By Lauren Siegel
Obsessive-compulsive disorder (OCD) is a pattern of thought and behavior characterized by unwanted, recurring thoughts or images (obsessions) that produce anxiety, and result in repetitive behaviors (compulsions) that function to reduce that anxiety. Essentially, an individual with OCD might experience an obsessive thought (i.e. “what if I forgot to turn the stove off and the apartment burns down?”), prompting significant anxiety, and may engage in a compulsive behavior (i.e. checking the stove 5 times in order to make sure it’s off, thereby reducing the anxiety temporarily). Living with OCD can be a painful experience, and many people report feeling unable to control their compulsions despite wanting to or disliking how the compulsions interfere with daily life.
An individual may meet criteria for OCD if their obsessions and compulsions are time-consuming, cause a significant amount of distress, and interfere with daily commitments such as work, school, and socializing. Many of us experience intrusive thoughts or recurring behaviors from time to time, and that doesn’t necessarily mean a person has OCD. One key differentiator is how much the behaviors are interfering with a person’s life. This can mean how much time they’re spending on compulsions, how much the compulsions are interfering with engagement in daily activities, or how much distress the obsessions and compulsions are causing.
Compulsions become a way of temporarily reducing the anxiety caused by obsessions. To make matters even more complicated, thoughts can be compulsions too! For example, a person might count lightbulbs in a room, or repeat a phrase to themselves in their head, in order to try to neutralize the anxiety caused by an obsessive thought pattern or intrusive image. Essentially, the formula is as follows for folks struggling with OCD:
If the recurring thought or image ramps anxiety up, it is likely to be an obsession.
If the recurring thought or behavior temporarily brings anxiety down, it is likely to be a compulsion.
So, why can’t a person use compulsions if it makes them feel better? Well, the short answer is that compulsions make us feel better in the short-term, but in the long-term they cause a lot more suffering. Essentially, our brain starts to become reliant on compulsions to help us manage our anxiety. The brain starts to believe that if we didn’t do the compulsion, we would be in danger or something bad might happen to someone we love. That keeps us pretty dependent on compulsions. Additionally, performing compulsions actually makes the obsessions intensify over time, because the brain believes that obsessions are a real threat and compulsions are needed to prevent harm. This leads to a pretty unpleasant cycle.
Exposure and response prevention (ERP) is widely considered the leading evidence-based treatment for OCD. Studies suggest that between 60-85% of people who meet criteria for OCD and complete the recommended course of ERP with a trained therapist experience significant symptom reduction (Yan et al., 2022). Those are good odds!
ERP works by prompting obsessive thoughts (with a trained professional) and then tolerating the anxiety and resisting the urge to engage in the compulsion. Yep, we’re actually trying to bring on the obsessive thoughts - and not because your therapist wants to be mean or cause you pain. The brain needs to learn that obsessive thoughts and the anxiety they cause, while painful, are not dangerous, and that our feared outcome doesn’t actually happen when we don’t engage in the compulsion. The brain needs to learn that the compulsions aren’t actually needed to keep you safe.
Let’s look at an example: If an individual has obsessions about germs on public transportation leading to serious illness, they might use compulsions such as cleaning, hand-washing rituals, or avoiding public transit altogether. With their therapist, the client would put together a structured list of situations that prompt a lot of obsessions about germs, and rank how distressing they think each situation would be. The therapist and the client would then actively seek out those situations (that’s the exposure part), and help the client resist the urge to use the cleaning compulsions (that’s the response prevention part). Over time and with lots of practice, the individual learns how to tolerate the anxiety that obsessions cause without using compulsions. Eventually, the individual learns that the anxiety associated with the compulsions eventually subsides without the compulsion, and that their feared outcome is unlikely to occur.
At Behavioral Psych Studio, we work with clients to deliver tailored ERP treatment, all within a safe therapist-client relationship.
Contact us today to take the first step in breaking the OCD cycle.
Sources
Junjuan Yan, Linyu Cui, Mengyu Wang, Yonghua Cui, Ying Li. The Efficacy and Neural Correlates
of ERP-based Therapy for OCD & TS: A Systematic Review and Meta-Analysis. J. Integr. Neurosci. 2022, 21(3), 97. https://doi.org/10.31083/j.jin2103097
Law, C., & Boisseau, C. L. (2019). Exposure and Response Prevention in the Treatment of
Obsessive-Compulsive Disorder: Current Perspectives. Psychology research and behavior management, 12, 1167–1174. https://doi.org/10.2147/PRBM.S211117
