An Interview with Dr. Daniel Zamir


Dr. Zamir is the president of the Anxiety and Panic Disorders Clinic of Santa Barbara. He will join us this April for a CE Webinar on “Obsessive Compulsive Disorder: Key Principles of Exposure and Response Prevention (ERP).” Sign up now to join the live event or to receive a video recording after the webinar’s taken place.

Q: Is there a genetic basis for OCD? Does it tend to run in families?


A: OCD does run in families and twin studies indicate a high degree of genetic influence on whether someone will develop OCD. Researchers are even starting to determine specific genes that likely play a role in the development of OCD. See more here.  

The environment can play a role in that highly stressful events can trigger OCD symptoms for someone who is already susceptible to OCD. High stress situations can also trigger relapse in someone who has achieved remission from OCD. 


Q: Do you think Jeffrey Swartz’s Book Brain Lock is helpful for OCD patients to read as an adjunct to their therapy and their medications? For example, can they successfully follow the four steps Relabel, reattribute, refocus and revalue recommended by Swartz, and achieve a gradual decrease in their symptoms?


A: I have found this book useful for conceptualizing OCD and having a simple and straightforward plan for dealing with OCD. I think it could be a useful adjunct to therapy. I have also found the books Overcoming Unwanted Intrusive Thoughts to be very useful for people to use during treatment for OCD with ERP to increase understanding and progress.


Q: Is it necessary to trace the psychological factors influencing OCD to early childhood trauma in order to effectively deal with the symptoms?


A: This is not necessary and likely to be misleading. There is no evidence that OCD is caused by childhood trauma. We have effective methods for treating OCD that get at the root of the problem. These methods address the core aspects of OCD. OCD is a highly heritable condition and childhood trauma does not appear to be the primary driver of OCD symptoms.


Q: What part do fears of death play in triggering a “Sticky Brain” ( an obsessive thought process and avoidant compulsive behaviors?)


A: For some people OCD can be related to fear of death or fear of other bad things happening. ERP addressed this directly and would involve exposure to these fears and the development of greater tolerance of things that are outside of our control. ERP can help people to develop acceptance of things that are outside of their control and to help them to habituate to anything that they are afraid of. Additionally, it helps them to develop greater tolerance of uncertainty and less reactivity to fearful thoughts. 

Q: What part does the critical inner voice play in maintaining OCD patients’ obsessive rumination and providing them with incorrect perceptions of reality?


A: I think it would be misguided to see intrusive thoughts related to OCD as a critical inner voice. These intrusive thoughts have a different origin and are fundamentally different than self-critical thoughts. That being said, people with OCD are often highly conscientious and they may be more prone to negative self-talk. When this is the case, these critical thoughts also need to be addressed. 


Q: Do you think the methods of Voice Therapy can be effective as an adjunct to Therapy in cases of OCD?


A: In the event described above where someone has negative self-talk in addition to OCD, voice therapy or cognitive therapy interventions may be necessary to address these self-critical thoughts.


Q: How do you help kids get over a fear of dogs, or thunder, or germs?


A: While these are not necessarily related to OCD, there are related methods of exposure therapy that can be used to treat phobias in kids and adults. Gradual exposure or systematic desensitization to feared stimuli can help people to overcome their fears and phobias. 


Q: How do you deal with the anger that patients express toward you when you are encouraging them to gradually give up a avoidance behavior?


A: I don’t tend to see a lot of anger, as I attend to building a strong therapeutic relationship with my clients. I also help them to have a clear conceptualization of their OCD such that they are highly motivated to eliminate avoidance, compulsions, and safety behaviors that maintain their OCD. I develop collaborative treatment plans with clients and get their buy in early so that they are the ones pushing for change and helping to identify their own behaviors that need to be changed in order for them to gain relief from their OCD