By Andrew GottWorth, IOCDF Advocate
If you stumbled upon this article, you probably know that it’s not possible, or at least very very hard to “just stop”. In fact, it can be quite hard to stop OCD behavior, but there are possibilities and proven ways to reduce the compulsive urges of OCD. It is even possible for large parts of your life to eliminate those OCD compulsions!
In my experience, I would be wary of anyone that promises an easy way to stop OCD behavior. It is not an overnight cure, but there are steps we can take to help improve our experience with it.
OCD and ERP
First, let’s start with a brief primer about what OCD is, and what the gold standard of treatment is for OCD. OCD is obsessive compulsive disorder and it is not always what you see in Hollywood or on TV. OCD can show up as contamination fears and as needing order and symmetry. It can also show up as intense worrying and compulsive behavior around your relationships, about your morals and values, about your body and somatic sensations. It can show up mentally through existential worries or ruminating itself! You may notice that there is a wide variety of ways that OCD can interfere with someone’s life, so how do we stop OCD behavior?
Well, the gold standard treatment is called exposure and response prevention therapy (also called ERP for short or sometimes you’ll see ExRP). This has been proven in numerous studies to be effective and is held by the International OCD Foundation as the first line treatment for OCD. Personally, I was in “regular therapy” for 10 years before discovering ERP, and it was a game changer in my recovery and my ability to stop OCD behavior!
Let’s break down the two parts of that phrase. The first part is exposure. Exposure, to me, means experiencing things that are distressing. For people with different categories of OCD, this could be exposing yourself to germs, exposing yourself to an uncomfortable relational moment, it could be exposing yourself to a movie that talks about death when you have existential fears, etc. It can be really anything that you and your therapist talk about as an exposure.
Then the next part – “response prevention” is super, super crucial! If you do just the exposure without the response prevention then, well, nothing changes. Response prevention means you’re preventing your normal response. Let’s look at some of the examples I mentioned and how they showed up in my own life. If I had an uncomfortable relationship moment/event/thing with my partner or a coworker or friend, my compulsion would be to avoid it – to run away, minimize it, not deal with it, etc. The response prevention is to instead prevent running away and stay there in the distressing time and continue to expose myself to that uncomfortable situation again and again so that with time and with help of a therapist, I can reduce the distress or the urge to do a compulsion.
In my own life, and in my own therapy, I did ERP through an intensive outpatient program for 10 days, then twice a week, then once a week, then every other week, and so on. Through therapy, I realized that OCD was affecting many parts of my life and not just the ones I initially thought about when I went in. It can feel overwhelming early on in therapy thinking “how am I going to stop OCD behavior for all of these things?” With time, each OCD behavior, one by one, got easier in my life.
I have this important moment in my memory of my first day of treatment with an OCD therapist doing ERP. She asked something along the lines of “How often do you feel the urge to do a compulsion, and then you don’t do it?” I think I said, “What? I didn’t know you can. So I guess zero?”
For some people and for some compulsions, simply learning that you can stop the behavior and do something else is enough. Once I realized that’s the mechanism that was happening, it could stop OCD behavior in some areas. For instance – I see a crooked picture frame and have an urge to straighten it, then think “Oh – that’s an OCD urge, gotcha.” Then I move on.
Other areas of my OCD were much more difficult. I say this not to scare you, but to know that if you are still struggling, it’s ok! It took years for our brains to learn these rules, and most won’t go away overnight.
For those harder aspects, I slowly made progress with the idea of non-engagement. It turns out, I’m quite skilled at arguing with my brain, and you are too! So if I have a thought pop in – “Oh, she didn’t respond to my message, she must be mad at me.” Then if I engage with it, it only gets stickier. Inner dialog:
“Well, it could be that she is busy”
“But you know her, and she doesn’t respond that way, she must be upset. You should text again and ask for reassurance”
“Maybe. But maybe someone interrupted her and she just hit send?”
“But she would have followed up. Send another text to check to be sure”
So then I would usually give in and ask for reassurance. Another option that doesn’t work well is to try to push it away.
“She must be mad at me”
“No, don’t think that. Think about something else. Soccer. Think soccer. Scoring a goal….”
“I bet she’s mad though”
“Scored a goal, won the game. Goal goal goal”
“Text her, I bet she’s mad”
It seems that pulling it in and arguing, or pushing it away, only made the thought come up more.
Finally, with practice and guidance from my therapist, I got better at not engaging.
“She must be mad at me”
“Maybe, maybe not” *shrug*
“You should text her”
“Thanks brain. I hear you, but I’m going to go to the grocery store”
Again – this was not an overnight solution, but learning to practice this – to notice it and move on, really helped me to stop OCD behavior.
Hierarchy and Successes
Hopefully now you are convinced to talk to a therapist and work through ERP. When you do, you will create a hierarchy about your OCD and the level of distress/discomfort it brings. You will start lower down on the hierarchy and work your way up. For me, I found a lot of success in a wide variety of domains! Here are some examples that might provide you some encouragement.
One thing we worked on was my avoidance around blood and knives. I avoided washing cutlery, getting my blood drawn, helping a loved one with a wound, having things touch my wrist or back of my hand, watching a movie with blood, etc. To work through that, we first just had a knife in the room during therapy. Then the next session, I held it. After that, I felt my veins. The next session, I felt my therapist’s veins. I practiced doing the dishes and feeling my veins at home while practicing non-engagement statements. Now, I can wear a watch (which touches my veins), get the back of my hand stamped, use and clean knives, watch movies with blood etc. My discomfort around those has also dropped tremendously. Although I still have discomfort around a blood draw, I can now do that as well!
A form of compulsive avoidance for me was leaving early: I would find reasons to leave work early, leave meetings, leave a party, leave an event etc. This played on a few OCD fears of getting too hot, being uncomfortable in dress clothes (some somatic OCD), social/relationship OCD, and rumination on “something will go wrong / get worse”. So I practiced staying at a party longer than I would normally. I sat in the middle of a booth at a restaurant on purpose, so that I can’t easily get up and escape the moment. I went back to work part-time, then full-time, practicing again some of the ERP techniques when I wanted to leave. All of these eventually granted me more social time and wonderful memories with friends and allowed me to move on to a job that I love. Here are a collection of “smaller” OCD behaviors or rules that I’ve been able to stop doing over the past few years:
Must not wear red
Must put dishes in the right spot
Must listen to music to fall asleep
Must not think about death
Must have a water bottle with me always
Must have a light on in whatever room I’m in
Must not wear tight clothes
There are many more I can talk about, but you’ve read this far and now it’s time to look up an OCD therapist in your area! Visit iocdf.org/find-help/. You can start finding some relief soon.