Obsessive Compulsive Disorder can be very debilitating for people to live through- could be hours and hours of compulsions in a day. Obsessions and compulsions are ever changing and OCD is tricky. Finding a provider that offers an evidence based treatment is necessary.
Let’s review OCD – it is full of obsessions (unwanted thoughts and urges). People learn to reduce the obsessions by doing compulsive behaviors or mental acts. This of course works in the short term, but compulsions will always lead to more compulsions and interfere in building joy and freedom from anxiety. OCD wants to find a certainty in situations and won’t stop. Really, it can’t stop because certainties are impossible, and that’s exactly why finding a trained treatment provider is critical.
So let’s talk about how to treat it! There are different therapies that are recognized with OCD – a type of Cognitive Behavior Treatment called Exposure Response Prevention (ERP), Inhibitory Learning, and ERP + AU (Accepting Uncertainty) . All these approaches have common ingredients: 1. Exposure to the obsession, 2. Avoid the compulsion (response prevention), and 3. Lean into accepting uncertainty (specifically related to the underlying fear maintaining obsessions and compulsions).
How do these three ingredients map on to OCD in the real world? Here’s an example of using all the parts and with a less common obsession than contamination- let’s say with obsession of losing something, a compulsion of checking items, and an underlying fear of ruining one’s life.
First, one has to do the exposure to the situation that they may lose something. This could look like taking an item (maybe or maybe not the most treasured item to start with) along for a period of time while doing errands. Then the response of checking for the item has got to be avoided at all possible causes and not planned to engage in later (for example, saying to oneself “I won’t check while on errands, but I will check when I get home”). And finally, there is a practice of accepting the unknown that the person could or could not have ruined their life or the life of another. Accepting the uncertainty may look like having the thought “I won’t know if not checking for this item ruined my life or not. Let’s continue living my life and see how it goes.” The goal is to learn to live with not knowing if that underlying fear is true or not while doing the exposure to situations that cause the anxiety AND avoiding the ritualizing behavior.
Exposure is difficult, time consuming work and extremely powerful and effective work! People (for understandable reasons) often want to turn away from the deep obsession and high anxiety. New obsessions will generally grow, as well as new compulsions when OCD is left untreated. The exposure practices will highlight the bizarre and extreme content of the obsession while developing the ability to experience anxiety (an unavoidable emotion) without a compulsion.
Sometimes people wonder if they have the untreatable OCD and need a different style of therapy, or they think how will these approaches exactly work for me. Regardless of the type of OCD, the three components (exposure, response prevention, and tolerating uncertainty) described above are applied the same. A well trained and experienced clinician will support the client in how to apply these strategies to their type of OCD. Getting this part right is the key to change and dominating OCD! OCD obsessions can become ordinary thoughts that are much more manageable day to day.
Contact me if you are interested in an OCD assessment or to start OCD treatment now.