Asking an Expert: Dr. Wayne Goodman
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If you ask someone in the OCD community, they’ll probably know about Dr. Wayne Goodman, MD. Dr. Goodman was behind many of the things we now take for granted in OCD research and treatment. In the 1980s, he co-developed the Y-BOCS, an assessment of symptom severity that’s used by clinicians all over the world. Dr. Goodman was one of the very first researchers to test SSRIs for OCD treatment, and co-founded the IOCDF in 1986. He has published hundreds of research papers on OCD.
Having established OCD centers at three other respected colleges, Dr. Goodman recently became Chair of the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. Thanks to Dr. Goodman for sharing with us his wealth of knowledge and experience.
NOCD: Thanks for speaking with us. First of all, how did you get involved in researching OCD? Can you tell us a bit of your story?
DR. GOODMAN: I entered my psychiatry residency program at Yale University with the intention of doing clinical research. Initially, I was interested in Schizophrenia because it seemed to be a clear example of a brain-based disorder. However, I started seeing patients with OCD and realized this disorder also must have a discoverable biological basis. I was both fascinated and puzzled by how someone who was otherwise completely rational and normal in every way could be imprisoned by obsessions and compelled to perform rituals. I stayed on as a faculty member at Yale, started its clinic and research program for OCD, and saw hundreds of patients with OCD. They, and the countless others since, have taught me what I know about OCD.
How might an understanding of underlying brain mechanisms help people who are living with these conditions?
We have two well-established treatment approaches for OCD, namely CBT (specifically exposure and response prevention, or ERP) and serotonin reuptake inhibitors like fluvoxamine and clomipramine. But about one third of patients with OCD fail to achieve an adequate response to treatment with ERP and multiple medications. We need new options for these non-responders, and that will require a better understanding of the underlying brain mechanisms that produce OCD. After identifying the causes of OCD, scientists can develop new treatments– whether behavioral interventions, medications, or devices– that target the areas in the brain responsible for OCD symptoms.
What are some of the most exciting frontiers in mental health research right now?
Twenty years ago, most biological hypotheses about the causes of OCD focused on the role of the brain chemical messenger serotonin. More recently, other brain chemicals such as glutamate have been implicated in OCD, and that is leading to clinical research trials of new medications like trigriluzole. Baylor College of Medicine is one of the sites participating in this study, which has participants add trigriluzole to current medications. Another exciting frontier is viewing OCD as a brain circuit disorder and using devices to modulate nodes in the putative OCD circuit to restore normal brain activity.
What led you to co-found the IOCDF?
In 1986, shortly after starting the OCD program at Yale, I became inundated with requests from around the country for more information about OCD. This was before the internet, and came in the form of many hundreds of letters and nearly non-stop phone calls.
Recognizing that besides their OCD my patients were highly capable and interested in helping, I gathered around ten people to discuss forming an advocacy group. We started meeting at Yale, and later acquired offices in New Haven. I remained chair of the Scientific Advisory Board to the IOCDF for ten years before handing the reins over to Dr. Michael Jenike when the IOCDF moved to Boston.
What led you to develop the Y-BOCS?
In the late 1980s, I was conducting clinical trials of clomipramine (Anafranil) and selective serotonin reuptake inhibitors, or SSRIs, like fluvoxamine (Luvox). The field needed an outcome measure that was specific to OCD, reliable, and valid. My colleagues and I developed the Y-BOCS to fulfill those objectives. It has since become the international gold standard for assessing severity and changes in OCD for all types of treatments, whether CBT, medications, or devices.
You started OCD centers in four prestigious academic settings. What was your experience at each one? What did you learn?
In addition to launching the OCD program at Yale, which is now run by Dr. Chris Pittenger, I established OCD Centers of Excellence at the University of Florida, Mount Sinai, and now Baylor College of Medicine in Houston. One of the most important lessons I have learned is to offer a full range of treatment modalities across the lifespan.
For example, at Baylor I have two nationally prominent CBT experts, Eric Storch and Liz McIngvale, who can evaluate and treat both children and adults. We also offer expertise in medication approaches and the use of devices like Deep Brain Stimulation for cases of severe and treatment-resistant OCD. The other lesson is being able to both provide routine clinical care and conduct research.
If you have OCD, you might be eligible to participate in the study Dr. Goodman mentioned above, involving an investigational medication that would be added on to your current treatment. To learn more, please fill out a quick form and a research site near you will contact you with more information.
If you’re not available to participate and just want to speak to someone about your OCD experiences, you can schedule a free call today with the NOCD clinical team to learn more about how a licensed therapist can help. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. At NOCD, all therapists specialize in OCD and receive ERP-specific training.
Thanks again to Dr. Goodman for his generosity in helping us learn more about OCD, what it’s like to be an expert, and what kind of research comes next.