OCD & ERP

THERAPY FOR OCD

AND

INTRUSIVE

THOUGHTS.

what OCD actually is, and why ERP works

In everyday conversation, OCD gets reduced to tidiness. For most people who have it, OCD is a loop: an unwanted thought, a surge of anxiety or doubt, and something done to neutralize it, like checking, confessing, mentally reviewing, or seeking reassurance. Then the loop starts again.

Intrusive thoughts

Almost everyone has them.

94%of people in a 13-country study reported at least one unwanted intrusive thought in the past 3 months

A 2014 international study of 777 people found intrusive thoughts were close to universal, with doubting thoughts the most common. Contamination and aggressive thoughts showed up too. What sets OCD apart is what happens next: the thought feels dangerous or revealing, and the mind demands that something be done about it.

What it looks like

OCD comes in more forms than most people realize.

Common themes include:

Harm: fear of acting on violent or unwanted thoughts
Relationship: constant doubt about a partner or the relationship
Contamination: germs, illness, or feeling "dirty"
Checking and doubt: locks, stoves, emails, mistakes
Scrupulosity: religious or moral fears of having done wrong
"Just right": symmetry, order, or a feeling of incompleteness

Compulsions can be invisible. Mentally reviewing, praying, counting, and searching online for reassurance all count, which is why some people describe their OCD as "purely obsessional."

How common it is

About 1 in 100 adults, and often years before treatment.

1.2%of U.S. adults had OCD in the past year

14 to 17 yrsaverage time from first symptoms to effective treatment

Those figures come from the National Institute of Mental Health and the International OCD Foundation. About half of adults with OCD in the past year had serious impairment. Part of the delay is that people hide symptoms out of embarrassment, and part is that it can be hard to find a clinician trained in the treatment that works best.

What tends to help

ERP is the first-line psychological treatment.

Exposure and response prevention means gradually approaching the thoughts and situations that trigger fear, while practicing not doing the compulsion. Two kinds of learning happen along the way. The first is habituation: stay with a trigger without doing the ritual, and the distress tends to come down on its own. The second is inhibitory learning: the brain files away new evidence that the feared outcome didn’t happen, or was more bearable than predicted. The Anxiety & Depression Association of America describes both. Put together, the brain learns it can tolerate uncertainty without the ritual, and the loop loses its grip. The pace is planned together, one step at a time.

A 2015 meta-analysis of 37 randomized trials found very large effects for cognitive behavioral therapy for OCD compared with waitlist and placebo conditions, and CBT outperformed antidepressant medication alone.

~70%of people with OCD benefit from appropriate treatment, according to the International OCD Foundation

Finding the right fit

Ask how a therapist treats OCD.

ERP is a specialty, and most therapists don't learn it in graduate school. The International OCD Foundation suggests asking a prospective therapist which techniques they use to treat OCD, whether they're familiar with ERP, and what training they have. A good answer names ERP directly.

Some people need more than a weekly session, at least for a stretch. Intensive outpatient, partial hospitalization, and residential OCD programs deliver ERP at a much higher frequency than standard therapy. The IOCDF keeps a directory of OCD clinics and programs that can be filtered by program type, including intensive treatment.

If OCD ever comes with thoughts of suicide, call or text 988 any time to reach the Suicide & Crisis Lifeline.

THERAPY FOR OCD AND INTRUSIVE THOUGHTS.