OCD TReatment

What is happening in OCD?

 
 

 

I-CBT (Inference-Based Cognitive Behavioral Therapy)

Obsessional doubt is an over-reliance on the imagination and a distrust of the senses.

In I-CBT, we address the reasoning process the makes obsessions and fears seem credible. It is a cognitive approach, meaning it targets thoughts.

I-CBT will allow you to drop the obsessional story and give zero credibility to the doubt.

I-CBT involves some of the following skills:

  • Understand the OCD follows a sequence: Your OCD is prompted by a trigger, followed by an obsessional doubt, which then creates an imagined series of consequences and anxieties, which then leads you to engage in a compulsion.

  • Seeing the role of story-telling and the imagination: We can change the way we feel and respond by changing the story and recognizing how big a role the imagination plays in perpetuating OCD.

  • Learn the ways in which obsessional doubt is not relevant to the here-and now:

  • Reality-sensing: You will learn to trust your inner and outer senses to reason, rather than imagination or other forms of reasoning.

  • Identify your feared-self and work on building trust with your real-self:

 

YOU are looking for relief in unhelpful ways

When you’re stuck in the cycle of OCD and anxiety, your mind is never quite at ease. You find yourself doing things to try to relieve the anxiety. You may look for reassurance in various forms or engage in behaviors repeatedly—these are called compulsions.

The problem with compulsive responses, is that they do not relieve anxiety in the long-term. Yes, they may temporarily offer relief, but they actually reinforce the anxiety.

Obsessions and doubt always creep back in.

To break out of the cycle, you must forge a new relationship to your OCD symptoms.

Treatment approaches

The two main treatment approaches we use for OCD are:

  • ERP (Exposure and Response Prevention):

    • A form of CBT (Cognitive Behavioral Therapy) that targets behaviors. It aims to reduce compulsive behaviors and increase tolerance of uncertainty through exposure exercises. Through exposures, clients confront feared situations while not engaging in compulsions, i.e., efforts to avoid or reassure or quiet anxiety.

    • ERP is one of the most highly researched treatment modalities for OCD. There are decades of research supporting it as an effective treatment.

  • I-CBT (Inference-Based Cognitive Behavioral Therapy):

    • Also a form of CBT, but one that targets obsessional doubt, i.e., the thought process behind OCD.

In addition to ERP and I-CBT, another type of therapy we may use for OCD treatment is:

  • ACT (Acceptance and Commitment Therapy):

    • ACT uses skills (such as mindfulness, thought defusion, acceptance, values identification, committed action) to support other treatment methods.

Benefits of OCD Treatment

  • Long-term relief

  • Improved relationships

  • ability to engage in activities you care about

  • ENHANCED COPING SKILLS

  • EMPOWERMENT AND IMPROVED SELF-EFFICACY

ERP (Exposure and response prevention)

Exposures should serve you, not torture you.

Exposures happen at your pace

ERP will generally unfold with the following steps:

  1. Assessment: In your first few sessions, your therapist will be learning all about how your OCD works. You’ll talk about triggers, obsessive fears, avoidant behaviors, and compulsive responses—all in order to make the most effective plan for exposure work.

  2. Education: We start with psychoeducation about the process. Before any exposures take place, we want you to be fully on board. We want you to understand the benefits as well as the mechanisms of the treatment.

  3. Skill Building: We will build a foundation of skills, e.g., mindful awareness and curiosity, distress tolerance/acceptance of discomfort, etc. to help you fully engage with exposures so you can get the most out of them.

  4. Gradual Exposure: And once you’re ready, we will have you encounter anxiety-inducing triggers or situations in a controlled and supportive environment.

    We will calibrate exposure exercises to be most effective for you. This can take some trial and error.

    You will never be pushed to engage in an exposure exercise you are not ready for or consenting to participate in.

  5. Response Prevention: You will be supported in resisting your typical compulsive responses aimed at reducing anxiety and distress. This helps break the OCD cycle.

  6. Homework and Practice Between Sessions: You and your therapist will usually discuss exposures you can do on your own to reinforce what you’ve learned and practiced in therapy.

  7. Support in Refinement and Practice: Exposure therapy requires practice. Your therapist will work with you to continue progressing and refining exposure practice. They’ll help you consolidate learning, manage set-backs, and observe and maintain your progress.

Exposures are values-based

We want to get you back to your life—doing what you love to do.

That does not have to mean torturing yourself through extreme exposures (like licking a boot or staring at deeply disturbing images).

We will identify exposures that align most with your values.