How is OCD (Obsessive-Compulsive Disorder) Treated?

Let’s start by dispelling some myths regarding OCD in the media. It goes beyond “being particular” or “being really clean.” Obsessive-Compulsive Disorder is a serious condition that affects about 2% of the U.S. adult population. OCD is characterized by the presence of obsessions and compulsions. OCD can range from mild to severe depending on how much the disorder gets in the way of day to day life.

What are Obsessions?

The way I’m using the word “obsession” is different from how it’s typically used in day-to-day conversation. We might say “I’m obsessed with this new show” or “I’m obsessed with this new ice cream place.” An “obsession” in this specific mental health context is defined as an unwanted, intrusive thought that causes distress. Most of the time obsessive thoughts trigger feelings of fear or anxiety, sometimes they cause feelings of disgust or uneasiness. Obsessions come out of nowhere and feel invasive and unwanted. The content of obsessions tends to be things that feel really scary, such as thoughts of dying, getting a terrible illness or harming a loved one. 

What are Compulsions? 

Compulsions are efforts to try and suppress that anxiety and fear caused by obsessions. Compulsions are efforts to cancel out, push away, prevent or distract from the obsession. Compulsions vary and include observable behaviors such as handwashing or repeatedly locking the door as well as mental rituals such as thinking a positive thought to cancel out a negative one or praying for forgiveness. The goals of compulsions are to reduce anxiety and to avoid or prevent a feared outcome. For example, let’s say a person has an obsessive (intrusive and unwanted) thought about dying from cancer. They might go to the doctor more often than is needed and repeat a particular prayer in order to prevent their feared outcome from happening. 

How does Therapy for OCD Work?

One commonly used approach for treating OCD is called Exposure and Response Prevention (ERP or EX/RP). ERP is an evidence-based treatment that works for about 70% of people who try it. ERP tackles the habitual connection between compulsions and obsessions. Obsessions trigger anxiety. When a person performs a compulsion, it reduces anxiety. A person is more likely to use that same compulsion again the next time because it’s provided relief in the past. Let’s say you are nervous about getting into a car accident. Every time you get in the car, you repeat a prayer ten times, and you feel less anxious, which makes you want to keep doing that. Also, you’ve noticed that it seems to work: every time you repeat the prayer you've never been in a car accident. Your brain has no opportunity to disprove this theory, and the prayer ritual keeps making you feel less anxious about driving, so you keep doing it. The obsessive-compulsive cycle keeps getting stronger and stronger. ERP is about figuring out your own personal OCD cycle, and disrupting that with new information and new habits. You’ll build up your ability to handle discomfort and anxiety and learn that what OCD says will happen doesn’t always happen. 

What Will We Do in Therapy Sessions? 

The majority of ERP sessions are experience-based rather than talk therapy-based. ERP begins by carefully evaluating your OCD symptoms (2-3 sessions). We'll chart your intrusive thoughts (obsessions) that make you anxious as well as the activities (compulsions) you engage in to calm yourself down. Then we’ll rank anxiety-provoking situations based on how much fear they cause you. Using the above example about fear of getting into a car accident, a low-level exposure could be sitting in the car and turning it on, without doing the prayer ritual. A high-level exposure would be taking a 20-minute drive without praying beforehand. In each session, we’ll do an activity from your fear list together, and I’ll be guiding and talking you through it. We start with something that causes low to medium levels of anxiety, then work our way up to the next one, until you’re able to do the majority of the items on your fear list without doing any compulsions.

Isn’t that Scary?

To be honest with you, it might feel scary at times. OCD will tell you that something terrible will happen and it’s difficult to take a chance to see if what OCD is telling you is wrong. I never “force” or persuade someone to do an exposure item they aren’t ready and willing to tackle. This is a collaborative, voluntary process and I’m there to provide support and coaching. The idea is that we repeat each exposure practice until you can do it comfortably with little to no anxiety, and then slowly work our way up to the next item. 

How Does This Work Over Telehealth?

Research done during the COVID-19 pandemic found that there was little to no difference in the effectiveness of in-person vs. telehealth ERP treatment. Telehealth allows for more access to effective treatment for people who previously could not receive services, such as people with fears of leaving the house. Telehealth may not be appropriate for young children or in severe cases where a higher level of care is needed. My telehealth platform works with most devices so sessions can happen from wherever your OCD shows up the most, such as outdoors, the grocery store or your home.

What are the Other Details?

Sessions can be 55 or 90 minutes and occur either once or twice a week. The ERP manual recommends two 90 minute sessions per week. For practical reasons such as scheduling, insurance coverage and finances, this may not be possible. Our schedule will be tailored to your specific needs. If OCD impacts your home life, you’re welcome to involve family members in some of our sessions so they can learn about how OCD works and the most helpful ways to respond to it. 

Will ERP Make My OCD Go Away? 

No. Most people continue to experience some mild symptoms after completing ERP but find their overall quality of life greatly improved. The “chatter” of intrusive thoughts won’t change, but your response to them might. ERP can help you tune out the chatter by decreasing the anxiety you feel about those thoughts. 

Get started with a free consultation call to see if ERP is the right fit for you!