*A revised version of this article has appeared in the International OCD Foundation Summer 2024 newsletter
The following was compiled by B.P., a patient suffering from Obsessive Compulsive Disorder (OCD) and later edited by Jordan Levy, Ph.D. It was originally composed to provide treatment parameters when dealing with this irrational and often complex anxiety disorder. These Exposure and Response Prevention (ERP) guidelines can be implemented for any OCD subtype.
When in doubt, blindly treat triggering situations as if they are OCD
Choose to not figure out the answer to OCD questions and instead proceed forward
Anytime you draw a line in the sand or build a wall by telling OCD what you are not willing to do for ERP, OCD just pounces on you and tortures you; be willing to take it to the extreme with ERP exercises
Act as if you do not have OCD which means NOT getting caught up in thoughts such as “Oh my god what just happened, Why is this happening, Where is this coming from, Let’s figure this out now”
A good response back to OCD is, “I think I’m going to move on even though I don’t feel like moving on and this seems wrong, but I’m going to choose to do it anyway”
You must be disciplined in order to “snap out of it” and not keep engaging with the OCD
Don’t allow your ERP practice to become compulsive; keep moving on with your day instead of sitting there and organizing the whole exposure and making sure you’re doing it the right way
You have permission to think and experience anything
Make quick decisions when you are stuck. Once you start obsessing over whether something is a ritual, an exposure, or OCD, then you are setting yourself up for failure; just make a decision, right or wrong, and learn to be okay with not knowing
Let intrusive thoughts come up, let them be there, do not assign them any importance and accept uncertainty
Risk making the wrong choice rather than sitting there for 15 minutes ensuring that you’re making the right choice. Your efforts to figure it out will never get you anywhere and it will keep you stuck.
Anxiety tolerance is the goal, not anxiety reduction. You are not curing OCD, you are simply learning how to manage it
OCD will let up once you have taught it with enough persistence that you are not going to allow it to push you around
OCD will always tell you that you might be doing the wrong thing
When it feels like you want to give up, remind yourself why you’re doing ERP and what you have to gain
The more exposures you do, the more beneficial it will be. Set aside specific time for ERP and at points throughout the day
You don’t have to like it, but sit with it anyway. ERP is not about what you want in the moment
Do ERP in the morning if you wake up dreading it and wanting to push it off. Do ERP at night if you are trying to get it out of the way as fast as possible in the morning
You can accept or agree with the OCD – you are sending the message that this isn’t that important right now
You may need to include evaluations about your relationship with your thoughts during ERP. For example, if you feel fearful that you are enjoying your intrusive thoughts and questioning why you are, you can respond with “I’m enjoying them because they’re not OCD thoughts, it’s who I really am”
The purpose of ERP is to MAXIMIZE anxiety in those moments, as much as you can tolerate
When you avoid, you make it more important and stronger (it becomes more of a monster than it needs to be); instead run right towards it
Sitting in your feelings is uncomfortable, but you have to in order to let it melt off naturally
You will become aware of how much better you’re doing organically. You don’t need to keep checking in on your progress
Do the opposite of what OCD is telling you to do (within reason)
You’re allowed to be ridiculous and have a sense of humor with it even though it makes you feel uncomfortable
It is always hard work but when you go to battle you’re going to come out on top if you are willing to take those heroic steps -- OCD is not going to last a long time if you’re willing to put up a tough fight
Don’t wait for the opportune time to engage in ERP exercises
You don’t have to do everything but you do have to do something
The bottom line is to just do the damn thing!
ERP treatment for OCD is a challenging endeavor that is easy to comprehend but difficult to implement. Self-help workbooks for OCD are available and are helpful for some but more often than not it is necessary to seek out the assistance of an OCD specialist. The treatment parameters listed above are intended to serve as a useful framework that can assist in the goal of living a full life with OCD in the background.