Got OCD? Try ERP

Most people have some notion (albeit a very superficial one) of what it might be like to have symptoms of obsessive compulsive disorder or OCD. Maybe they’ve felt compelled by superstition to avoid black cats or walking under ladders to ward off bad luck. Or maybe they make sure to always wear their lucky underwear on travel days to provide themselves with a sense of calm. They comply with these internal directives to ease anxiety and/or avoid the guilt they think would haunt them if they were not to comply and then something bad happened afterward. While these types of behaviors may be OCD-like and are not uncommon, true OCD can be a cumbersome anxiety disorder that causes considerable distress and often monopolizes a significant chunk of a person’s day.

OCD is characterized by the presence of “obsessions” — thoughts or sensations deemed unacceptable or intolerable — and, usually, “compulsions” — behaviors the person feels must be performed in order to neutralize or eliminate the anxiety-provoking obsessions. While engaging in compulsions might indeed make the anxiety go away in the moment, doing so ends up strengthening the OCD over time by reinforcing the belief that compulsive action is the only way to effectively manage an obsessive thought.

Interestingly, the thought content of OCD sufferers is quite similar to that of people who don’t have OCD. A major difference between the two groups is that when people with OCD have an uncomfortable thought, they are more likely to consider the thought significant and unacceptable and conclude that it must be gotten rid of immediately, rather than simply disregarding it as irrelevant and trivial as non-sufferers tend to do. The problem is that trying to get rid of a thought just causes it to stick around and fester, raising the sufferer’s level of desperation and anxiety.

The most effective and lasting known treatment for OCD is “Exposure with Response Prevention” (or ERP), an approach that falls within the realm of cognitive behavioral therapy. ERP involves learning tools for coping with obsessive thoughts and then using these tools to resist engaging in compulsions. A CBT therapist helps clients to develop an exposure hierarchy for targeting their unique OCD symptoms, enabling them to tackle situations that trigger low levels of anxiety first and then gradually build up to situations that are more challenging.

Compulsive behaviors are misguided and futile attempts to achieve certainty and a sense of control over the future. An important objective of treatment for OCD is helping the client to accept that absolute certainty is impossible and realize that, even though the thought of a particular outcome might be absolutely dreadful, no amount of compulsive ritualizing can ever guarantee that the catastrophic outcome won’t come to pass. And that is simply the reality that we all must face.