Science-based treatments for OCD

MY METHODS

There are multiple ways to treat OCD. We’ll find the one that’s right for you.

Exposure & Response Prevention (ERP)

ERP is based on the idea that in OCD, people respond to fear and anxiety of intrusive thoughts by doing compulsions (which can be overt behaviors or mental rituals, reassurances, or rumination).

The compulsions give temporary relief of the fear and anxiety, but ultimately send the message to the brain that the threat is real. The brain then sends more intrusive thoughts in a misguided attempt to protect you from the perceived threat, creating a cycle that is difficult to break. The key to stopping the cycle is stopping the compulsions.

In ERP, we’ll do exposures to the thoughts or things that trigger you, while tolerating the fear and anxiety, and NOT doing compulsions.

One (or both) of 2 things usually occurs:

Habituation: the body cannot maintain fear and anxiety for very long. So after awhile, those feelings go down. With repeated exposure, they don’t start out as high. With each new exposure, they get less and less intense. Eventually the scary things don't scare you or lead to anxiety any more.

Inhibitory learning: you learn that the things you were afraid would happen are less likely to happen than you thought, or, even if they happen, you learn you can handle them better than you thought.

Through habituation and/or inhibitory learning, you learn you don’t need to do compulsions and you can engage in things that are much more enjoyable and important instead.

Inference-Based CBT (I-CBT)

Inference Based CBT helps people understand that their OCD is a result of a reasoning process (there are good reasons they believe what they do) and of being absorbed in a story that is not based in reality (what they can perceive through their senses and common sense).

OCD is based on obsessive doubts (such as what if I left the door unlocked…I could hurt a child…I never stop noticing my breathing…my hands have germs…etc.) and inferences, which mistake an imagined possibility for a real probability. (It’s POSSIBLE I could hit someone and not know it, so I need to make sure I don’t do that.)

I-CBT teaches you to trust yourself, use your senses, recognize when you are getting sucked into a story, and learn to get back to reality. In essence, it allows you to regain the certainty you once had before the doubt crept in. To quote my colleague, Theresa Chiu, “Living with OCD is sort of like trusting our doubt and doubting our reality. I-CBT helps us trust our reality and doubt our doubt.”

This approach is not like traditional CBT, which might lead us to disputing the content of the doubts (which could maintain the OCD). Rather, it is an approach that sheds light on the reasoning process and uncovers the way OCD has tricked you so you can stopped being tricked.

Rumination-Focused ERP (RF-ERP)

A common compulsion in OCD is rumination: sustained attention you are giving a problem. It can be worrying about something, analyzing, figuring out, researching, getting reassurance, checking, reviewing a situation again and again, etc.

RF-ERP suggests that anxiety in OCD is the result of ruminating, and if people can stop ruminating, their anxiety will go away. Using this method, you learn that rumination is a behavior you can control, how to stop ruminating, and then uses exposure simply as an opportunity to practice not ruminating. In therapy, we’ll work on practicing not ruminating until you can encounter something that was previously triggering and not be impacted by it.

This can be especially helpful for themes of OCD that involve mental rituals and what is commonly called “Pure O.” In Pure O, people believe they are assaulted by obsessive thoughts and often don’t recognize compulsions. RF-ERP breaks down the differences between a thought occurring to you, it being in your awareness, and you directing attention towards it and engaging with it. You can then realize that even if you cannot control whether a thought occurs to you or is in your awareness, you can control how much attention you give to it and how much you interact with it.

RF-ERP gives people control where they thought they had none. It is incredibly empowering and effective! It can be used as a treatment on its own or if rumination is impeding other treatments.