What Is OCD Treatment, and How Does It Work?
Obsessive-compulsive disorder (OCD) keeps you down with fear. It sneaks into your mind and convinces you that you are it, that its fears are yours. So how do you fight something that feels so completely to be you? This is how we fight back. You are not your OCD.
The treatment for any illness is never easy and OCD is no exception. Even I, who has successfully made it through treatment before OCD regained its power; even I, who can acknowledge its effectiveness; even I, who can see how dark and unhappy I have become once again under OCD’s grasp. Even I find it extremely difficult to drag myself to treatment, to commit to the fight.
I wish there were some magical pill to cure OCD, but there isn’t. Many people have asked me what treatment looks like. And while it can be hard to explain, when I am able to find the right words, not only does it help them understand the process, but also to understand and respect the illness itself.
I am no expert, but I will do my best to put into words how we fight this debilitating illness.
To understand the treatment, we must first understand at least a very basic picture of how an OCD brain functions. I personally struggle with contamination OCD, so I will be using that as a framework for my examples, but please keep in mind there are many types of OCD.
Let’s start with someone who is not battling OCD. If they touch something dirty, whether it just be dirt or a mild chemical of some sort, their brain has a process or pathway to handle that. First, they touch the contaminate and their brain says, “That’s dirty, should wash hands,” which sends the signal further down the pathway and instructs the person to wash their hands. The person does so, which then sends the signal to the brain that their hands are now clean, and finally signals the person that they are safe, and can move on with their day. A linear, cause-and-effect pathway.
For someone with OCD, that pathway becomes stuck on a loop, feeding back into the original signal of “dirty, contaminated, etc.” and magnifying it to a signal of “extreme danger.” In this case, I would touch the contaminate and my brain says, “That’s dirty, should wash hands,” which sends the signal to my hands to wash. I do so, but instead of sending the “clean” signal, my brain says, “Wow, whatever you touched was so dangerous you had to wash your hands, so you should wash again just to be safe.” So the normal response of washing hands further validated and intensified the original signal of “dirty,” rather than produce the normal response of “clean.” And the next time I wash my hands, the signal will again get looped back, most likely adding to the list of suggested safety behaviors.
“Better wash your hands again just to be safe,” becomes “Wash your hands, also you touched the faucet to turn the water on, so wash that too,” becomes “wash your hands and what else could you have possibly touched on your way from first coming into contact with the contaminate and making your way to the sink,” and so on and so on, deeper down the spiral. Every time I give in to another safety behavior, I am magnifying that fear, getting stuck in a never-ending cycle, never reaching that final stage of “clean.” It’s like running with all your might, but never moving an inch.
So the way we fight this is by retraining our brain. Retraining it to have the proper amount of fear, and only require the proper safety procedures. But retraining your brain is not easy, especially when your brain is sending you signals of “danger” and you are in the habit of believing your own brain. It is very frustrating, to say the least, to have someone tell you that you can no longer believe what your mind is telling you, that you must go against those very real feelings of danger. That doesn’t come naturally and it is very distressing. Not only must you stop doing the multitude of safety behaviors you have been performing, but in order to successfully retrain your brain, you actually have to go above and beyond the normal — deliberately go past gross, go past scary, so that you can come back to the “normal” and not feel any fear. Until “normal” is boring again.
This process is called exposure and response prevention (ERP). I must purposefully and deliberately expose myself to the contaminate I fear and then prevent the response for as long as possible. In doing so, I can hopefully retrain my brain that those responses (safety behaviors) are not necessary to be safe.
Basically, when I or anyone else is asking me to go to treatment or to fight my OCD, they are asking me to do the thing I am most afraid of. Do the thing my brain — the brain I have trusted my entire life — has told me could mean life or death.
I feel like even this far in the description, it is hard for someone without OCD to truly grasp the magnitude of this process — the sheer amount of willpower and strength it takes to battle this illness head-on, simply because it can be very hard to wrap your mind around an OCD fear. OCD usually takes something minor, something the rest of the world doesn’t necessarily associate with that amount of fear and turns it into a monster. So, if you can’t see or understand what I am afraid of — if it looks to you like I am afraid of the invisible — then this will be hard for you to grasp.
So, what are you most afraid of? Spiders, snakes, the ocean, sharks, heights? Whatever it is, picture that. We’ll use snakes in this example — specifically non-poisonous, harmless snakes. Because your therapist, while they will encourage you to face your fear, they will never tell you to do something that would actually put you in harm’s way.
Picture that you are living in a world where snakes are as common a sighting as dogs. Currently, your fear of snakes has become so severe it prevents you from leaving the house in case you might encounter one. Now someone presents you with a deep, dark pit of snakes, and tells you the only way to get over your fear is to stick your arm in it (remember, deliberately go past normal so you can come back). And if you don’t stick your arm in, then your fear of snakes will intensify to include objects that look like snakes, including hoses, cords and headphones, shadows that move like snakes, a whisper or a plastic bag blowing in the breeze that sounds like a snake. You will be afraid of things that may have touched snakes until you can no longer let people into your house without a grueling process to protect you from what they may have touched outside your house in the real world. You will be afraid of the color green, so much so you flinch when green passes by your peripheral vision. You will be afraid of small green crumbs and pieces of plant life, for the chance it could have come off a snake. Your mind will convince you of the presence of invisible, ethereal snakes that float around in your home. You won’t be able to see them but you will be sure of their phantom touches, as real to you as if a 6-foot boa constrictor brushed passed your head. What began as a fear of snakes will be magnified to fear of almost everything.
And while you are standing there with your biggest fear staring back at you out of that pit, you are going to tell yourself it’s not worth the risk. That you may be limited by your fear of snakes right now, but you’ve still got your house, and being stuck in there is not so bad. Much better than the possible alternative if you were to stick your hand in that pit. But what you are not seeing is that your house will soon turn into just a single room, and that room will turn into a chair, and you will be afraid to blink.
So you start with something small. You’ll simply sit and deliberately imagine snakes. You will do this until your spike of fear begins to subside, you will do this until you are bored of thinking about snakes. Then you will open your blinds and look outside, watching for snakes, again doing so until you are bored. And will continue to increase the magnitude of these exposures, until it’s time for you to step outside. Until you find yourself in front of that pit again. Now truly imagine yourself standing in front of a pit containing what you fear most. It will not be an easy decision to put your arm in. Every fiber of your body will be fighting against any movement toward that pit. It will feel like someone is playing tug-of-war with your arm.
Even so, you eventually bring yourself to do the unimaginable. You’ve decided the chance of freedom from this debilitating fear is worth the risk.
You did it! And after weeks of distress, unbelievable willpower and effort, you can now… finally… plug in the lamp because you are no longer afraid of the cord.
And this is the moment you realize you will have to continue facing your deepest fear again and again in order to fully regain your independence. You have a long way to go. But you did just take a giant step towards freedom — one you thought impossible, but now know to be possible.
This is what treatment looks like for someone battling OCD. This is a daily battle. You don’t get breaks; OCD won’t give them to you, and if you get tired and slip back into old safety behaviors, you’ll feed the fear. It’s crucial to build a support team for yourself; family, friends, a therapist you can trust to walk next to you through the fear. While they cannot fight it for me, I have found, at least, I cannot fight it without them.
Keep in mind that once one fear is conquered, a person still must continue to maintain it, as it will always be right behind the veil trying to find a way back in. And on top of that, OCD is now like a hurt little bully who had their toy taken away. So, while you are maintaining your control over the fear, OCD is waiting on the sidelines looking for a new trigger to turn into a monster. And this time, OCD has learned the same tools you have during treatment, and it has adapted. So you must do so too, again and again.
I don’t paint this picture to seem hopeless, although it can feel that way, and it will certainly be a long battle. But I do so in the hopes someone will pause when they see someone struggling to conquer their mental illness and it may appear they are doing nothing. In truth, they are doing quite the opposite; they are fighting the monster in their brain, the monster you can’t see. Because this is what they are asking themselves to do. What they are trying to muster up the courage to commit to, all while OCD lives in their brain gleefully playing whack-a-mole with every bit of courage that pops up.
A version of this article was previously published on the author’s blog.
Photo by Thomas Griesbeck on Unsplash