OCD Treatment & Resources

Those who live with obsessive-compulsive disorder (OCD) experience repetitive obsessions and enact compulsions, or rituals, in response to these obsessions. Obsessions are unwanted intrusive thoughts, urges, or images that cause significant anxiety. These can include obsessions or doubts about contamination, sexuality, religion, harm to self or others, or health. Compulsions are repetitive mental or observable behaviors that are meant to decrease the anxiety brought on by these intrusive thoughts and/or to prevent feared outcomes. Compulsions can include excessive checking, reassurance-seeking, praying, counting, repeating routine activities like reading or writing, or special statements meant to neutralize the upsetting intrusive thought, urge, or image. Often, individuals with OCD also avoid triggering situations, places, objects, or people in order to prevent the experience of unwanted thoughts, feelings of anxiety, and urges to engage in compulsions. When these obsessions and compulsions together take up at least an hour a day and cause a disruption in one’s functioning, OCD may be diagnosed.

When you have OCD, your brain is essentially misfiring in response to intrusive or unwanted thoughts that everyone experiences. One study from the early 1990s actually found that 90% of participants in their sample experienced the same intrusive thoughts that those with OCD report. The issue is NOT the occurrence of the intrusive thought, but the brain’s appraisal of that intrusion as something dangerous. When you have OCD, your brain is interpreting a normally occurring thought as a sign of problem or that with certainty, something terrible will happen. Picture your thoughts on an assembly line at a factory and your friend’s thoughts right next to you on a parallel assembly line. Now imagine that rather than letting all of your thoughts pass through, OCD is sounding an “emergency!” alarm in response to specific thoughts, even though your friend right next to you has the SAME thoughts, and they are allowed to pass through without a problem. OCD throws your body into the fight-or-flight anxiety response. Your brain then interprets that anxiety as further cause for alarm, which leads to urges to engage in compulsions or avoid, with the hope that if you do these compulsions or escape, flee, the situation, your worst fears will be prevented.

Through emotional, rather than logical reasoning, OCD makes people rationalize that because they feel anxious, they must actually be in danger. The problem of course is that doing compulsions temporarily takes away that anxiety and gives you the illusion that you are now safe- these compulsions are negatively reinforced. When you do compulsions, your brain is unfortunately taught that these compulsions are necessary in reducing your anxiety, and you are more likely to repeat these compulsions/avoidance the next time you get an unwanted thought/feel anxious. In this cycle, your brain, meaning to help you, is actually misguiding you in telling you to do your compulsions. Remember, the problem is the response to anxiety, NOT the presence of the unwanted thought.

Exposure and response prevention (ERP) is the most evidence-supported treatment for OCD, and it is a type of cognitive-behavioral therapy (CBT). CBT focuses on active, goal-oriented therapy that teaches individuals how to change their unhelpful thoughts (cognitions) and behaviors, in particular their response to difficult emotions and unwanted experiences. Thoughts, behaviors, and emotions all impact each other. When it comes to OCD, we focus primarily on behavior change, in particular, one’s response to the intrusive thoughts. Through exposure to the anxiety, the feared thoughts, and related situations, you will learn that you CAN tolerate the anxiety and that the presence of the intrusive thought, image, or urge does NOT actually signal danger. Through repeated ERP, you will learn how to accept the presence of unwanted intrusive thoughts, to face your fears, and to identify and resist urges to engage in compulsions. This will in turn help you to stop the endless cycle of OCD and to instead better accomplish your goals and live your values. You will learn that anxiety IS actually tolerable, something that simply cannot be learned if you are immediately engaging in compulsions or avoidance.

Always, when presented with doubt and anxiety, our goal is to make a mood-independent values-driven choice and that is worth the risk of no longer seeking certainty/need to ensure perfection. In the beginning of ERP therapy, the high anxiety may make it feel like you are walking towards an oncoming car, but over time and through collaborative practice and game-planning, you will build a tolerance for discomfort and you will work towards mastery of OCD. Over time, anxiety and the urge to engage in compulsions decrease. Individuals with OCD are successful in treatment when they are spending their time and energy on living their values and not on trying to get rid of intrusive thoughts.