OCD TREATMENT

OCD is a disorder where a person has uncontrollable, recurring, and intrusive thoughts (“obsessions”) and/or behaviors that the feel they need to repeat over and over in order to neutralize a fear (“compulsions”). These thoughts and behaviors are intrusive, meaning the person doesn’t want to be having them or engaging in them, and so they are highly distressing and can take up a lot of time throughout the day.

OCD has a variety of different subtypes based on the themes of the obsessions and compulsions. Some people have OCD that falls into only one subtype, but many people experience a combination of subtypes.

Some themes of OCD include but not limited to:

• Contamination OCD - thoughts that food, surfaces, other people, etc could cause illness or harm to yourself or others

• Harm OCD - fears of harming yourself or someone else

• Pedophile OCD (P-OCD) - fears that you are secretly a pedophile

• Morality/Scrupulosity OCD - fears of being a bad person sinning, hell, demons, , superstitions, saying something racist/sexist/etc, being ‘cancelled’, etc

• Perfectionism OCD - thoughts and compulsions around order and things being “just right”

• Sexual Orientation OCD - fears that you are secretly homosexual and have been lying to yourself and others

• Relationship OCD - intrusive thoughts regarding your relationship, whether your partner is “the one”, etc.

• False Memory OCD - intrusive doubts about past events

All of these themes can also result in compulsions related to neutralizing the fear and those behaviors. There are no “unusual” compulsions with OCD. All compulsions are due to the brain thinking it is keeping you safe.

Pure OCD (also called Pure O) is OCD that is categorized by the existence of obsessive thoughts without any visible compulsions. Many people with Pure OCD feel they don’t have any compulsions when in reality, they are likely engaging in mental compulsions such as rumination, reassurance seeking via research or checking in with others, and thought compulsions. People with Pure OCD often are doing phsyical compulsions that they don’t realize are compulsions. Regardless, the treatment of OCD is the same regardless of subtype.

While OCD is not curable, it is highly treatable. There are a number of evidence-based practices that work for the management of OCD. Together, we can get you to a place where you no longer feel that OCD is running your life. While treating your OCD, we will establish healthy ways to cope with the anxiety and fears, ways to distance yourself from your thoughts so they have less control, and decrease your desire to do your compulsions.

At Haven Therapy & Wellness, we use a combination of treatment methods to find the best fit for your OCD symptoms. The gold standard for OCD treatment is Exposure and Response Prevention (ERP).

From The International OCD Foundation: “ The exposure component of ERP refers to practicing confronting the thoughts, images, objects, and situations that make you anxious and/or provoke your obsessions. The response prevention part of ERP refers to making a choice not to do a compulsive behavior once the anxiety or obsessions have been “triggered.” All of this is done under the guidance of a therapist at the beginning — though you will eventually learn to do your own ERP exercises to help manage your symptoms. Over time, the treatment will “retrain your brain” to no longer see the object of the obsession as a threat.”

Now, that probably sounds really scary. The reason you even do compulsions in the first place is your brain’s attempt to NOT face the discomfort of the intrusive thoughts. Through ERP, we learn slowly and gradually how to face and sit with smaller discomforts and fears in order to eventually face the bigger ones. You do this all with the help and support of your ERP trainer therapist. We do not start ERP in the first session! We first start with lots of education about ERP, coping skills for the anxiety and discomfort you will feel, and confidence building so that by time we start ERP, you feel ready and able.

In addition to ERP, we also use Inference-Based CBT (I-CBT). I-CBT is another evidence-based treatment that is based on the central idea that obsessions are abnormal doubts about what “could be”, or “might happen” (e.g. “I might hurt my child”; “I might be contaminated”; “I might be gay”). Obsessional doubts do not come out of nowhere, but instead arise from inferences that come about due to prior reasoning, an over-reliance on possibility, and a distrust of the senses.

I-CBT aims to bring resolution to obsessional doubts by teaching clients that obsessional doubts do not arise in the same way as normal doubts. Normal doubts come about for legitimate reasons, and are relevant to the here-and-now, whereas obsessional doubts never are. With this in mind, clients being treated with I-CBT are encouraged to trust their inner and outer senses, which leaves no room for obsessional doubts in the first place. Clients learn how their brain make inferences and why, and how to train your brain away from the obsessional doubt.