OCD
OCD Resources
On average it takes people *17 years to get treatment for OCD after the first experience of symptoms. In the meantime symptoms often get worse, and the person’s quality of life suffers. All while being in the dark about what is going on. This is made worse by society having an inaccurate view of what OCD actually is.
What is OCDand ERP?
Obsessive-compulsive disorder (OCD) is, at its core, an intolerance for uncertainty. Much of life is uncertain and out of our control. Most people are able to manage this, but for reasons that aren’t fully understood, some people develop a complete intolerance for these uncertainties in life.
Compulsions in OCD serve to get rid of the anxiety that is felt around uncertainty. Thoughts of doubt pop in (what we call obsessions), and the mind wants nothing more than to eliminate this doubt, so a person with OCD will try to manage this doubt by attempting to gain certainty through rituals and behaviors.
The desire to get rid of obsessive thinking creates a paradoxical effect, what is sometimes known as the “pink elephant effect”. If I tell you to not think about a pink elephant, it will surely be on your mind the minute I mention it. The same process happens with obsessional thinking. The more a person with OCD attempts to get rid of a thought that creates a sense of uncertainty, the more prominent the thought becomes. OCD is unique in that the “content” of the disorder (what it is the person is actually worried about) is different from person to person. There are common themes and sub-types, but each person with OCD is going to have something a little different that they worry about.
Common sub-types include:
Relationship OCD
Symmetry or “just right” OCD
Contamination OCD
Harm OCD
Common compulsions seen in OCD include:
Reassurance seeking
Checking
Counting
Washing or scrubbing
Thought neutralization or “opposite” thinking
Thought suppression
Sometimes, people with OCD struggle with doubting their morality, or they wonder if they are a good person. They sometimes have thoughts that they might hurt animals, other people, or themselves. With these intrusive thoughts, it’s important to note the difference between ego-syntonic and ego-dystonic thoughts. OCD intrusive thoughts are ego-dystonic, meaning that these thoughts go against what the person actually values or desires. Although these intrusive thoughts can be alarming, there are no safety concerns regarding these thoughts.
So what is ERP?
OCD can be debilitating, and can take up so much time that the person with OCD isn’t actually able to do what is truly important to them. The treatment for OCD initially looks very scary, but it is extremely effective and is known as the gold standard treatment for the disorder.
Exposure and Response Prevention (ERP) is a protocol for intentionally exposing a person to the triggers of obsessional thinking, and then inhibiting the compulsive response. Through this process, the person with OCD learns that they are able to cope with uncertainty. Please note that the goal of ERP is not to gain more certainty, but to instead develop tolerance for uncertainty.
The first step in the protocol is to document obsessions and compulsions as they happen throughout the day. Once we have this data, the next step is to build an exposure hierarchy. This hierarchy will go from least distressing triggers to most distressing triggers. We will then work our way up the hierarchy and practice exposures related to the content of the obsession. Throughout the exposure, we will keep track of the anxiety level and note when the anxiety begins to decrease on its own. Throughout the exposure process, it is very important to not engage with any compulsions. By engaging with compulsions, we continue to teach the mind that we can’t handle the thought and something needs to be done about it. Know that the anxiety can and will pass on its own.
Throughout the ERP process, you will also learn to practice thought diffusion. Thought diffusion is a series of techniques to separate ourselves from our thoughts. Obsessions stick around because we take our thoughts very seriously. By learning to not take our thoughts so seriously, we are able to let go and let the obsessions pass through.
NOCD
NOCD offers effective, convenient therapy available in the US and outside the US. To find out more about NOCD, their therapy plans and if they currently take your insurance head over to
International OCD Foundation website
Information on Exposure Response Therapy (ERP), and why its the treatment model for OCD.
The OCD Stories podcast & some highlights | Stewart Ralph
Podcast dedicated to educating and understanding OCD
“We aim to bring more awareness and understanding of OCD through the podcast, for people who are suffering from it but also for those family members and friends, and other people like therapists and researchers who work in this area everyday”.
To listen to our free weekly podcast, hosted by Stuart Ralph, simply subscribe through any podcast app, Spotify, the website or YouTube.
Highlights
Pure O, episodes 1 and 2 as a setThe concept of “Pure O”- obsessional thinking without compulsions that are visual or active, helps to create space for a more nuanced understanding of different ways OCD can present.