Living with OCD

If you’ve landed on this page, you probably know what OCD is, and I won’t bore you with the technical details of what an OCD diagnosis entails. In a nutshell, OCD is: 
The pairing of relentless worries or intrusive thoughts (obsessions) and  the urge to do something (compulsions, rituals) to reduce the anxiety created by those nagging obsessions.
I am passionate about working with adults and children with OCD because I have seen time and time again, the pain and struggles that OCD brings to everyday life. And by providing effective therapy to adults and families in the South Florida area over the last decade, I have also had the incredibly rewarding opportunity of being a part of many people’s journey toward recovery. I have helped many adults kick OCD’s butt, and if you’re ready – I would love to help you beat OCD, too.

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What I hear patients say about their intrusive thoughts:

• I obsessively worry about… getting contaminated/sick, keeping things organized/even/perfect, acting in an immoral way (e.g., doing something sinful/irreverent), things not feeling “just right” (e.g., the way I said or did something, the way I touched something), etc. This list is just a small sample of intrusive thoughts.

• What kind of horrible person am I to be having these kinds of thoughts? (e.g., harming myself, harming my child/parent/loved one, doubts about my sexuality, violent thoughts, etc.)

• I know these thoughts don’t make any sense. They are not logical - but in the moment I can’t help but believe them and give in to them.

• I try to distract myself – but no matter what, these unwanted thoughts come back, stick around, and make me feel miserable.

What patients say about trying to break free from the grip of compulsions:

• I am so tired of (insert compulsion/ritual here: counting, fixing, checking, straightening, ordering, washing, swallowing, blinking, etc.), but it feels impossible to stop.

• I worry that others might notice my compulsions/rituals (at work, at home) and will think I’m strange/weird/crazy. 

• Am I crazy? What is wrong with me? Why do I keep doing these compulsions?

• Once I start a compulsion or ritual, I just can’t stop. It’s like I’m in a trance and want to snap out of it, but I can’t.

• I want my life back. There are so many things I would rather be doing, and I’m so tired of spending my time on these rituals.

 
If any of this sounds familiar to you, you are not alone. I want to tell you loud and clear: there is hope. With effective OCD treatment - you CAN get better, and you can have your life back.

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Effective Therapy for OCD

Tons of research studies have shown again and again that Cognitive Behavior Therapy (CBT) and Exposure and Response Prevention (ERP) are effective treatments for adults and children with OCD. ​

In a nutshell, CBT helps you change the way you think, which helps you change how you approach and handle different situations. In therapy, you will learn how to “talk back” to your obsessions with facts, and importantly, learn to tolerate and accept uncertainty. An important focus of CBT is learning to gradually face your fears. In therapy, we call approaching anxiety-provoking situations exposures. Through lots of exposure practice, you will teach your body and brain that:
1.  The feared situations are uncomfortable but not dangerous
2.  You can tolerate that discomfort
3.  If you stick with the exposure, the discomfort will subside
​4.  The more you practice facing your fears, the easier it gets

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Now what about this ERP business?

ERP (Exposure and Response Prevention) just means that you will learn to face your fears AND gradually stop doing the compulsions/rituals you feel that you have to do. This might seem hard at first, but when needed, we ease into it. You might first try to delay the compulsion, change it or mess it up in some way, before you eventually learn to stop doing the compulsion altogether.

What else can help me beat OCD?

Another effective OCD treatment with lots of research supporting its effectiveness is Acceptance and Commitment Therapy (ACT) . ACT helps us to clearly identify your values in life, to practice mindfulness and self-compassion, and perhaps most importantly: ACT helps us understand and accept that thoughts are just thoughts. You can choose to act on your intrusive thoughts by engaging in a compulsion, OR you can choose to look at the thought, hold it out in front of you, diffuse from it (separate yourself from the thought) – and mindfully choose an action that aligns with your values. It takes practice to learn to treat intrusive thoughts in this way, but with the right therapist and lots or practice, it is possible.

Choosing to Get Help

Although the grip of OCD can be intense, there is likely a big part of you that wants things to be different – to be able to make decisions in your own life, without regard for those nagging intrusive thoughts, and without spending time ritualizing (which provides short-term relief from anxiety, but in the end leaves you feeling exhausted).
 
But taking that initial step toward OCD treatment can feel so scary. What if therapy doesn’t work for me? What if my therapist doesn’t really understand what this feels like and doesn’t understand me? ERP sounds really hard; maybe I’m not ready for that. These doubts and questions are all completely normal.
 
But, if you make the courageous decision to come in for that first therapy session, I would feel honored to join you on your personal journey toward beating OCD. Here is what I can promise you about that first therapy session with me:

• The space that we will create in therapy together will feel empowering and free of judgment
• The intrusive thoughts that feel shameful or wrong, and that you cannot fathom sharing with anyone else– I have almost certainly heard before from other patients struggling with OCD. I know that the content of these thoughts reflects nothing about who you are or what you value.
• The journey toward beating OCD is tough, but we WILL find a place where you feel comfortable starting this difficult work.
• My specialized training and experience using Cognitive behavior therapy (CBT), Exposure and Response Prevention (ERP), and Acceptance and Commitment Therapy (ACT) will give us an effective roadmap to beat OCD and win back your life, one step at a time.

 
If you’re ready to start the hard but empowering work toward healing from OCD – let’s do this!  Schedule your first appointment today. If you’re unsure about scheduling and would like to talk with me first, let’s set up a time to chat.

Social Anxiety

Worry Talking Back Exposure

• Identify worry thought:

  If I make a mistake while ordering my food at a restaurant, I’ll look so stupid.

• Talk back to the worry with facts/evidence:

  I’ve been to this restaurant before, and the waiters are usually friendly, so even if I fumble over my words, he/she probably won’t think much of it.

• Gradual exposure:

  • Go with a friend, and have him/her order my food. I might order my drink.
  • Go with a friend. Order both my food and drink order on my own.
  • Go to restaurant alone, and order both my food and drink.

Panic Attacks

Worry Talking Back Exposure

• Identify worry thought:

  I notice that my heart is beating a little faster than usual, so I should probably leave this situation in order to prevent a panic attack.

• Talk back to the worry with facts/evidence:

  My heart could be beating faster than usual because I’m walking quickly. I’ve had this sensation before and it does not usually lead to a panic attack. If I do have a panic attack, it will be very uncomfortable, but it will pass quickly.

• Gradual exposure:

  • Do activities that lead to the experience of a fast heart beat (e.g., run vigorously or do jumping jacks for a minute)
  • Do these activities in situations where it might be difficult to leave quickly

Obsessive Compulsive Disorder

Worry Talking Back Exposure

• Identify worry thought:

  I’m not sure I did that quite right (e.g., a task, a conversation), and that makes me feel very anxious/uncomfortable. I will [insert compulsion] to help myself feel better

  Compulsions are quite varied and can include: mental rituals (counting or repeating a phrase in your mind), reordering/arranging, hand-washing, etc.

• Talk back to the worry with facts/evidence:

  Even though I feel uncomfortable about messing up, the compulsion will not actually fix anything, it’ll just help me take the edge off or now.

• Gradual exposure and response prevention (ERP):

  In OCD treatment, the focus is on reducing the compulsive responses and learning to manage the obsessions in a more effective manner. To engage in ERP in the current example, you might start with purposefully doing something not quite right (e.g., mess up on a minor task) and experiencing feeling some anxiety/discomfort. Then, you would gradually work on the response prevention component:

  • Allow myself to engage in the compulsion minimally (e.g., repeat phrase in mind only two times rather than ten times).
  • Delay the compulsion: wait one minute before repeating the phrase
  • Do the compulsion differently: Say the phrase, but only part of it or say it backwards.
  • Do not engage in the compulsion

Separation Anxiety (child)

Worry Talking Back Exposure

• Identify worry thought:

  After Mom drops me off at school, I will miss her too much and will have a long, terrible day at school. So I’m going to try to stay with her as long as possible.

• Talk back to the worry with facts/evidence:

  Even though I will miss Mom while I’m at school, there are some things that I could do, like talk with my friends or go to the playground.

• Gradual exposure:

  • Spend time separate from Mom in fun places (e.g., at a friend’s house).
  • At school drop-off time, walk with Mom into the classroom and stay with her for a few minutes before she leaves.
  • At school drop-off time, walk with Mom to the school entrance and say goodbye there.

Specific Phobia: Vomit (also known as emetophobia)

Worry Talking Back Exposure

• Identify worry thought:

  My stomach feels a little queasy, which means I might throw up. If I throw up, I will feel terrible/disgusting/very nervous. Others might notice, and think I am gross.

• Talk back to the worry with facts/evidence:

  Since my stomach is feeling queasy, there’s a small chance that I may throw up. I’ve thrown up before and it is uncomfortable, but it is not harmful and I can handle it.

• Gradual exposure:

  • Read stories about vomiting
  • Look at pictures and watch videos of people vomiting
  • Engage in activities that could lead to nausea (e.g., spin in chair to get dizzy, shake head quickly from side to side for a full minute, eat foods that may have been previously avoided due to fear of vomiting)