Dr. Jonathan Grayson tells his patients to go take a hike -- and very often, it works.
For almost 30 years, Grayson, head of the Anxiety & OCD Treatment Center of Philadelphia, has been leading obsessive-compulsive-disorder sufferers on annual camping trips.
Members of Grayson's OCD support group, GOAL (Giving Obsessive-Compulsives Another Lifestyle), tackle their anxieties head on by trekking through the woods, sleeping in dirty tents and using grungy outhouses.
For newcomers, it's a springboard to treatment; other campers return year after year for a therapeutic tune-up.
Ten years ago, Grayson decided to bring the camping concept to a larger audience, setting up "virtual camping" sessions at annual conferences hosted by the International OCD Foundation. During these excursions, he leads 100 to 200 conference attendees on a tour of the hotel and surrounding area, challenging them to touch doorknobs, shake hands, hold knives, chew "abc" gum (that's "already been chewed," in middle-school vernacular) and even climb into dumpsters.
Even with banquet halls and parking lots instead of tents and trees, the simulated camping prompts breakthroughs for participants.
He was recently recognized for his efforts: At this year's International OCD Foundation conference in Arlington, Va., held in mid-July, Grayson was honored with a lifetime achievement award.
"Dr. Grayson has a very high profile in the OCD community -- he gives so much time, effort and energy," says Dr. Jeff Szymanski, executive director of the Boston-based International OCD Foundation. "The virtual camping is really a highlight of our conferences, and for many people, it's their first introduction to what effective treatment is."
With OCD, the brain gets stuck on a specific thought, whether it's a fear of germ contamination, of burning the house down, or harming or killing someone -- "anything you can ask a 'what if' question about," explains Grayson.
The question or concern itself might be one that would cross anyone's mind; it's the inability to dismiss it that distinguishes OCD. The underlying theme of OCD, says Grayson, is a need for certainty: "If germs are the area of concern, the person needs to know for sure that his hands are completely clean so that he won't get sick or make someone sick. But, of course, no one can be absolutely certain of that, so the thought goes around and around."
Effective treatment -- according to the International OCD Foundation, Grayson and others in the psychiatric community -- is a behavioral therapy called Exposure and Response Prevention.
Like the name implies, patients are exposed to their anxieties and encouraged to refrain from their usual responses. Someone with a fear of germs, for example, would get his hands dirty, then challenge himself to not wash them -- an act easier to enforce when you're camping in the woods.
But not all rituals are as obvious as compulsive hand-washing.
Take scrupulosity. The International OCD Foundation estimates that of the 3 million to 4 million OCD sufferers in the United States, approximately 20 percent have a fixation on religious thoughts, prayers or rituals, known as scrupulosity. For an estimated 5 percent, this is their primary form of OCD.
A Jew with scrupulosity might obsess over correctly following Jewish law, such as kashrut, or incessantly seek reassurance from a rabbi.
"When a regular routine gets invaded by OCD, someone might think over and over, 'Did I lock the door? Did I turn the stove off? Did I check everything this morning?' " says Szymanski.
"With scrupulosity, OCD invades a person's faith-based routine, so they question, 'Did I pray properly? Did I do that ritual with a pure heart? Did I do something that might offend God?' "
In 1981, when Grayson started the support group GOAL with then-patient Gayle Frankel, the existence of OCD of any type wasn't as widely acknowledged. "Back then, you didn't see it on TV programs, people didn't talk about it," says Frankel. "I would find other people who had OCD, and the one thing they always said was that they felt very isolated."
Frankel, who lives in Lower Merion, served as president of the Philadelphia branch of the International OCD Foundation, which runs GOAL, for 23 years. She retired in 2004, and now facilitates an OCD support group for Orthodox women.
"They have their own set of issues. But the idea of it is the same as GOAL, or the camping trips," she says. "When you have that camaraderie, that connection in a group -- there's just a great sense of helping one another."