Obsessive compulsive disorder - OCD treatment and therapy from NOCD

I’m too scared to drive my car. Could therapy help?

By Grant Stoddard

Aug 22, 20237 minute read

Reviewed byPatrick McGrath, PhD

You walk out to your car, keys in hand, heart racing, palms sweating. The mere thought of getting behind the wheel sends waves of anxiety coursing through your veins. 

It’s not the traffic, the winding roads, or even the prospect of parallel parking that terrifies you. Instead, it’s the ever-present possibility of harming yourself or others that paralyzes you. If this scenario sounds all too familiar, you might be grappling with a lesser-known aspect of Obsessive-Compulsive Disorder (OCD)

In this article, we’ll explore what OCD is and the many ways it shows up. We’ll examine why the condition fills your head with nightmarish scenarios and introduce the increasingly accessible treatment that can alleviate its distressing symptoms and get people back to living life on their own terms.  

What is OCD?

Obsessive-Compulsive Disorder, commonly known as OCD, is a mental health condition that is pretty common—affecting 1-2% of people globally—yet woefully misunderstood. While many are aware of the benign tidying habits and hand-washing routines portrayed in media, OCD is actually marked by distressing obsessions that trigger overwhelming anxiety, coupled with compulsions aimed at alleviating this distress. 

The OCD cycle: a never-ending loop

A never-ending cycle of thoughts and behaviors that seem inescapable. This is the essence of OCD. Intrusive thoughts, like uninvited guests, crash into the mind, evoking intense anxiety and discomfort. Everyone experiences intrusive thoughts, but for people with OCD, these thoughts feel impossible to dismiss. In short order, these intrusive thoughts become obsessions

To quell the extreme distress these obsessions provoke, people with OCD engage in compulsions. Compulsions are repetitive actions or mental rituals that people with OCD turn to in a desperate attempt to gain relief. Unfortunately, the relief that comes from compulsions like checking, reassurance-seeking, or avoidance is only temporary, and it actually reinforces obsessions and fears over time, creating a vicious cycle.

This cycle can be so all-consuming that people find their lives upended by it. It can impair everyday functioning, reduce productivity at work, severely limit social interactions, and place relationships under severe strain. The longer OCD goes untreated, the worse it gets. The condition can often become debilitating, not only increasing a sufferer’s risk of developing other mental disorders but also their risk of suicide. 

When fear takes the wheel

One of the lesser-known obsessions that often grips people with OCD is the fear of causing harm while driving. Whether it’s hitting a pedestrian, causing a catastrophic accident, or losing control, intrusive thoughts of vividly imagined scenarios or momentary urges can turn a routine drive into a heart-pounding ordeal. 

The power of OCD lies in its ability to latch onto our deepest fears and values, creating major distress and discomfort. In the case of driving, horrifying thoughts about causing or receiving harm infiltrate the mind, causing immense guilt, shame, and self-doubt. Despite being aware that these thoughts are irrational, people feel as if they have to do something to avoid danger or distress, leading to compulsions.

Compulsions done by drivers with OCD may include checking rituals, scrutinizing their surroundings, or avoiding certain routes altogether. Unfortunately, these compulsions offer only fleeting relief, leading to a vicious cycle of escalating anxiety and avoidance.

Hit-and-run OCD 

“Many people’s fears about driving aren’t confined to what could happen while in control of a vehicle, but can extend to fears about what may have already happened,” says Dr. Patrick McGrath, NOCD’s Chief Clinical Officer. “This is sometimes referred to as Hit and Run OCD. You might be driving and hit a pothole. Even though that pothole is in your cul-de-sac and you hit it every time you drive anywhere, your OCD’s impossible quest for 100% certainty can lead you to stop and get out of your car to ensure you didn’t hit the neighbor’s kid. While your investigation might reduce your worry that the unthinkable has happened on this particular occasion, you’re unwittingly reinforcing the OCD cycle, virtually guaranteeing that in the future, any unexpected noise or sensation while driving will make you pull over to check that you haven’t hurt or killed a pedestrian, cyclist, cat, or dog.”  

As fears related to driving intensify, people may find themselves increasingly confined to their comfort zones, avoiding situations that trigger their obsessions. This self-imposed isolation can profoundly impact daily life, hindering personal freedom, social interactions, and professional opportunities. And eventually, people can be entirely ruled by their fears, avoiding driving altogether.

If you can relate to these fears, you’re not alone; there are many, many others in a similar situation. Understanding that this fear about driving is a product of OCD is the first step towards reclaiming control. The second step is an evidence-based, effective treatment for the condition: exposure and response prevention therapy (ERP)

Turning the corner: exposure and response prevention therapy (ERP)

ERP was created in the 1960s and further developed in the 1970s and 80s. This evidence-based therapeutic approach aims to break the chains of OCD by confronting fears head-on, actively challenging distressing thoughts by gradually exposing people to their fears while they refrain from reinforcing the OCD cycle through compulsions. 

It’s important to know that traditional talk therapy can potentially exacerbate OCD symptoms by inadvertently reinforcing rumination and ego-dystonic thoughts, without addressing the underlying compulsions that make OCD worse over time. This approach may inadvertently strengthen maladaptive coping strategies and avoidant behaviors, intensifying the cycle of anxiety and distress.

ERP, on the other hand, involves working closely with a therapist who understands how OCD works, and operates by targeting the root cause of OCD: the vicious cycle of obsessions and compulsions. ERP consists of several steps:

  • Assessment: You and your therapist will first work together to assess your specific obsessions and compulsions and how they impact your life. Understanding your unique triggers is crucial for creating a personalized ERP plan. Your therapist will work with you to create an exposure hierarchy, or list of scenarios ranked from least to most distressing.
  • Goal-setting: You and your therapist will then set clear, achievable goals for treatment. These objectives will guide your progress and give you a sense of direction throughout the therapy process.
  • Exposures: The core component of ERP involves exposure to situations, thoughts, or objects that trigger your OCD-related anxiety. This can be challenging at first, but a crucial step as your brain learns that you are able to cope with the resulting distress without compulsions.
    At first, these might involve imagining certain scenarios while driving or reading through scripts. Eventually, exposures will likely involve actually driving routes you have been avoiding.
  • Response prevention: During exposure, you’ll also practice response prevention. This means refraining from engaging in your usual compulsive behaviors or rituals. Doing this will break the cycle of anxiety and compulsion, allowing your brain to rewire its response patterns.
    When engaging in exposures that involve actual driving, for instance, you would resist the urge to revisit your route or check your car’s paint for scrapes or dents.
  • Gradual progression: ERP is usually conducted in a graded manner. You’ll start with exposures that evoke mild anxiety and gradually work your way up the exposure hierarchy to more challenging situations. This step-by-step approach helps build confidence and resilience over time.
  • Homework: ERP often includes homework assignments to practice outside of therapy sessions. These assignments reinforce what you’ve learned and help generalize your skills and apply them to real-life situations. 
  • Maintenance and relapse prevention: ERP is a long-term strategy that treats your symptom’s root cause. Once you’ve made significant progress, the focus shifts to maintaining gains and preventing relapses. Your therapist will equip you with coping strategies to use beyond the formal treatment period.

ERP is a brave step towards regaining control over your life and finding relief from OCD symptoms. Your therapist will be there to support you until you’ve mastered your ERP toolbox and can get back to living life to the fullest. 

Get on the road to recovery today

Schedule a free call with the NOCD Care Team today and learn more about how a licensed therapist can help you overcome your fear of driving. Once we match you with a therapist, you can start sessions quickly and from the comfort of your home. Over time, typically just a few months, you’ll learn how to resist your compulsions and enjoy driving once again. 

We specialize in treating Harm OCD

Reach out to us. We're here to help.