People with OCD have obsessions, which are unwanted thoughts, images, or impulses that repeatedly occur and feel out of control. Obsessions create a lot of distress and anxiety. In an effort to find some relief, a person with OCD will engage in compulsions to alleviate anxiety and distress levels. Compulsions are urges to perform behaviors that follow a rigid set of “rules.” Compulsions can be observable, external behaviors, such as counting, checking or washing; or covert mental rituals such as praying in a certain way, or having to “undo” thoughts to erase the distressing ones.
Although obsessions and compulsions tend to have common themes, they can be highly specific to the individual.
Common obsessions include:
- Contamination fears
- Intrusive thoughts about harming self or others
- Intrusive sexual thoughts or urges
- Excessive religious or moral thoughts
- Superstitious ideas
- Thoughts related to evenness or exactness
- Concern with needing to know
- Pathological doubt
Common compulsions include:
- Washing rituals
- Asking for reassurance
- Needing to confess
- Repeating activities for no reason
- Avoiding situations that trigger obsessions
- Mental undoing of a disturbing thought
OCD symptoms are distressing and time consuming, which interferes with normal daily activities. Most people with OCD recognize their obsessions and compulsions as being excessive and unreasonable.
Leading researchers who study OCD have found six common mistaken beliefs that people with OCD have. These beliefs provide fuel to the OCD symptoms. These are:
- Intolerance of uncertainty – need for 100% certainty
- Over-importance of thoughts – having a thought means something important
- Overestimation of threat – holding an exaggerated estimation or the occurrence of harm
- Inflated responsibility – belief that one has the power to prevent a negative outcome
- Perfectionism – belief that perfection can be attained, minor mistakes have huge consequences
- Importance of controlling thoughts – belief that it is important to have complete control over thoughts
At the heart of treatment for OCD is exposure and response prevention (ERP). With exposure therapy, you will learn how to gradually face your fears. Acceptance and commitment therapy (ACT) and mindfulness strategies are integrated into the therapy for OCD.
We will complete a functional assessment of your OCD by identifying what your obsessions are, and what compulsions you use as strategies, such as rituals and avoidance, to make your anxiety go away. Your solutions have unintentionally made your OCD symptoms worse. We will identify how your mind gets “tricked” into performing behaviors that just get you stuck. Understanding how your OCD cycle is maintained will help us design exposure and response prevention (ERP) tasks for you to practice.
We will look at how OCD has interfered with meaningful life activities and important relationships. A variety of activities may be used to help you Identify what having a meaningful life would be for you. We will use this to inform us on what actions you will work on with exposure therapy. We will collaboratively develop tasks that will help you get on with life. As you face your fears, you will learn a variety of skills to help you relate to your obsessions and discomfort in a different way. With practice, you can move toward having the life you want.
You will define the pace at which you will work on exposure tasks. ERP tasks are practiced in the office so you can be coached through it. Practice between sessions is crucial to see good results. We may also take “Field trips” to complete ERP outside the office where you experience triggers, including school, work, or public places.
Helpful Treatment Augmentations
Family therapy is often useful so that your family members have a plan to support you in ways that will help you reach your goals. We will address problematic behaviors that affect your relationships and interfere with your progress. Together, we will find alternative strategies that can help you.
Compassion focused therapy is useful for clients who feel guilty, are self-critical and lack self-compassion.
Medication can be a helpful addition to your therapy. If you are not currently taking medication for your anxiety, and we determine that it may be useful, a referral to a physician will be provided.