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OCD is a treatable condition, and with the right treatment a majority of people who engage with therapy get a good quality of life back. Unfortunately, the recommended therapy for OCD, while very successful, can be quite challenging to take part in. There are a few things you can do to make your experience of therapy both easier and more likely to work for you.
CBT with ERP works directly to challenge the OCD cycle through changing the way you think about your intrusive thoughts and the way you respond to them, including choosing to engage in activities or situations that bring on anxiety.
The only recommended therapy for OCD is Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP). This is a specialised type of CBT, while general CBT for anxiety is unlikely to bring to an improvement of your symptoms. If you are unsure about whether you are getting the right type of CBT, you can read more about what to look for in other parts of this pack. Links for these are on the left-hand side of this page.
Ideally, you want to be able attend, and be on time for, as many sessions as possible. Unfortunately, difficulty leaving the house or travelling can make this difficult.
If you see any barriers to your attendance, try to discuss these with your therapist beforehand. They may be able to offer to see you at a more convenient time.
It’s important to communicate the contents of your obsessions. Avoiding this is a bit like not mentioning your physical symptoms when you go to the doctor. A big part of OCD is the shame that comes with it, so it’s understandable that some people might want to keep their intrusive thoughts secret. However, this reinforces the idea that they are something to be feared, or that you are alone. Also, your therapist will be most able to help you if they know exactly what you’re experiencing and what you’re fighting against. If you don’t feel you can be honest with your therapist, you can explore this with them or speak to the mental health team about working with someone who better understands your condition.
As with attendance, the more time you put into tackling OCD, the more you will get out of it. It’s important to take part in any exposure or cognitive exercises that are set, that way the progress made within sessions can be applied to the rest of your life and will sink in better over time.
If you are having trouble with the homework, or you have concerns around whether you will be able to take part in it, speak to your therapist. It is part of their job to adapt it so that it’s both challenging and doable. Your therapist should never tell you that you just need to try harder.
Some people find it helpful to attend support groups. This can be a way of keeping your motivation up between sessions and an opportunity to connect with other people who are in a similar position.
The OCD Action helpline also offers a support service called Next Steps, aimed at helping people make the most of their therapy and engage in good quality CBT with ERP. This service provides 5 calls at different key points of the therapy, in which a volunteer will provide information about what to expect, check in with you about whether this is happening, and support you to work through any blocks you come across.
Medication is always a personal choice, and you can read more about in other parts of this pack.
A common misconception about medication is that it will make the therapy less effective. Understandably, someone might think that medication, by reducing the symptoms of OCD, will take away some of the elements they should be working with in therapy. The worry here is that, even after successful therapy, coming off medication will cause the symptoms to return because they were never actually faced. You could liken this to using crutches, because the hurt leg won’t be getting any exercise while walking around.
A more accurate way of thinking about medication, on the other hand, is like a floatation device being used in a swimming lesson. If someone can’t swim, using a board to hold on to while they practice allows them to focus on getting their technique right without having to worry about keeping afloat. In the long run, this means they will have learned how to swim better and quicker. Similarly, medication reduces the impact or ‘stickiness’ of the OCD cycle, making it easier to practice new reactions. For most people, it allows them to throw themselves into the work in a safer and more effective way.