As a therapist, when I first meet someone new for treatment, I start by saying that discomfort and anxiety are just feelings — not unlike any other feelings. Anxiety, in and of itself, is not “bad”—it can even be very important when it works properly. It can teach us what might not be safe. Discomfort helps us to learn, to decipher what we value, what we want, and what we would like to avoid.
Obsessive-compulsive disorder (OCD) hijacks these useful, important feelings and distorts them. OCD sets off the “alarm system” of anxiety when, in fact, there is no real threat. This false alarm creates a strong urge to act in response to it. This only allows OCD to be reinforced whenever the false threat is perceived again. And instead of discomfort being embraced for all the good things it can do for us, OCD causes people to avoid discomfort entirely, and blocks them from doing the things they actually want and enjoy.
What is distress intolerance?
People with OCD often believe that they simply cannot tolerate distress or anxiety; we call this distress intolerance. One of the most important parts of OCD treatment is teaching an individual that they can, in fact, tolerate anxiety and distress. You may not like it, but you can get through it.
One of the false messages that OCD sends is that you cannot bear uncomfortable feelings. This is why people with OCD try so hard to avoid these feelings. This is why they spend countless hours lost in compulsions, in a feeble attempt to rid themselves of all difficult feelings. These overwhelming feelings are what keep people with OCD from freely doing the things that they value. In their attempt to avoid these hard emotions, they end up avoiding everything else that matters to them.
It can be a powerful realization when you stare discomfort in the face and choose to experience it, rather than avoid it at all costs. Making the decision to stop running from hard things is one of the most important choices a person with OCD can make: saying that, in spite of these feelings, I will keep moving forward. Saying I know I will never feel ready, and I will do it anyway. That is the heart of OCD treatment: developing distress tolerance.
Facing your OCD fears to regain your life
When you are in the midst of OCD, it’s important not to let feelings be your guiding compass. They will steer you wrong, and tell you that compulsions are what protect you. The truth is that compulsions provide temporary relief, but they will never be sustainable. OCD will always demand more.
Building tolerance for distress and anxiety lies at the heart of exposure and response prevention (ERP) therapy, the gold standard in OCD treatment. This form of behavioral therapy is the most successful treatment for OCD. Unlike traditional talk therapy, which can backfire and make OCD worse, ERP was developed specifically to treat OCD and is highly effective.
What that means is that ERP will help you live the life you would choose to live if OCD did not exist. You won’t be riddled with distress and anxiety from intrusive thoughts. And you’ll no longer spend hours each day performing compulsions in order to rid yourself of the discomfort you feel.
A lot of people think that ERP will be too scary for them to handle, so they avoid it. But that’s not the case at all. With an ERP therapist guiding you the whole time, you’ll practice confronting your fears in very small doses and in the controlled setting of therapy. When you’re ready, you’ll then bring these lessons that you work on with your therapist back into your everyday life. The result is that something amazing happens: Your fearful thoughts lose their power over you and your need to engage in compulsions goes away.
ERP is now more accessible than ever thanks to virtual ERP therapy — which is as effective as in-person therapy. In fact, ERP delivered in live teletherapy sessions can bring results in under half the time of outpatient ERP therapy. As someone who has worked with countless people who were struggling — as well as someone who has struggled with OCD myself — I know that one of the biggest hurdles to getting started is finding a therapist who is an expert in treating OCD. But we’ve made it easy, with our network of expertly-trained ERP specialists. Help is available, and you can reach out for it today.
A personal story of my own journey with OCD
I often share parts of my own OCD journey with therapy members when I feel it is beneficial. My only goal in sharing is to help others and for them to see that they are not alone, because OCD can be incredibly isolating.
There was a time in my life when I was starving myself because of the lies OCD told me. OCD told me that if I ate a particular item, it would mean that the thoughts I had while eating that item would somehow be true. I believed that if I ate at certain times, I could avoid feeling anxious. I ate only prepackaged fast food items—just enough to survive, going whole days without eating. I was walking through life but not experiencing it, stuck in endless thoughts and compulsions. Eventually, I found my way to ERP therapy, and I started facing my fears in order to regain my life.
The scariest thing for me was when I had to eat ketchup. It had been years by this time since I had eaten “red” foods. They triggered so much distress for me, and I avoided them as if my life depended on it. As I sat in the therapist’s office touching the ketchup and eating it, I was so mortified. I knew as soon as I ingested it that the feelings of discomfort and intrusive thoughts would flood in. At that moment, I made a choice to commit to 12 hours of discomfort, believing for some reason that the food would stay in my system for that long. It felt safer to believe it.
During those 12 hours, I was tormented by what-ifs about my ability to tolerate distress: What if I believe I have ingested blood? What if I convince myself of all the possible ways that blood got in my mouth? It felt so real. I couldn’t trust my own mind, my memories. I knew I would never ever do anything that would lead to ingesting blood, yet OCD made me doubt whether my brain would know. OCD told me that I would convince myself I had done bad things. Somehow this could only happen if I ingested red food.
This was the beginning of my journey to face the most difficult fears that I held. There were ups and downs, to be sure. Today, I don’t think twice about eating red food. I don’t keep track of the times I am eating. I don’t even think about it 99% of the time. When the thoughts return, they go away on their own, and the thoughts become quieter and quieter. They don’t bother me so much. Like anyone else, I don’t get to choose the thoughts that pop into my head, but I get to choose what to do with them. You can too.
