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OCD Treatment: Back to Basics

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In previous posts, I have discussed various aspects of the “OCD Cycle,” but it never hurts to have a quick refresher. After all, understanding how OCD works can help you see through its lies and help mobilize you to stand up and challenge it. What is OCD, and how does OCD treatment work? OCD has two mains parts: obsessions and compulsions. We’ll talk about the obsessions first. Obsessions are unwanted thoughts, impulses, or images that intrude into your awareness, and cause significant anxiety or distress. Thoughts include such examples as, “What if I get sick?”, “What if I secretly want to harm my loved ones?“, “What if I just got sexually aroused by that child?“, and “What if I forgot to lock my front door and someone breaks in?“. Impulses are experienced as urges to commit actions that you...

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Driving Fears & Driving Avoidance in Teens & Young Drivers

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Reader Question: My daughter just turned 15, and no matter what I say, I can’t seem to convince her to practice her driving. It’s strange, because in the past, all she could do is talk about how excited she was to finally get her permit. I truly thought that she’d be practicing constantly once she was legally able to. Have you seen this before? Could her driving avoidance possibly be related to her OCD? Sincerely, Stressed-Out Parent Answer: Maybe, maybe not. Driving Fears May Be Normal… Driving-related anxiety is a completely normal phenomenon. For many people, learning to drive is the first time that they are individually responsible for handling a situation that could potentially be life-threatening. Although car accidents are (hopefully) rare for most individuals, accidents can be harmful (or deadly) when they do occur. Being in charge...

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Anger and OCD – Getting Mad…

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“I hate having OCD! Why can’t these thoughts just stop?!?! How can I be the person I was before?!?!” Many people with OCD are extremely familiar with the anxiety-related aspects of the disorder. OCD is an anxiety disorder after all, so it’s not terribly surprising that anxiety is often core to its experience. But anxiety is certainly not the only emotion that shows up in OCD. I’ve discussed briefly how some people with OCD have symptoms of guilt, shame, disgust, and depression, and how treatment may sometimes need to be modified when these emotions are primary aspects of the disorder. Today, though, I’d like to comment briefly on anger and OCD, which I don’t think I’ve mentioned explicitly in previous posts. Anger can be a powerful force in many people’s OCD. What’s the relationship between anger and OCD? Actually,...

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ERP Tip of the Day #2

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It’s ERP tip time. This series of posts focuses on tips to enhance the effectiveness of your exposure and response prevention (ERP). If you’re interested in more ERP tips, click the following link for all the posts in this series. Exposure and Response Prevention (ERP) Tips for OCD Without further ado, here’s another ERP tip to consider when designing your next exposure. ERP Tip #2 When completing your next exposure, avoid rules that dictate what you’re allowed to think during the exposure. If you try to complete an exposure without having a certain bad thought, chances are that you’re setting yourself up to think that very thought. Instead, design your exposure around having that very same unwanted thought. I love it when people with OCD do exposure, but I don’t love it when they have a long list of...

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ERP Tip of the Day #1

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Starting today, I am going to start posting random ERP tips as they occur to me, as there are certain roadblocks that many of my OCD patients tend to encounter. If it’s helpful for my patients, maybe it’s helpful for you. If you’re interested in more ERP tips, click the following link for all the posts in this series. Exposure and Response Prevention (ERP) Tips for OCD These posts will probably be a bit shorter unless the concept requires a more thorough discussion. Please feel free to leave comments below, if you need more information. Today’s tip is… ERP Tip #1 Do not label your rituals as ERP. Instead embrace openness, defenselessness, and vulnerability. You might think that you never do this, but it happens more often than you think. Some people that I know will encounter triggers for...

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Imaginal Exposure vs. In Vivo Exposure for OCD

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As I’ve talked about in numerous posts, overcoming OCD involves learning to co-exist with doubt and uncertainty. This idea can be a bit counter-intuitive at first, as many people initially expect OCD treatment to reduce uncertainty. One therapeutic approach that helps with this process is exposure and response prevention (ERP) for OCD. Not surprisingly, ERP consists of two parts: 1) exposure, and 2) response prevention. An exposure is when you do something on purpose to provoke an anxiety spike. By definition, exposures are not accidental; rather, they are pre-planned, deliberate offensive strikes against your OCD. Exposures are designed to help you build up your tolerance to fear-producing situations. Exposures are often completed according to an exposure hierarchy, meaning that people typically complete lower level exposures (i.e., less distressing exposures) before gradually working up to higher level ones. Response prevention...

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