OCD Treatment

What to Expect in Treatment

An important step is to recognize that OCD is a genetic predisposition, neurological condition, and a behavioral challenge. OCD is not your fault! During treatment, you will learn these psychological flexibility skills to disrupt the OCD cycle:

• •Become more open to painful internal experiences. Learn skills to get unstuck from them and allow them to come and go without getting caught in the OCD trap.
• •Enhance your awareness so you can connect with the here and now and recognize that you are aware of being aware without having to become absorbed in compulsive and avoidant behaviors to get rid of internal events (e.g., thoughts and feelings).
• •Become actively engaged in what is worth (values) your focus, time, and energy and choose to do what matters most in your life.

Values-Based Exposures

Values-based exposures are based on what you value (what matters most to you). The exposures are so that you can start living the life you want and deserve.

• •Bodily Sensations - Learn to change your relationship with your sensations and emotions.
• •Imaginal Exposures - Prepare to start living life by imagining and visualizing doing what matters even though OCD may be present.
• •Real-Time or In-Vivo Exposures - Start doing the things that matter to you and be with those who matter in your life!

You can learn to be actively engaged in what matters most each and every day!

Common OCD Themes

We treat all common themes in OCD including:

• •Moral and Religious Scrupulosity
• •Perfectionism
• •Harm
• •Sexual
• •Relationship
• •Existential or Philosophical
• •Pedophiliac
• •Sexual Orientation
• •Contamination
• •Just Right

Common Obsessions and Examples

• •Religious (fears around having blasphemous thoughts)
• •Contamination (fears around environmental contaminants)
• •Losing control (fears around acting on impulses to harm others or oneself)
• •Harm (fears around harming others when not careful enough)
• •Sexual (fears around inappropriate sexual behavior with others)
• •Superstitious or magical (excessive worry around objects and other situations)
• •Health (excessive worry around physical well-being)
• •Perfectionistic (questioning whether you have told the truth perfectly)
• •Neutral (excessive awareness of your thought processes)

Types of Compulsions

• •Mental (private) compulsions (mentally reviewing past events)
• •Behavioral (public) compulsions (shaking one's head to "get rid" of a thought)
• •Reassurance-seeking compulsions (these can be private or public)
• •Avoidant behaviors (staying away from loved ones for fear of harming them)

For more detailed examples of the most common obsessions and compulsions, visit this link from the International OCD Foundation: https://iocdf.org/about-ocd.

The OCD Cycle

When you get stuck in the OCD trap, you'll notice the following events:

• •Triggers: Anything in your environment (people, places, pets, words, sounds, etc.) or internal experiences, such as thoughts or feelings, that bring about the urge to obsess and lead you to become stuck in the OCD trap.
• •Obsessions: Repetitive, excessive "worry thoughts" that can lead you to experience other difficult internal events.
• •Distress: Unpleasant events, such as feelings, bodily sensations, and urges, that can feel intolerable.
• •Compulsions: Unhelpful safety behaviors you engage in to temporarily alleviate the discomfort triggered by a situation. These behaviors can be public (things others see you doing, such as repetitively asking for reassurance from a loved one or reading and rereading information on the internet) or private (things you do internally and privately, such as figuring things out in your head, fixating on past actions, or trying to predict the future). You may also find yourself engaging in excessive avoidant behaviors to find relief from your distress.
• •Relief: Because you may have found seconds, minutes, or perhaps even hours of relief, your anxious mind leads you to believe that if you do these behaviors more intensely or longer, you might eventually find permanent relief. This short-term relief keeps you stuck in the cycle when you get triggered again.

OCD Scales and Questionnaires for Assessment

• •PIOS - Penn Inventory of Scrupulosity
• •Y-BOCS - Yale Brown Obsessive-Compulsive Scale
• •Obsessive Concern Checklist and Compulsive Activities Checklist
• •Acceptance & Action Questionnaire II for Obsessions & Compulsions

References

Twohig, M. P., Abramowitz, J. S., Bluett, E. J., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., Smith, B. M. (2015). Exposure therapy for OCD from an acceptance and commitment therapy (ACT) framework. Journal of Obsessive-compulsive and Related Disorders, 6, 167-173, http://dx.doi.org/10.1016/j.jocrd.2014.12.007

Twohig MP, Abramowitz JS, Smith BM, et al. Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial. Behav Res Ther. 2018; 108:1-9. doi:10.1016/j.brat.2018.06.005, https://pubmed.ncbi.nlm.nih.gov/29966992/

Twohig, M. P., Abramowitz, J. S., Smith, B.M., Fabricant, L. E., Jacoby, R. J., Morrison K. L., Bluett, E. J., Reuman, L., Blake, S. M. , Ledermann, T. (2018). Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial. Behaviour Research and Therapy, 108, 1-9, http://jonabram.web.unc.edu/files/2018/08/Twohig-et-al-2018-ACT-ERP.pdf