Obsessive-compulsive disorder, or OCD, affects 2% to 3% of the U.S. population, between 4-9 million people. Many who seek treatment for OCD wonder how long it will take for it to offer relief. Of course, everyone’s OCD journey is different, but with the help of a trained provider , treatment for OCD can begin to take effect relatively quickly.
If you have OCD, you have options when it comes to treatment. Therapy, medication, and, in severe cases, surgical procedures have all proved effective when treating the disorder. But the “gold standard and first-line treatment,” according to Keara Valentine, Psy.D., a postdoctoral fellow at Stanford University School of Medicine in the OCD and related disorders track, is exposure and response prevention, or ERP.
A two-pronged method, ERP involves exposing yourself to the stimuli that trigger your anxiety, and then choosing not to respond with a compulsive behavior. “You expose yourself and lean in to fear and uncomfortable emotions, and engage in response prevention where you choose to not escape from or neutralize the discomfort,” Valentine explains.
If a dirty surface leads to excessive hand washing, for instance, ERP would have you touch the surface and not follow up with a rinse. It’s a challenging response to achieve permanently, but over time and with the help of an expert to pinpoint what triggers you, ERP can be an incredibly effective method of treatment. In fact, Valentine says the success rate for ERP is “approximately 65% to 80%.” For comparison, using medication alone results in 40% to 60% effectiveness, Valentine says. “ERP in combination with medications is also highly recommended,” she adds.
Here’s the tricky part: Treatments and therapies are rather cut and dry, but actually getting diagnosed with the disorder can get sticky. According to Science Direct, only about 200,000 people with OCD out of the 4.1 million who need treatment actually seek effective therapy.
For some, it can take years to learn they have the disorder. “One of the biggest barriers to receiving treatment for OCD is being diagnosed with OCD,” Valentine says. “I’ve seen statistics estimating that it can take 17 years on average for people to receive an OCD diagnosis.”
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Once diagnosed, however, you should seek some form of treatment when your symptoms—ritualistic behavior, anxiety, depression, fear—become unmanageable. “When symptoms start interfering with your functioning, take up excessive amounts of time, and/or cause a great deal of distress,” Valentine says, you should seek treatment.
In a nutshell, it depends. For some, treatment is quick, and its benefits can take immediate effect. Others won’t see improvement for weeks, even months. “The length of treatment can vary greatly based on severity of symptoms and subtype of OCD,” Valentine says. “On average, we say folks will need 12 to 20 sessions of ERP, but that number can be higher or lower.”
Further, people with severe OCD might need elevated care before returning to individual therapy. That could look like an initial residential or partial hospitalization program, or perhaps an intensive outpatient program, for four to six weeks, and then sessions of ERP. Bottom line: It takes as long as it takes. And that’s okay. Treatment is still worth doing even if it doesn’t produce overnight results.
“Do I have to do ERP for the remainder of my life?” “Can ERP even completely cure OCD in the first place?” These are valid questions that elicit fuzzy answers.
There is no guaranteed cure for OCD; in fact, Valentine says that those in her profession don’t even use the word “cure”; rather, there are effective interventions and treatments that have proven successful. “I have met people who had one round of ERP and stated that their OCD symptoms never returned,” she says. “Likewise, I have worked with people who have been to therapy to receive ERP several times.”
So, yes, it is possible that ERP may be a lifelong commitment. But over time, managing the symptoms of OCD can get easier, even becoming an afterthought, or what Valentine calls “background noise.” Intrusive thoughts or compulsive behavior may still arise, but learning to innately not respond is the trick. In therapy, you will learn practices to bring into your day-to-day life and hopefully decrease the impact of your compulsions. “One thing is for sure: You cannot maintain your progress with ERP if you are engaging in compulsions,” Valentine concludes.
Although ERP is the leading treatment for children, adolescents, and adults with OCD, it isn’t guaranteed to work the same way for everyone. But just because ERP doesn’t work right away doesn’t mean there aren’t effective treatments for your OCD. It just may take a deeper understanding of what is actually triggering your OCD response.
“It is a fairly common experience to have someone start ERP and find that it is not working for them,” Valentine explains. “When this happens, it doesn’t mean all hope is lost, but rather we have to take a look at what might be interfering. For example, I have had people do exposures and find that their anxiety isn’t habituating over time or the exposures just aren’t getting anymore doable. In these situations, we have to thoroughly assess whether any compulsions or avoidance are occurring.”
She adds, “Sometimes OCD can be sneaky (not people with OCD—the OCD itself), and we can be engaging in compulsions that not even we know about or doing some avoidance that keeps us from being fully in the exposure! Trained ERP therapists will know to query for any possible way we might be detaching ourselves from the exposure experience.”
ERP, which requires working with a trained and specialized therapist, can be a marathon. Count on spending several sessions with your therapist, exhausting every aspect of the method as well as considering the addition of medication, before declaring the process a failure.
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Once all corners of ERP have been explored and proven null, seeking a different treatment is advised. This could mean treating “extreme and unrelenting” OCD symptoms with additional medications or, in the most severe cases, with surgical procedures, such as deep brain stimulation.
“In reality, there are folks who have treatment-resistant OCD,” Valentine says. “I would want to make sure I exhaust medication trials and ERP attempts before I make that distinction though.” According to the doctor, a patient would need to fail three rounds of ERP and several trials of SSRIs to even be considered for such treatment.
If you are struggling with OCD and want best-in-class ERP therapy to help you please know that NOCD works with patients in all 50 states. A free 15 minute call can give you all the information you need to regain your life from OCD.