How is OCD Treated in Therapy?

can-OCD-be-cured

Obsessive-Compulsive Disorder (OCD) is a mental health condition that affects 1-2% of the population. The World Health Organization estimates that it is one of the top 10 causes of illness related disability worldwide.

You might wonder if OCD can be cured? The issue with this question is that mental health is not black and white. Instead it can be better understood as a pattern of thoughts, feelings, and behaviours. OCD has a very specific pattern of thoughts, feelings, and behaviours.

Psychotherapy (in particular Exposure and Response Prevention) can help free you from the OCD cycle, and gain more autonomy in your life.

The OCD Cycle

To understand how OCD is treated in psychotherapy, it is first important to understand the OCD cycle.

If you are caught up in this cycle you’ll find it consists of four parts:

  1. Obsessions – First an intrusive and distressing thought or image (called an obsession) will show up in your mind. This thought can feel very alarming, and will often centre on something you care about. You might have a thought that you will harm someone you love, or maybe you will bring in a germ that will get someone you care about sick.
  2. Feelings of Distress – This thought or image will trigger significant distress. You may feel anxiety, fear, guilt, shame, or a feeling like you are losing control.
  3. Compulsions – Because so much distress shows up, you do something (either an action or a mental act inside your head) to get rid of it. If the obsession is about harming someone maybe you start avoiding being alone with people you care about, or maybe you say a prayer in your head to try to protect them.
  4. Relief – This compulsion provides you with some relief from the distress. This relief however does not last, and the cycle starts again when another obsession shows up.

Everything we do, we do for a reason – we just may not know the reason at first! With OCD, the final part of the cycle is what keeps it going. The compulsion provides you with relief from the distress.

In some sense doing the compulsion works for you. However you may notice that there is no end to the cycle, and even though you feel some relief it is not long before another obsessive thought shows up again.

How is OCD Treated in Therapy?

Research has shown that Exposure and Response Prevention (ERP), a form of Cognitive-Behavioural Therapy (CBT), is effective for treating OCD. In ERP the aim is to interrupt the OCD cycle.

In therapy you are gradually exposed to situations where obsessions will show up, and then you practice interacting with the obsessions in a new way where you watch thoughts come and stay and go instead of getting caught up in them. These skills can help take the power out of your thoughts so they no longer bully you or push you around.

An important part of breaking the OCD cycle is the response prevention part – as we allow the obsessive thoughts to come and stay and go we reduce and eventually stop the compulsions. This work can be challenging as your distress levels might increase. What you will find though is that this distress does not last forever, it will often peak and then subside.

Thought-Action Fusion – Don’t Believe Everything You Think

One experience that is very common in OCD is something called thought-action fusion. This is just a fancy way of saying that you see thoughts as the same as actions. For example, you might be sitting in a crowded theatre and have the thought enter your head “wow, I could stand up and swear in front of this entire crowd!” Everyone has thoughts like these, but if you have OCD it might feel as if you actually stood up and swore at everyone.

Your mind might start saying “why am I having that thought, that must mean I am going to do it, I should get out of here as fast as possible”. This is why part of therapy involves practicing treating our thoughts as thoughts instead of actions.

Through practice it is possible to relate to your obsessions in a new way, one where they no longer push you around, or control you. This will allow you to move through the world the way YOU want to, not the way OCD wants you to!

Interested in Therapy with Stephanie?

Emotions as Allies

We all know that being human means we experience a wide range of emotions; happiness, sadness, anger, fear, guilt, surprise, joy, loneliness, and love to name a few.

Yet quite often when a difficult emotion comes up, we try to avoid it, get rid of it, or beat ourselves up for having it in the first place.

Emotions contain messages

We forget that our emotions have evolved for a purpose and often contain important information. Here are some common messages an emotion might be telling us…

Anger often tells us that we have been hurt or treated unfairly. It can serve as a warning sign that there is something wrong that needs to be addressed.

Sadness often tells us we have experienced some type of loss. This could be an external loss such as the loss of a person, experience, or job. It can also be an internal loss such as a loss of meaning or perhaps we are not living up to some ideal we have about ourselves.

Fear has evolved to warn us of some type of danger, its purpose is to protect us. This was especially important back when we were living in caves and there was danger everywhere.

Guilt shows up when we believe we have done something wrong. It can tell us that we need to make amends with someone.  

Love tells us that we appreciate someone, and we want to be close to them. It motivates us to connect with others.  

How can our emotions help us?

When we try to hide, or fight, or runaway from our emotions, we often miss the message they might be trying to tell us. To help think about this, the next time you’re experiencing a difficult emotion, ask yourself:

  • Is this emotion telling me I need to address, solve, or come to terms with something?
  • What does this emotion tell me about what I care about? Are there any values underlying this emotion?
  • Is this emotion telling me I need to do something differently?
  • Can this emotion help me empathize with other people who may be experiencing something similar?

Sometimes when we experience a difficult emotion there might not be a clear purpose, or message. In these situations, an emotion like this can be a reminder to be more self-compassionate. To read more about this idea click here.

When we reframe any difficult emotion as having a purpose, or a message (even if it is just to be more compassionate to ourselves), our emotions can become an ally, instead of an enemy we need to run away from.

Self-Compassion

Self-compassion has received a lot of research recently (over 1,000 published studies)! Psychologist Dr. Kristen Neff was the first to come up with a formal definition of self-compassion, and use it as a measure in psychological research. Her definition of self-compassion is made up of 3 components.

1.) Mindfulness

In order to give ourselves compassion we must first be aware that we are suffering. Mindfulness simply means opening up and acknowledging our pain. In other words, noticing your thoughts and feelings. For example, you might say to yourself I am having the thought that I am not good enough, or I am having the thought that I am a lousy parent. You could also take note about what feelings these thoughts bring up, for example I notice a feeling of guilt, shame, sadness, worry, etc. For more information on mindfulness, check out my blog post on the topic.

2.) Common Humanity

When we suffer it is common to experience a sense of isolation. Common humanity involves reminding ourselves that as humans we all suffer, we all fail, and we are all inadequate in some way. If you are having a certain thought or feeling it means that millions of other people around the world have also had that same thought or feeling. This part is not intended to minimize your pain, or imply that things are not that bad. Instead, the purpose is to remind yourself that you are not alone.  There is a great quote that sums this up nicely.

“You are not one drop in the ocean, you are the entire ocean in one drop”

Rumi

In other words your pain is part of the wider human experience. It does not isolate you, in fact it unites you with everyone else.

3.) Self-Kindness

This can be the trickiest part of self-compassion for many people. Self-kindness means speaking to yourself the same way you would speak to someone you deeply cared about. Quite often, our minds are our own worst enemies. When we are struggling with something, our minds tend to beat us up. However, if someone we loved was struggling with the exact same thing, we usually would respond with kindness. Take a moment to think about the last time someone you loved was going through something difficult… what did you say to them? How did you act towards them? Now, think about the last time you were going through something difficult… what did you say to yourself? How did you act towards yourself? For many of us there is a drastic difference.  

But does it actually help?

There is a growing body of research that shows self-compassion can protect us from developing mental health issues. One study really stood out to me. Hiraoka et al. (2015) measured levels of self-compassion in U.S. combat veterans coming back from Iraq and Afghanistan. They found that those with higher levels of self-compassion were less likely to develop symptoms of Post-Traumatic Stress Disorder (PTSD) one year later, and that this was more predictive than the amount or quality of the combat they faced. Think about that for a second, how these veterans related to themselves in their moments of pain and struggle was more predictive of whether or not they would later develop PTSD than the actual trauma they faced. 

We all have different levels of self-compassion. But what is very exciting, is that research has shown self-compassion is something that can be learned, and when taught, can increase emotional resilience in the face of stress and lead to greater overall psychological well being. There are many different types of self-compassion practices you can implement into your daily life. Below I have attached an excellent workbook that does just that, as well as Dr. Kristen Neff’s website where you can measure your current level of self-compassion, access free self-compassion exercises, and also learn the common misconceptions people have about self-compassion. 

Resources

Dr. Neff’s Self-Compassion Website

References

Hiraoka, R., Meyer, E. C., Kimbrel, N. A., DeBeer, B. B., Gulliver, S. B., & Morissette, S. B. (2015). Self‐compassion as a prospective predictor of PTSD symptom severity among trauma‐exposed US Iraq and Afghanistan war veterans. Journal of Traumatic Stress28(2), 127-133.