Obsessive compulsive disorder - OCD treatment and therapy from NOCD

How To Deal With Compulsive and Intrusive Thoughts?

5 min read
Patrick McGrath, PhD

There are few things like the feeling when intense worry lifts. Whatever degree of anxiety you’re feeling– whether your kid still isn’t home three hours after curfew or you desperately want your favorite sports team to win– there’s real relief in its resolution.

These two situations are widely recognized, to varying degrees, as understandable causes of heightened anxiety. But other causes are misunderstood or flat-out rejected: There’s no reason he should be freaking out about the way she’s doing the dishes or Why does this even matter to you so much? Sometimes people are said to be overthinking a situation, or “just coming up with things to worry about.”

People with all kinds of so-called mental disorders are swept to the side because they don’t fit in with accepted expressions of distress. In a way this rejection is self-protective– it can be draining to acknowledge the legitimacy of a depressed friend’s withdrawals, the difficulty a family member has in maintaining a job as they deal with psychotic episodes, and so on. To recognize these things fully is to admit that nobody is really in control of everything they think and feel.

When we think of obsessive-compulsive disorder (OCD), pop culture images of strange people spiraling into increasingly desperate situations might emerge. A more likely situation, though, is that you won’t be able to spot that person unless you’re very close with them. Shame is a powerful motivator, and people tend to be good at hiding things they know will be misunderstood.

Leonardo DiCaprio from The Aviator movie playing role of Howard Huges who had OCD
Howard Hughes, an aviation magnate who had OCD, played by Leonardo DiCaprio
in The Aviator (Warner Bros., 2004)

Repeated attempts to mitigate distress are called compulsions when they feel unavoidable. They’re not habits, and they don’t feel voluntary. People don’t act compulsively because they enjoy doing so. And, like the withdrawals characteristic of depression, another person’s compulsions can be hard to approach with empathy.

When unpleasant feelings are alleviated by a specific behavior– say, getting checked by a doctor– it becomes more likely that someone will perform that behavior again. This isn’t unique to OCD; it’s a natural human response, and psychologists see it as an example of both negative reinforcement and operant conditioning. In this way, compulsions evolve over time, their temporarily alleviation of anxiety snowballing on itself while they continually shift in their specifics. What starts as a voluntary, controllable behavior can morph into a compulsion through reinforcement.

Someone might start getting a physical exam from a new doctor each month, before they realize that searching for symptoms online allows them to obtain 24/7 relief. They’re responding to obsessions– intrusive thoughts, images, or urges– because those obsessions have latched on and started causing tremendous distress.

A man and woman discussing

Here, the person feels incapable of accepting sudden images of dying from a serious illness whenever something looks or feels a bit different with their body. Getting a physical exam or finding new information online reassures them for a bit: this is normal, nothing bad will happen. But, in doing so, the compulsive behavior seems to legitimize the obsession: good thing I got that checked out. It’s a cruel fact: behaviors that bring temporary relief can generate long-term suffering.

The fact that other people can only witness compulsions– and not the obsessions that fuel them– makes it hard for them to understand OCD, even if they truly want to. This isn’t unique, of course, as nobody can read another person’s mind and know exactly why they’re behaving in a certain way. But we’re able to make assumptions about most behaviors: he’s straightening things before guests arrive so they’re comfortable or even impressed, she’s buying groceries to make a meal later, they’re playing soccer because they enjoy it or want some exercise.

It’s much harder for us to make a guess as to why someone would feel completely panicked until they’re able to loop back while driving to make sure they haven’t run someone over, for example. These behaviors are not rational, so to speak, and the resulting misunderstanding means people with OCD are alone until they seek help.

Compulsions, through their reinforcement of obsessions and the way they steal so much time and energy, are the core of the suffering OCD causes. In learning to resist compulsions, people can free themselves from this vicious circle. This process, called response prevention, helps people learn how to respond to unwanted thoughts without feeling compelled to behave in any particular way.

Because our instinct is to escape suffering, it’s no wonder people tend to hope OCD treatment will get rid of the excruciating thoughts that seem to make their lives so difficult. But, in the end, thoughts may prompt suffering but do not cause it. And the most effective forms of OCD treatment don’t try to change anyone’s thoughts; they aim to help people change their behavior instead. Many find that they experience the exact same thoughts after treatment– these thoughts are, however, drained of their debilitating power.

The goal of the most research-backed type of therapy for OCD, Exposure and Response Prevention (ERP) therapy, is to stop using compulsions and get used to distress. All of this hard work is in the service of developing lifelong and widely applicable skills for responding to unwanted thoughts by… not really responding to them.

Get support for compulsions, OCD treatment, and ERP in the free NOCD app!

If you or someone you know is struggling with OCD, schedule a free call today with the NOCD clinical team to learn more about how a licensed therapist can help. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. At NOCD, all therapists specialize in OCD and receive ERP-specific training.

Patrick McGrath, PhD

Dr. McGrath is a Licensed Clinical Psychologist and the Chief Clinical Officer at NOCD. He is a member of the Scientific and Clinical Advisory Boards of the International OCD Foundation, a Fellow of the Association for Cognitive and Behavioral Therapies, and the author of "The OCD Answer Book" and "Don't Try Harder, Try Different."

ERP Therapy
Obsessive compulsive disorder (OCD)

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Taylor Newendorp

Taylor Newendorp

Network Clinical Training Director

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Madina Alam

Madina Alam

Director of Therapist Engagement

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

Andrew Moeller

Andrew Moeller

Licensed Therapy, LMHC

I've been a licensed counselor since 2013, having run my private practice with a steady influx of OCD cases for several years. Out of all the approaches to OCD treatment that I've used, I find Exposure and Response Prevention (ERP) therapy to be the most effective. ERP goes beyond other methods and tackles the problem head-on. By using ERP in our sessions, you can look forward to better days ahead.

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