Obsessive Compulsive Disorder (OCD) is often the most misunderstood diagnosis as there are false and/or limited perceptions around how OCD may show up in someone’s life. Often movies or TV shows depict a person with OCD as someone who washes their hands excessively or likes things in a certain way. This can lead to people who prefer to be tidy or practice good hygiene, to refer to themselves as “OCD about…” This can be incredibly hurtful to those who have OCD, as it minimizes the daily struggle of dealing with it. Within the OCD community, a powerful saying goes, “If it makes you happy, it is not OCD.” We here at Embracing You Therapy Practice stand behind this saying, as it highlights the shame, pain, and overwhelm behind having OCD. Having color-coded bins to hold art supplies is not the same as having Obsessive Compulsive Disorder.
While these common stereotypes about cleanliness and organization are true symptoms of OCD, what is unhelpful about these scenarios is misleading the public on all the ways
OCD can show up. Because the truth is that OCD will latch on to anything you value and/or like. Therefore nothing is off limits. It can also plague someone’s thoughts with no visible action for those around that person to witness. It may manifest as a completely private torment that nobody would ever be able to recognize. What appears to be someone who is “difficult” or “stubborn” may actually be someone whose OCD rituals limit their ability to be flexible or compliant. Someone who is often running late, or disorganized, may be that way because of certain things they feel compelled to do before they can leave the house or take on a task. As a result, OCD is a very debilitating mental health disorder that can feel invisible and misunderstood. The good news is that there is treatment available!
What is Exposure and Response Prevention?
Often you wonder, “How do I go about treating my OCD or support someone I love who has OCD?” Currently, the golden standard of treatment for OCD is Exposure and Response Prevention (ERP) which is research-proven to be the most effective form of treatment. ERP is a type of Cognitive Behavioral Therapy (CBT), one of the therapeutic approaches we use here at our therapy practice in Woodland Hills, CA. CBT teaches us how to identify and change negative thought patterns. ERP, with the guidance of a trained therapist or counselor, allows us to face our fears in a safe environment while not giving in to the compulsions that usually accompany them. Exposure may be imagined at first through visualization techniques or be a real-world exposure. Over time, habituation occurs; we stop regarding the stimulus as out-of-the-ordinary, and therefore our response to it reduces. This stimulus might be something we see, think, or do. To understand how it works, think of it this way: when you first put a fragrance on, you can smell it. But within not much time at all, you don’t notice that you’re wearing it anymore. It has become a part of your awareness that the conscious mind no longer needs to tell you about.
Why does treating OCD with Exposure and Response Prevention work?
1. You learn to face your fears:The first part of ERP is the ‘E,’ which stands for ‘exposure’; it is a key feature. Here is why: in the OCD cycle, you have an obsession, which can be a thought, image, or sensation that you find to be unwanted, uncontrollable, repetitive, and intrusive. As a result, you feel an uncomfortable emotion – in many cases, it is anxiety, but it can also be disgust, fear, worry, or discomfort. What happens next is called ‘compulsions,’ which are your responses to your obsessions with the end goal of reducing the unpleasant emotion you are experiencing. Compulsions can be mental or behavioral, meaning mentally reviewing or counting that no one can tell or see, whereas behavioral compulsions are things others can witness or notice you doing. A common compulsion is an avoidance, which gives you a false (and temporary) feeling of control. It also reinforces the idea that there is something to be afraid of. By learning to face your fears, you are learning to walk towards your discomfort rather than walk away from it. Ultimately, this is a safe exercise, as the nature of OCD is to perceive a threat when there isn’t one. Exposure therapy helps to rewire your brain so that you can be aware of true dangers and let the rest go.
Exposure is also a powerful way of rewiring your brain, as it teaches your brain to accept the presence of these obsessions. Let us be very clear about this concept; this does NOT mean you accept the validity of your thoughts or conclude that they mean something about you. Obsessions are ego-dystonic (in direct opposition to the actual needs of the ego) and are never meant to be analyzed. However, by exposing yourself to the feared thoughts or objects, you can mindfully teach yourself that these thoughts do exist whether you like them or not. And honestly, every one of us has bizarre thoughts. So you are never alone. In accepting these thoughts, you can confront and manage them. There is no way to improve an internal situation or circumstance that you are avoiding. It’s not like never returning to a restaurant you didn’t like; you carry your compulsions with you wherever you go.
Exposure therapy may have you go to certain places or participate in certain activities. It may have you participate in specific endeavors without a certain behavior attached; for example, going to a restaurant without looking up the menu first online. Exposure therapy might have you experience your compulsive or intrusive thoughts without doing anything to neutralize them, such as compulsive behaviors that you utilize to comfort yourself or as a good omen. When it comes to your thoughts, ERP doesn’t eliminate them; it simply allows you to deal with them.
2. You learn to challenge your OCD rules, aka rituals:
The second part of ERP that is significant is response prevention. This second part is addressing the compulsions, aka the rituals, you engage in to reduce your anxiety, seeking a false sense of control and certainty. It allows you to practice experiencing your anxiety without trying to nullify it with whatever your predetermined set of rules is.
Response prevention is just as it sounds: preventing your usual OCD responses/rituals. These rituals may be conscious, or you may not even realize you are doing them. If a ritual has been in place for as long as you can remember, it might go completely unnoticed by you at this point in your life.
One of the important things to know about response prevention is that you will be sitting with the discomfort and the guilt. Remember that response prevention is not just about “not ritualizing,” but just as much about sitting with the discomfort of not ritualizing. As a result, most people with OCD also report feeling an intense sense of guilt and concern that now that they didn’t ritualize, something bad will happen to them or to someone they love. While this is scary and overwhelming, learning to manage your OCD will require you to ride the wave of this guilt to get to the other side. This is like going through a door to a room that you believe to be dangerous. The only way to know for certain that there is no danger waiting for you on the other side is to go through the door. The good news is that your therapist is going through the door with you.
It is also important to be aware of how sneaky OCD is. While you think you are not ritualizing by not doing your “typical” compulsion, you may find yourself doing another one. It is normal to struggle with response prevention, which is why most people will start with gradually reducing their rituals before completely eliminating them. In OCD therapy, we will have you identify all the steps involved in your rituals and find ways to reduce them, whether that means reducing the number of times or the duration of your rituals.
One of your rituals may be to research whatever you are obsessing about. You probably use technology as a resource to put your mind at ease about your health, your relationships, or your behaviors. Whether to reassure yourself or validate your intrusive thoughts, a quick (or not-so-quick) browse on the internet may be how you cope with concerns you have that won’t let you go. While this ritual may put your mind at ease, it is ultimately reinforcing the compulsion to worry. It doesn’t teach you to let go of your intrusive thoughts; it only temporarily comforts you. You might think that looking something up on the internet isn’t all that intrusive; what’s the harm? In fact, the nagging in your thoughts until you quell them by pulling out your phone or giving a voice command to a home system is intrusive. Any behavior that restricts or prevents you from going about your daily life until you’ve done it is going to be an obstacle for you in one way or another.
3. You learn to make value-based decisions, not fear-driven:
A need for certainty and rigidity on how things should be done can follow you even while doing ERP. Focusing on making progress rather than trying to do it perfectly is important. It can be challenging to let go of the compulsion to adhere to strict protocols, which is why we try to focus on our values.
It has been proven that human beings would rather avoid pain than pursue pleasure; the fear response is that strong! However, adjusting our focus to habits and behaviors that align with our values is a great way to stay connected to our objectives.
For example, if you value friendship, you may try to make choices that support your relationships with your friends. This does not mean that all at once, you will be able to subvert your compulsions because you love your friends. And it doesn’t mean you don’t love your friends if you struggle to subvert your compulsions. It is something positive to focus on. In a moment when you have to choose between nurturing a friendship or participating in a compulsion, your values might help you to resist your compulsion. It is a tool and support to boost your efforts, not a black-and-white pass-or-fail tactic.
Evaluating your values might be something you choose to do in therapy with the guidance of a trained professional. We offer therapy in Woodland Hills, CA, that deals with OCD, among other services. You might think that a therapist or counselor is best utilized providing exposure therapy, but the truth is that all aspects of your ODC journey can benefit from a safe and supportive environment. A neutral third-party can see things from a different vantage point and help you to truly discover express, and prioritize your values so that they can be put to best use.
This is not to say that knowing your values will immediately neutralize your compulsions. But they do give you something to focus on and work toward to stay motivated to continue with your ERP work. For example, as you are experiencing a thought, or evaluating a choice, having a touchstone of your ultimate priorities can help you to persevere in avoiding or reducing your rituals or choosing a path that will make you less susceptible to them. These values can become part of affirmations you say to yourself (without ritualizing them). You might say, “I am capable of being more present with my loved ones,” or “I choose the action that aligns with my greater purpose.”
Exposure-based therapies such as ERP present the challenge of agreeing to tolerate acute symptoms of your OCD, often for longer than you are used to. This is one of the main challenges of this treatment, as people become overwhelmed and drop out. You may find, if you take this on, that your path isn’t a continuous one. If you do take a step back from ERP, remember that there is no reason you can’t try again. Many things we achieve in life happen over time, with stops and starts, highs and lows. Of course, ideally, you can begin therapy and stick with it as your compulsions gradually lessen, but a glitch doesn’t mean failure. OCD has a lot of black-and-white aspects to it; ask someone you trust to support you in remembering that progress ebbs and flows. Your mental health disorder is not a casual fussiness or a conscious decision to straighten items on your desk. You deserve to be and feel supported and taken seriously. You deserve to know that you are not alone and that there is help available to you so that you can enjoy more of your life.
Here at Embracing You Therapy, we invite you to explore with us how life would be different if you had more control over your thoughts and emotions, and we invite you to consider that it is possible to accept things just as they are, embracing imperfections to create a gentler place for calm in your life.
Let’s learn what drives your unique perspective on anxiety and stress. Then, let’s find the tools-your unique tools that help you respond to life in a healthy, calm way. Contact us today for your complimentary 20-minute phone consultation with our Client Care Coordinators.
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