Obsessive Compulsive Disorder (OCD)
Obsessive thoughts can be the most painful part of the OCD experience. While you can work to directly change behaviors (e.g., hand washing, checking the stove), unwanted and intrusive thoughts and urges (e.g., mental reviewing, doubting something feels “just right”) can remain, and even intensify as you make these shifts. I use different evidence-based practices for OCD, given how you want to approach treatment. Importantly, the work we do together is collaborative, and you get to control the pace of how the work proceeds and what targets we address.
Exposure and Response Prevention (ERP), helps you learn to tolerate the discomfort of anxiety and obsessions without acting on them. Response Prevention may involve interrupting the habitual ways in which you move away from the discomfort of OCD and related triggers, including how you may seek reassurance (e.g., asking others’ opinions, mentally reviewing events) and rituals in which you may engage to quiet your OCD (e.g., triple-checking that you did not leave papers near an electrical outlet, extensive washing and decontaminating procedures). Exposure activities may involve approaching situations or items that trigger your OCD (e.g., household items, loved ones, reading about related topics), writing about the stories your OCD tells you will happen if you do not listen to it, and importantly, practicing willingness to experience these activities that are uncomfortable, yet not unsafe.
Inference-Based Cognitive Behavioral Therapy (I-CBT) is focused more on the thinking processes that further OCD symptoms. I-CBT helps to identify the ways in which the doubting process occurs in OCD (e.g., I might have hurt someone, I might have touched a contaminated object, I might never know if my partner is right for me). Importantly, we will talk about why these doubts are so painful and targeted, when you may not doubt other thoughts or activities, even when they seem similar (e.g., worrying about risk of having a heart attack, but not getting cancer, worrying about not having locked a door, but not a filing cabinet). We will work together to identify and address the ways in which OCD hijacks your imagination (arguably one of the coolest parts of being human!), help you to develop greater trust in yourself and your senses, and more quickly come back to the moment as the person you are, not who OCD says you might become.
I also use mindfulness- and acceptance-based approaches like Acceptance and Commitment Therapy (ACT) to supercharge this work, as they help you to focus on the larger reasons you are willing to get uncomfortable and engage in the hard work of treatment (e.g., relationships, creativity, self-confidence). I can help you can learn how to become more flexible in how you respond to your OCD-based thoughts and urges and reclaim your life, instead of your OCD getting to dictate what is possible for you.
For more information, see the International OCD Foundation and I-CBT Online