OCD

My Approach to Treating OCD

Jonathan Greyson once asked, "Are you willing to live with uncertainty?"   Acceptance, Commitment, and Exposure Response Therapy are known ways to assist with the uncertainty that OCD brings to your thoughts.

OCD Can Make You Feel Isolated 

I have worked with people with OCD and what I have found is that OCD makes you feel isolated and like you are the only one feeling these intrusive thoughts or experiencing the compulsions and anxiety that accompanies those compulsions. 

The fact is…. If we were to ask all the people in the United States to come together who had OCD it would fill up the entire city of Los Angeles.  

You are not alone! OCD is a common mental illness with many people who have OCD just like you.

OCD Demands Certainty

OCD has many common subtypes. There are many themes that OCD likes to disguise itself as the truth. But, OCD mixes truth and lies and makes you feel like you are unable to make a good decision. The main point is that no matter what your OCD decides to attack, the goal of OCD is certainty, and nothing is ever going to be certain! 

OCD will ask you to check, ask for reassurance and make you doubt yourself AND when you decide to listen to OCD it will continually make you look for answers and ways to make some situation certain. The content of what OCD wants to have you doubt is always going to be the same-- there will be no certainty because LIFE IS UNCERTAIN.  In Jonathan Greyson’s book, Freedom from OCD,  he tell us that doing treatment means you have to be willing to live with uncertainty in order to get better.  He asks the question, “Are you willing to live with uncertainty?” In order to do treatment, you have to be willing to live with some uncertainty. 

OCD is the “Doubting Disorder.”

OCD is the “Doubting Disorder.” It will make you:

• Doubt your identity
• Doubt your friends
• Doubt your values
• Doubt your emotions
• Doubt those around you
• Doubt your thoughts
• Doubt your diagnosis

Even if you had 100% certainty that your obsession was not true, you would still doubt it. That is the very nature of OCD. This is why we need to learn to accept uncertainty in OCD

Types of OCD

There are many types of OCD.  Including the following:

Just Right OCD

A subtype of OCD is characterized by obsessions and compulsions around organization, symmetry and the need to feel just right. Unlike other subtypes of OCD which are motivated by specific fears and are motivated by particular outcomes, Just Right OCD tends to be characterized by underlying anxiety caused by an unsettling feeling that something is just not right.  Just Right OCD can be time-consuming because the person does the action over and over to get it “just right” or so it feels “just right.”

People with Just Right OCD may deal with the following feelings:

“ I have to switch the light switch seven times in order to feel okay. “

“When I go outside I have to step on an even number of pavement cracks or it does not 

feel right.”

“When I wake up it is hard to get out of bed because I do not feel just right.” 

“If I don’t touch my right shoulder and then my left shoulder it will not feel like it is 

going to be just right”

“The tension  when I tie my shoelaces in my right shoe has to be the same as the tension when I tie my shoelaces in my left shoe.”

“When I walk up the steps I have to have the same number of steps with my right foot as with my left foot.”

Contamination OCD

This subtype of OCD is characterized by the sufferers who are concerned that one of the items that they see is unacceptably unclean and will cause other things to be unclean. They fear that they will become unclean and they are going to be responsible for other things getting dirty or contaminated. 

Some items that are triggers for contamination OCD suffer include:

• Items in the public including doorknobs and light switches
• Bodily fluids including urine, sweat, saliva, semen and vaginal secretions
• Anything to do with bathrooms including fecal matter, toilets or parts of the toilet
• Blood including anything that could be near blood like needles, bandages  
• Anything that is having to do with illness including sick people, the homeless, and being in a doctor’s office or hospital

Harm OCD

This is a subtype of OCD that is characteristic by the sufferers having unwanted and intrusive thoughts of a violent or tragic nature. It would include a fear of harming others or yourself. It is the thought of losing control and with OCD it is ego-dystonic meaning the person having the thought would do anything to prevent the thought from happening and is terrified of something happening to hurt himself or others. 

Some common obsessions in harm OCD include:

• Fear of snapping and violently attacking another person or yourself
• Fear of hurting someone with something sharp such as a knife, scissors, or something else that would be hard. 
• Fear of hitting someone with a car and not knowing until it is on the news or the police come to the door
• Fear of failing to respond to violent thoughts appropriately

Gender Identity OCD

A subtype of OCD characterized by obsessions and compulsions related to a person’s gender identity. People with GOCD experience thoughts around doubt/confusion of their gender identity. It is rooted in the inability to know with certainty about one’s gender rather than actually being transgender.

 People with Gender Identity OCD may ask questions like:

“What if I actually identify as a male?” 

“What if I am transgender?”

“What if I am actually a female?” 

“What if I am living a lie when I think about my gender?”

Scrupulousity/Religious OCD

This subtype of OCD targets people who place a high value on their religion. They focus on the idea that they can't measure up and fail to adhere to the rules, meaning that they may not make it to heaven. These people focus on black and white thinking and the absolute rightness or wrongness of what they are trying to accomplish in their religion.

People with Scupulousity or Religious OCD would say things like:

"I will be judged and go to hell because I can't measure up to what is being asked of me."

"I can't read my scriptures enough, and the more time I read, the more I can say I am measuring up."

"I am a bad person if I can not pray in the right way or perfect way." 

"Do I have enough faith, and can I be perfect in the way I conduct myself in my religion?"

Relationship OCD  

This subtype of OCD targets people who care about their relationships. When we care about our relationships, OCD likes to target your relationship's quality and the genuineness of your feelings about another person. If you are in a relationship, your OCD will also make your primary source of comfort your primary source of anxiety. 

When you have Relationship OCD you may ask:

"Is my partner the right person for me?"

"What if this person is not right for me, and I need to get out of it now?"

"Sometimes I don't like the way my partner's face looks, and I wonder if his nose is 

 too ugly and does not match mine."

"What if I am not attracted to my partner as I thought I was? "

"What if my partner leaves me when I open up to him?"

Other types of OCD

Order and Symmetry OCD

Somatic OCD

Magical Thinking OCD

Health Concern OCD

Postpartum OCD

False Memory OCD

Suicidal OCD

Pedophilic OCD 

Existential OCD

And other types of OCD (this list is not conclusive)

Treatment Options for OCD

I have been trained to work through OCD and find ways to lower anxiety through two different methods of treatment. The methods are Acceptance Commitment Therapy and Exposure and Response Therapy. 

Acceptance-Commitment Therapy 

The goal of Acceptance Commitment Therapy is to help us accept our emotions and commit to moving toward our goals and values. There are six processes of ACT Therapy including mindfulness, committed action, values, defusion, self in context and acceptance. 

The goal of Acceptance Commitment Therapy is to feel psychological flexibility and be able to accept your emotions and work through the uncomfortable feelings we usually avoid. This brings us closer to living a value-centred life and doing the things we want to do. 

By using the ACT processes we are able to reduce anxiety about a feared consequence. 

Exposure And Response Therapy

The most evidence-based therapy that has proven to work with OCD is called Exposure and Response Therapy. 

The idea is that as we face our feared consequences, we allow our response to become more and more desensitized by having you face the thing you are afraid of and not doing the compulsion to lower the anxiety. As you continue to face the fear, you lower your anxiety by gaining tolerance to whatever you fear or the consequence of what is going to happen.

The parts of Exposure Response therapy include:

• Assessment: Administering the Y-BOCS assessment and finding out what your obsessions and compulsions are.
• Start to track your compulsions with the goal to lower those compulsions slowly until you have reduced them.
• Writing a hierarchy of feared consequences or situations and assigning it a SUDS score of how much anxiety it would give you to be in each of those situations.
• Starting to do the smaller SUDS-rated activities that would give you less anxiety and work our way up to your list of feared activities based on your obsessions.
• Do In Vivo Exposures which are exposures that are real-life experiments to see how well you can tolerate them
• Do imaginal exposures with situations that we might not be able to do in a “ real-life” setting.
• To be able to set a goal to slowly reduce your anxiety and tolerate your feared consequence of an activity in order to slowly become more and more desensitized to your feared consequences.  You will be able to say, “I touched that doorknob and I might get herpes from touching it, we will just have to wait and see.” The goal is to live with uncertainty. OCD will want urgency and an answer to every fear you have and when you have completed Exposure and Response Therapy, you will be able to reduce the fear that OCD causes you to feel because of your inability to tolerate uncertainty. 
• Managing Lapses in your work with your OCD. You begin to start to decrease your frequency of compulsive behaviours and will once in a while go back to your old habits of checking by asking for reassurance and need to have a check-in on your goals for managing your OCD thoughts. 
• Ritual Reduction. Our goal is to reduce your rituals or your compulsions so that you will have less anxiety and less fear about the OCD thought.

I will work with you and will team up to overturn the OCD thoughts that you are experiencing because of OCD and how it likes to demand urgency, and want to know “Right now” how you are going to solve problems. 

I am often asked, “How long will this treatment take?“ 

ACT therapy takes between three and four months to master in weekly sessions. It is recommended that ERP therapy is done twice a week for an hour and a half each session. Often this is not possible with the limits of insurance or self-pay but this means that more homework is going to be assigned and more in-between session phone calls and consistent homework on ERP will be needed.  With sessions once a week, for one hour a week, it could be anywhere from 17 to 45 sessions of ERP or more before results are noticed and come to a person working on their OCD.  This is to be expected, that consistent work with the therapist will result in a reduction of anxiety and a reduction of fear but it will take time and effort on the client’s part. I will be with you the whole way. We will work on it together and you will be able to master your OCD thoughts and learn to identify and resist compulsions.

Anxiety Disorders

Tools for Anxiety

Are you afraid that anxiety will show up for you when you are in a work meeting or socially out with friends? Have you felt your heart start pounding and shortness of breath and feel like you need to get out of the situation right away? Panic attacks and anxiety are key components in OCD  and can be overwhelming. I don’t want you to suffer from anxiety anymore. I have helped many people with anxiety attacks by giving you tools so you can regulate and calm yourself. I want to help you to feel like you are safe and calm.

I have a goal to give my clients at least 5 different tools they can use to cope with anxiety and feeling unsafe. I use skills from Acceptance Commitment Therapy and Exposure Therapy. I want to work with you to give you techniques and tools that you can carry in your psychological tool belt to help you be brave when your anxiety decides to show up for you.

I can create a safe space for you to talk about your feelings with no judgement. You and I will gently work through your feelings of anxiety and hopelessness. I can give you the tools to be brave when you feel overwhelmed. My goal is to instill bravery in your challenges. You can learn to work through difficulties. I can help you face your fears with hope.