How Should OCD Be Treated?
One of the most common things we hear from clients who come to us for OCD treatment is that they have done years of talk therapy without much improvement.
This doesn't mean talk therapy isn't helpful. Many people find it helpful to talk with someone about their feelings and get validations. But most people with OCD will not see improvement in their symptoms by talking alone.
In fact, much of the time talk therapy can involve "co-compulsing" with the therapist by analyzing thoughts, seeking reassurance, and making meaning out of thoughts by looking for hidden traumas.
It's important for you to know that there are treatment approaches for OCD that have been backed by research. And this may come as a surprise to you, but most therapists have no idea how to use this treatment approach.
The majority of graduate school programs for therapists do not include training on OCD assessment, diagnosis, and treatment. Therefore, the only therapists that can adequately treat OCD are ones that have sought more specialized training.
What is the most effective treatment approach for OCD?
Research has shown that Exposure and Response Prevention in the most effective way of treating OCD. There are some additional treatment approaches proven to be helpful as well. A combination of medication has also shown to improve OCD symptoms. There is also a growing amount of research on the use of Acceptance and Commitment Therapy (ACT) for the treatment of OCD (which blends very well with ERP!)
At State of Mind Therapy, Jenny and Justin use both ERP and ACT in treatment of anxiety disorders and OCD.
What is ERP?
ERP stands for Exposure and Response Prevention. In its most simple form, it means to gradually expose yourself to your fear while not engaging in any behaviors that may serve to reduce your anxiety.
When you engage in an anxiety reduction behavior, you reinforce the need to keep doing the behavior. This prevents you from learning that anxiety is safe and tolerable. And it can make your world a lot smaller by keeping you from doing the things you love in life.
ERP helps you to change the relationship you have to the feared stimuli. Its helps you to be more flexible with how you respond and makes you better able to handle difficult thoughts and feelings.
We know it can feel scary but it's worth it.
You can check out some related videos here that we did on this topic:
How to Effectively Treat OCD (video)
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Common Sub-Types of OCD
Many people think OCD is characterized by symptoms of excessive handwashing, counting, checking, and having things be "perfect." Although these are indeed symptoms of OCD, it is a limiting description of the possible ways OCD presents itself.
Why are sub-types helpful for OCD?
Because the symptoms of OCD are not widely understood, many people are still under-diagnosed with OCD. And this means people are not recognizing it and likely not getting treated...especially the most appropriate type of treatment. So by identifying sub-types and talking openly about them, more people may get the help they really need. Many of our clients with OCD had thought they were "just weird" or "had anxiety." There is relief in knowing there is an explanation and name for your symptoms.
The downside of sub-types for OCD
Although sub-types are helpful in some ways, it can common with some issues too. It's important for people to know that these subtypes are not separate diagnoses. They are under the OCD diagnosis. It can actually be a slippery slope to over-identify with a subtype because it can make people more susceptible to relapse. For instance, if you are focused on your symptoms of Harm OCD, you could make great improvements in therapy but years down the road OCD could come back in a different theme, such as sexual orientation OCD, you could struggle with applying your previous skills to this theme because it "feels different." This is why it's important in treatment to not focus too much "on the content" of what OCD says, but instead understanding the ways it can play it's game and suck you in. This way, no matter what theme shows up, you can use your skills
Common Subtypes of OCD
Contamination OCD-fear of getting sick, fearing of spreading illness, fear of disgust, fearing of becoming a "dirty" person
Responsibility/Checking OCD-fear of items (like appliances) being left on, items being unlocked or properly secured
Just Right OCD-excessive awareness of something not being symmetrical, unease when completing routine activity, concerned an item doesn't belong somewhere
Harm OCD-fear of snapping and harming others or yourself, fear of acting on intrusive thoughts, fear of being responsible for a tragedy caused by an error you made, fear of hitting someone with a car and not knowing it
Sexual Orientation OCD-fear of living in denial of your sexual orientation
Pedophile OCD-fear of snapping and becoming a pedophile, fear of touching a child inappropriately, fear of being in denial of being a pedophile
Relationship OCD-fear of not really loving significant other, fear of partner leaving
Scrupulosity/Moral OCD-fear of interpreting scripture incorrectly, concern about words/symbols being a sign of condemnation, fear of being judged for not following religion perfectly
Hyperawareness OCD-excessive awareness of involuntary bodily processes such as breathing, swallowing, blinking, etc.
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Asking to be cured of OCD is for dead people
Wait, I can’t be completely cured of OCD?
Let’s begin by first acknowledging that OCD SUCKS!! There is a reason you are looking for help, and I’m guessing it’s because you’re suffering and becoming sick and tired of being sick and tired. Trying to get rid of obsessive thoughts through compulsions is exhausting. And it makes your world smaller and smaller. The suffering is often evident once OCD begins to rob you of your time, relationships, work performance, and simply just makes you feel very uncomfortable under your own skin. However, asking to be completely free of OCD can only be achieved once you’re 6 feet under. I know, that sounds dark and dramatic - but it’s true. OCD is a chronic disorder, which means it cannot get better without treatment. When I tell my clients that I can’t completely cure them of their OCD, I often see their body posture almost collapse. But the truth is - there is no magic Men in Black device that can delete our thoughts and memories - they’re now in our repertoire. HOWEVER, there is hope - so please stay with me.
How Acceptance and Commitment Therapy (ACT) can help treat OCD
Exposure and Response Prevention (ERP) has been (until recently) the only gold standard for treating OCD. However, there is a new treatment in town, and it has not only been shown to be just as effective as ERP, but also incredibly influential with helping people design a life that is more rich and meaningful. This treatment is called ACT. I describe how ACT works by having my clients visualize a glass of water that is about 25% full of water, but also completely saturated with salt. I explain that the water represents their lives and everything in it that brings them meaning and joy, and the salt is their OCD symptoms. During this exercise, I confess that I can’t remove that salt, but what I can do is help my clients fill their glass with more water, which decreases the significance of that salt in their lives. I also teach my clients skills to help them deal with that salt more flexibly as we move forward together -filling their cup with more purpose, meaning, and value.
Do you use ERP to Treat OCD?
Yes. ERP is certainly still very useful and I incorporate ERP into my practice. I like to describe working within ERP and ACT as a marriage - each model having their own unique benefits that contribute to the treatment process. For more information about ACT’s usefulness with treating OCD, please go here: https://iocdf.org/expert-opinions/expert-opinion-what-is-act/
My role as a therapist in treatment for OCD
I describe myself as more of a coach than as a “healer.” I often use a metaphor (I use metaphors a lot!) to describe my role in treating someone with OCD. Here we go, let’s begin by imagining two mountains that are right next to each-other. These mountains represent “life.” Life is hard and it is much like climbing a mountain. Mountains can be incredibly dangerous to climb if you don’t have the right tools to help you get to the top. So now imagine your mountain being right next to mine, and let’s pretend that we can magically hear and see one another. The benefit of this circumstance is that I know some tips that can help get you up this mountain, and maybe even enjoy this climb. I can give you strategies for feet placement, how to sharpen your pick axe, I may even see an alternate route up that you can’t see from your perspective, or I may see an avalanche racing your way before you do. Assuming I don’t slip and face my own adversity on my mountain (hey, I’m human too!), I can coach you up your mountain with the help of scientifically-proven skillsets. I may even have us pause occasionally, and just take the time to enjoy the scenery up there, because that’s important too!
What I’m trying to say here is that I’m not this magical healer that is just basking in the sun on top of my mountain - free from any anxieties or curve balls that life throws at us. I’m just like you, a normal human trying to climb this mountain we call life. And the truth is, this mountain only ends when the credits to our story begin to roll. So let’s make the most of what we can out of this adventure.
Written by Justin Matthews, LGSW
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"I know I need to sit with anxiety...but HOW?"
It sounds so simple, right?
As you start to learn about the strategies that help and don’t help with anxiety, you’ve likely come to learn that running from discomfort is only making matters worse.
So everything you have been learning tells you to not avoid, distract, or do a compulsion but to “sit with anxiety” instead.
I get this isn’t easy. If it was, you wouldn’t be avoiding in the first place.
I find that there are important skills I need to help my clients learn in order to effectively “sit with” anxiety. So here are my tips on how to “sit with anxiety.”
My 5 Tips on How To Sit With Anxiety
Be curious about what your body is doing
Close your eyes to really allow yourself to be present with your mind and body. Do a scan of your body and notice where you are experiencing sensations. Just name the sensation you notice in a matter of fact way. For example: “I notice chest tightness” or “here’s nausea.” Draw an imaginary circle around that area.
Acknowledge the sensation for what it is
When we feel anxiety in our body, we can begin to interpret these sensations for real danger. If you find your mind doing this, remind yourself “this is just a sensation” or “here is discomfort.”
Be curious about what your mind is doing
Close your eyes once again and notice what your mind does. Is it giving demanding threats? Is it spinning with a bunch of random thoughts? Is it desperately trying to focus on something else? You don’t have to do anything here, just sit back as if you were sitting in the chair of a theater and watching a show.
Be gentle
Sitting with anxiety isn’t easy. You need to give yourself relentless grace and encouragement for doing something difficult. No judgment allowed here. Tell yourself “this isn’t easy” or “I can do hard things.” Beating yourself up for having anxiety is not helpful in moving you forward, so commit to being more kind to yourself. If you had a close friend who began to panic, would you say “what’s wrong with you?” I doubt it. So don’t tell yourself that either. Treat yourself like you would treat a friend.
Remove temptation
If you are working on sitting with anxiety without avoidance or compulsions, you may want to modify your environment to make it more challenging to access those. For instance, if you are working on reducing handwashing, remove extra soap or hand wipes. If you are working on not checking the rear view mirror, flip it up or cover it. If you seek excessive reassurance (online or with loved one), leave your phone/computer and go for a walk so can’t research the internet.
Practice, practice, practice
If you are working on relating to anxiety differently, then these skills are crucial to your success. If you are doing exposure therapy, then you are moving towards situations that make you uncomfortable all the time.
If you are struggling to sit with the anxiety, then you will likely abandon the exposure exercise quickly and end up avoiding the situation (or doing a compulsion).
If you are struggling with “sitting with anxiety”, then I would recommend practicing these skills on a regular basis before doing exposures. If you only practice these skills during times you are highly anxious then it may make it more difficult to sit with the uncomfortable feelings.
If you need help with applying these skills, then you may want to think about starting therapy for anxiety or OCD. Our therapists are trained in using the most effective strategies for treating anxiety disorders and OCD.
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It's Not Your Mental Health Symptoms That Are The Problem
What is this guy talking about!? My mental health symptoms are terrible and are ruining my life!!!
Look, I get it.. Anxiety, panic, and depression symptoms suck! They make us feel like we can’t concentrate, feel joy, be happy, get sleep, and so on. However, many of us are quick to blame our symptoms for the hell we feel we are stuck in.
What I see over and over in my sessions with clients is a tendency for clients to become hyperaware and obsessed with their symptoms, to the point where they begin avoiding being around their loved ones or engaging in the activities they enjoy.
The worst thing you can do when your symptoms show up is to stop doing the things in your life that bring meaning, joy, and purpose into your life. When we engage in the things we care about, and are able to become present with what matters, our “feel good” chemicals are released in our minds and bodies, which help reduce the impact of anxiety and depression.
The truth is, anxiety, panic, and depression are part of being a human being.
Let’s be honest, we are living in unprecedented times (oh, I said it!). There’s a million reasons why you may be feeling anxious, panicky, or depressed - but the key here is to not become anxious about being anxious or depressed because you’re depressed.
We do this by applying the skills you will learn in ACT. Can I promise you a total cure of anxiety or depression? ABSOLUTELY NOT. And if someone says that they can - run away!
The truth is, anxiety and depression are part of the human experience, but if we don’t have the tools to ride out some of these storms, your symptoms can become chronic and you may lead yourself down a road that only keeps the unhelpful and painful cycle on repeat.
We don’t have full control of all of our thoughts and emotions, but we do have full control with how we REACT to difficult thoughts and emotions. How you choose to RESPOND to your symptoms is your ticket out of suffering.
So how am I suppose to do these things when I’m totally consumed by my thoughts and emotions?
Acknowledge the difficulty you are experiencing right now. Example: “Here is anxiety” or “I notice the urge to cancel plans today.”
Come back to your plans for the day or the task in this moment. “What am I supposed to be doing right now?” or “What was I planning to do before this thought/feeling showed up?”
Ask yourself “What action does this thought/feeling want me to do?” If I followed that, would that bring me closer to the kind or person I want to be? Or would it bring me further away?
Recommit to the plans you had or the task you were working on. Don’t let feelings be the decision maker. Let your values the decision maker.
Remind yourself that the goal isn’t to “feel good” before you take action.
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7 Mistakes I Made During My Anxiety Recovery
Years ago I was diagnosed with GAD, Social Anxiety, and Panic Disorder. I tried countless ways to overcome anxiety.....which includes making a ton of mistakes along the way. In this blog, I describe the top 7 mistakes I made in my anxiety recovery, so hopefully you won't make the same mistakes. Need therapy for anxiety? Schedule a free 15 minute phone consultation to get started.
Hiding my anxiety from others
The feeling of shame began to dominate my life once the anxiety became chronic. I didn’t want anyone to know that I had an anxiety disorder, because I had created a narrative in my head about who I was and how I wanted to be seen by others. Because of the fear of being rejected by society and possibly ruining my reputation, I decided to keep the anxiety my dirty little secret - which ultimately made my anxiety even worse.
Assuming that always “pushing through” anxiety was the ticket out of my anxiety
I discovered the hard way that all of us need time to “rest and digest.” I often avoided this very important piece of self-care because I thought that taking time to binge on Netflix meant that I was lazy. The truth is, we all need to find our activities that allow our parasympathetic nervous system to engage so our nerves can take a rest.
Spending excessive amounts of time researching anxiety
I can’t tell you how many books, blogs, YouTube videos, and podcasts I’ve listened to in order to “solve” my anxiety problem. The truth is, our mind is great at solving problems such as financial issues, maintenance repairs, etc., however, the mind is TERRIBLE at solving its own problems.
Engaging in reassurance seeking with my wife
Reassurance seeking is a classic symptom of anxiety. The problem with this behavior is that it often mutes our anxiety worries in the short-term, but in the long game it never helps. Worries such as, “Did I damage my nervous system beyond repair?” or “Is there something else in my life that is causing this anxiety?” always seemed to return, even after obtaining reassurance from my wife. This behavior can also hinder your relationships with those you seek reassurance from for many reasons.
Framing anxiety as the enemy that I need to conquer
When I was diagnosed with Generalized Anxiety Disorder (GAD), Social Anxiety, and Panic Disorder - I established a narrative in my mind (without even realizing it) that I now had an enemy to conquer - which lead to excessive research that I discussed earlier. I would also visualize myself beating up my anxiety, which would maybe help temporarily, but it always returned with vengeance.
Engaging in pseudo-science practices
In the very beginning of my anxiety story, I decided to treat myself with “antidotes” that I found on the internet. One of the biggest mistakes I did was fall into the trap of practices that were not evidence-based treatments for anxiety disorders. I became enamored with practices like “The Law of Attraction,” which suggest through meditation, we can attract what we want in our lives through pure thought alone (for me it was to be anxiety free!!). Well, let me save you some time and just say…that shit doesn’t work.
Avoiding activities until I was “cured”
Because of my fear of other people finding out about my mental health crisis, I unconsciously decided to avoid people and activities that I use to enjoy until I was “cured.” Unfortunately, this only made my life smaller, less joyful, less meaningful, and you guessed it - made my anxiety worse.
Hindsight is 20/20. We all make mistakes when we are going through something. What mistakes have you made while trying to recover from anxiety? Share them below so others can learn from you too.
I know first hand how hard it can be to live with anxiety, but recovery is possible. If you want help untangling from anxiety, schedule a free 15 minute phone consultation to get started.
[VIDEO] What You Need to Know About PANDAS/PANS?
In this video, you will learn:
-What is PANDAS/PANS?
-How PANDAS/PANS is diagnosed
-The difference between PANDAS or OCD
-Treating PANDAS/PANS medically and with psychotherapy
-Treating PANDAS/PANS with CBT and ERP (exposure and response prevention)
-Supporting families
Find an OCD Therapist at www.iocdf.org
Learn more about PANDAS/PANS at www.pandasnetwork.org