EmPowerPlus: Dr. Julia J. Rucklidge: Successful treatment of OCD


On March 9, 2009 an exciting case study was published in the Journal of Anxiety Disorders. The study was conducted by Dr. Julia J. Rucklidge, a psychologist from the University of Canterbury, Christchurch, New Zealand. Dr. Rucklidge reported a successful intervention using EMPowerplus in a treatment-resistant male (SJ) who was diagnosed with Obsessive Compulsive Disorder (OCD). In this study she used an ABAB design — which involved the measurement of SJ's symptoms before he began taking EMPowerplus, a period of taking EMPowerplus, a period of discontinuing EMPowerplus, and then a period of again taking EMPowerplus. It was observed that when SJ was taking EMPowerplus, his symptoms improved markedly, and that when he discontinued EMPowerplus, his symptoms returned.

This brings the total number of published EMPowerplus mood studies to 7.

Here are a few more facts about the study:

Key Findings

SJ's response to EMPowerplus has been classified by others as an ‘‘excellent response.’’
Response occurred within a shorter time frame than that reported for other OCD treatment studies.
No side effects were reported for EMPowerplus.

“The case study reported here involves an 18-year-old male, referred to as SJ, who was treated initially with CBT [Cognitive Behavioral Therapy]. Then, following a relapse, he participated in an ABAB [off-on-off-on] design using EMPowerplus. SJ was first referred in April 2006, at age 16 years, to a youth specialty service that assesses and treats adolescents with severe mental illness. The psychiatrist diagnosed him with OCD (of at least 3 years duration) and Asperger’s Disorder. He had high levels of anxiety and obsessions, mostly about safety issues: fears of getting hurt, that his house was going to burn down, and that his brains were going to fall out. He also had religious obsessions such as fear of becoming a non-Christian. His compulsions typically reduced these fears, such as drinking lots of water (to prevent the house burning down), stretching his head (to stop his brains falling out), or washing his hands repeatedly (fear of germs). The family declined pharmacological options but was happy to be referred to the author for psychological treatment.

Baseline (prior to the nutritional intervention)

“In February 2008, almost a year after termination of CBT [Cognitive Behavioral Therapy], SJ’s mother called the author and reported that SJ’s OCD had worsened, his mood was more depressed, and she was concerned about his suicide risk. On assessment, the author confirmed the presence of significant religious obsessions. SJ continued to meet [the] criteria for OCD, and in addition he now met criteria for Major Depressive Disorder (MDD) of 4-week duration. SJ reported he spent approximately 80% of his waking time obsessing about God, unforgivable sin and unrelenting fear of going to hell. His mother said that evenings were particularly difficult, her husband spending hours with SJ attempting to reassure him.

“The family was informed of treatment options in the community (he was now too old for the adolescent service) including medications, CBT [Cognitive Behavioral Therapy], and a referral to the adult anxiety disorder unit. They were also informed of the case studies using EMPowerplus to treat obsessions and mood disorders as well as the experimental nature of the treatment. The family chose to begin a trial of EMPowerplus and written consent was obtained from the patient to begin the trial.

First intervention with micronutrient formula

“SJ began the micronutrient formula at two capsules three times a day and titrated up over a 1-week period to the full dose of 15 per day divided into three equal doses, taken with food and plenty of water… No adverse effects were encountered. His compliance was excellent in that he easily swallowed the 15 capsules per day. After 1 week, no changes were reported by the patient or his family. However, at 3 weeks, there was a notable change in SJ. His mood had lifted and his anxiety had dropped markedly. His OCD was still present but more manageable, less distressing and less interfering. His Y-BOCS [Yale-Brown Obsessive Compulsive Scale] score was 12, the lowest it had been in over 4 years. SJ was followed every few weeks for a 2-month period. Four weeks after starting the treatment, SJ remarked that while his obsessive thoughts still occurred frequently, he found it easy to ignore them. He also reported that his obsessions typically occurred for a few seconds to a minute and then would stop, without the need to perform a ritual or without dwelling on them.

“This report was in contrast to pre-treatment when he could obsess for hours without relief. His mother could not recall a time when she had seen SJ’s anxiety so low. Although up to this point SJ had wondered if the change in his OCD had simply coincided with taking the micronutrients, he now considered that this degree of change would be unlikely without an active intervention. At this point, SJ decided to discontinue treatment to determine whether it was the treatment or the passage of time that had caused the change in symptoms. He was aware that symptoms could return and consented to be monitored during the withdrawal phase.

Treatment withdrawal

“Ten days after the treatment was stopped, mild symptoms began reappearing and reassurance seeking was becoming more evident. At 3 weeks, SJ experienced a significant increase in his obsessions… He woke his family screaming when the obsessions became too overwhelming for him. He had 3 days of constant obsessions while on a camping trip; he reported crying, feeling he was going to hell, having thoughts telling him to eat only certain types of food, and telling him not to draw (during the treatment phase, SJ had resumed expressing his artistic talents by drawing, after years of abstinence). He noted that his background anxiety was getting noticeably worse as well. SJ then experienced an improvement in his symptoms for a few weeks and then deterioration in symptoms occurred again. After 8 weeks off the micronutrients, the outcome measures were repeated. All measures indicated that the obsessions had increased in severity, mood had dropped and anxiety increased. His OCD symptoms were in the high end of the moderate range of the Y-BOCS [Yale-Brown Obsessive Compulsive Scale] (23). It was recommended that some form of treatment needed to be reinstated. All options were reviewed and SJ decided to resume EMPowerplus.

Reintroduction of nutrient treatment

“Twelve days after reinstating EMPowerplus, SJ’s scores had dropped… By 4 weeks, SJ’s Y-BOCS [Yale-Brown Obsessive Compulsive Scale] score (10) indicated the OCD symptoms were back in remission. SJ’s OCD remained at this level although once every couple of weeks, he had small bursts of distressing obsessions that would last a few minutes until he regained control.

“Anxiety had decreased and obsessions reduced. His mood had also lifted somewhat but fell within a moderate range. Although he reported no sad feelings, he was still endorsing items related to guilt, feeling inferior, and low self esteem. On inquiry, it seemed evident that these rankings were driven more by his religious beliefs and concrete thinking associated with Asperger’s Disorder than by low mood. He no longer met criteria for a major mood disorder. He was re-contacted 6 months later (he was still taking EMPowerplus) and he continued to be in remission with further improvements to his mood and maintenance of low anxiety. Indeed, he remarked that his anxiety had continued to improve without on going therapeutic contact.”

Click on the citation below to read more about the study:

Rucklidge, JJ. Successful treatment of OCD with a micronutrient formula following partial response to Cognitive Behavioral Therapy (CBT): A case study. J Anxiety Disord. 2009 Mar 9.

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Placebo response cannot be ruled out, but there are several reasons it is unlikely to explain the therapeutic effects:

- No therapeutic benefit occured until 2 weeks after beginning the formula.

- The patient was adamant that the nutrient formula would not make a difference.

- The changes have been maintained for over a 6- month period.

- Not all symptoms improved; motor tics were still present, minor OCD-like symptoms (but no longer within a clinical range), and the black and white thinking associated with Asperger’s Disorder had not changed.

-Julia J. Rucklidge, PhD. Successful treatment of OCD with a micronutrient formula following partial response to Cognitive Behavioral Therapy (CBT): A case study. J Anxiety Disord. 2009 Mar 9.

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