Have you ever wondered why you have been in treatment for OCD for quite some time and have still not improved? Or, even worse, why you have been doing the recommended therapy, Exposure and Response Prevention (ERP), and are getting worse.
3 Reasons Your OCD Isn’t Improving
1. You are in talk therapy or traditional psychoanalytic treatment. You are in the wrong treatment (see here). Research has shown that cognitive behavioral therapy is the best treatment for obsessive-compulsive disorder. CBT teaches the sufferer how to actively reduce the number of compulsions they perform by helping the person face what it is that they fear, in a systemic way, to overcome it. This is a behavioral process known as desensitization. Desensitizing a person to what they fear or are avoiding is a key component to overcoming OCD.
2. Even if you are attending the correct therapy, you may be engaging in what OCD specialists call “sneaky compulsions.” What is a sneaky compulsion? A sneaky compulsion occurs when the OCD sufferer becomes so triggered during the exposure — they wind up feeling so terrified and overwhelmed that they feel a desperate need to perform compulsions during the session that their therapist cannot see.
Furthermore, they cover it up by not telling the therapist what they are doing. The covering-up part is also considered a compulsion. The reason a sufferer will cover up the compulsion from their therapist is the fear that the therapist will push them to not perform the compulsion. Also, the client may not want to disappoint the therapist.
Clients become worse over time when sneaking compulsions during therapy. They are training their brains to believe the exposure is dangerous or deadly. Indeed, doing a compulsion tricks anyone's brain into thinking that there is a significant risk associated with what they are doing.
3. Lastly, a person may not feel a strong sense of courage or bravery before beginning the treatment. Many times a client begins treatment but is not in a state of readiness to tackle the OCD. They may be in a pre-contemplative stage, in which they feel like they would love to not have OCD, but are not fully committed to giving up the OCD.
3 Tips to Overcome Barriers to Success
1. Always seek behavioral therapy by a trained, certified, and licensed therapist. Especially if you are going to be receiving ERP therapy. Also, you may want to consider asking for in-person ERP. Therefore your clinician is next to you throughout the exposure.
2. If the idea of being exposed as part of the therapy is daunting to you. You can try a different CBT option. The treatment program that I created—Rock bottom, Interruption, Practice, and Replacement therapy (RIP-R)—does not include creating exposures for the OCD sufferer. Instead, the client learns all the strategies needed to resist compulsions. The actual exposure occurs all the time in the sufferer's everyday life. So, their assignment is to always resist compulsions by practicing and using the strategies/interrupters they practice during therapy. Thus, this eliminates the risk of sneaky compulsions and allows the client to desensitize to many different scenarios.
3. Whatever therapy you decide, assess if you feel ready to start. Ask yourself questions, like what would my life be like if I didn’t do compulsions? Determine if this is the best time to begin treatment, and if you are ready to stop allowing OCD to make decisions for you. If you feel a strong sense of courage, then now is the time to start beating the compulsions.
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3 Reasons Your OCD Isn't Getting Better and How to Heal - Psychology Today
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