How OCD gives you the tools necessary to overcome it
OCD’s strict instructions and limits are key to the therapeutic technique considered to be the gold standard of OCD treatment.
I bet you left the stove on. Did you even use the stove this morning? Doesn’t matter. You need to check anyway or your house will burn down, you’ll lose everything, and your job will fire you for being too sad.
Sound familiar? You’re not alone. OCD can be exceptionally cruel, as detailed in Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life, a 2018 memoir by Shala Nicely, LPC. In Fred, Nicely chronicles her journey to freedom from the demands and limitations OCD had placed on her since she was a child. Years of denial and ineffective therapy ultimately culminated in successful treatment with Exposure and Response Prevention therapy.
Often referred to as ERP, this approach works by blocking the usual response or ritual before, during, or after exposure to the fear- or anxiety-inducing stimulus, allowing the brain to learn that the usual ritual or response isn’t necessary for safety or survival. At times, the interruption of the cycle can even force the ERP user to notice that their anxiety, fear, or OCD was threatening them with “an unloaded gun," which is how Nicely described experiencing this realization for herself.
Becky Beaton-York, a licensed psychologist and founder of The Anxiety and Stress Management Institute, states that one can’t just jump into ERP. Before starting exposure and response prevention therapy, you must be evaluated for severity of your OCD, anxiety, and/or trauma. If the heart of your OCD lies in a traumatic experience and response to that trauma, then the trauma must be treated before any OCD symptoms can be lessened.
In addition to the above prerequisites to ERP, there are several nonnegotiable rules to using ERP, as a client and provider:
Do not get caught up in the content of the OCD or anxiety
Never have a client do something you wouldn’t do (or, inversely, don’t do something that your therapist would never do)
Don’t do any exposure only once in therapy. If time is limited, relegate the exposure to out-of-session homework.
And, equally important, remember that successful ERP therapy does not require you to feel less stressed out by any of the anxiety-inducing stimuli that sends your OCD or anxiety into overdrive.
A Simplified Guide to ERP:
Identify and Rate Anxiety-inducing Stimuli
This list doesn’t have to be exhaustive and related to all anxiety-inducing stimuli, but you may find that the general fear often underscores a wide range of anxiety-inducing stimuli. For example, a person whose OCD manifests through a deep fear of illness may find that this fear is behind why they avoid touching doorknobs, shaking hands, eating out at restaurants, traveling, etc.
This exact fear appears in Nicely’s book, as does her fear of animal cruelty. Her list of anxiety-inducing stimuli ranges from activities such as eating a sandwich that had touched the floor to visiting a PETA exhibit, both of which left her feeling deeply uncomfortable and victorious.
Your list should cover low-level anxiety-inducing stimuli that leaves you just a bit uncomfortable (a 1 out of 10) to major behaviors or exposures that send your anxiety through the roof.
Use this Hierarchy of Exposures as a Guide to OCD and Anxiety Defiance
Starting at the beginning of the scale, start pushing back on your OCD and anxiety by purposely choosing to be anxious. Nicely puts this effort perfectly in her book when she describes starting to curse and talk back to her OCD. Your OCD is not in charge of you, and it’s time that it learns that. The only way to show OCD and anxiety is that it’s not the boss of you, regardless what it threatens or promises, is to shove its instructions back in its face and pursue the very stimuli that makes OCD and anxiety raise their heads.
It’s important to note that seeking this stimuli may not always be possible or advisable due to the nature of the stimuli. Perhaps you’re afraid of volcanos, we don’t want you diving into lava, but it could be helpful for you to increase your exposure to volcanos through imaginal experiences or even virtual reality. Imaginal is exactly as it sounds; Imaginary exposure through imaginary or visualized circumstances.
Welcome Discomfort and Anxiety as Signs of Progress
Do not give into any behaviors that quell your anxiety. It’s important that your brain learns through exposure and response prevention that your responses or lack thereof aren’t guaranteed to create or prevent the ever-threatened outcome.
Your friends and family may have picked up habits to help you manage your anxiety and OCD. Perhaps they’ve started double checking the front door or letting you know they also think the stove is off. While that may feel helpful, this actually enables and strengthens your OCD or anxious response to the original stimuli. Part of treating OCD and anxiety requires you to tell your friends and family to not help you feel less anxious or afraid about OCD-related stimuli.
Giving in to safety-seeking behavior and reassurance undermines all the work you put into feeling so uncomfortable in the first place. You deserve to live the life you want; When ERP becomes even more difficult than you imagine, remember and imagine what you’ll gain once OCD and anxiety don’t reign over your choices.