Treatment for Obsessive-Compulsive Disorder
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 (that’s the exposure part) while they refrain from performing the compulsions they’ve previously relied on to manage their distress (that’s the response prevention part). For example, someone with a fear of contamination might work on touching a doorknob without immediately washing their hands afterward.
If you have OCD the prospect of engaging in this kind of treatment likely sounds fairly daunting. And I won’t lie. ERP isn’t always easy. At times it can be scary and stressful. That’s why a good OCD therapist will always ensure that you have the tools you need to manage your distress non-compulsively and that treatment progresses at your pace.
An experienced OCD therapist will generally focus on targeting less anxiety-provoking exposures first, and then gradually progressing to more challenging ones. As the client gains experience and confidence, they come to learn that their anxiety is manageable and that it naturally decreases over time without the need to engage in time-consuming compulsive behaviors. With practice, ERP allows you to take back your life from the obsessions and compulsions that used to control you.
Treatment for Anxiety and Anxiety Disorders
When treating anxiety and anxiety disorders I use a combination of ERP, Cognitive-Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Self-Compassion.
If you read the bit about OCD treatment you can probably see why something like ERP would be useful for anxiety disorders. While non-OCD disorders might not feature true compulsions, someone with an anxiety disorder is very likely to lean on unhealthy coping behaviors to temporarily manage their distress. As in OCD treatment, ERP would be used to help these clients confront their triggers, and the resulting anxiety, rather than engaging in avoidance or unhealthy coping behaviors.
Simultaneously, CBT techniques and exercises 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 focus on taking 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, I think it’s important to bring aspects of self-compassion to therapy. Often, anxious individuals come to view themselves as weak, inadequate, or incapable of handling their fears. By cultivating self-compassion, individuals can begin to treat themselves with kindness, understanding, and patience, much like they would treat a close friend who is struggling. This shift in thinking helps break the cycle of self-criticism and creates a healthier, more nurturing internal dialogue, reducing the intensity of anxiety.
