Until the mid-20th century, Obsessive Compulsive Disorder (OCD) was considered to be untreatable. But the 1960s saw major breakthroughs for OCD treatment in the form of Exposure and Response Prevention (ERP) therapy.
Today, ERP therapy is the most common and successful treatment option for OCD. ERP is a form of Cognitive Behavior Therapy (CBT) involving efforts to change unhelpful thinking patterns and destructive compulsive behaviors. Seems straightforward enough, right?
But don’t be fooled; ERP therapy is anything but straightforward. On the contrary, it forces you to sit with your biggest fears and anxieties and resist otherwise uncontrollable urges.
So before you jump into the deep end, here are five things you can expect from OCD therapy.
1. It’s Going To Be Difficult
People often view therapy as a calm and soothing experience. They picture themselves lying on a comfortable couch as their therapist magically lifts the weight off their shoulders through the simple act of talking.
But ERP therapy is purposefully difficult, strenuous, and distressing.
ERP forces you to sit with your intrusive thoughts, fears, and anxieties. Unfortunately, many people with OCD are extremely ashamed of their intrusive thoughts, especially when the subject matter is taboo. Moreover, you’ll have to go against the very fiber of your being and resist the urge to perform your compulsions.
For example, let’s say you suffer from checking OCD, making you quadruple-check whether you locked all the doors and windows in your house. You and your therapist will then roleplay a scenario of you leaving your house, and your therapist will challenge you to check your doors and windows only once.
Over the course of 12 to 24 weeks (depending on the severity of your OCD), your therapist will expose you to various triggering situations and guide you through them. Indeed, coming face-to-face with your fears and doubts is mentally and physically exhausting.
2. You Have To Put In Extra Work
Think of OCD therapy as the acquisition of certain tools, techniques, and skills.
For example, consider piano lessons. During your classes, your piano instructor teaches you a new chord progression or a new lesson about music theory. You are then expected to practice these new techniques outside of the classroom so you may become proficient.
Similarly, your OCD therapist will equip you with essential tools and techniques to deal with the intrusive thoughts in your head. Of course, you then have to apply these tools and techniques in your everyday life.
3. Be Honest With Your Therapist
The key to successful OCD therapy is honesty. Unless your therapist knows the precise details of your obsessions and compulsions, they can not help you overcome them.
Some obsessions, such as contamination, order and organization, symmetry, and relationships, are easier to discuss. It’s easier to talk about these things not because they don’t trigger anxiety or distress but because these subjects are not taboo in nature. Hence, at least there’s the reassurance that you won’t be judged or ostracized for admitting these thoughts.
However, certain thoughts or obsessions bring a lot of shame and guilt to the sufferer. Unfortunately, these people are so ashamed of their intrusive thoughts that they dare not utter them to anyone else.
Take pedophilia OCD (POCD), for example. This subtype of OCD involves intrusive thoughts and urges revolving around pedophilia, triggering fear, anxiety, and doubts about self-identity. The point about fear and anxieties is an important one, as it proves that this person doesn’t want to have these thoughts or act on these urges.
So, while you might be worried about being judged, you must cast aside all that fear and be fully transparent with your therapist.
4. You Might Have To Take Medication
As mentioned previously, the foremost option for OCD treatment is ERP. ERP forces you to confront your OCD triggers head-on, which can be very taxing and exhausting.
Hence, depending on the severity of your OCD and response to the ERP therapy, you might require medication. Medication for OCD is prescribed either short-term to supplement your ongoing ERP sessions or long-term and even lifelong.
The prospect of taking medication for your entire life can be daunting, but it isn’t uncommon. In fact, over half of the people under treatment for OCD take low-dose medication for years, if not for life.
The four most common classes of OCD medication include:
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Tricyclic antidepressants
Keep in mind that medication isn’t a standalone treatment option for OCD. In other words, you can not treat your OCD with medication alone.
Furthermore, it might take a lot of trial and error before you find the right medication. Everyone’s brain chemistry is different, and what might work for someone else might not necessarily work for you.
5. Setbacks And Relapses Are Common
OCD is an incurable and chronic disease, which means that setbacks and relapses are common and expected. Much like diabetes or arthritis, you can control the symptoms of OCD but not cure them altogether. Let’s break down why this happens.
Think of OCD as that little nagging, controlling, and hostile voice in your head that convinces you something is wrong even when it isn’t. ERP therapy teaches you the appropriate ways to deal with that voice so that it doesn’t take over your life. Similarly, medication helps you quieten that voice when you are unable to do so by yourself.
But that voice is still there, looking for an opportunity to rear its ugly head. Maybe you’ve experienced something traumatic which renders you unable to ignore that voice. Hence, you may relapse.
But don’t be discouraged; relapses and setbacks are a common part of treatment and don’t mean that you have to start from square one.
OCD is an extremely debilitating mental and behavioral disorder, and its treatment is no walk in the park either. When it comes to OCD therapy, things will get worse before they get better.
OCD therapy forces you to face your fears head-on and ignore every instinct you have to soothe those fears. Moreover, you can never fully cure your OCD symptoms; you can only control them enough, so they don’t take over your life.
But don’t let these challenges stop you from seeking OCD treatment. Now that you know what to expect from OCD therapy, you’ll be much better equipped to overcome these challenges.