Obsessive compulsive disorder - OCD treatment and therapy from NOCD

If you’re struggling to resist compulsions, try these 5 strategies

7 min read
Jackie Shapin, LMFT
By Jackie Shapin, LMFT

Recovery looks different for everyone. Recovery is never linear and there is no set time frame. The key to finding freedom from obsessive compulsive disorder (OCD) and learning to manage it so you can have a more freeing life is to lessen the compulsions you do in response to distress.

In a previous article, I discussed five tools to help cut out compulsions. I want to acknowledge that learning to do this is not “black and white.” If those tools were difficult to put into action, don’t worry. You are not doomed. There are still steps you can take when cutting out compulsions feels impossible.  

While compulsions might feel good in the moment, they reinforce your reliance on them, which frequently causes them to grow stronger. When we continue doing compulsions, we are telling our brains that the thought or experience we’re grappling with warrants a specific response—but it doesn’t. By performing a compulsion you give in to the idea that your intrusive thoughts have power and meaning, when they don’t. Compulsions don’t teach our brains anything new, nor do they create a corrective experience. 

Cutting compulsions takes time, motivation, and practice—and it looks different for each person. When urges feel so strong that a compulsion feels impossible to resist, I want you to start with these other options. You’ve got this!

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Response Prevention

Before we get into specific techniques, it’s necessary to know that Exposure Response Prevention (ERP) is the gold standard and research-based treatment for OCD recovery. It’s important to focus on the response prevention (RP) part of ERP. This means responding to an obsession or urge without performing a compulsion. Refer to my previous article for some examples of practices that can help you develop response prevention skills. 

By responding in a different way, you’re quelling the unhelpful thing your OCD wants you to do. OCD causes your brain to send off danger alarms even when there is no danger. In order to reduce the severity of OCD symptoms, you have to teach your brain that many of these alarms are errors. Sometimes eliminating compulsions feels too hard too fast. Even though the ultimate goal in managing OCD is resisting rituals, sometimes we need to start somewhere else.

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NOCD Therapists have used ERP therapy to help thousands of people regain their lives from OCD. I encourage you to learn about accessing ERP therapy with NOCD.

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Five tools to interrupt OCD’s vicious cycle

SUDs Scale

The Subjective Units of Distress (SUDs) scale is a tool for measuring the intensity of feelings such as distress and anxiety. Think of it as a fear thermometer that uses a one-to-ten scale. One is feeling relaxed and chill and ten is complete panic—the worst distress imaginable. 

When starting out with ERP, it is helpful to create a hierarchy of exposures utilizing your SUDs scale as a guiding point. I will usually have my clients start with exposures that rank around a three or four. As you do this, you may find the exposure ranks higher than you expected or surprisingly lower. It can be helpful to keep track of your SUDs to help you get more in touch with the intensity of your emotional and physical feelings. If you have difficulty resisting compulsions using tools you have learned, your SUDs level is probably too high, or you may be experiencing a lack of motivation. It’s okay to walk it back and try something less intense—the goal is to work your way up! 

Self-Compassion & Motivation

Cultivating self-compassion and motivation can be helpful tools for resisting compulsions. Self-compassion has three main elements: self-kindness over harsh criticism; the ability to recognize your own humanity, imperfection, and pain; and mindfulness, or unbiased awareness of experiences, even if they are painful. 

One of my favorite tools for increasing self-compassion is focusing on curiosity over judgment. People with OCD often believe that the contents of their thoughts mean something about who they are, that those thoughts define their worth. This could not be farther from the truth. OCD latches on to what someone cares about most. If you have OCD, you can increase your self-compassion by taking note of how you speak to yourself. Shift self-talk towards a more compassionate voice. Allow yourself grace when things don’t happen as quickly or easily as you’d like. Try not to compare yourself to others. Stay mindful about the fact that your experience and feelings are valid. 

Motivation is what drives us to behave the way we do, and research shows that self-compassion is more motivating that self-criticism. It’s hard to practice ERP when you have trouble recalling why it’s worth practicing in the first place. Think about the freedom you can have when OCD begins to loosen its grip on your life. Think about your values and how they align with recovery. Managing your OCD helps you get back to these values. Learning about treatment, and knowing that it can help significantly, can be a great motivator. 

Delay/Postpone

My favorite method for beginning to reduce compulsions is delaying the amount of time that elapses between the obsession and compulsion. 

When you have intrusive thoughts, your anxiety rises, as does the urge to act on a compulsion. Begin increasing your awareness of the obsessions that turn up your anxiety, and when you notice one, set a timer for five to ten minutes and do your best to resist the compulsion until the time is up. You may end up acting on the compulsion once you’ve hit “time,” but sitting with your anxiety as the time passes will help you get used to it, and sometimes your urge will even pass entirely. 

Many people have an “all or nothing mentality” around compulsions. Remember that if you do one, it doesn’t mean you took steps back. Increasing the time between these behaviors, even by five minutes, is big progress. Do the compulsion later. And sometimes, “later” never comes. 

Change it up/Do the compulsion “wrong”

Another way of messing with OCD’s patterns is to do a compulsion differently. If your compulsions involve a number of rituals, change up the order, up the speed, or take part of the ritual out. 

You can also intentionally do your compulsion “wrong,” breaking the rules that OCD has created for you. This way, you will still be doing something, but not exactly what your OCD wants. Be creative with how you can act on your compulsion differently—and be sure to mix up how you shake it up to avoid forming new compulsions. If it feels a bit less comfortable than your usual compulsion, that’s probably a sign that it’s helping.

Undo

Undoing a compulsion is retriggering yourself after the compulsion is done. For example, someone with Contamination OCD might intentionally touch something contaminated after washing their hands. If you drive over a bump and worry you hit someone, you might compulsively drive back around to check. You could then purposely drive over a second bump to retrigger that hit-and-run fear. 

Set intentional goals for your recovery

These tools are building blocks that can give you the nudge you need to resist compulsions when at first it doesn’t feel possible. It is important to try different strategies more than once. Find what works for you, and mix it up often so new rituals don’t form. 

It’s also important to adjust and re-tool your goals. Remember, if your goal is to get rid of obsessions, you will have a very hard time managing your OCD. Just like we cannot get rid of feelings, we cannot get rid of thoughts. Focusing your attention on getting rid of obsessions often only makes them stronger. Reframe your goal towards cutting out the compulsions that follow. The more you can allow discomfort and anxiety to exist, the more you are teaching your brain that you can handle anything without compulsions.

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Jackie Shapin, LMFT

Jackie Shapin is a licensed Marriage and Family Therapist and has a private practice in Los Angeles, Ca. Jackie provides therapy to adult individuals and specializes in Anxiety, OCD, and Eating Disorders. Jackie has treated clients with eating disorders since 2011. In 2017, she attended the International OCD Foundation’s Behavior Therapy Training Institute (BTTI) and has continued to expand her knowledge of OCD and related disorders. She has spoken on the topic of Obsessive Compulsive Disorder for various organizations, including IOCDF, OCD SoCal, The International Association of Eating Disorders Professionals & Antioch University Counseling Center. You can learn more about Jackie at Jackieshapintherapy.com or on Instagram at @jackieshapintherapy

NOCD Therapists specialize in treating 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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