Understanding OCD & Effective Treatment

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What You'll Learn:​

• How the brain’s fear response contributes to OCD

• Why compulsions reinforce OCD rather than relieve it

• The role of Exposure and Response Prevention (ERP) in treatment

• How ERP changes the brain’s response to fear

• What to expect from ERP therapy and long-term outcomes

 

Humans are hardwired to fear.

It is incredibly important for survival that our brains can quickly detect threats in our environments and initiate an entire sequence of biological reactions that enable us to fight off an attack, escape a danger, or freeze in place to better hide. Think about the last time someone accidentally startled you—your brain reacted as if there was a threat before you could even fully process the situation.

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In OCD, the part of the brain that regulates fear is overactive and constantly sending erroneous signals.

This results in “obsessions”—or the recurrent, intrusive, unwanted thoughts that something “bad” is going to happen. The OCD brain also significantly overestimates the likelihood that the “bad” thing will happen. For example, those with contamination OCD may fear that they will definitely become sick or not be able to tolerate their disgust with dirt or germs. Those with harm OCD may have obsessions that they will get someone else sick, stab someone, or cause some other bodily harm because they were not careful enough. These obsessions cause such a distressing spike in anxiety that sufferers engage in repeated behaviors aimed at trying to prevent the predicted event from occurring in order to reduce their anxiety.

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Listening to OCD and performing compulsions keeps OCD alive and well.

Even though most people with OCD are well aware that their fears are unfounded, they feel driven to perform their compulsions regardless because of the “off chance” that it could happen. Those with OCD have a very low tolerance for ambiguity and the resulting distress this causes. The OCD brain tells the sufferer that they cannot tolerate their body’s fear response, that the feared outcome will certainly happen, and that they will not be able to cope with the consequences. This also contributes to the steady worsening of symptoms that most with OCD experience over their lifetime. Most people suffer with OCD for an average of 7 years before seeking therapy.

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Exposure and Response Prevention (ERP) is a treatment that disrupts the feedback cycle.

Gradually facing the situations, thoughts, or images that trigger distress is a key part of ERP. This component is called exposure. During exposures, we will also work toward resisting the use of compulsive behaviors or avoidance strategies. This is known as response prevention. By way of analogy, if you had to get into a cold pool (and did not want to do a cannonball), you would start by getting your ankles wet and resist the urge to immediately jump back out. Once acclimated, you might go a little deeper, then a little deeper. Eventually, the water will no longer feel like a jarring, unpleasant experience, and you can go about enjoying the pool.

 

ERP changes the brain’s response to feared situations.

By fostering three types of new learning, the brain is able to update the algorithm it uses for fear processing. In ERP, you will learn that your feared outcomes do not occur (at least not the way you expect), your anxiety will not persist (even in the presence of a fear-provoking stimulus), and that you are far more resilient than you expect.

 

ERP is a collaborative and structured approach.

Each exposure is planned ahead of time (there are no surprises in ERP). If your fear is related to contamination, we might design an exposure where you're in contact with something your brain perceives as "dirty," but will resist the urge to wash your hands. Whenever possible, I will do the exposure activity right along with you. We will also monitor your anxiety levels throughout the session using a scale, helping to track your progress. At the end of the session, we’ll reflect on the experience and plan how you will practice the exposure independently until our next session.

 

Following treatment, most people achieve significant reduction in symptoms.

Some people achieve total remission. However, it is not uncommon for OCD symptoms to increase during times of stress, or for completely new forms to emerge later in life. However, those who have completed ERP therapy are better able to manage stress and prevent future increases in OCD symptoms. They are also better able to spot and effectively respond to new obsessions in the future and prevent future episodes from becoming debilitating.