Obsessive Compulsive Disorder
What is OCD: Obsessive Compulsive Disorder (OCD)is an anxiety disorder that includes cycles of obsessive thoughts, urges, sensations, and feelings followed by compulsive behaviors. An assessment by a trained clinical is important, as OCD can often be missed in treatment or misdiagnosed as another concern. There are many themes or ways obsessive compulsive disorder presents and an expert provider is trained to assess the signs and symptoms.
Who does OCD effect: Obsessive Compulsive Disorder is the fourth most common mental health disorder. OCD effects 2-4% of the population or 1 in 40 adults, and OCD is more prevalent in women than men. The onset is typically childhood or adolescence with an average age of 19 y.o. At least half of people with obsessive compulsive disorder experience severe symptoms and the symptoms fluctuate over a lifetime, even after treatment.
What are obsessions in OCD: Obsessions are unwanted and uncontrollable thoughts, images, or urges that trigger anxiety. Obsessions are repetitive and persistent and can create a sense of urgency to resolve them. People often recognize their obsessions are irrational and ego-dystonic (inconsistent from one’s self-image and values, not who a person is or what a person believes), but the obsessions create discomfort and doubt that is difficult for the person to tolerate. Obsessive compulsive disorder is known to be the “doubting disorder.”
What are compulsions in OCD: Compulsions are the behaviors or mental rituals that people engage in to reduce the discomfort and uncertainty created by the obsessions. The compulsions are very time consuming, quality of life interfering, and only maintain the anxiety because they result in short-term relief. The relief is only short-term without successful treatment, as obsessive compulsive disorder will continue the cycle of doubt and compulsions as the way of coping.
Symptoms of Obsessive Compulsive Disorder
- Feel stuck in thoughts
- Treat intrusive thoughts as likely, meaningful, and risky
- Difficulty tolerating uncertainty
- Feel overly responsible for self, others, or outcomes.
- Overestimate risk in situations – often resulting in anticipatory anxiety, dread, and avoidance
- Low belief in abilities to cope
- Can’t stop the compulsions or don’t want to due to the relief.
- Symptoms cause great distress and interfering in a meaningful life.
Treatment for Obsessive Compulsive Disorder
A type of cognitive behavior therapy (CBT) called exposure response prevention (ERP) is the leading evidence based therapy for OCD.
Exposure Response Prevention for OCD
What is Exposure and Response Prevention treatment (ERP): In ERP, one learns to intentionally face fears associated with the obsessions (exposure) while removing the compulsions (response prevention). Exposure is completed in a gradual, compassionate, and purposeful way by approaching what one is missing out on in life due to OCD. Exposures may be imaginal (an exercise of vividly imagining the obsession and outcomes) or in-vivo (in real life approaching the obsessions while tolerating the feared outcomes). The goal of ERP is to gain new learning related to the fears, which includes decreased fear responses, ability to tolerate uncertainty and doubt, and have mastery over anxiety.
Treatments for OCD
What other treatments are used with ERP: ERP has evolved over the years from an approach centered on habituation or decreases in anxiety to an exposure treatment focused on new learning and emotional mastery. As the treatment has been further researched, there are other evidence based therapy approaches that have been found to be highly effective to add to ERP.
- Mindfulness teaches one to come to the present moment curiously and without judgment. People learn to observe and accept thoughts and feelings.
- Acceptance and commitment therapy (ACT) helps one learn cognitive flexibility by having a willingness to accept and experience unwanted thoughts and emotions without having to resist. ACT emphasizes mindfulness, distance from thoughts, and accepting what we can’t control. It also highlights the importance of structuring exposures and treatment around one’s goals and values.
- Self-compassion skills are incredibly helpful in empowering individuals through treatment. Often OCD induces shame and embarrassment. Self-compassion combats those interfering emotions and increases abilities to cope effectively. The key components of self compassion include:
- Mindfulness to oneself, thoughts, and emotions to directly face treatment. Mindfulness can make treatment less overwhelming by allowing and accepting instead of resisting and increasing distress.
- Common humanity is knowing that all people have experienced painful emotions and experiences. It is when a person accepts oneself as similarly suffering instead of personally failing.
- Self-kindness is used to decrease unhelpful criticisms and to become a loving cheerleader. A gentle frame of mind is encouraged to recognize successes and to maintain motivation. Self-kindness also includes holding oneself compassionately accountable to change.
- DBT skills can help in tolerating stress and regulating emotions during difficult exposures. DBT is a treatment heavily rooted in mindfulness, behaviorism, and dialectics (flexibility in viewpoints). This makes it consistent with the leading treatment for OCD, ERP. Exposures can cause a lot of distress making one want to avoid. DBT skills can help tolerate that discomfort to stay in the exposures. Exposures can also result in high dsyregulation. DBT is a leading treatment for regulating emotions, anxiety and others. It includes strategies to decrease vulnerabilities, to change unwanted emotions, and the importance of building positive emotions.
Wise Mind Counseling is highly trained and has years of experience treating OCD using ERP and additional treatment approaches.
OCD Resources
For more information:
Anxiety and Depression Association of America
International OCD Foundation
NOCD