Anxiety Therapy

How is OCD treated?

For more information about OCD itself, please visit the About OCD page.

OCD is primarily treated with Exposure and Response Prevention, also called ERP. Traditional “talk therapy” does not help with OCD, and can often make things worse, as people spend hours analyzing their obsessions without finding any way out.

Fortunately, there is a well-established way forward.

ERP has been the gold-standard OCD treatment for several decades.

Exposure means gradually confronting situations that make you anxious or that trigger OCD concerns. Response prevention means learning to do this without doing rituals or compulsions. By approaching these situations without doing compulsions, your mind and body have the opportunity to learn that anxiety will go down on its own, and that compulsions are not necessary to tolerate it.

My ERP practice is largely based on Rumination-Focused ERP (RF-ERP), as developed by Michael Greenberg, PhD, with whom I have completed extensive training.

This ERP approach begins with teaching response prevention, and in particular how to stop ruminating, BEFORE exposures. Rumination refers to ongoing mental engagement with OCD concerns, including analysis, reviewing and replaying, generally directing attention towards the content, or actively trying to push it away. These thinking styles are clearly prevalent in so-called “pure O” OCD, but also drive symptoms in all OCD themes. At first, many people with OCD can’t imagine being able to stop ruminating. However, learning to stop ruminating is possible. It is a skill you can learn just like anything else, and it may take much less than you might think.

Most people find that once they disengage from rumination and compulsive thinking processes, their anxiety decreases, and exposures are easier. In this view, the purpose of all exposure isn’t to spike your anxiety for no reason, but to simply teach you that you can disengage from mental and physical compulsions in the presence of a trigger.

And in fact, when you do this completely, you actually feel less anxious, not more.

My approach is straightforward:

1. Identify all of your OCD symptoms, both obsessions and compulsions, and how they are impacting your life

2. Teach you how to stop ruminating, and otherwise how to do response prevention

3. Practice not ruminating and response prevention in day-to-day life as exposures naturally arise

4. Plan purposeful exposures for the purpose of showing you that you can go on the offense against obsessional content, still refrain from rumination and compulsions, and therefore actually control your experience of anxiety

5. Troubleshoot stuck points, make a plan to integrate these plans into everyday life, and address any emotional or relational dynamics that arise as OCD symptoms decrease

   Concurrent with these steps, your treatment may include:

   • Incorporating family or close friends into treatment (always and only with your consent) to help them best support you, as OCD often impacts family / friend systems

   • Collaboration with medication managers, should you choose to seek medication

   • For children, collaboration with school professionals

   • Other unique strategies tailored to your specific situation or other symptoms you may have.

One more note on ERP:

Many people are nervous that this will be too difficult or too anxiety provoking. This is a common reaction, but it often based on an old-school version of ERP, in which people were thrown in to the deep end and asked to tolerate dramatic situations. This is not how I practice ERP, and this dramatic version is now rarely practiced in the OCD treatment community. In addition to lacking compassion, it is entirely unnecessary for success. As mentioned above, Rumination-Focused ERP sees ongoing mental rumination as the primary driver of anxiety. When people learn to drop this mental engagement, anxiety decreases, and exposure becomes easier, not harder.