Exposure and response prevention (ERP) therapy can help you manage ROCD by gradually exposing you to your relationship-oriented obsessions while preventing you from responding to them with compulsions.
Relationship obsessive-compulsive disorder (ROCD) is a subtype of obsessive-compulsive disorder (OCD) that involves obsessions about your relationships—both romantic and platonic. You may have thoughts like, “What if I’m not truly in love with my partner(s)?” or “What if my partner doesn’t actually love me?” These intrusive thoughts can create intense doubt and uncertainty, making it difficult to trust your feelings or the authenticity of your relationships.
Fortunately, ROCD and all forms of OCD, are treatable using exposure and response prevention (ERP) therapy—an evidence-based treatment that caters to your unique needs.
Here’s what you need to know about ERP treatment for ROCD, what exposures can look like, and how a therapist can guide you through the process to help you manage your symptoms effectively.
How is ROCD treated?
Exposure and response prevention (ERP) therapy is a specialized form of cognitive behavioral therapy (CBT) specifically designed to treat OCD. ERP involves working with a trained therapist to gradually expose you to your intrusive thoughts and triggers while resisting the urge to do compulsions.
At the start of treatment, you’ll create an exposure hierarchy, which involves listing out your fears, beginning with ones that you find the least distressing, and working your way through more challenging exposures.
A low-level exposure could be thinking about your partner doing something that you might normally question, such as spending time with an attractive friend, and sitting with the resulting anxiety. Higher level exposures can look like engaging in an activity where you are present with your partner, but intentionally allow your doubts to arise (e.g., wondering, “What if they aren’t actually in love with me?“) and resist the urge to ask for reassurance.
Over time, ERP will allow you to build tolerance to anxiety-provoking thoughts and situations. As you face these fears, you’ll start to realize that the distress you experience doesn’t last forever and that the anxiety naturally diminishes on its own.
You can practice exposures in a variety of ways, both inside and outside of therapy sessions. In fact, real-world practice is one of the most important parts of treatment because it helps you to generalize the skills you’re learning.
What makes ERP different from other forms of therapy?
The goal of ERP, explains NOCD therapist April Kilduff, MA, LCPC, LMHC, LPCC, LPC, is to teach you how to tolerate the discomfort of intrusive thoughts. Will you totally get rid of them? No: intrusive thoughts are a universal human experience. But you’ll learn that they are not threats that you need to act on.
The process is geared to address your specific, so your therapist will take the time to understand your symptoms. They’ll ask about what your relationship-focused intrusive thoughts most often sound like, how they make you feel, and what your typical compulsions are. You’ll then work together to actually learn different responses to the things that worry you, cause you to seek reassurance, or do anything else to seek perfect certainty.
In other forms of therapy, including cognitive behavioral therapy (CBT)—this may be counterproductive. In a talk therapy session, you might work with a therapist to disprove your fears and doubts, feel better about your relationship, or dig deeper into why your worries are coming up. While this can lead to helpful realizations, goals, and relief from some relationship issues, it doesn’t help with OCD: these methods of feeling better don’t do anything to keep the worries and “what ifs” from coming back, and actually reinforce the OCD cycle.
“OCD is not a logical disorder,” says NOCD therapist Tracie Ibrahim, MA, LMFT, CST. “Typical CBT has more to do with challenging cognitive distortions, or unhelpful ways of thinking. Instead, in ERP, we go toward the thing that our brain is telling us is scary to learn that it’s not and to learn ways to not engage or do compulsions.”
It’s important to find a therapist that specializes in ERP because it requires a highly structured treatment plan. They’ll know how to create an appropriate exposure hierarchy, ensuring that each exposure is manageable and builds on previous exposures.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Examples of ERP therapy for ROCD
Often, exposures look like confronting your obsessions and triggers in a gradual, controlled way, while resisting the urge to perform compulsions. Here are some examples that apply to ROCD:
- Obsession: You may worry that your partner is “not the one for you” and that they may be attracted to someone else.
- Compulsion: To decrease distress, you may ask your partner for reassurance that they aren’t attracted to anyone else. You may also mentally review past interactions to try to confirm or disprove your fears.
- ERP exercise: Your therapist might have you sit with the discomfort of not knowing whether your partner is truly “the one for you,” or that they may or may not be attracted to other people. Over time, this exercise helps you build tolerance for uncertainty.
- Obsession: You may worry that you’re attracted to someone else or may be cheating on your partner because you can’t stop thinking about another person, or because you felt a fleeting attraction to someone outside of your relationship, even if you’re in an open relationship.
- Compulsion: You may try to “figure out” your feelings by analyzing every interaction with the other person, mentally reviewing past moments for signs of cheating, or even checking your social media and texts for any “evidence” of inappropriate behavior. You might also seek reassurance from your partner by asking if they think you’re loyal to the relationship.
- ERP exercise: You’re encouraged to confront these thoughts head-on and resist the urge to perform any compulsion such as asking for reassurance from your partner or mentally reviewing past interactions. Instead, you might practice sitting with the anxiety by allowing yourself to simply notice an intrusive thought without responding to it.
- Obsession: You might look at social media as a point of comparison, asking yourself questions like why you don’t seem as happy as other couples, if their relationship is more fulfilling, or if they’re more in love than you and your partner are.
- Compulsion: You may feel compelled to scroll through social media for extended amounts of time, looking for signs that your relationship doesn’t measure up or comparing your interactions with your partner to those of others.
- ERP exercise: Your therapist might ask you to resist the urge to compare your relationship to others’ online. Instead, you practice tolerating the discomfort of uncertainty and insecurity. You might set boundaries around social media use, like limiting the time you spend on it, or intentionally exposing yourself to posts that trigger comparison, and saying to yourself “Maybe we are similar to that couple. Maybe we aren’t.”
Can my partner be involved in treatment?
Yes! Your partner can be involved in your treatment plan. In fact, it’s encouraged, says Ibrahim. “Adding your partner into treatment looks like educating your partner on what OCD is—it doesn’t matter what subtype. Educate them on what accommodations look like and make sure that they’re not feeding your OCD by doing things like offering reassurance or answering the same questions.”
Adding your partner into treatment looks like educating your partner on what OCD is—it doesn’t matter what subtype. Educate them on what accommodations look like and make sure that they’re not feeding your OCD by doing things like offering reassurance or answering the same questions.
Involving your partner in treatment can help them understand how to support you without unintentionally enabling OCD. They can become a crucial part of the healing process, not by participating in compulsions, but by being supportive and encouraging you to face your fears rather than avoid them.
Are there any other treatment options for ROCD?
Generally, ERP is the most effective treatment option for all subtypes of OCD. However, there are some tools that can work well when used in conjunction with ERP.
Certain medications can be highly effective in the treatment of OCD. The most common class of medication prescribed are selective serotonin reuptake inhibitors (SSRIs). However, many people have found the most success at managing their OCD symptoms by combining medication with ERP therapy.
Another treatment that can be used in conjunction with ERP is acceptance and commitment therapy (ACT). Rather than specifically targeting compulsions, it aims to change your overall relationship to your obsessions and become more accepting of their existence. It guides you in acknowledging the thoughts without assigning them judgment or meaning.
Bottom Line
ERP therapy directly targets core symptoms of OCD by helping you confront your fears and resist performing compulsions. If you’re considering starting ERP for ROCD (or any other type of OCD), there is help available.
Key Takeaways
- Relationship OCD (ROCD) involves intrusive thoughts and compulsions centered on doubts about your relationship(s).
- Exposure and response prevention (ERP) therapy, a specialized form of cognitive behavioral therapy (CBT), is an effective way to address the symptoms of ROCD.
- You can add your partner(s) into your ERP treatment plan—helping them recognize signs of compulsions and supporting you in avoiding accommodations that may feed the cycle of OCD.