Facilitation Technique Category: Therapeutic Massage

Activity Title: Aromatherapy

Equipment Needed: Essential oils, massage oil or lotion, massage table, and a towel.
Activity Description: Combining the common Swedish massage with essential oils can
increase promotion of reducing physical and emotional stresses. Aromatherapy massage
includes adding essential oils to the massage oil or lotion (made from the oil extracted
from nuts and seeds). The purpose of this activity is to use essential oils to achieve
therapeutic benefits. The essential oils have an effect when inhaled and are also believed
to be absorbed through the skin. Each session is an hour long, consists of one participant
at a time, and is performed on nude clients. The therapists will leave the room so the
client can undress in privacy and ask them to lie down in prone position with a towel
covering their bottom rear. Before beginning the session the therapist will conduct an
initial assessment to learn what desired outcomes need to be reach. Whether a client is
there to release aches and pains, anxiety, to calm the mind, or to increase circulation the
therapist will choose the proper sent for them. Some essential oils used are peppermint,
eucalyptus, rosemary, lavender, and jasmine. Peppermint has a cooling, refreshing effect
and is used to enhance mood, sharpen focus, reduces irritation and redness, alleviates
congestion, and aids in digestion. It is a natural energy- boosting property. Eucalyptus is a
powerful treatment against respiratory issues. In addition it is used as an antiseptic,
antispasmodic, decongestant, diuretic and stimulant. It has a cooling properties help fight
migraines, fevers, and helps with muscle aches and pain. Rosemary is known as a mental
stimulant and antidepressant. It enhances memory, focus, and overall brain performance.
It can be used as a remedy to relieve pain such as soothing aches, cramping muscles,
headaches and migraines. Lavender is the most popular essential oil as it acts as a stress
reliever. It also acts as an antiseptic, antidepressant, anti-inflammatory decongestant,
diuretic and sedative. Jasmine has been known to ease depression and childbirth. Its great
for respiratory problems, addiction issues, and reducing tension and stress. The benefits
of aromatherapy massage affect a wide range of health conditions of nervous, circulatory,
lymphatic, immune and muscular systems. Aromatherapy massage is a great method for
mental clarity, relaxation, stress and headaches alleviation.
Leadership Considerations: The therapist must be a licensed massage therapist to
ensure that the participant is getting proper and quality care. Knowing that the therapists
and certified makes the participant fell safer, because they know they went through
training for the different techniques. There are also classes on aromatherapy that a
therapist should have taken in order to know the proper essential oils to use for specific
areas of improvement. The therapists should know of any allergies the participant may
have or of any scents that may bother them. They should also provide a quiet soothing
atmosphere for the participant and make them feel comfortable. The staff to participant
ratio is 1:1, and the therapist is only giving the massage in a secluded room.
Adaptations: Participants with Parkinsons Disease:
Parkinsons is a chronic and progressive movement disorder involving the malfunction

and death of nerve cells in the brain. These nerve cells produce or neurons produce
dopamine, a chemical that controls movement and coordination. With this disease the
dopamine production levels decrease. Tremors, bradykinesia or slowness of movement,
rigidity or stiffness of the limbs and trunk, postural instability or impaired balance and
coordination are some of the major signs of the disease. Individuals who utilize massage
therapy with the inclusion of aromatherapy find it helps to alleviate joint and muscle
stiffness, and promotes relaxation. The neck and shoulder region should have the most
attention when working with participants with Parkinsons. These areas are important
because of the client being in a slumped forward posture with the head bent, shoulders
rounded, and arms hanging down to both sides. The therapist can even perform some
stretching exercises to ease the muscles. From the essential oils mentioned in the
description lavender is best recommended for these participants. Assistance onto and off
the massage table will be given depending on the participants needs.
Participants with Muscular Dystrophy: Muscular dystrophy is a group if disorders that
characterized by progressive loss of muscle mass and loss of strength. It affects those
skeletal muscles that control movement. Aromatherapy massage can be very beneficial
for these participants as it can stimulate and relax muscles. The therapist should put their
hands on either side of the spine and work in upward strokes. The therapist can also
massage the feet, hands, and head if the participant has discomfort on the back are. From
the essential oils mentioned in the description lavender, eucalyptus, peppermint, rosemary
are recommended, along with other scents. Assistance onto and off the massage table will
be given depending on the participants needs.
References:
H. (n.d.). What Aromatherapy Massage Can Do for You. Retrieved September 20,
2016, from https://www.verywell.com/aromatherapy-massage-89736
Most Popular Essential Oils. (n.d.). Retrieved September 20, 2016, from
http://www.aromatherapy.com/most_popular.html
Birch Hill Happenings Aromatherapy, LLC. (n.d.). Retrieved September 20, 2016,
from http://birchhillhappenings.com/parkinsonNTM2015.htm
Worwood, V. A. (1991). The complete book of essential oils and aromatherapy.
San Rafael, CA: New World Library.
(n.d.). Massage Therapy Can Ease Symptoms of Muscular Dystrophy. Retrieved
September 20, 2016, from
http://www.integrativehealthcare.org/mt/archives/2007/11/massage_therapy_2.ht

Facilitation Technique Category: Expressive Arts as Therapeutic Media

Activity Title: Paint to the Sound of Music
Equipment Needed: Acrylic paint, an 8x10 canvas per participant, a radio to play music,
an extra sheet of paper for participants to write reflection, paintbrushes or sponges, and a
white apron to cover clothes.
Activity Description: Painting, a type of visual art, is greatly used to encourage
participants to recognize, identify, and come to terms with their feelings. Music can be
used to increase language skills, promoting pro- social behavior, expressing emotions,
and gaining self-control. The purpose of this activity is to combine painting and music to
help participants show the emotions they feel and hear from the music onto their canvas.
The class should include no more than 10 participants with an instructor and an assistant
to help with the materials. The instructor should first introduce the meaning of emotion
and what the different types of emotions are. Also the types of colors and what they may
represent should be discussed. A table with palates, different color paints, and extra
brushes or sponges should be set up in the front of the room. Before participants sit down
in their desired seat around the room have them come to the front table and pick out the
colors they want and have them put it on the palate. If at anytime they want to add a color
they can go to the front table and get what they need or ask the instructor if they could
bring it to them. Once seated at their seat with the easel already set up with a cup of water
to clean brushes, have the participants close their eyes and start playing the music. It is
encouraged to choose instrumental music with lots of emotional range. Once the
participants have some feeling or see a story encourage them to begin painting whatever
they feel or see while listening to the music. The instructor should be walking around the
room quietly just in case anyone needs help and making sure everyone is on the right
track. Once the music is finished if participants are still painting give them as much time
as they need. Give participants a sheet of paper and have them write down a few
sentences of what the painting represents, what they felt while painting, and what role did
the music play. Hang the paintings up so they can dry and have the participants go around
the room observing the different paintings.
Leadership Considerations: The instructor must be a CTRS with a certified art
therapists certification by the American Art Therapy Association. The therapist has to be
experienced in expressive arts therapy in order to fulfill the needs of the participants and
understand what the outcome of the activity is. It is also encouraged that the instructor be
a certified music therapist by the Certification Board for Music Therapists or has an
education in music with the understanding of certain songs and emotions they bring
about. The instructor is to be encouraging and have a positive, calm tone of voice with
participants. They are to help anyone at any time their assistance is needed.
Adaptations: Participants with Huntingtons Disease: Huntingtons disease is a
progressive breakdown of nerve cells in the brain and is a genetic disorder (What Is
Huntington's Disease?). Participants with HD experience personality change, mood
swings, depression, forgetfulness and impaired judgment. They also may have unsteady

gait, involuntary movement, and slurred speech. This activity can benefit these
individuals because they should be involved in mentally stimulating activities. Instead of
a standing easel with a chair in front, participants with HD can sit at an adapted desk that
slants where their wheelchair may fit perfectly in it (2016). Sitting at the desk with keep
them in an upright position. The instructor. Using different size paintbrushes from thick
to thin can vary among individuals depending on which one they feel more comfortable
with.
Participants with Developmental Disabilities: Developmental delays is when a child
does not reach their developmental milestones at the expected times. For these
participants the instructor should begin slowly explaining the activity in a short step-bystep process. When introducing colors take them out one by one so they dont have visual
overload (2016). Also let the participant sit wherever they feel more comfortable whether
its sitting on the floor, sitting at a desk, or sitting in front of the easel. If they have
trouble grasping the brush the instructor can add a piece of foam around it to make it
easier to hold and they could even use sponges or their fingers to paint (2014).
References:
(2014). Adaptations for Children with Disabilities. Retrieved October 05, 2016,
from https://eclkc.ohs.acf.hhs.gov/hslc/tta-system/teaching/Disabilities/Staff
Support and Supervision/Support and Supervision for Staff Serving Children with
Disabilities/disabl_art_00001_060205.html
(2016). Day 3: Painting with the Child with Special Needs - GABRIELLA
VOLPE, B.Ed. Retrieved October 05, 2016, from
http://www.gabriellavolpe.com/day-3-painting-with-the-child-with-special-needs/
Creative Drama lesson. (n.d.). Retrieved October 05, 2016, from
http://www.childdrama.com/paintmusic.html
What Is Huntington's Disease? (n.d.). Retrieved October 05, 2016, from
http://hdsa.org/what-is-hd/

Facilitation Technique Category: Mindfulness

Activity Title: Mindful Breathing
Equipment Needed: None
Activity Description: The intention of this exercise activity is to focus your attention
on your breath as you allow thoughts and sensations to come and go in the
background. Find a comfortable place to sit. Put your feet flat on the ground and try
to straighten your posture. Gently close your eyes. Let your shoulders drop down. Pay
attention to your breathing and just allow yourself to continue to breathe naturally.
Now, rest your hands gently on your belly with the fingertips of each hand lightly
touching in the middle. Breathe in smoothly through your nose. And exhale slowly
through your mouth. Continue to take slow, smooth breaths. When you breathe in,
notice your belly push your hands gently apart, as you fill your lower lungs with air.
When you breathe out, notice your belly sink back towards your spine as you release
your breath. You can imagine that your belly is a balloon. Fill it with air and then
watch it deflate. Now continue to focus on the gentle inhalation and exhalation of
your breath. In...and out... If any other thoughts or images come into your mind
during this exercise, just notice them, and gently bring your attention back to your
breath. You may also become aware of physical sensations or feelings in your body.
Simply notice them, and then again, bring your mind back to your breath. Continue to
focus on your breathing and stay in this relaxed state for as long as you like. When
you are ready, slowly open your eyes and bring your attention back to your
surroundings.
Leadership Considerations: The instructor must be a CTRS in order to help
participants create a life of meaning, personal growth, and positive emotions. The
instructor should explain the steps in a low calm tone as the exercise is being
executed. They should always have a positive attitude and talk with grace so the
participants feel calm. Always redirect the participant in a positive manner.
Adaptations: Participants with Aspergers Syndrome: Participants with
Aspergers Syndrome exhibit serious deficiencies in social and communication skills.
Many can face anxiety or depression. This activity can benefit these participants in
helping them accept themselves, make them feel comfortable, help them generate
positive feelings, and releasing tension and anxiety they may have. The instructor
must make sure the participants are comfortable and create a quiet peaceful
environment. Having different types of seating arrangements such as chairs, a couch,
a beanbag chair, etc. are great to have for different participants.
Participants with Acquired Brain Injury: Participants with ABI can benefit from
this activity by releasing any anxiety they have. Also by focusing their attention on
the breathing exercise they can clear their mind of any worry they have. These
participants can perform the activity in their wheelchair, with out having to get out,
with any support they need.

References:
Authors, J. (2011). How meditation can help people with Asperger's
Syndrome release tension and recognise body language - JKP Blog. Retrieved
October 05, 2016, from http://www.jkp.com/jkpblog/2011/01/art-chrismitchell-aspergers-syndrome-and-mindfulness/
Mindfulness Exercises. (n.d.). Retrieved October 05, 2016, from
http://youth.anxietybc.com/mindfulness-exercises

Facilitation Technique Category: Stress Management

Activity Title: Visualization Meditation
Equipment: A chair or yoga matt for each participant
Activity Description: Visualization meditation or guided imagery requires one to utilize
their visual sense, and also their sense of taste, touch, smell, and hearing. This technique
involves imagining a scene in which one feels at peace. Free to let go of all tensions and
anxiety. This activity should be performed in a quiet relaxed place, either sitting on a
chair or laying down on yoga matt. If the participants are beginners they should be seated
on the chair or on the matt because they may fall asleep. The lights may be dimmed just a
little to make the environment calmer, but not to dark so the participants wont fall
asleep. Also some calming music may be played depending on the instructor and the
population they are serving. Once in position the instructor will ask participants to close
their eyes and let their worries drift away. Instruct them to imagine a place that is restful,
where they can picture themselves relaxed and calm. They should picture this place as
vividly as they can; from everything they see, hear, smell, taste, and feel. Let your body
enter a state of deep relaxation as you calmly explore your restful place. Whenever the
participant is ready they may open their eyes and return to the present. The participants
shouldnt worry about zoning out or losing track of where they are during visualization,
because it is normal. It is also normal to experience feelings of stiffness or heaviness in
ones limbs, minor involuntary movements, or even cough or yarn.
Leadership Considerations: The recreational therapist should be certified by the
NCTRC to perform this activity. It is also recommended that the CTRS have a stress
management consulting certification by the American Institute of Health Care
Professionals (AIHCP). These requirements are needed to provide the highest quality to
the participants in this activity. Stress management instructors must use a calm and
positive tone a voice when explaining the activity and if assisting the participants in
guided imagery. They must make the participants feel safe in the environment and
overwhelm them so their anxiety or stress wont take over. The instructor to participant
ration should be 1:8, the activity is performed individually so the instructor can be the
only leader with a group of individuals.
Adaptations: Participants (children) with Autism: Visualization activities can be a fun
way to get a child motivated and excited about practicing stress management with
breathing techniques (Hardy,47). This activity can help these participants with regulation
of emotions, calming the body, energizing the brain, releasing negative energy or
emotions, focus and concentration. The instructor can use descriptive language to help
the child visualize a scene, a specific animal, feeling or emotion to support the child in
tapping into the part of the brain that is responsible for imagination and visualization
(Hardy,47). The instructor may also incorporate breathing techniques, by breathing
through the nose, into the activity to switch up the procedure a little so the participants
wont become bored. This will help release tension, decrease anxiety, sooth the nervous
system, support a healthy digestion and relieve insomnia and fatigue. An example of a

scene they may describe follows: Imagine lying down on a towel at the beach. The
warm sun is shining on your body. Your body is relaxed. Your towel is soft and cozy.
Your body is relaxed. You hear the sound of the waves. Your body is relaxed. You feel the
warmth from the sun. Your body is relaxed. You see the color of the blue waves. Your
body is relaxed.
Participants with Spina Bifida: Spina Bifida is a birth defect where a babys spine does
not form normally. As a result, the spinal cord and the nerves that branch out of it may be
damaged (Spina Bifida). Symptoms depend on the severity of the defect and where it is
on the spine. Mild defects may cause few or no problems, while more severe defects can
cause serious problems, including weakness, loss of bladder control, or paralysis. Since
spina bifida usually results in physical problems participants may perform the activity in
their wheel chair with cushioned support or if they have walking aids they may be seated
in a cushioned chair, the participant must feel comfortable in order to be relaxed and
calm. Most participants with spina bifida are of normal intelligence so they dont need the
instructor to guide them through a scene, they can find their own peaceful place and
imagine they are there. The instructor must be understanding to their condition and
provide any support needed.
Resources:
Hardy, S. T. (n.d.). Asanas for autism and special needs: Yoga to help children
with their emotions, self-regulation, and body awareness.
Relaxation Techniques for Stress Relief: Finding the ... (n.d.). Retrieved October
20, 2016, from http://www.helpguide.org/articles/stress/relaxation-techniques-forstress-relief.htm
Spina Bifida - KidsHealth. (n.d.). Retrieved October 20, 2016, from
http://kidshealth.org/en/parents/spina-bifida.html
Stress Management Consulting Certification - AIHCP. (n.d.). Retrieved October
20, 2016, from http://aihcp.net/stress-management-consulting-certification/

Facilitation Technique Category: Therapeutic use of Animals

Activity Title: The calming effects of a beta fish
Equipment: Fish bowl with a beta fish in it and rolling cart to carry bowl.
Activity Description: The leader of this activity will have a medium size fish bowl with
a colorful beta fish swimming inside with different accessories, such as plants and
colorful pebbles. The fish bowl must catch the eye of the client/participant. The leader
will put the bowl on a rolling cart and go around the facility visiting different clients. The
goals of this activity are to decrease levels of stress and anxiety, establish a calming
environment, and have clients reminisce about animals they may have had in the past.
Remembering the importance of past pets will make clients feel joyful about these
memories.
Leadership Considerations: The leader of this activity would be a Certified Therapeutic
Recreation Specialist. The therapist must have a positive attitude with knowledge of how
to administer discussions with a client/participant. The therapist to client ratio is 1:1, with
the therapist giving their full attention when client is speaking about a past memory with
a pet. Proper care of the animal must be considered by the therapist such as keeping the
bowl cleaned and feeding as necessary to the fish.
Adaptations: Participants with Generalized Anxiety Disorders: Anxiety disorders are
characterized by persistent, excessive, and unrealistic worry about everyday things
(Generalized Anxiety Disorder). Have clients with GAD simply gaze and admire the beta
fish first. Once their sadness and worry has diminished for the time being ask them if
they remember an animal they may have had that made them feel worry free and happy.
As conversation begins try to have them describe activities they performed with their pet.
The therapist should keep the conversations and once 30 minutes have pass have them
gaze at the fish in silence again before leaving to another client.
Participants with Alzheimers Disease: Alzheimers disease is an irreversible,
progressive brain disorder that slowly destroys memory and thinking skills, and the
ability to carry out the simplest tasks (Alzheimer's Disease Fact Sheet). The therapist
should introduce the fish first to Alzheimers clients showing how graceful they are. Have
the client watch the fish swimming, as this can increase their attention span and decrease
aggressive behaviors. As the client is watching the therapist should start describing an
animal they once had that meant a lot to them. Alzheimers clients will have difficulty
remembering past memories with a pet they once had, as it was probably a time in their
life very long ago. If this doesnt trigger the client to remember an animal they may have
had in the past have a family member or close friend have a picture of an animal
meaningful to them ready and give it to the client. Have the client describe what is in the
picture and if they start to remember have them talk about their experience. If a client
cannot remember just have them gaze at the fish and put them in a calm state until the 30
minutes are up.

References:
Animal Assisted Therapy Ideas. (n.d.). Retrieved November 10, 2016, from
http://www.recreationtherapy.com/tx/animalassisted.htm
Alzheimer's Disease Fact Sheet | National Institute on Aging. (n.d.). Retrieved
November 10, 2016, from
https://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-fact-sheet
Generalized Anxiety Disorder (GAD). (n.d.). Retrieved November 10, 2016, from
https://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

Facilitation Technique Category: Therapeutic Use of Play

Activity Title: Sand Play
Equipment Needed: Different boxes/trays with colorful kinetic sand, small toys that can
be hidden in the sand, flash cards with different shapes on them, hand sanitizer.
Activity Description: This activity has many different approaches depending on the
participants needs and goals. It provides a free and protected environment for selfexpression. The therapist does not interfere with or direct the clients actions. The client
will first choose what color sand they want and then they can choose activities such as
finding hidden objects in the sand, drawing different shapes as seen on a flash car, and
free play with the sand where the client can draw on the sand and just let it run through
their fingers. All the activities can even be incorporated into one session, depending on
the client. Before and after the activity each participant must use hand sanitizer to keep
germs out. This activity should be taken place in an activity room with minimal
distractions and take 30-40 minutes.
Leadership Considerations: The instructor of this activity must me a CTRS with the
knowledge of different activities to incorporate play as a therapeutic means. For this
particular activity the instructor must take a nondirective approach to play where the
client takes the lead in the activity. The instructor to participant ratio is 1:1, where this
will be an independent activity for the client to be free from external pressures.
Adaptations: Participants with Fibromyalgia: Fibromyalgia causes widespread pain
and tenderness (Fibromyalgia). Participants may also experience fatigue, sleep
disturbances, and feelings of anxiety and depression (Porter, H. R.). Participants with
fibromyalgia may also experience cognitive problems such as feelings of confusion,
lapses in memory (especially short-term memory), word-finding problems, word mixups, or difficulty concentrating. This activity can help these participants express hidden
emotions they may have due to the chronic pain. It can also distract them from the pain as
they are focused on play and the soft feeling of the sand. It is important for the therapist
to make the environment very comfortable for the client such as having them lay down or
sit on a cushioned mat, sit in a bean bag chair, sit on a sofa, or on a chair with back
support.
Participants with Aphasia: Aphasia is the loss of the ability to produce or comprehend
language, whether expressive or receptive. It is a communication disorder that results
from damage to the parts of the brain that contain language. During the activity the
therapist may ask questions to the client such as how does the feel of the sand make you
feel? What objects they found in the sand? Why they chose the color sand they did? This
will give the client the opportunity to play freely while practicing communication. The
therapist should only help the client with words they may have difficulty expressing when
it becomes clear that they are having trouble (Living with Aphasia).
References:

Fibromyalgia. (n.d.). Retrieved November 15, 2016, from

http://www.rheumatology.org/I-Am-A/Patient-Caregiver/DiseasesConditions/Fibromyalgia
Living with Aphasia Aphasia West Texas. (n.d.). Retrieved November 15, 2016,
from http://www.aphasiawtx.org/1505
Porter, H. R. (2015). Recreational therapy for specific diagnoses and conditions.
Enumclaw, WA: Idyll Arbor.
Sandplay Therapy Studies - Continuing Education. (n.d.). Retrieved November
15, 2016, from
https://extension.ucsd.edu/programs/customprogram/documents/whatisSandplay.p
df
Sand Tray Therapy. (n.d.). Retrieved November 15, 2016, from
http://www.goodtherapy.org/learn-about-therapy/types/sand-tray-sand-playtherapy

Facilitation Technique Category: Sensory Stimulation

Activity Title: So many beans!
Equipment Needed: A medium sized clear box, measuring spoons with different sizes,
spoons, medium size mason jar, a funnel, and different types of beans, peas, and lentils.
Activity Description: This activity offers participants an opportunity to explore in an
unstructured way. The instructor will put a bunch of different beans, lentils, and peas in a
clear box. The participant will sift through the mix using their hands and different tools.
The purpose of the activity is to find different size and color beans and separate them into
a jar creating different layers of the beans and lentils. The participant can place them into
the jar in any order they want and they may use a funnel to make it easier for them to
place them in layers. They can describe the different beans and lentils that they have
never seen before to the instructor or another participant. The participants are using their
seeing, feeling, touching, and even smelling senses during this activity. Other
opportunities it provides are fine motor development, hand-eye coordination and control,
concentration, spatial awareness, language development, and social interaction. The
activity can be done individually or in pairs, as the participants may work together
helping and discussing with each other.
Leadership Considerations: The instructor of this activity must be a CTRS. The
instructor must be very observant during this activity making sure that the participants do
not try to consume the beans and lentils, resulting in a choking hazard. The instructor
must let the participants explore on their on and give support when needed. The instructor
to participant ration would be 1:1 or 1:2.
Adaptations: Participants with ALS: Amyotrophic Lateral Sclerosis (ALS), sometimes
called Lou Gehrigs Disease, is a progressive neurological disease that attacks nerve cells
(ALS Fact Sheet). This disease causes weakened muscles and impacts physical function.
The therapist should start off with letting the participant put their hands in the box and
feel the beans, getting their touch senses going. The therapist may provide a wrist support
where the spoon used to sift through the beans can be attached. If the participant has very
limited mobility in their hands the therapist may get their hands and move them around in
the box and help them pick out the beans.
Participants with OCD: Obsessive Compulsive Disorder is a chronic and long-lasting
disorder in which a person has uncontrollable reoccurring thoughts and behaviors
(NIMH). The instructor shouldnt try to interfere with the compulsions instead try to
distract the participant from them. One example could be if the participant has a fear of
germs they may use gloves during the activity. If a participant has a compulsive behavior
of ordering and arranging the therapist should try to have the participant arrange the
beans and lentils in different groups in the mason jar. This activity would be best
individually for participants with OCD in order for the therapist to focus on them.
References:

ALS Fact Sheet. (n.d.). Retrieved November 15, 2016, from

http://www.ninds.nih.gov/disorders/amyotrophiclateralsclerosis/detail_ALS.htm
H. (2015). Mixed Beans & Peas Sensory Tub. Retrieved November 15, 2016,
from http://www.learning4kids.net/2014/09/28/mixed-beans-peas-sensory-tub/
NIMH Obsessive-Compulsive Disorder. (n.d.). Retrieved November 15, 2016,
from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorderocd/index.shtml