OCD in general is highly underrecognized and misunderstood. What people think and what is typically portrayed in the media is someone that gets ‘stuck’ in their pursuit of symmetry and organization or someone that repeatedly cleans out of concern for germs and contaminants. In actuality, there are so many subtypes of OCD and it takes extensive training, supervision, and continuing education from therapists and mental health providers to recognize the signs.

What is Obsessive Compulsive Disorder (OCD)?

OCD is characterized by cyclical patterns of obsessions and compulsions.

Obsessions are persistent and recurring thoughts, images or urges that are intrusive, and unwanted. Experiencing these thoughts is very distressing for folks with OCD. A common experience is persistent doubt. Always feeling unsure…never certain enough. Someone struggling with obsessions will go to great lengths to ignore, suppress, or ‘neutralize’ these thoughts in some way, with some other thought or action.

Compulsions are the repetitive thoughts, actions, and behaviors the individual feels driven to perform in response to obsessions. Repetitive thoughts, which we can call ‘mental rituals’, can even take the form of rumination or excessive problem solving, which can be much more difficult to identify as an outside observer! These behaviors or mental rituals are aimed at preventing or reducing the anxiety, distress, discomfort, or feelings of disgust that surfaced due to the obsession. However, engaging in the compulsions or mental rituals only brings temporary relief. It won’t take long until an individual with OCD will find themselves doing the rituals over and over until they are caught in an OCD cycle. The OCD grows and grows and can take over one's life. The OCD can also spread to more than one subtype or theme.

Examples of common subtypes include (this is not a comprehensive list):

Harm OCD

Contamination OCD
Checking OCD
Relationship OCD
Postpartum OCD
Emotional contamination OCD
Sensorimotor OCD
Pedophilia OCD
Scrupulosity (religious) OCD
Counting OCD
“Just Right” OCD

and the list goes on!

A Black woman sits at a table under subtypes of OCD

Treatment Recommendations

Exposure and Response Prevention (ERP) is the leading effective treatment for people who exhibit OCD. ERP is an evidence-based treatment that involves gradually exposing ourselves to anxiety provoking situations/fears in a safe and empathic environment. The patient learns to approach these situations while engaging in response prevention, which means they will resist engaging in compulsions, rituals, or safety behaviors. With the guidance of the therapist, this process allows the person to learn new, more helpful responses rather than continuing to reinforce the vicious cycle of OCD.

One of the main goals is for a person to realize that while the distress they experience is uncomfortable, it is actually tolerable, manageable, temporary, and does not need to inhibit them. When this type of new learning occurs, a person can make the choices in their lives that they normally would have avoided.

There are particular patterns of unhelpful behaviors that are typical of OCD and should be assessed for and targeted in treatment:

Patterns of avoidance
Reassurance seeking from others as well as self-reassurance
Checking behaviors
Excessive efforts to distract
Substance use & misuse
Family accommodations

What to expect when doing ERP in CBT of Central & South Florida

Together, we’ll create a comprehensive assessment and list the main things that you’re distressed about, anxious over, or avoiding. Then, we’ll start to address those barriers in a gradual way. We don’t flood or overwhelm you to the point that you would want to leave your session or avoid coming back to treatment.
ERP includes guidance through either the actual situation (In Vivo) or through the use of your imagination (Imaginal) to make yourself vulnerable to distress without resorting to protective behaviors.
This teaches you how to tolerate the distress you experience, work through it, and ultimately lower your distress when you encounter an activating situation in daily life.

Acceptance & Commitment Therapy (ACT) as an adjunct to treatment

Sometimes, clients may benefit from integrating Acceptance & Commitment Therapy (ACT) into their treatment. ACT is a “Third Wave” form of CBT that involves cognitive, behavioral and mindfulness practices.

In ACT, the main focus of the work is helping people to utilize certain psychological processes: Acceptance, Defusion, developing a Self as Context, Committed Action, Value driven behavior, and Contact with the Present Moment in order to achieve Psychological Flexibility.

The goal of using these processes is not symptom reduction, but to learn to accept our experience, to develop a different relationship to it, and as result, we experience less suffering, people tend to feel better and their thoughts and feelings often become less relevant.

OCD Treatment & Medication

Oftentimes, medication can be extremely helpful for some people. If a person feels stuck and unable to do the exposures or finds them too distressing, or the distress is not going away fast enough, we can refer them for medication with a psychiatrist or psychiatric nurse practitioner.

Our providers are specialized in treating OCD with Exposure and Response Prevention (ERP). Contact us to schedule a free 15 minute consultation.