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Have you ever wondered why you’ve been in treatment for OCD for so long and still haven’t gotten better? Or, worse yet, why you’ve been doing the recommended therapy, Exposure and Response Prevention (ERP), and it’s getting worse.
3 Reasons Your OCD Isn’t Getting Better
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 patient how to actively reduce the number of compulsions she engages in by helping the person confront what she fears, 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’re in the right therapy, you may be engaging in what OCD specialists call “sneaking compulsions.” What is a sneak compulsion? A sneaky compulsion occurs when the OCD patient becomes so activated during exposure: he ends up feeling so terrified and overwhelmed that he feels a desperate need to perform compulsions during the session that his therapist cannot see.
Also, they cover it up by not telling the therapist what they are doing. The cover-up part is also considered a compulsion. The reason a patient will hide the compulsion from his therapist is the fear that the therapist will push him not to do the compulsion. Also, the client may not want to disappoint the therapist.
Clients get worse over time when they have sneaky compulsions during therapy. They are training their brains to believe that the exposure is dangerous or deadly. In fact, doing a compulsion tricks anyone’s brain into thinking there’s significant risk associated with what they’re doing.
3. Lastly, a person may not feel a strong sense of courage or bravery before beginning treatment. Many times a client begins treatment but is not ready to address the OCD. They may be in a precontemplative stage, where they feel like they would love to be free of OCD, but are not fully committed to leaving OCD.
3 Tips to Overcome Barriers to Success
1. Always seek behavioral therapy with a trained, certified and licensed therapist. Especially if you are going to have ERP therapy. Also, you may want to consider applying for an ERP in person. Therefore, your doctor is by your side throughout the entire exhibition.
2. If the idea of being exposed as part of therapy intimidates you. You can try a different CBT option. The treatment schedule I created (Background Interruption Practice Replacement (RIP-R)) does not include creating exposures for the OCD patient. Instead, the client learns all the strategies necessary to resist the compulsions. The actual exposure occurs all the time in the victim’s daily life. Therefore, your task is always to resist the compulsions by practicing and using the strategies/switches that you practice during therapy. Therefore, this removes the risk of sneaky compulsions and allows the client to desensitize to many different scenarios.
3. Whatever therapy you decide on, see if you feel ready to start. Ask yourself questions, like what would my life be like if I didn’t have compulsions? Determine if this is the best time to start treatment and if you are ready to stop letting OCD make decisions for you. If you feel a strong sense of anger, now is the time to start overcoming the compulsions.