Monthly Archives: May 2009

Exposure and Response Prevention Motivators

Exposure and response prevention (ERP) is hard work and it can be terrifying.  We always say that both ritualizing and treatment are difficult and that the only difference is that treatment leads to an end of rituals and avoiding treatment leads to endless rituals.  Nevertheless, ERP is painful and what can you do when you feel your fear rising and the idea of a OCD free life doesn’t seem as important as your anxiety in the moment.  I think at these times it is useful to remember why you want to get away from OCD.  Below are two sets of questions with suggested sub-questions.  I would urge you to write about these in the most painful way you can remember, so that when OCD threatens to overwhelm your treatment, you will have more to fight back with.

The first set of questions concerns what have you lost to OCD?  Within this set think about 1) Because of OCD, I’ve Missed; 2) Humiliating Experiences; 3) Financial/Employment Losses; 4) Guilt; 5) Lost/Wasted Time; 6) Because of OCD, I’ve Been Late To; 7) Damaged or Lost Relationships; 8)Other OCD Losses:

The second set of questions concerns how have you hurt your loved ones with your OCD? 1) Forcing Them to Ritualize; 2) Making Them Late or Missing Events; 3) Hurt Them with My Other OCD Demands; 4) Hurt Them with My OCD Anger; 5) Hurt Them with My OCD Rigidity; 6) Ignoring Them Because of OCD Thoughts; 7) Ignoring Them by Withdrawing; 8) Other.

So rather than avoiding an exposure think about your reasons to fight OCD and remember that if you get better, not only will your life improve, so will the lives of your loved ones.

Answer to Reassurance Seeking/Self Reassurance/Uncertainty

Canadian with OCD tells us the s/he feels overwhelmed at times and seeks reassurance from others or attempts to reassure her/himself  about self harm.  S/he also notes that listening to the exposure script activates his/her fears.   I know it is really hard to do exposure, but remember, almost all OCD involves trying to attain 100 %certainty.   Most OCD sufferers are unable to do this, because there is no true certainty in the world.  As you know for every answer or reassurance there is a what if.  Thus every attempt at seeking reassurance from anyone is ultimately doomed.

I suspect that part of the problem with the script is that you don’t want to cope with the possibility that it could come true.  I would ask you to think of how you would best cope with it if it did (assuming you survived).  How can any of us know what we will do next.  I don’t expect to slice and dice my wife tonight, but I can’t know that I won’t go crazy and do it — after all, one doesn’t plan on going crazy.  I have to learn how to live in a world where that might happen and I can only hope it doesn’t.  What would I do if it really happened?  If this were my OCD problem, then my exposure would be to plan how to cope with the guilt afterward and to try to continue on.  Yes it would be horrible and I don’t want it, but what choice do I have?

Why would you want to cope with your worst possibility taking place?  Because trying to not have it happen is robbing you of life.  If it does happen, you will have lost the precious little time you have.  If it never happens, you will have lost all.  In life, the past is nothing but memory, the future nothing but hope and all we have is now.  The goal of acceptance is to learn to enjoy the only thing we can have, the moment.

Answer to Medication didn’t work for my OCD

OCD is both a learned and biological disorder. Given this, medications play an important role, but you need to remember that medication affects biology and not the learned parts of OCD. Because of this, medication alone usually results in a 30-50% reduction in symptoms and sometimes the learned parts of the problem are so powerful, that they overshadow the effects of medication. The best plan of attack with OCD is medication and a form of cognitive behavior therapy known as exposure and response prevention. This treatment has been around since 1979 and both the American Psychological Association and the American Psychiatric Assocation recognize this as a core part of OCD treatment. Unfortunately, it is harder to change mental health professionals than it is to help sufferers of OCD, so that there are many mental health practitioners who ignore these recommendations. 

With this in mind, it still may be that besides exposure and response prevention, you needed a higher dose and needed to give medication more time.  As to what is the best one or the ones with least side effects — there are 6 SSRI’s that on the average are all good and tend to not have side effects.  However, individually, there is much variation, so I wouldn’t be able to predict which might have the least side effects or which would work best for you.