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An Overview of OCD

Obsessive compulsive disorder (or OCD) is characterized by the presence of unwanted thoughts, urges or mental images (called obsessions) which cause distress, leading to engaging in repetitive behaviors (called compulsions) in an attempt to neutralize the anxiety. While obsessions and compulsions are at the core of this condition, there are various ways in which it can manifest. An individual’s presentation of OCD is typically centered on a particular subject matter, such as contamination, fear of harming oneself or others, sexuality, health, relationships, moral scrupulosity, etc. It is not unusual for an individual to experience intrusive thought patterns about more than one of these areas, or for it to fluctuate at different periods in their life. Symptoms of OCD generally find a way to latch onto what a person cares the most about at the current time.

If you find yourself in a pattern of ongoing fear and anxiety, ruminating on certain thoughts that cause distress, or engaging in repetitive behaviors or rituals that are disrupting your daily activities, consider reaching out to a mental health professional who can help you to determine if you may have OCD.

What is the Most Effective Type of Psychotherapy for Treating OCD?

Research has revealed a type of Cognitive Behavioral Therapy called Exposure and Response Prevention (ERP) to be highly effective in the treatment of OCD. This type of treatment involves gradually exposing an individual to certain thoughts, sensations, or situations that evoke anxiety, and then refraining from engaging in compulsive behavior. With repeated exposures, there is often a reduction in one’s anxiety which is referred to as habituation. A person also learns that they are able to tolerate the discomfort they experience when in the presence of a trigger, and their perceived fear is often more pronounced than their actual fear in those moments. ERP also works to carve out new pathways in the brain that serve to weaken the associated fear response over time. 

Individuals with OCD may find that cognitive behavioral therapy (without exposure response prevention) or other therapy methods do not help to alleviate the severity of symptoms or distress. This may be because the cognitive component alone, or reframing how an individual thinks about their distressing thoughts, is typically not enough to break out of the all-consuming hold of obsessions and compulsions. There must also be a behavioral component, which allows an individual to alter their way of responding to a trigger (confronting it instead of avoiding).

Many individuals living with OCD find themselves hesitant at the thought of exposure therapy. This makes complete sense, as they have arranged their lives around avoiding certain thoughts or situations that trigger discomfort or distress, and engaging in behaviors that they believe will mitigate any potential danger. However, doing compulsions (including avoidance behavior)  only serves to exacerbate an individual’s fear over time. They come to learn that what they fear is a legitimate threat that needs to be addressed, and they must take action in order to prevent a certain outcome. It may seem counterintuitive, but it is only in confronting the fear and refraining from compulsions that an individual can find freedom from all-consuming anxiety.

It’s not as scary as it seems either, as an ERP-trained therapist will work with you to create a fear hierarchy of what evokes the least distress to the most. They will then guide you through the exposure process at a pace that feels comfortable for you. You may think to yourself ‘there’s no way I could potentially do this,’ but by the time you work your way through your hierarchy, you may surprise yourself by what you are able to tolerate. ERP is not easy work by any means, though it ultimately teaches you that you are able to do hard things and tolerate more discomfort and uncertainty than you ever thought you would be able to.