Something led you to seek out information on OCD. Maybe you have a loved one who suffers, or maybe you just wanted to learn more about your own mental health. Perhaps you suspected you might have OCD for most of your life, but it recently began interfering far more in your life.
Regardless, here you are. Now what? What does your diagnosis mean, and what should you expect on your journey? As an OCD specialist here at NOCD, as well as someone who has suffered from a lifetime of OCD and learned to manage it with exposure and response prevention (ERP) therapy, I’m familiar with a wide range of different experiences that people with OCD might encounter. Here’s what you should know.
What does OCD mean?
It seems like everyone has heard of obsessive-compulsive disorder (OCD), but few people truly understand what it means. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) indicates that for someone to meet the diagnostic criteria for OCD, their symptoms must be time-consuming or cause significant distress and difficulty in their daily functioning.
The primary symptoms of OCD are obsessions and compulsions. Obsessions are defined as unwanted, recurring thoughts, images, or urges that bring distress and anxiety. People with OCD don’t want these thoughts—in fact, they often do everything in their power to avoid, reduce, or neutralize them.
This is where compulsions, sometimes called rituals, come into play. Compulsions are any behaviors or mental acts done in an attempt to prevent or reduce the anxiety or discomfort that results from obsessions, or to prevent an unwanted outcome. These actions may be irrational, excessive, or repetitive.
What kind of treatment should I expect?
Hopefully, if you or a loved one is diagnosed with OCD, a referral will be made for you to work with someone who specializes in OCD. Just as you would not want to see a general practitioner for a specific illness, you should seek treatment from someone who has specialty training in OCD and understands the pest practices for OCD treatment.
The most effective treatment for OCD is exposure and response prevention (ERP) therapy. ERP works to provide long-term relief from anxiety and distress. By allowing uncomfortable feelings like anxiety, uncertainty, and doubt to be present without engaging in compulsions for quick relief, you can teach your brain that it can tolerate these feelings and allow them to pass on their own, without engaging in compulsions that only reinforce the vicious cycle of OCD.
OCD demands to know 100% that nothing bad will happen, and unfortunately, it will never feel satisfied enough. When someone is experiencing OCD, the mere thought of not knowing something for sure can be terrifying. By learning through ERP that they can actually tolerate the feelings of uncertainty, they feel more confident in their ability to handle the distress and the situations that trigger these feelings.
First steps in ERP
The first steps in ERP involve assessment, education on both OCD and ERP, and identification of obsessions, compulsions, and triggers. Triggers are situations or feelings that lead to intrusive thoughts, urges, or images. It is important to get a good idea of one’s triggers in order to help formulate the best treatment plan. ERP works through exercises called exposures designed to target one’s triggers or obsessions and provide opportunities for response prevention, in which one resists the urge to engage in compulsions as a result.
Then, one works alongside their OCD specialist to develop what we call a hierarchy. A hierarchy can be described as a list of triggers in order from the least distressing to the most. They then assign a number, typically 1-10, to signify how much anxiety and discomfort these triggers bring about. This is referred to as a SUDS rating or subjective unit of distress scale. The key here is the gradual nature of the process: ERP is a slow, steady process that takes time, commitment, and practice.
In sessions with an OCD specialist, an individual with OCD gradually works on exposures with the help of their therapist, and then they are asked to practice in between sessions as homework. This allows them to confront triggers that arise in daily life, as well, gaining confidence and mastery of their ERP skills.
James is a 34-year-old teacher who started having intrusive thoughts about harming the students he works with. He would never want to hurt anyone and he finds these thoughts to be extremely stressful. He even contemplated quitting the job he had worked so hard to get, because he’s so afraid that he could hurt his students.
Recently, James took a leave of absence to seek treatment. The idea of returning to work seemed impossible when he first began ERP. James listed several triggers such as being at work, being around students one on one, seeing anything in the news about violence, and other similar situations.He and his therapist developed different exposures or scenarios in which James could confront his fears in a safe and controlled manner. James needed to see that he could tolerate the awful feelings that the thoughts brought along with them, and that they would fade on their own. He would need to learn that he was able to continue throughout his daily life, doing the work he loved, even when these distressing thoughts and feelings were present.
Initially, James would look at the yearbooks of former students while sitting with discomfort, allowing distressing thoughts to be present without engaging in any of his usual compulsions. Previously he would say certain things in his mind to “neutralize” the scary thoughts: I am a good person. I would never hurt them. It’s not possible. It could never happen. He would feel compelled to say this several hundred times a day, every time one of those unwanted thoughts entered his mind.
Eventually, he noticed that the thoughts didn’t bother him as much as before, and they didn’t even come up as often. He was no longer feeling nearly as anxious when he looked at the photos.
James’s next exposure involved going on walks by the school where he had worked after hours. Over time, he was asked to go while students were in school. Again, he was able to see that although this was difficult, he was able to withstand the feelings without resorting to compulsions to feel better in the short term. It wasn’t long before he was able to return to school as a teacher the very next semester.
Starting the process of ERP
A successful ERP therapist will guide, support, and motivate you. They will come up with reasonable and creative ways for you to gradually face the fears that are holding you back from living the life that you want to live. By working with a licensed, specialty-trained OCD therapist, you can fight back against the vicious cycle of OCD.
Effective, specialized OCD therapy is hereLearn more
If you have any questions about starting ERP therapy or need more information about the treatment, please don’t hesitate to book a free 15-minute call with our care team. On the call, we’ll assist you in either getting started with a licensed therapist at NOCD who has specialty training in OCD and ERP, or connect you to other resources that might be helpful.