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  • Stacy G. Smith, MS, LPC

Treating OCD: What Do I Need to Succeed?



You've decided you finally had enough of OCD and are ready to begin treatment. Whether through research, or at your first intake session with a therapist, you come across the term Exposure and Response Prevention (ERP). ERP is the gold-standard treatment for OCD, and involves deliberately, and repeatedly, confronting your feared thoughts/situations (obsessions), while refraining from engaging in any means of finding relief (compulsions). If this sounds challenging, you are correct! OCD treatment will be one of the toughest journeys you embark on, but it will also be one of the most rewarding. As a therapist treating OCD every day, I have seen first-hand how well ERP works, and how many individuals have reclaimed their lives. What I have also noticed first-hand, is a quality that often predicts how successful a client's treatment will be. This is a quality that anyone can work towards, and is one of the first discussions I have with my own clients before diving into ERP exercises.

That quality?

A Willingness to Tolerate Discomfort.

Here's the reason: ERP involves spending time outside your comfort zone - over and over again - while reducing, and then eliminating, your methods of seeking safety. I understand this may seem wrong, and terrifying, but the rationale is that by repeatedly experiencing, and tolerating, high levels of discomfort, you will allow your mind and body to habituate. In other words, when you practice staying with discomfort, instead of running from it, your mind will gradually learn to no longer see the feared thoughts and situations that trigger that discomfort as "bad," or as a threat. As a result, your overall level of discomfort in these situations will begin to decrease. The more willing you are to stay with the discomfort, the faster your mind can learn this valuable lesson. Another way to view OCD and the above rationale is to think of OCD as a continuous false alarm, alerting you to danger when no danger actually exists. In order to prove to your mind that unpleasant thoughts/feelings are in fact okay to have, and are not to be feared, it is important to stay with them. Continuously trying to avoid and push them away, only reinforces to your mind that these thoughts/feelings/situations are in fact "bad."

Now, a willingness to tolerate discomfort does not mean you have to enjoy the discomfort, or even like it - that is not the goal. The goal is to be accepting of discomfort, and to learn to live alongside it, not without it. Willingness is key - being willing to do something means you are wanting to, and ready to. It is approaching an ERP exercise with a "let's go for it!" attitude, recognizing that discomfort will arise. On the other hand, doing something willfully, including approaching discomfort, means you are doing so reluctantly, and only because someone may be telling you to, such as your therapist. Think of willfulness as dragging your feet, going through the motions, but not feeling fully invested in the process.

Having a willingness to confront discomfort is important because OCD treatment does not focus on relaxation strategies. It focuses on learning to accept the presence of unwanted thoughts and feelings, without trying to prove them right or wrong, or figure out the best means to get rid of them. While deep breathing, coping skills such as taking a walk, listening to music, or calling a friend, are all good strategies for stress relief, they are not used to treat OCD symptoms specifically. These strategies all focus on reducing anxiety, similar to the function of compulsions; but remember, the goal of treatment is to function with discomfort, not develop new tricks to get rid of it. You and your therapist will collaboratively develop exercises that intentionally make you anxious; and remember, you will simultaneously work on removing your specific go-to methods for trying to calm yourself down. This means gradually taking away all those little tools and tricks you reach for in the hopes of finding relief.

The more willing you are to stretch your limits with how much discomfort you can tolerate, the more successful your treatment will be. I understand this is very challenging, but magic does happen when the goal becomes learning to live with discomfort, rather than learning to prevent it.

Now, take a minute to (honestly) ask yourself, how willing am I to tolerate discomfort? How willing am I to experiment with seeking it out, leaning into it, and allowing the feelings to be present without seeking safety? If you are hesitant about treatment, and bringing on this discomfort, it is important to work on motivational exercises first. Willfully engaging in ERP can result in frustration, and repeated feelings of defeat. A few questions I will review with my own clients to improve motivation are:

"What has OCD cost you - emotionally, physically, financially, spiritually...?"

"What have you missed out on because of OCD?"

"Does engaging in rituals actually reduce your overall discomfort?"

"How are your friendships and family interactions affected?"

I also ask the question, "if my life continued on exactly as it is, without addressing my OCD symptoms, would I feel a sense of comfort in my daily life?" If the answer is no, it can be helpful to consider what you have to lose by engaging fully in treatment, and experiencing the discomfort it will elicit. Chances are, OCD has already made your day-to-day life uncomfortable, and for many individuals, unbearable. The only difference is, the discomfort from engaging in treatment will ultimately lead to positive results, while the discomfort from continuously giving into OCD will only leave you caught in its endless cycle.

Always remember, OCD is a treatable condition. It takes hard word, persistence, and yes, a whole lot of discomfort; but, with dedication and a willingness to roll with the anxiety, rather than fight it, you will be well on your way to finding the relief you've been searching for, and deserve.

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DISCLAIMER: The blog posts shared on www.StacySmithCounseling.com contain the opinions of Stacy Smith, MS, LPC, and do not reflect the opinions of any organizations or affiliates. While Stacy is a licensed mental health professional, all blog posts on her site are for informational purposes only, and are never a substitute for professional advice catered to your individual needs. Stacy Smith is not liable for any diagnosis, treatment plans, or decisions made based on the information presented on this website. Furthermore, commenting on posts does not mean a treatment relationship has been established with Stacy Smith.

#ERP #Treatment #OCD

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