Obsessive-compulsive disorder (OCD) is marked by repeated, distressing intrusive thoughts, images, sensations or urges. Because these thoughts are often so upsetting, they lead to compulsions. Compulsions are the things we do to try to make ourselves feel more certain or less distressed by intrusive thoughts—like thinking good thoughts to replace bad ones, tapping, checking, counting, and more. While it may seem like these actions are helping you feel better, compulsions are actually what is making the thoughts ‘stick’ in your mind, because they reinforce the idea that the thought needs to be dealt with. Exposure and response prevention (ERP) therapy—the most proven, evidence-based treatment for OCD—works to break this cycle by reducing, delaying, and eventually eliminating compulsions.
Sounds simple, right? It is simple, yet often can feel difficult. But there is something subtle going on beneath the surface; something that many new Members at NOCD find surprising: we are not working to get rid of the intrusive thoughts. In fact, we are working to accept them instead.
One of the questions I get most often as a therapist at NOCD is: What? You want me to accept these terrible thoughts I have?
“This is my life. How can I just accept that I might be with the wrong person?”
“I don’t want to die in a car crash. I’m not just going to accept that it’s possible.”
“I can’t accept that I might be a pedophile. It’s immoral!”
“These thoughts are making me miserable. I don’t want to accept that this is how my brain works.”
These reactions aren’t wrong—in fact, they make a lot of sense. Most people don’t want to die in a car crash. Who you marry (or if you marry) is quite consequential to your overall life story. And it is generally understood that hurting children is wrong. Intrusive thoughts are extremely difficult and can make people feel miserable.
Unfortunately, these thoughts are impossible to prove or disprove, especially for someone who has OCD. OCD is often called the “doubting disorder” for a reason. It will doubt any answer or reasoning you give it. That is why ERP therapy is so effective for OCD. It does not ask us to figure out whether our fears are true or make our thoughts go away. ERP therapy helps you regain control over your life without asking you to do the impossible, like find certainty.
I want you to know that if this sounds scary, you aren’t alone. Some people might even avoid getting help because they don’t want to talk about or accept these terrible thoughts they have. It is completely normal to be worried about this, but professionals trained in ERP are skilled at helping you address this, so that you can learn to manage your OCD and regain your freedom.
So, what do we mean by “acceptance” in the context of OCD and ERP therapy? Acceptance is not surrender. It is not saying that these thoughts are okay, or that we like them. Acceptance does not mean accepting that whatever thoughts OCD throws into your mind are true about you, or that you will one day go on to act on them, harming people or committing horrible crimes that we will do nothing to stop. You also do not have to like the fact that you have OCD. It is completely understandable that you might hate the thoughts or feel frustrated that you have to deal with these symptoms.
To me, as an ERP therapist, acceptance comes down to two things:
- There is very little—perhaps nothing—in life that we can know for certain. OCD demands absolute certainty, but it is simply not possible. Instead, we accept that we will always have some level of uncertainty in life, whether it is about our obsessive fears or what we will have for breakfast tomorrow.
- OCD is a chronic disorder with ups and downs. Unfortunately, it doesn’t have a cure in the way most people think of that word. Accepting that we will likely live with some discomfort because of OCD ultimately helps us cope with it and not be surprised when it rears its ugly head.
Let’s take a deeper look.
Nothing in life is certain—but OCD will try to convince you otherwise
Every person deals with an incredible amount of uncertainty on a daily basis, whether they have OCD or not. My trash is typically picked up on Tuesdays. Do I know for certain they will come this week? I think they probably will, and may even feel very confident it will—but I can’t be completely sure until it happens. When a doctor washes their hands after seeing a patient, can they be sure that all of the germs are gone? No, they don’t have a microscope available at all times to inspect and identify every piece of bacteria that may or may not be on their hands.
For people with OCD, the inherent lack of certainty in life can feel especially difficult, but the uncertainty itself is not unique. Part of acceptance in ERP is acknowledging that we cannot give OCD the certainty it craves.
Think back to the examples I gave above. A person who experiences POCD has probably read about pedophilia, thought about every interaction they’ve ever had with a child, even gone to a therapist to see if they can get reassurance that they don’t fit the diagnosis. None of this will bring absolute certainty. Acceptance, then, is not about accepting that you’re a pedophile. It is about accepting that OCD is demanding a level of certainty that no person can ever achieve. That is to say that we cannot get a 100% guarantee about any feared possibility. Ultimately, the goal is to stop trying to prove, disprove, or eliminate the thought—because OCD only feeds on those behaviors—and instead learn to move forward based on your values, even while that uncertainty is present.
Accepting OCD as a chronic condition: Why it helps
OCD probably isn’t going away. That doesn’t mean you can’t learn to manage symptoms and dramatically improve your quality of life, but the chronic (and sometimes relapsing) nature of OCD can be a very difficult thing for people to accept. People often tell me this feels incredibly unfair. They’re frustrated that they have to deal with OCD when other people don’t.
I completely understand and agree. It is not fun to have to deal with intrusive thoughts. It is very hard to resist compulsions. It is uncomfortable to sit with anxiety. However, it is important to remember that intrusive thoughts are a part of OCD. They are not a representation of who you are or what you will become.
It is also important to accept that OCD symptoms will wax and wane over the course of your life. There is great power in embracing this—because ERP helps you build the skills and confidence to handle it when those intrusive thoughts inevitably return. Instead of viewing intrusive thoughts or compulsions as a major setback, you will understand that they are an unpleasant yet expected part of the condition. You can recognize when it might be time to get additional support from your therapist. And you will know that you need to reach back into your ERP toolbox to handle them.
This is where getting specialized help is crucial. You don’t have to suffer just because you have OCD. ERP will make a big difference.
Grieving and OCD
People with OCD often feel like they are grieving the life they had before their symptoms ramped up, or the life they might have had without OCD. If you are going through this, please know that it is normal. You can live a full, happy life with OCD, but it is completely fair to be unhappy that you have to deal with the symptoms. Allowing yourself to feel these feelings is key to acceptance. It is, in fact, a form of acceptance—accepting your emotions. Otherwise, we can get trapped in a cycle of shaming ourselves for being sad or frustrated by our symptoms. When we allow ourselves to grieve and accept, that opens up avenues for action. It might sound like this: “This really sucks. I wish I didn’t have to deal with it, but I do. What is in my control is getting treatment and tackling these compulsions.”
Whether you are struggling with an OCD relapse or OCD-related grief, or you are just now realizing that you might have OCD, please know that we are here to help. NOCD Therapists are all very knowledgeable about OCD—not only the treatment of it with ERP, but also with long-term maintenance, which often involves grieving and accepting this as part of your life. Reach out to us if you need help navigating this complex disorder. We’re here to help you, and we can understand all of the complex emotions you may be feeling.
