Obsessive compulsive disorder
Obsessive Compulsive disorder is when a person experiences recurrent intrusive thoughts about something they find distressing and feels the need to carry out a behaviour to Get Rid of the feeling. Contrary to popular understanding OCD is not about being tidy or clean. There is a sub set of OCD called contamination but this describes a person feeling ‘disgusted’ by feeling dirty.
An obsession is an intrusive recurring thought that causes distress, the content is unacceptable to the person and not a thought that they feel comfortable having. There is a lot of variation in the content of the thoughts, some common ones are listed below.
The reason the thought is causing anxiety is because it goes against your belief system and is unacceptable to you.
- Self injurious
- Remember – the reason the thought is causing anxiety is because it goes against the persons moral belief system and is unacceptable to them.
It is this anxiety/distress that triggers the compulsive behaviour as the person experiencing the distress begins to develop ways to manage the behaviours and may develop complicated rituals.
The compulsive behaviour can be something a person does like washing hands excessively, checking doors are locked or it can also be a mental compulsion (mental in this context is a thought process). Some people may be compelled to count, undo things they have just done or have certain images in their mind.
OCD is a very individual illness and can manifest in many different ways.
Developing an idiosyncratic understanding of your individual anxiety is a big chunk of the treatment. This is because OCD can present in so many different ways and can change quite a lot. It is important to have a clear map of how your OCD functions before starting treatment.
Exposure and Response Prevention is the treatment of choice.
ERP exposure and response prevention involves the client and therapist agreeing a list of avoided thoughts, behaviours, situations and areas and with the support of the therapist the client starts to systematically work through this list using ERP. Exposure and response prevention describes the process of triggering the anxiety/distress but not doing anything to manage it or get rid of it.
Exposure Response Prevention
When we feel anxious, we might find the feeling intolerable and want to push it away. You might find yourself developing compulsions to help you manage your anxiety. However, the more you do the compulsion the stronger the compulsion becomes and the more you have to do it. This becomes a vicious cycle that is reinforced by the behaviour.
Exposure describes purposely triggering the fear/anxiety that you are scared of and instead of doing the ritual or compulsion you stay with the anxiety. The purpose of this it to give your brain time to learn that you can tolerate the anxiety and the feared outcome doesn’t happen.
When we don’t do anything our level of anxiety will come down naturally (see chart). It can be hard to believe this will happen when you are experiencing a high level of anxiety. That is why we will agree a hierarchy of feared situations and work our way through them at your pace. Using this approach, you will learn that you do not have to react to every thought you have and you can tolerate anxiety. ERP is the treatment of choice and has been shown to be very effective in helping people manage their OCD symptoms which can be very distressing. ERP is the recommended treatment for OCD and it has a large evidence base behind it. It is not an easy treatment and requires the participant to be willing to experience high levels of distress/anxiety feelings that you probably have done everything you can to avoid. However, if you are willing to try something new and would like to know more about ERP please contact me using the form.
Avoidance is a natural response to difficult feelings, it is something we all engage in at times. Human beings have a natural response to danger called flight fight or freeze. This is an evolutionary response and describes our internal alarm system. It can be thought of like a traffic light system but instead of going from Red to Yellow to Green it is going RED RED RED. However, we know that the more you avoid something difficult the harder it will be to cope with it. Avoidance behaviour will prevent you from learning any new information about the situation which will stop you from learning to cope in the situation.
As can be seen in the graph the exposure triggers the anxiety but over time the anxiety will start to drop and the more you face the feared thought, place etc the less anxious you will be.