Obsessive compulsive disorder - OCD treatment and therapy from NOCD

How ERP Can Treat All OCD Themes

7 min read
Stacy Quick, LPC

If you have OCD, hang out in OCD communities online, or read articles about OCD, it will not take you long to see that there are many themes or categories—often called subtypes—that people use to identify their OCD symptoms. Though everyone’s experience is unique, many people with OCD share similar underlying elements, and their thoughts tend to center around particular themes. 

I like to refer to themes as flavors because while each one has a uniqueness to it, their cores are very similar: there’s a need for certainty and a sense of urgency that comes with their intrusive thoughts, images and urges. People may have several themes or just one, and these themes can also change from time to time. 

One of the reasons that some people find it beneficial to categorize their symptoms into a theme is because it can provide a sense of relief in itself. If you’ve been living with symptoms that were puzzling and that caused you to think the worst things about yourself, finding out that there are others who experience the same or similar feelings can be a life-changing experience. 

Doubt and uncertainty at the root

Identifying themes can help some people categorize areas that OCD often latches onto and the intrusive thoughts that center around these topics. Still, with all subtypes, doubt and uncertainty are the driving force. What a person’s OCD chooses to focus on can be a result of their environment; it might relate to things that they grew up valuing, or things that were taught to them. OCD attacks what people value. 

For example, someone who grew up in a religious household where there were very high expectations for behavior may develop religious-themed obsessions. They may have intrusive thoughts about God being angry at them or about perceived moral faults in their character. They likely will be on high alert about anything that could be recognized as sinful or “wrong.” 

OCD can attach itself to any category, even if most people experience similar themes. These categories are often topics that people are prone to avoid talking about. For many, these areas are shrouded in shame and guilt. It is almost as if OCD attaches itself to an individual’s most dreaded fears and the things that they find the most frightening. 

Treatment for OCD subtypes

The good news is that regardless of the OCD subtype, or the nature of the intrusive thoughts—whether violent, taboo, sexual, or otherwise upsetting and unwanted—all themes of OCD are treatable with exposure and response prevention (ERP) therapy. ERP is the gold standard of treatment for OCD and involves specifically targeting the source of a person’s obsessions by directly exposing them to it. In most cases, people find that ERP helps their anxiety subside to the point where they no longer experience intense fears related to their thoughts on a regular basis. 

That’s why a therapist who is specialty-trained in ERP will know how to treat your OCD theme, whether you’ve seen your subtype many times before, or have never heard of anyone else struggling with your specific subtype or intrusive thoughts. But every individual will have a personalized treatment plan when they begin ERP that will be customized to meet their personal needs.

Some themes and examples of exposures for treatment

The following are some of the many OCD themes that have been identified, with examples of exposures that may be used in treatment (though again, I emphasize that all treatment plans are personalized based on specific needs, so exposures can differ for everyone’s experiences).

  • Contamination OCD: can include fear of germs, dirt, etc. An example of an exposure may include touching a “contaminated” item and resisting the urge to wash your hands afterward.
  • Just Right OCD: having perfectionistic tendencies or a need for symmetry. Possible exposures include “purposefully” un-straightening pictures on walls or messing up items on your desk.
  • Harm OCD: fears surrounding accidentally or purposefully causing harm to loved ones or others. Exposures may include having knives or sharp objects out when you are around others.
  • Suicidal OCD: often falls under the umbrella of harm OCD, but the primary intrusive thought is centered around fears that you may want to kill yourself and that you may someday act on these thoughts. Exposures may include reading about suicide and watching videos about suicide, or maybe writing a “fake” suicide note or obituary.
  • POCD (pedophilia): fear of sexually abusing children or having inappropriate thoughts, images, or fears around feelings involving children. Exposures may include looking at photos of young children or babysitting children.
  • SO-OCD (sexual orientation): fear of actually being attracted to the gender you do not identify as being attracted to. An exposure could be looking at photos of people with the gender that you have intrusive thoughts about being attracted to, or purposefully complimenting people of that gender.  
  • Religious Scrupulosity OCD: fears of disappointing God or intense feelings of guilt surrounding morality. Exposures could involve praying only when you want to–-not out of duty or due to anxiety—or writing the number 6, or other things that you may consider to be “sinful” that you believe other members of your same faith would not do.
  • ROCD (relationship): thoughts surrounding not being in the right relationship or not being attracted to one’s partner. As exposures, you may be asked to look at pictures of your partner and identify everything “unattractive” about them, or to watch television shows in which people do not end up together. 
  • Real Event/False Memory OCD: fears surrounding past events or trying to figure out what may have happened in the past. Exposures could be hearing about false memories or about buried memories. It could also include writing an imaginary script about past events and including the worst-case scenario for what would happen if it were true. 
  • Health Concern OCD: fears surrounding one’s health or obsessive thoughts surrounding perceived symptoms in their body. Exposures may look like writing out a story of the worst-case scenario, such as being sick with something life-threatening, then reading it repeatedly while not engaging in compulsions. You might even record your voice reading this story aloud and listen to it repeatedly.

NOTE: This is not an all-inclusive list; rather, it is a short summary of some intrusive thoughts, images, urges that OCD focuses on, and the categories or themes that they fall under. It is also not uncommon to have several of these or to experience multiple themes at any given time. (You can learn more on the topic of subtypes here.)

Treating OCD no matter the theme

As with all exposures, the key piece for treatment is response prevention: resisting the urges to do compulsions or anything that relieves anxiety temporarily. The goal of ERP is to learn to manage OCD effectively and to provide long-term relief from anxiety. 

ERP does this by teaching you to respond differently to your obsessions, without compulsions or rituals. You will learn how to accept uncertainty, no matter how upsetting and distressing a thought, image, or urge may seem. In letting go of the idea of certainty, you gain freedom from the intense fears that OCD tries to control. By responding differently, you retrain your brain to recognize that you are not in actual danger. 

ERP therapy is an active form of treatment and requires intentional buy-in from the member through participation in exposures, a willingness to feel discomfort, and honesty with their therapist about their obsessions and compulsions (even if they believe they are shameful or taboo). ERP therapy has been proven to effectively treat people with OCD. About 80% of people with OCD experience positive results, and the majority of people experience results within 12 to 25 sessions

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. If you have questions or think that you may need ERP therapy for your OCD, speak to someone on our care team on a free 15-minute call.

If you’re worried or uncomfortable about discussing your symptoms and thoughts with anyone else, keep in mind that a therapist won’t judge you, and a trained OCD specialist (like the ones at NOCD) will deeply understand all themes of OCD. You don’t have to suffer in silence, and many people find relief in sharing their experiences. Over time, you can learn how to manage OCD and regain your life.

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