Treat
your OCD
Cali Keating, LCSW-S
Exposure Response Prevention for OCD
Do you have repeated intrusive thoughts that you could never tell your friends about? Keep things you don’t need, count, check, skin pick? Avoid, seek reassurance, or distract yourself from situations you feel you can’t handle? If you have OCD, or believe you may have OCD, you may have developed advanced “safety behaviors” that take hours of your time every week.
OCD tells us we just need to keep doing safety behaviors, and then we’ll feel better.
I just need to finish going over every word I said and every gesture I made to make sure I didn’t embarrass myself, then I can relax.
I just need to pick one more part of my skin, then I can relax.
I just need to wear gloves and goggles to do the dishes, then I can relax.
Many of my clients have not had the opportunity to learn how to be safe without the safety behavior.
As a team, we will create some structure in dismantling your safety behaviors so you feel sturdy, tough, and confident.
We’re not going to get rid of every stressed or anxious feeling, but you will be able to handle emotional discomfort in the short term to have lasting peace in the long term.
Exposure Response Prevention (ERP) is considered the most effective treatment for OCD. This protocol involves structured exercises in session, like imagining not using your safety behaviors (checking if the door is locked, analyzing social situations, etc). You will do some similar exercises between sessions. Over time, you will feel more confident without your safety behaviors. From the IOCD website:
You will find that these feelings and thoughts are distressing, but also that they can’t hurt you — they are safe and manageable.
When you stop fighting the obsessions and anxiety, these feelings will eventually begin to subside.
This natural drop in anxiety that happens when you stay “exposed” and “prevent” the compulsive “response” is called habituation.
You will find that your fears are less likely to come true than you thought.
You will get better at managing “everyday” levels of risk and uncertainty.
Nothing is too weird for OCD and nothing is too weird for me as your OCD therapist. We will work together to confront discomfort at your pace, and you will have an encouraging teammate.
My approach
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Data-driven
Exposure response prevention (ERP) therapy is considered the gold standard for OCD treatment. If you’ve tried talk therapy for OCD, you may have noticed that you still have OCD! Behavioral therapy is considered the most effective pathway to OCD recovery. You can have a massive decrease in intrusive thoughts, watch intrusive thoughts float away with ease, and stop doing your compulsions. That’s OCD recovery!
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Skills based
ERP comes with a number of skills you can use to manage OCD in your real life. You will be able to accept uncertainty, have self-talk ready to go to disconnect from intrusive thoughts, and feel in charge of your impulse to do compulsions. Skills come from ERP but I also pull from Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy (CBT), mindfulness practices, and self-compassion.
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Ready for real life
The experience of OCD over the life span can be confusing and scary. You may notice that your past symptoms no longer bother you, but you have new fears and new compulsions that keep coming. When you have the owner’s manual for your OCD, you will begin to see every intrusive thought and every impulse to do compulsions as the same. It doesn’t matter if new fears evolve, you will have confidence that you can handle symptoms with ease.
