When I first meet someone new for treatment, I start by saying that discomfort and anxiety are just feelings, like any other feelings. Anxiety, in and of itself, is not “bad”—it can even be very important when it works properly. It can teach us what might not be safe. If I am crossing a busy intersection, I need something that lets me know when I have to act. Discomfort helps us to learn, to decipher what we value, what we want, and what we would like to avoid.
OCD hijacks these useful, important feelings and twists them. OCD sets off the “alarm system” of anxiety when there is no real threat, creating a strong urge to act in response to it and protect something of great value to a person. This only allows OCD to dig in deeper whenever the false threat is perceived again. And instead of discomfort helping someone distinguish what they want and enjoy, OCD causes people to avoid discomfort entirely, and keeps them from doing the things they actually want and enjoy.
Distress intolerance
People with OCD often believe that they cannot tolerate distress or anxiety; we call this distress intolerance. One of the most important parts of OCD treatment is teaching an individual that they can, in fact, tolerate anxiety and distress. You may not like it, but you can get through it.
One of the false messages that OCD tells us is that you cannot bear uncomfortable feelings. This is why we try so hard to avoid these feelings. This is why we spend countless hours lost in compulsions, in a feeble attempt to rid ourselves of all difficult feelings. These overwhelming feelings are what keep us from freely doing the things that we value in life. In our attempt to avoid these hard emotions, we end up avoiding everything else that matters to us.
It can be a powerful realization when we stare discomfort in the face and choose to experience it, rather than avoid it at all costs. Making the decision to stop running from hard things is one of the most important choices a person with OCD can make: saying that, in spite of these feelings, I will keep moving forward. Saying I know I will never feel ready, and I will do it anyway. That is the heart of OCD treatment: developing distress tolerance.
Facing your OCD fears to regain your life
I often share parts of my own OCD journey with therapy members when I feel it is beneficial. My only goal in sharing is to help others and for them to see that they are not alone, because OCD can be incredibly isolating. When you are in the midst of OCD, you can feel that it will never get better or that you will always feel this way, but feelings are always changing. We must not let out feelings be our guiding compass when we have this condition. They will steer you wrong, and tell you that compulsions are what protect you. The truth is that compulsions provide temporary relief, but they will never be sustainable. OCD will always demand more.
There was a time in my life when OCD made me believe that I could not sit on any of the furniture in my own home. Everything was “dirty”: I couldn’t touch anything. I couldn’t hug people I loved. I couldn’t eat anything from my home. It was all overwhelming. I was starving myself because of the lies OCD told me. OCD told me that if I ate a particular item, it would mean that the thoughts I had while eating that item would somehow be true. I believed that if I ate at certain times, I could avoid feeling anxious. I ate only prepackaged fast food items—just enough to survive, going whole days without eating. I was walking through life but not experiencing it, stuck in endless thoughts and compulsions.
Eventually, I found my way to exposure and response prevention (ERP) therapy, and I started facing my fears in order to regain my life.
Getting angry at OCD
The scariest exposure for me was when I had to eat ketchup. It had been years by this time since I had eaten “red” foods. They triggered so much distress for me, and I avoided them as if my life depended on it. As I sat in the therapist’s office touching the ketchup and eating it, I was so mortified. I knew as soon as I ingested it that the feelings of discomfort and intrusive thoughts would flood in. At that moment, I made a choice to commit to 12 hours of discomfort, believing for some reason that the food would stay in my system for that long. It felt safer to believe it.
During those 12 hours, I was tormented by what-ifs about my ability to tolerate distress: What if I believe I have ingested blood? What if I convince myself of all the possible ways that blood got in my mouth? It felt so, so real. I couldn’t trust my own mind, my memories. I knew I would never ever do anything that would lead to ingesting blood, yet OCD made me doubt whether my brain would know. OCD told me that I would convince myself I had done bad things. Somehow this could only happen if I ingested red food.
This was the beginning of my journey to face the most difficult fears that I held. There were ups and downs, to be sure. I felt anxious—even sick at times—but I kept pushing, one step at a time. I didn’t always get it right, but I got it right enough. I was consistent more times than not. I don’t think I could have done this without the support of my therapist. He kept pushing me on, reminding me why I was fighting so hard. Today, I don’t think twice about eating red food. I don’t keep track of the times I am eating. I don’t even think about it 99% of the time. When the thoughts and distress return, I get mad at OCD. I get mad at all the time and energy it has taken.
And you know what? The feelings dissipate. They go away on their own, and the thoughts become quieter and quieter. They don’t bother me so much. Like anyone else, I don’t get to choose the thoughts that pop into my head, but I get to choose what to do with them. You can too.
That’s why I often say that the people who become angry at OCD are often the most successful in treatment. They have decided to dig in their heels, to be unshakeable in doing ERP. They make the choice that even though it may feel difficult in the moment, it is worth it for the long-term relief. Of course, this doesn’t mean they don’t struggle. They just keep moving forward, step by step, and begin taking back what OCD has tried to steal.
ERP can help you to face discomfort and anxiety
Building tolerance for distress and anxiety lies at the heart of exposure and response prevention (ERP) therapy, the gold standard in OCD treatment. In ERP, you’re gradually exposed to the things that trigger your anxiety and discomfort, and your therapist guides you in resisting the urge to engage in compulsions for short-term relief. Instead, you sit with the uncomfortable feelings and accept uncertainty. In time, you learn that you can do difficult things, and the anxiety you feel in response to your triggers decreases over time.
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, too.
