Let’s Talk About What OCD Actually Is And How Exposure Response Prevention Treats It..

Okay so, what IS OCD?

Let’s first clarify what it’s not, which is making things neat and tidy. OCD stands for Obsessive Compulsive Disorder, the D simultaneously represents distress. These components: obsessions, compulsions and distress, make up the diagnosis. OCD affects the neurological functioning of your brain, and those with OCD really cannot control what their brain is doing, unless they get treatment.

How does it work exactly?

First, everyone has intrusive thoughts. You know you’ve thought something like, ‘what if I just started screaming and walked away?’ Or ‘what if I just punched this person in the face?’ People without OCD are able to immediately be like huh? and dismiss the thought. For those with OCD, their brain attaches meaning to that intrusive thought that the thought is real (“this will really happen”) or that the thought is a reflection of themselves (“I must be a terrible person for having this thought”). This is how an obsession is created, through attached meaning to the intrusive thought. This obsession then will cause the person such distress that they feel they need to do something to prevent the feared outcome from happening and/or to calm themselves down. This action is a compulsion. Compulsions can either be done physically or mentally. This compulsion will then lead to temporary relief. The key word here is temporary. The next time this intrusive thought pops up, the person with OCD will engage in compulsive behavior again because it “worked” last time. This ultimately creates the cycle of OCD.

Let’s look at an example together.

Meet Craig. He, like the rest of the world, gets intrusive thoughts, but his brain places meaning to them. One day when Craig was watching his nephews, he got the random thought, ‘what if my nephews get hurt while playing?’ This then caused Craig serious distress because he loves his nephews and would never want anything to harm them. Although Craig is aware it is unlikely that they will get injured while playing, and if they do, they would likely be fine, he still can’t shake the thought. The possibility of them getting hurt feels really real and he believes it is his responsibility to keep them safe. To ensure their safety and find relief from worrying, he decided to take their toys away which made them scream and cry. Craig feels terrible because he knows they were having fun, but still decided to redirect them to a movie which distracted them. Craig felt everyone was now safe since they were sitting calmly on the couch. This now goes on every time Craig watches his nephews. Even though part of him knows this is not logical or not fair to them, taking the risk still feels too scary.

So, what’s happening here?

Now what? Craig and his nephews only ever watch TV?

How would ERP look for our friend Craig?

Let’s look at one more example.

Wrapping up OCD and ERP

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