Approaches to Treatment

The treatment for Obsessive-Compulsive Disorder with the strongest evidence base to support its use is a type of Cognitive-Behavioral Therapy called Exposure and Response Prevention (ERP).

ERP works by gradually exposing clients to the situations or thoughts that trigger their obsessions while they refrain from performing the compulsions they’ve previously relied on to manage their distress. If you have OCD the prospect of engaging in this kind of treatment likely sounds fairly daunting. Don’t worry, a key part of doing exposure therapy for OCD is that the client is always in control. We move at the client’s pace and on time line, beginning with their least anxiety-provoking obsessions and then working our way up to the more challenging ones as they gain confidence.

When treating general anxiety and anxiety disorders I use a combination of Cognitive-Behavioral Therapy (CBT),  Acceptance and Commitment Therapy (ACT), and Self-Compassion.

CBT techniques are used to help uncover and address negative thought patterns and self-defeating behaviors that contribute to a person's anxiety. ACT techniques encourage clients to take value-driven actions while changing the relationship they have with their thoughts from one marked by confrontation to one of non-engagement and acceptance.

Lastly, since anxiety often triggers harsh self-criticism, anxious individuals often come to view themselves as weak or inadequate. By cultivating self-compassion individuals  begin to treat themselves with kindness, understanding, and patience, much like they would treat a close friend who is struggling. This shift in thinking often helps break the cycle of self-criticism and creates a healthier, more productive internal dialogue.

Other thoughts on therapy

While understanding the technique-based strategies a therapist relies on  is important, I think it’s equally important for a potential client to understand something about where a therapist is coming from in a more general sense. To that end, here are a few key concepts I find myself returning to again and again when working with clients:

  • We usually think of this the other way around. We get motivated and then we act. And it’s great when things work out that way, but very often they don’t and we end up stuck, wondering how to make ourselves feel what we think we need to feel in order to act. I try to stress the importance of not waiting to attain any particular emotional state or mindset before doing things that matter to us. The secret is that once we start actually doing these things, that energetic, motivated feeling we hoped for often begins to emerge.

  • If we’re going to work towards acting before we feel fully ready we need the ability to experience  nervousness, insecurity, anxiety, or fear without letting it stop us. Once we recognize that all of these feelings are a collection of uncomfortable,  largely physical, sensations that don’t necessarily predict anything about our ability to act or the magnitude of the threats we face, it gradually becomes easier to allow ourselves to simply feel what we’re feeling and keep on going.

  • There we are trying to enjoy a nice evening at home when suddenly anxiety grabs hold of our attention and insists that we worry incessantly about the future. What if instead of having our attention captured by emotional bullies we were able to direct our attention where we wanted it? On our friends and family. On our work. On a beautiful summer day. The good news is that controlling our attention is a super power we can practice and strengthen. Once we do, those emotional bullies are free  to demand our attention but they might find that we’re no longer listening.

  • Sometimes we let ourselves down. We don’t study as much as we should for that big test and we get a bad grade. We aren’t quite as nice to a family member as we know we should be. Often these things set off a storm of  self-recriminations. How could I be so stupid and irresponsible? Why am I such a jerk?  These tendencies grow out of an understandable desire to regulate our worst tendencies, but it’s important to recognize that there’s being honest with ourselves and then there’s being cruel to ourselves. The first one can be useful, even necessary, while the second one never is. I urge all of my clients to treat their failings as they would the failings of a beloved friend—with honesty, with understanding, and with kindness.

  • Our brain is our most trusted advisor. We rely on it to evaluate whatever life throws at us and  guide our reactions. Due the importance and intimacy of this relationship  it’s natural for us to take the things our brain says pretty seriously. But the truth is this miraculous organ, which sends us a steady stream of thoughts all day long, is fallible. Some of the thoughts it sends us are accurate and  important. Some of them are flat out wrong. Some of them are simply irrelevant. Our problem is that it’s not always easy to know which is which. That’s why coming to view our  thoughts as a series of suggestions—sometimes driven by our own fears and biases—rather than a series of truths can go a long way towards helping us not make some of our worst mistakes.

  • If there’s one idea I come back to the most it’s probably this one. Even at the best of times our world can be a chaotic and scary place. People we love become sick and die. We grow old. Injustices abound. Often, we feel trapped in a world we don’t control and can barely understand. Faced with this, we’re all doing whatever we think we need to do to manage the uncertainty and fear that comes with being alive. This is true of the best people you know and the worst. Accepting it allows us to bring more compassion to ourselves and to the rest of the world.

  • The honest truth is that therapy won’t entirely eliminate anxiety, depression, insecurity, or uncertainty. As troubling as these things can be they are a normal part of being human. What therapy can do is give us tools to manage these challenges more effectively, day-in, day-out. Maintaining good mental health, like maintaining good physical health, is a lifelong project.