, and Throstur Bjorgvinsson, PhD, as part of the OCD Research Collaborative Association, will be hosting a symposium entitled “Evaluating the Effectiveness of Residential and Intensive Outpatient Treatment Programs in Adolescents and Adults.”  The topics included in the symposium are:

• “Treatment of OCD at Rogers Memorial Hospital: Description of the Programs and Patient Characteristics at Admission” by Bradley Riemann, PhD
• “Residential and Intensive Outpatient Treatment of Adult OCD: An Investigation of Treatment Response, Mediators, and Moderators of Treatment Outcome and Comparison With Efficacy Trials” by Shawn Cahill, PhD, University of Wisconsin, Milwaukee
• “Cognitive-Behavioral Therapy in Adolescents: Examining the Effectiveness of Residential and Intensive Outpatient Treatment” by Martin Franklin, PhD, University of Pennsylvania School of Medicine
• “Comorbid OCD and Eating Disorders: Results From a Specialty Residential Program,” Chad Wetterneck, PhD, University of Houston, Clear Lake

Rogers Memorial Hospital is also exhibiting throughout the conference.

How do you know if you or someone you love has a hording disorder?

Here are some signs a person can look for when evaluating whether or not they or a loved one may need professional treatment with their hoarding disorder.

1. Acquisition of, and inability to discard, meaningless objects
2. Cluttered living spaces that limit their use
3. Significant distress and/or interference in functioning

What are some ways to treat a hoarding disorder?

1. Get professional help. Contact Rogers Memorial Hospital’s admissions department or complete our online form for a screening.
2. Once you have a relationship with a mental health professional, you can begin working to identify triggers to hoarding and track items brought into the home
3. Through exposure and ritual prevention patients are repeatedly exposed to the anxiety, anger and sadness associated with discarding possessions.
4. Organize: To keep an item the patient must have a place to put it. Develop rules for sorting, discarding and organizing. Encourage decision making and problem solving.
5. Develop alternative behaviors: Perform previously avoided activities such as doing the dishes, laundry, preparing meals. Establish short and long term goals such as work, volunteering, socializing etc.

What are some resources for learning more about hoarding?

The Obsessive Compulsive Foundation

The OCF is a not-for-profit organization of people with OCD and related disorders, their families, and mental health professionals. The OCF also has a sub site on hoarding.

Anxiety Disorders Association of America

ADAA Provides prevention and treatment information for individuals, family members and professionals.

Obsessive Compulsive Disorder Support Group:

An OCD support group is held on the 2nd Wednesday & 4th Thursday of every month from 7:00-8:30 p.m. at First United Methodist Church: 121 Wisconsin in Waukesha. 542-4256.

• Rogers Memorial Hospital is nationally recognized OCD treatment is available in southeastern Wisconsin.
• The Obsessive-Compulsive Disorder Center at Rogers Memorial Hospital celebrates its 10th anniversary this year under the clinical direction of Bradley C. Riemann, PhD.
• Rogers Memorial is one of the few places in the country to offer intensive CBT services in a residential setting for children and teens.

Residential treatment

• One of two programs in the country, the OCD Center provides intensive treatment for severe and difficult cases of OCD, OC spectrum disorders and other severe anxiety disorders.
• The staff of the OCD Center also oversees CBT treatment in other residential programs at Rogers Memorial, including The Child Center and The Eating Disorder Center.
• Treatment is effective
• Outcome studies of CBT treatment done at Rogers Memorial Hospital show that up to 80 percent of the people who complete its CBT program significantly reduce their anxiety symptoms from a sever to a much more manageable level.

OCD resources

RogersOCD.org
To learn more about the treatment of OCD, OC-spectrum disorders or other severe anxiety disorders.

Obsessive-Compulsive Foundation
To access research information and networking resources for individuals, families and professionals.

OCD Services at Rogers Memorial Hospital
Rogers Memorial Hospital is Wisconsin’s largest, not-for-profit, behavioral health care provider for children, adolescents, adults and older adults. The hospital is nationally recognized for its residential treatment centers including The Eating Disorder Center, The Obsessive-Compulsive Disorder Center and The Child and Adolescent Centers. Rogers Memorial also provides residential treatment services for chemical dependency, inpatient and partial hospitalization, as well as day treatment programs.

One in four of people in America will suffer from an anxiety disorder in their lifetime. These disorders are the most common mental illnesses affecting both children and adults. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, relentless and can be progressively debilitating if not treated.
People with an anxiety disorder have persistent, intense and irrational anxiety, fear or dread that is uncontrollable and significantly affects their daily functioning at home, work or school.
The term “anxiety disorders” refers to many psychiatric disorders, each with its own distinct features. The disorders are bound together by the common theme of extreme fear or worry:

• Generalized anxiety disorder

Generalized anxiety disorder (GAD) is characterized by excessive and unrealistic worry about multiple life areas. Individuals with GAD find it difficult to control their worry.
GAD may also result in physical symptoms, such as dry mouth, nausea or diarrhea, headache, restless leg syndrome, cold hands, sweating, or a “lump in the throat” feeling.
GAD is experienced by 5% of the U.S. population, affecting a wide variety of ages. However, 50% of sufferers will develop symptoms in adolescence. GAD tends to be a chronic condition with a fluctuating course, unless treated properly.

• Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is characterized by obsessions and compulsions.
Obsessions are unwanted, intrusive thoughts, images, or impulses that generate high levels of anxiety.
Common examples of obsessions include contamination fears, repeated doubt, the need for exactness or order, aggressive or inappropriate/unacceptable thoughts.
Compulsions are repetitive acts done in an attempt to neutralize the obsessive thought, or the anxiety it causes, or to somehow prevent the feared event from occurring.
Common compulsions include washing and cleaning, checking, counting or ordering, repeating, praying, hoarding or seeking reassurance.
The average age of onset for this condition is roughly 20 although it can occur in individuals much younger.

• Panic Disorder

Panic Disorder (PD) is characterized by recurrent panic attacks. Panic attacks are defined as discrete periods of intense fear that at least initially occur “from out of the blue” or “for no apparent reason.”
These attacks occur very suddenly and build to their peak rapidly leading many PD sufferers to visit emergency rooms or primary care medical offices.
Physical symptoms or sensations experienced include: pounding heart or skipping beats, difficulty breathing, chest tightness or discomfort, sweating or chills, dizziness, tingling or numbness in the extremities, shaking, throat tightness, stomach upset or nausea or feelings of unreality.
These bodily sensations are commonly misinterpreted by individuals as a sign of impending doom (e.g., believe they are having a heart attack, going insane, fainting or about to lose control), and fear having additional attacks.
Agoraphobia
Panic disorder is also commonly associated with agoraphobia. Agoraphobia refers to the fear of certain situations due to the belief that one may have a panic attack and escape would be difficult or embarrassing.
Situations commonly feared and typically avoided by people with agoraphobia include: driving or riding as a passenger in a vehicle, being home alone, crowds or public places, bridges, escalators, open spaces, and closed spaces.
Agoraphobia generally develops within the first year of the onset of recurrent panic attacks.

• Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a condition that can develop following a traumatic event or experience, and creates a sense of fear, helplessness, or horror with the individual. Examples of situations which may trigger PTSD include combat, violent assault, abduction, natural or man-made disasters, and serious vehicle accidents.
Individuals with PTSD frequently “re-experience” the event, including intrusive distressing recollections of the event, nightmares, flashbacks, and distress upon exposure to things that remind them of the event. They may also have trouble sleeping, problems with concentration, feelings of guilt, angry outbursts or startle easily.

• Social anxiety disorder

Social anxiety disorder (SAD) is characterized by a persistent fear of social or performance-related situations in which embarrassment or possible negative evaluations by others could occur, resulting in avoidance that affects daily life. This fear is often accompanied by physical symptoms such as sweating, blushing, heart palpitations, shortness of breath, or muscle tenseness. SAD can lead to high levels of academic and occupational impairment.
SAD affects 13.5% of the U.S. population. The average age of onset is roughly 15, however, signs of SAD maybe present even in toddlers.
Anxiety disorders can be complex and disabling, but can be effectively treated to reduce the severity of symptoms.
Rogers Memorial Hospital is a nationally recognized leader in the treatment of anxiety disorders. Research suggests that the vast majority of people respond well to our treatment approach.
If you, or someone you know suffers from an anxiety disorder, contact our admissions department at 800-767-4411 to schedule a free screening. Or, request a screening online.

Exposure work targets the obsessions, and seeks to prolong the obsessional thought, image, or impulse long enough for the process of habituation to occur. Habituation is the natural, normal process of anxiety levels reducing with nothing more than the passage of time. Research has shown that 97% of people experience the process of habituation. Ritual prevention is the blocking of the ritual or compulsion that would normally be performed upon exposure (e.g., hand washing, checking).

In addition to ERP, cognitive restructuring strategies are also taught. Cognitive restructuring or ‘thought challenging” is the identification and correction of “errors” in thought that create anxiety. Two errors in thought most focused on are “probability overestimation errors” and “catastrophizing errors.”

A probability overestimation error is when someone overestimates the likelihood of a bad event happening (e.g., the house will burn down if I don’t check the stove). A catastrophizing error is when someone blows out of proportion, magnifies, or catastrophizes how bad fairly likely events really are (e.g., dropping something on the floor for someone with contamination obsessions).

Located on a 9-acre site about a mile east of the hospital’s Oconomowoc campus, the center’s specialized staff and facilities have the capacity to treat up to 24 adults with OCD and other anxiety disorders. The comorbid program, which is jointly operated by The Obsessive-Compulsive Disorder Center and The Eating Disorder Center at Rogers Memorial Hospital, is the only place in the United States to offer highly specialized cognitive-behavioral therapy treatment for adults with co-occurring diagnoses of eating disorders and anxiety disorders.

Prior to admission, an initial telephone screening – which includes administration of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) as well as an assessment of related psychosocial factors – is conducted by admissions staff and then reviewed by the clinical director and key clinical staff. Based on this review, a recommendation is made for the appropriate level of care. Upon admission, a comprehensive evaluation is conducted, which includes a battery of assessments to ascertain the patient’s medical, emotional, educational, developmental and social history. This detailed assessment also includes administration of Y-BOCS, generation of exposure exercises and creation of a graduated exposure hierarchy.

Upon admission, each patient is assigned to a core clinical team consisting of a psychiatrist, behavioral specialists, nursing, dietary staff and residential counselors. The staff-to-patient ratio average is 1 to 6. Members of the core clinical team conduct a detailed assessment, develop the treatment goals and exposure hierarchy, then facilitate and monitor the patient’s progress. Treatment goals are accomplished through a program consisting of individual work sessions and group psychotherapy. The center’s staff uses a strict cognitive-behavioral approach and graduated exposure hierarchy for each individual.

For OCD, the main emphasis is Exposure and Ritual Prevention (ERP). In addition to ERP, cognitive restructuring strategies are also taught. Approximately 50 hours of cognitive-behavioral therapy treatment is provided each week. The length of stay at The Obsessive-Compulsive Disorder Center is open-ended; the average length is 60 days. Our overall goal is for patients to complete at least 75% of their hierarchy during their treatment stay.

The primary goal of this program is to alleviate symptoms, while allowing continued involvement to fulfill family, school or work activities.

Day treatment patients may participate in the following treatment components:

• Problem-solving skills training
• Daily living skills training
• Patient and family education

Why Treatment Is Effective

• Cognitive-behavioral therapy treatment services directed by a nationally recognized expert in anxiety disorders treatment
• Use of evidence-based treatment components by a highly trained staff
• Individualized treatment plan and length of stay
• Emphasis on family involvement and education
• Comprehensive case management/coordination of continuing care

Admissions and Insurance Coverage

This treatment service can effectively treat adolescents and adults who meet the following criteria:

• Have a primary diagnosis of OCD, OC-spectrum disorders or another anxiety disorder
• Demonstrate a willingness to receive treatment and a desire to recover
• Meet medical criteria for day treatment services

An initial screening starts the admission process. Based on a review of this screening, the clinical director will recommend an appropriate level of care. After the review, admissions staff will contact the patient and share the clinical director’s recommendation.

As a courtesy to prospective patients, admissions staff will contact the individual’s insurance carrier to obtain a quote of insurance benefits. Benefit availability, service providers, and medical necessity criteria vary with each insurance plan. We recommend that potential patients check with their medical insurance carrier to determine what is covered and if there are any exclusions. After admission, patient care specialists can provide assistance with remaining questions or concerns.

Treatment Team

On admission, each patient meets with members of the multidisciplinary treatment team for a comprehensive evaluation, which forms the basis of a personalized plan of care. Members of the treatment team may include:

• Board-certified psychiatrist
• Licensed clinical psychologist
• Behavioral specialists
• Registered psychiatric nurse

Treatment Components

Treatment plans are based on a comprehensive, graduated exposure hierarchy and a strict cognitive-behavioral therapy approach. Treatment components may include:

• Individual therapy
  • Exposure and ritual prevention
  • Cognitive restructuring
• Group therapy
• Psychiatric consultation and medication management
• Patient and family education

Continuing Care and Discharge Planning

With proper consents the treatment team works closely with the referring professionals to communicate treatment progress and assist in making discharge plans. If necessary, staff will assist with locating resources needed to provide continuing care.

The treatment team monitors each patient’s progress and level of participation. If, based on the patient’s behavior, the program is no longer a helpful or appropriate form of treatment, or if the patient needs a different level of care, then the treatment team will explore options with the patient and his or her family.

Should they become necessary, Rogers Memorial Hospital provides short-term acute stabilization of psychiatric symptoms on its inpatient units.

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