OCD is a neurobiological condition that can be found in the brain. It is thought to be caused by a neural miscommunication between the frontal lobe and smaller subcortical areas such as the orbital cortex, cingulate gyrus, and caudate nucleus.

These brain areas communicate with one another via serotonin, a neurotransmitter. While having low serotonin levels is not exclusive to OCD, it has been found that those who have the diagnosis often have a serotonin deficiency, which is why SSRIs are the preferred medication prescribed to those with OCD.

Despite the fact that OCD has a neurological component, research has been unable to pinpoint a single cause or causes of OCD. No two people with the disorder are completely alike. It is believed that OCD likely is the result of a combination of neurobiological, genetic, behavioral, cognitive, and environmental factors that trigger the disorder.

According to research, OCD can also be inherited, and family history and genetics are likely to have a part in the disorder's development. Genes are often only part of the equation though. Other variables might be involved, like trauma or even ordinary life stresses that may activate the genes associated with the symptoms of OCD.

One thing's for certain. Those who have OCD did not ask for the disorder and have no control over whether or not they develop it, just like those who have cancer or pneumonia.

Intrusive thoughts center around certain themes. The first that comes to mind for the majority of people is the fear of getting contaminated by germs, paired with excessive hand washing. However, there are actually many subtypes of OCD.

The most common themes relate to contamination, harm (to self or others), pedophilia, scrupulosity (concern with morality), perfectionism, and “just right” OCD.

Though there are varying themes of OCD, the cycle of obsessions and compulsions are the same, which means the same treatment can be used no matter the subtype. Many patients often present with multiple subtypes of OCD and/or their subtypes transform over time.

Example obsessions:

• Fear of becoming contaminated or dirty from contact with corrupted objects or people.
• Fear of being emotionally contaminated from contact with something dirty, wrong, or evil.
• Fear of harming yourself or others.
• Fear of acting on a violent impulse.
• Unwanted thoughts, images, or urges related to sex.
• Fear of making a mistake or failing.
• Fear of becoming a pedophile.
• Need to feel “just right.”
• Excessive concern with morality, or right and wrong behavior.
• Fear of going to hell or being punished by a religious deity.
• Fear of being a bad person.
• Excessive concern with your sexual orientation.
• Need for symmetry or perfection.
• Need to tell, narrate, or confess to others.
• Need to remember every detail, fact, date, etc.
• Excessive focus on somatic experiences (such as blinking, swallowing, breathing, etc.)

Example compulsions:

• Avoidance of triggering people, objects, images, numbers, colors, etc.
• Seeking reassurance from self or others.
• Arranging objects in a very specific way.
• Rereading, erasing, redoing, or rewriting.
• Excessive hygiene rituals such as bathing, cleaning, or washing your hands.
• Repeatedly checking things, such as locks, switches, and doors.
• Physically or mentally checking you haven’t harmed someone.
• Tapping or rubbing an object a certain amount of times or until it feels right.
• Repeating routine movements like standing up/sitting down, walking in and out of a door, etc.
• Repeatedly saying certain words, phrases, or prayers while doing unrelated tasks.

Exposure and Response Prevention (ERP) is an evidence-based practice and considered the "gold standard" of mental health treatment for OCD and related disorders. And, when combined with medications like selective serotonin reuptake inhibitors (SSRIs), it has been found to be the most effective therapy.

Current research has indicated that approximately 2 out of 3 of patients who receive ERP experience improvement in symptoms, and approximately 1 out of 3 patients are considered to be recovered after completing the treatment (Hezel & Simpson, 2019). (Source)

ERP assists people in managing their behavior in response to obsessive thoughts, uncomfortable emotions, and unwanted somatic sensations. The ultimate goal of ERP is to help people break free from the cycle of obsessions and compulsions so they may live better lives. Over time, one learns that they can choose to respond differently in the face of fear and anxiety.

ERP is an advanced behavioral therapy with two components:

• The first component is exposure, which is gradually exposing patients to anxiety-provoking situations and obsessions.
• The second component is response prevention, which is an intervention that helps patients resist and ultimately eliminate compulsions in reaction to their discomfort.

ERP is most effective when the therapist conducting the treatment has experience with OCD and specific training in ERP.

When ERP treatment is attempted by a mental health professional with little to no specialized training, the results can be ineffective or unintentionally make the symptoms worse in the long run.

If you have questions or think that you may need ERP therapy for your OCD or anxiety, schedule a 15-minute phone consultation. It’s absolutely free.

ERP may sound difficult and frightening. Just getting started takes a lot of drive because you are actively choosing to encounter thoughts and circumstances that you fear and deliberately resist or avoid. But you aren’t alone, you will have an experienced OCD therapist to guide you along the way.

Over the course of treatment, you can expect to learn more about OCD and ERP, as well as speak to your therapist about your specific fears and compulsions. Knowledge is power and will help in the fight against OCD. You and your OCD therapist will also identify your goals, values, and what you would like to get out of treatment. You will collaborate with your therapist to develop an exposure list and fear hierarchy, which is a list of exercises arranged in order of difficulty that target a certain OCD-related fear. Once that list has been created, your therapist will guide you through your first exposure where your goal will be to sit with your distress without trying to avoid or reduce it.

You might be asking what else you should be aware of about the OCD treatment process. Below are different things you can expect from OCD treatment.

1. It will be challenging. ERP is designed to be tough because it develops a skill called distress tolerance. We will need to generate discomfort so that you may eventually learn how to deal with it without resorting to compulsions. This will also teach you that you can tolerate challenging things, thus increasing your confidence. It is critical to remember that you and your therapist are a team. Nobody will ever be forced into an exposure. Everything moves slowly and at the pace of the patient.

2. It gets worse before it gets better. Oftentimes, you may feel worse before you make significant progress. The treatment is meant to take away your safety behaviors (e.g., compulsions) that have been holding strong feelings at bay. Once those safety behaviors are taken away, what you are left with are those uncomfortable feelings you have been trying to avoid. Once you begin to build your strength towards those distressing feelings, it may feel like you are regressing. This is a totally normal part of the treatment progress and does not last forever.

3. You will have to put in the work to see results. There is a misconception that therapy is “all talk and no action." However, with ERP, it is the opposite. For example, if you workout for one hour once a week, you likely will see little improvement in your strength and endurance. But, if you exercise for one hour daily 3 times a week consistently for a long period of time, you are going to see progress. No one builds strength by doing nothing. The same idea applies to OCD therapy. You must consistently practice what you are working on in treatment sessions, as well as several times outside of therapy sessions. Otherwise, you won't see the desired improvement.

4. While ERP is difficult, living with untreated OCD is even more difficult. You can choose to continue to be ruled by your thoughts and emotions. Or you can face them and take back your life. ERP will assist you in realizing that you can choose how to respond and that you don't have to engage in compulsions to live a great life. You will be back in control, not OCD.

1. What is the difference between ERP and CBT?

ERP is a type of CBT. Although the name cognitive behavioral therapy would seem to be a single type of treatment, it is actually an umbrella term that encompasses an array of different cognitive and behavioral therapies.

Many types of CBT focus on modifying the relationship between emotions, thoughts, and behaviors, while ERP focuses entirely on modifying behaviors.

2. Could I just take medication?

Medication is beneficial and can give much-needed symptom relief, but it cannot solve everything.The majority of progress will be made during therapy sessions and acquiring skills to manage the condition.

Consider this: someone who has broken their foot may use crutches to move about. Crutches do not cure the injury, but they do make mobility easier. Medication, in essence, can act as crutches and be a beneficial aid in the therapy process.

3. What do I have to do in sessions?

Each session is tailored to the individual because each person has unique concerns, presentations, and goals for treatment. A broad summary of what is done in therapy includes setting goals, identifying values, learning about your condition, and participating in some form of intervention (like ERP) in which you develop and practice skills to help you get closer to living the life you desire.

4. How long will treatment take?

Everyone's circumstance is different, and the time it takes for treatment to help you reach your objectives and make progress will vary from one person to another. Simply put, a precise estimate is difficult to provide, but therapy progress is regularly monitored and discussed throughout treatment.

5. What does an ERP therapy session look like?

Hand washing is a compulsion that is frequently addressed using ERP. After coming into contact with a "contaminated" surface, someone suffering from OCD may wash their hands until they're raw. During an ERP session, they may begin by touching a contaminated surface with one finger and without washing their hands immediately.

The difficulty of the exposure steadily rises with time and they increase their contact with the surface or even further delay the hand washing. As part of response prevention, the patient learns to gently wash their hands just when required, rather than obsessively scrubbing. Exposures are always voluntary and no one is ever forced to engage in an exposure.

6. Does exposure therapy work for other types of conditions?

Yes, ERP is just one type of exposure therapy. Exposure therapy has been shown to be effective for social anxiety, specific phobias, trauma, generalized anxiety, health anxiety, and panic disorder.

1. The first step is to either schedule a callback or give The Psychology Group a call: (954) 488-2933

2. Our practice offers complimentary 15-minute phone consultations. During this consultation we will learn more about your needs and goals. You'll be matched with one of our expert therapists

3. Next, you'll meet with your therapist for an initial session. There, your OCD specialist will get a very thorough understanding of your unique background, history and what you'd like to accomplish. They’ll explain the treatment plan and collaboratively, you'll both decide next steps