Got OCD? Here's the Plan.
OCD feels like a trap. Once you're stuck in the OCD cycle, it can be hard to find your way out. I use a 3-pronged approach for conquering OCD: 1) exposure and response prevention (ERP) to break the cycle, 2) EMDR therapy to get at the root of OCD fears, and 3) mindfulness skills to calm anxiety.
#1 ERP for OCD: Breaking the Cycle
Exposure and response prevention, a cognitive-behavioral technique, is the gold standard treatment for OCD, supported by lots of research. ERP helps you get out of the never-ending OCD cycle. OCD is self-sustaining because the “compulsion” is an action or ritual that has served to reliably reduce anxiety. The compulsion or ritual may be something like tapping, counting, saying a certain phrase, checking, washing, etc. Even if you intellectually know the ritual doesn't make you safer, it serves its purpose to reduce anxiety. Of course, this reduction is only temporary. The compulsion has to be done again the next time the anxiety arises… and the next time… until you feel stuck in a cycle you can’t get out of.
As the name suggests, Exposure and Response Prevention consists of gradually exposing yourself to the anxiety, and then preventing your normal compulsive response or ritual. This way we break the chain. Instead, we may find other ways to reduce anxiety, such as using mindfulness tools. You start with easier situations for you, and gradually work your way up. You are always in control of choosing what situations to practice. Exposure is never a surprise and always agreed upon ahead of time. We take steps as small as you like. Even if it seems like a small step, each time you practice, you get stronger, and OCD gets weaker. Eventually, the goal is to be able to say, "Thanks OCD for helping me feel in control and making me feel less anxious, but I don't need you to do that for me anymore."
#2 EMDR for OCD: Getting to the Root
At the same we use EMDR (eye movement desensitization and reprocessing) to get at the root of OCD fears so that the anxiety is less triggered in the first place. We create a list of targets to desensitize and process using EMDR, weakening the anxiety that drives OCD, and strengthening you in your ERP practice.
We begin by identifying the fears, triggers, avoided situations, and rituals that are done to try to control the fear. Then we create a hierarchy by rating each one on a scale of 0-10 for how distressing it is to you, 0 being neutral and 10 being the highest you can imagine. Together, we pick a starting point that feels comfortable and manageable for you. We desensitize targets in the order below. The plan may be modified or tailored to your particular needs, circumstances, or to how OCD developed for you.
EMDR Targets for OCD
· First time you felt afraid of the current fear/trigger
· Worst time you felt afraid of the current fear/trigger
· Most recent time you felt afraid of the current fear/trigger
· When you first started doing a compulsion or ritual to reduce the fear
· Past events that may have contributed to making anxiety or OCD worse such as traumatic experiences, childhood events, etc.
· Future goals: Imagining successfully responding to the trigger in the future without fear
· Reinforce with in-vivo exposure in office or exposure and response prevention homework as agreed upon together
#3 Get started with Mindfulness
You can get started on your own now by building your mindfulness skills. It's helpful to be able to let go of OCD thoughts, and notice them as just thoughts. Download the Letting Go of Thoughts meditation here, and get started with the book Mindfulness Workbook for OCD shown here.