What is Obsessive Compulsive Disorder (OCD)?
Obsessive Compulsive Disorder includes 3 primary concerns:
1. Obsessions
Obsessions are recurrent thoughts, images, or impulses that are unwanted or distressing. Common types of obsessions include fears of being contaminated/getting sick/having a serious disease, excessive doubt, intrusive thoughts about harming others or being a pedophile, obsessions with religion or morality, feeling as though things are "not just right", or perfectionism.
2. Compulsions
Physical or mental acts that an individual feels driven to perform according to rigid rules. These can include common actions like hand-washing, but also could be less obvious like seeking reassurance or replacing "bad" thoughts with "good" thoughts.
3. The obsessions and compulsions cause distress, are time consuming (in that they take more than 1 hour per day), or they significantly impair functioning.
How does Obsessive Compulsive Disorder Develop?
Emotional Processing Theory (EPT) is the leading framework for understanding how anxiety disorders are developed, maintained, and treated.
According to this theory, there are certain fear structures in the brain that are learned. In the case of OCD, a thought that is initially harmless (like "I might hurt my dog") creates a fear response and increases anxiety. Overtime, the brain starts to fear the obsessive thought, even though the thought itself is harmless.
To demonstrate what we mean, think about camping in the woods and you hear a bear outside the tent. This would be a very appropriate event to fear, causing a fight or flight response for survival. Now, imagine a person safe in their bed, THINKING about camping with a bear outside the tent. The thought in this example is NOT dangerous, but the brain can inadvertently learn that it is.
In OCD, after feeling distress from a thought (like "what if I get AIDS"), people will find temporary relief after doing a compulsion (like washing their hands 3 times). Initially, this makes them feel better in the moment but what is actually happening according to EPT, is that the compulsion makes the distress/anxiety WORSE. The brain learns that the thoughts are really something to fear, and the temporary relief that is felt after the compulsion is reinforcing the fear.
Understanding how OCD develops helps to understand the treatment. First, we focus on the thoughts/obsessions themselves. We need to train the brain that the thoughts are really nothing to fear. The brain learns through repetition, so by exposing the brain to the thoughts (and fears) over and over, for long periods of time, we can train the brain to learn through experience that the thought is not harmful. This introduces new learning to help the brain learn to tolerate and not get caught up in obsessive thoughts.
Next in treatment, we need to discontinue the compulsions (googling, rumination, checking, and so on) to train the brain that not only can it handle the anxiety/distress, but that it actually HELPS to ride out the anxiety without receiving quick relief from a compulsion.
This is ALL about brain training! Really, no different than going to the gym 5x per week to build muscle. To build new neural networks in the brain that are healthy, we have to engage in behavioral treatments that are designed to provide information that is sufficiently incompatible with the fear to reduce fear. Continuing obsessions and compulsions only reinforces fear because there is NO NEW LEARNING. The brain never learns that the thought itself is really nothing to fear.
If you are willing and committed to the treatment, just as working out for an hour 5x per week will absolutely lead to increased strength, exposure and response prevention for OCD will reduce distress and anxiety and will help you to regain quality of life.
We are experts in Exposure and Response Prevention and would love to support you in the process to regain your quality of life. Schedule your free treatment consultation here.