Conquering obsessive-compulsive disorder (OCD) can look like many things. Each person will walk their own unique path. The speed at which we walk may also be different, but we’re trying to get to the same place: a place of relief, where life is not consumed by OCD.
The truth is that you may never experience a complete absence of symptoms—though that can happen for some people. But as a therapist, and someone who also lives with OCD, what I can tell you is that a majority of people learn to manage their chronic OCD symptoms and regain control over their lives. Here are a few things that can truly make a world of difference during your treatment journey.
2 key qualities in successful OCD treatment
Be truly willing to get better
By this I mean have the motivation and determination to do the hard things that therapy requires. Rarely do people want to do something scary or distressing—that’s just human nature. It’s not as if the OCD sufferer wakes up one day thinking, I want to face this terrifying thought head-on. Instead we need to think, I will face this so that I can live the life I really want.
So how can this shift happen? When you become so tired of being controlled by OCD that you’re willing to do anything you can to get better—when you’ve resolved to no longer allow the condition to determine the direction of your life. But here’s the crucial key to success: It is not about trying harder, but trying differently, as Patrick McGrath, PhD, our Chief Clinical Officer here at NOCD says.
When you change your thinking from trying harder, or fighting more, to choosing to do something—likely outside of your comfort zone—that is when the big changes happen. In OCD treatment, this means choosing to do uncomfortable things, to allow your anxiety and distress to be present. That’s what exposure and response prevention (ERP) therapy is all about.
If you haven’t heard about ERP, it’s the most research-proven method of treating OCD. There are many treatments for different mental illnesses, but ERP is the gold standard treatment for OCD. Your therapist will ask you about the fears you have, and start with a small exposure—a trigger. Then you’ll learn ways to sit with the discomfort that follows without engaging in compulsions. Once you learn to tolerate that, you’ll work your way up to larger and larger fears. Here’s what that does: Over time, it will allow you to let go of the lies that OCD has likely fed you for many years. It will never be a perfect process. It’s a journey where you’ll learn new skills and tools to handle the cycle of OCD. It is a process that can be a lifelong one.
Accept the doubt that OCD wants you to have
At its core, OCD is often all about a fear of uncertainty. Without this powerful weapon, the condition doesn’t seem as scary or as real. To deal with doubt effectively, you need to learn to accept it—to embrace your feelings of uncertainty rather than merely tolerating it.
Through ERP therapy, you can get to a place where you appreciate the challenges that you face. As human beings, we all feel doubtful from time to time. We all question ourselves, our motives, and so many things that occur in the world around us. But you can get to a place where you’re able to acknowledge these doubts and let them pass by.
When you suffer from OCD, it can be confusing to hear that you should accept your doubt, because the thoughts that get stuck in your head—that you obsess about—can go against your values and true nature. As those who suffer know, OCD latches onto the very subjects that you feel most strongly about.
In OCD treatment, the idea is not to accept that your thoughts or obsessions are true. Rather, you learn to accept that you can never feel 100% sure. You’ll never feel ‘certain enough’ that your thoughts don’t have a secret meaning, or that they don’t really want to act on these thoughts, images, or urges. But it is possible to accept that you have a disorder that doesn’t allow you to have confidence in yourself and your mind.
How I learned to accept the unknown with my OCD
When I began my treatment path many years ago, I was mortified at the idea of accepting all of the “what ifs” that my brain played on repeat all day long. I had spent a lifetime doing everything and anything in my power to cancel out the things that popped into my mind. My days and nights were entrenched in compulsions, trying to rid myself of some of the most horrifying thoughts my brain could envision.
To say that the idea of giving up that perceived power was intimidating would be the understatement of the century. I had somehow convinced myself that I had perfect control, and that I could feel perfectly certain about something. Or at the very least, I reasoned that if I just did all of the things that OCD said to do, I would find peace.
But this peace never fully came. It was a temporary relief, a false sense of security. Little did I realize that it was this deception that kept the OCD growing.
There I was, in my early 20’s with my whole life presumably in front of me. I had already spent over half of my youth battling this strange enemy called OCD. I had been in therapy for almost a year when I finally began to gain the courage to open up about the things that were going on in my mind. The shame and guilt had been so excruciating that to even say the words out loud felt traumatic. Still, I knew that in order to get better and to live a life beyond the OCD I would need to say the things that I feared the most out loud.
I remember my therapist playing out the worst-case scenarios with me out loud. The effect was two-fold: I realized that saying scary things out loud tends to take away their power, to take away the internal shame that often accompanies these thoughts and feelings. And secondly, hearing out loud how illogical the thoughts were made them somehow less believable. This process also allowed my therapist to ask important questions that I hadn’t fully thought about, like, “And then what?”
Here is an example of one of many scenarios we would spend time recreating,
Me: What if I think I killed someone and confessed
Therapist: Okay, you could do that. What do you suppose would happen when you do this?
Me: Well that would be awful. I would be arrested for murder.
Therapist: Okay. So let’s say you get arrested, and then what happens next?
Me: I go to jail. I have to inform my loved ones, and then they begin investigating.
Therapist: I see. That does sound scary. So there you are sitting in jail, you told your loved ones you killed someone. They are out investigating you for murder. Then what happens?
Me: Well, it’s horrible. I feel terrible. What if I really believe I killed someone and no one checks to see if I really did? What if they all really believe that I am capable of killing someone?! What if I have completely lost my mind and I believe that I am a monster who kills people?
Therapist: You may be in jail, unsure about whether you have killed someone, other people may believe that you did and think you’re a monster who is capable of murder. That would be hard, and then what happens?
Me: (at this point, I’m visibly outraged by his lack of understanding about how critical this situation is and his calm demeanor): I will forever be seen as a bad person, no one will ever love me and I will be alone for the rest of my life believing the lie that I killed someone.
Therapist: So you could end up all alone and people will think you are bad?
I am sure I then said something to the effect of, “Yes! Have you even been listening?” Looking back though I can see the technique he was utilizing. He was having me do an exposure in which I was playing out or imagining my worst-case scenario. That’s what ERP is all about. We were able to find a core fear of being all alone and unloved.
The fear of being all alone and unloved would be central to many of my other fears as well. The more times we went through this scenario and others like it, the more details we’d add. The result was that repeating these things over and over—the things that had been holed up inside my mind for so long—the less guilt and shame I experienced.
Why accepting uncertainty helped me conquer OCD
Something truly amazing began to happen, I was able to see that my worst-case fears had never happened. He would have me say things like, “I suppose someday that could happen,” and it hadn’t happened yet.
In those moments, I wasn’t accepting that I was a murderer or that I was a monster. I was sitting with the fears that tormented me. I was accepting that my brain would not allow me to feel ‘sure enough’ that someday I couldn’t lose my mind and believe this thing was true. But if and when this ever happened, that is when I would need to address it. I could spend my entire life living in the what-ifs, or I could choose to handle things as they arose. I could live in the here and now.
And someday, if I confessed to something awful, there was a possibility someone may believe it, there was a possibility I could go to jail and they would investigate. But they would find nothing, because it wouldn’t line up with who I am as a person or what I value. Maybe my family and loved ones would turn against me and no longer care for me. I cannot know the future. I cannot predict what others will do, think, or feel. It could happen, I suppose.
The point is that I learned to accept the possibility that bad, scary, things could happen in my life that were outside of my control. Isn’t that really what it is all about? At the root of all OCD symptoms, what if I cannot prevent this tragedy from occurring? Through treatment, I was letting go of this false sense of security and control.
I never left treatment believing I was a monster or accepting that I was capable of doing something immoral. I did leave my sessions knowing that even if something is possible, it doesn’t mean it is likely. I could live day by day, in each and every moment. I could cross that bridge as it came, if and when it ever came. Here I am, 20-something years later, and I have never crossed that bridge. And I can live a life based on my values and not my fears. I am living a better life because I conquered OCD. Please join me.