Our culture is chockablock full of misinformation about Obsessive Compulsive Disorder or OCD. The phrase “a little OCD” has permeated everyday vernacular, and even well-meaning people often deploy it when talking about their “quirky” habits of neatness or cleanliness. Perhaps when we think of OCD, we imagine someone washing their hands a little too vigorously or straightening the papers on their desk a few too many times.
But OCD is so much more complex than just a general sense of fastidiousness. It is a pervasive, sometimes debilitating, mental condition that takes an immense amount of fortitude and bravery to confront every single day.
Clinical Description of OCD
To get technical, OCD consists of two major symptom categories, both of which must be present to have a diagnosis:
Persistent, unwanted thoughts or mental images, otherwise known as obsessions: These can be about any number of wide-ranging topics, but here are a few potential categories that our fears can gravitate around:
Contamination (germs, disease, chemicals, etc.)
Harm to self or others
Embarrassment or social humiliation
Religious or moral deficiencies
Rituals that are performed to try and assuage those thoughts/images, otherwise known as compulsions: It’s important to note that these rituals can be physical OR mental acts, and they provide only temporary relief from the anxiety caused by the intrusive obsessions
OCD Treatment
To treat OCD, we zone-in specifically on the compulsions, as there is actually nothing wrong with the obsessions themselves! No matter what the content of the obsession is (and they can range from generally annoying to extremely disturbing), there is truly nothing there to be ashamed of. Brains are wild and unpredictable entities, and even brains that don’t have OCD will pop-up random sounds, words, and images outside of conscious control (Still got that jingle from that commercial from 10 years ago stuck in your head? Or maybe you’re still thinking about that time you misspoke in that meeting last week?). I wish we could control these unfun, sometimes unsettling, intrusions, but most of the time, we just can’t.
What we CAN do is prevent ourselves from engaging in the compulsions that justify, and ultimately fuel, these obsessive thoughts. When we engage in compulsions, we validate our obsessions. We convince ourselves that there actually IS something horrible to be prevented, when in reality there is no problem needing to be solved, no monster needing to be slayed.
Addressing the compulsions is done through a course of treatment called Exposure and Response Prevention (ERP), which is the gold standard for alleviating this typically hard-to-tackle disorder. The ethos behind ERP is that we gradually and thoughtfully expose ourselves to the fears generated by our OCD, while systematically preventing ourselves from engaging in our compulsive rituals. Over time, our brain learns that we can survive and thrive in these previously impossibly scary scenarios, and our fear response drastically lessens.
To give you a more detailed picture, ERP consists of the following important components:
1. Assessment: We work collaboratively to identify the obsessions, compulsions, and triggers that are most distressing for the client.
2. Hierarchy Development: We then work together to create an exposure hierarchy, a list of situations or triggers ranked from least to most distressing, which ensures a gradual and manageable approach to exposure. This is a living document and will change over the course of treatment based on the client’s needs.
3. Exposure: Beginning in the safe and controlled environment of session, we begin to tackle the exposures lined out in our hierarchy. For exposures that can’t physically be recreated (for instance if our obsessions revolve around sexual or religious content), we engage in the exposures with our imagination, working hard to make them feel as psychologically real and tangible as possible.
4. Response Prevention: During those exposures, clients are specifically instructed not to engage in their usual compulsive behaviors or rituals. This prevention of the response allows the anxiety to decrease naturally over time.
5. Homework: Clients then leave session with explicit assignments to carry out exposure exercises in their daily lives. Again, all of this is done collaboratively, nothing is forced or pushed through without full buy-in from the client.
OCD Counseling
If that whole process sounds a little overwhelming, I totally understand. Engaging in any mental health therapy is a vulnerable and courageous act, but ERP in particular is a treatment which requires full commitment and bravery to pursue. If you are looking to loosen the shackles of OCD, I promise that we will embark on this path with a sense of teamwork, and I will be with you every step of the way. Our hope is that treatment helps you regain a fuller, freer sense of yourself, creating a life outside of the fearful confines of obsession and compulsion. Give us a call today to schedule and inquire about this liberating treatment.
Begin Counseling for OCD in Houston, TX or San Antonio, TX:
Taking the first step can be scary. We are here to help with the process every step of the way. To begin counseling in Houston, TX or San Antonio, TX, follow these steps:
Contact our Houston Heights and San Antonio's Alamo Heights counseling clinic and set up your free phone consultation,
Meet with one of our skilled adult therapists,
Begin counseling for burnout and find passion in your profession again.
