View original article published in Psych Central–
“It just doesn’t feel right. I have to fix it until it is just so!” “I need to figure it out, and once I do, I’ll feel free to move on!” “I have to check all the windows, then I’ll be able to sleep peacefully.” “I have to repeat my prayers until I know God has really heard them.” “Not knowing whether I may hurt my child makes me anxious. I waste too many hours reviewing my behavior to ensure I haven’t harmed her.”
What do those statements have in common?
When individuals experience OCD, accepting uncertainty seems to be the greatest challenge. They have extreme difficulty moving on with their day unless they feel 100% sure the answers to their doubts have been resolved. Whether it is doing something until it feels right, checking or washing, or questioning one’s behaviors, thoughts, or feelings, uncertainty is a main cause for compulsions.
Becoming open minded to uncertainty is difficult for those struggling with OCD. A while ago, a client said to his therapist, “Once I know the answer, I want to wrap it up, tie a bow on it, and stick it on a shelf. Then I can go on with my day!”
OCD sufferers daydream about this possibility and spend needless hours repeating certain behaviors, rationalizing, figuring things out, and seeking reassurance. The doubts and anxiety may subside, but when a trigger shows up, they start all over.
“Wrapping your doubts and placing them on a shelf, so you can go on with your life would be wonderful,” were the words of a psychotherapist to her client. Then he answered, “OCD is like a bow you have to keep on tying.” He understood the problem but needed to learn how to let go of the urges to wrap and tie bows around his doubts. Practitioners can teach their patients how to accept uncertainty. One of the essential elements in treating OCD successfully is ERP (Exposure and Response Prevention).
Exposure and Response Prevention:
Research has shown that Cognitive Behavioral Therapy is the treatment of choice for OCD. Exposure and Response Prevention is a key element of CBT when helping those struggling with this disorder. Keep in mind that not all of CBT skills are adequate for OCD. For example, asking them to “look for the evidence” for and against their thoughts will not be effective. They are already trying to “find the evidence” to their thoughts, feelings, sensations, and urges. A client once stated, “I’d rather be in jail as long as I knew with 100% surety I did something wrong. Walking around with the doubts is agonizing.” Uncertainty is painful and thankfully there are solutions.
Clients can learn how to face their fears and respond differently. They can do it with imaginal and in vivo exposures. Clinicians can teach their patients how to do both. The Response Prevention part is when clients learn how to abstain themselves from doing mental or behavioral rituals that decrease the unpleasant feelings.
When people are triggered, they inadvertently create internal and external rituals to alleviate their anxiety and uncertainty. These compulsions reinforce the disorder. ERP is a powerful therapy because OCD is not only a biological but also a behavioral issue.
In order to change the brain pathways, it is crucial that individuals learn ERP correctly. They need to be trained to avoid misunderstandings and mishaps. To help you enhance your understanding about ERP, consider the following points:
- Be aware that exposing yourself to the feared thoughts, objects, images, persons, or situations won’t be effective until you have learned the correct guidelines and skills.
- ERP provides the means to change the mental and external habits. Your mental health practitioner will also teach you how to write short stories to be used with the exposures.
- There is a difference between “white-knuckling” a situation and purposefully putting yourself in the feared situation. When you practice ERP you will have learned what to do with your thoughts.
- Your provider will teach and prepare you so you can be more open to experiencing anxiety and uncertainty. When triggers show up in your life, you’ll be able to handle the situation differently than you do now. You can do this during exposures and in your daily life.
- ERP may have a negative reputation because of the media and lack of training. ERP does bring anxiety, but if done properly, you will be willing to carry on with the exposures on your own because you understand the Why.
- Compulsions bring relief, but it’s temporary. Through ERP you will experience unpleasant feelings and discomfort, but long-lasting results can be achieved.
- Most likely you are feeling overwhelmed by trying to wrap things up and tying mental bows. ERP will take a lot of your time and effort, but the results will be worth it.
- Through ERP you will learn not to feed your thoughts. Instead you will learn how to accept uncertainty and become comfortable with being uncomfortable.
The OCD mind may trick you and tell you it is possible to wrap things up. Most likely you will crave that sense of certainty. Fortunately, as you practice ERP, you will learn to let your thoughts and feelings stay unwrapped and untied. Doing the compulsions may be easier, but you may have to keep tying bows without end. ERP is an alternative that takes effort, and it will make you resilient.
Your family will support you emotionally. Your clinician will support, teach, and coach you. You are the only one that can execute the skills. You can make it happen. Don’t let the OCD mind tell you otherwise!