Obsessions and Compulsions
Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by Obsessions- unwanted, disturbing thoughts and/or images that intrude into the mind. Compulsions which are repetitive behaviors, actions or mental acts done to "neutralize" the fears and relieve the distress obsessions cause.
Compulsions or neutralizations can range from simple behaviors to very complex rituals that must conform to rules the person invents. They can be simple actions or behaviors such as repeating, checking, reassurance seeking, avoidance, specific ways of doing thing or mental such as trying to recall a checking behavior or repeating a number or ruminating about something that occurred. People neutralize to lighten the distress obsessions; but this relief is short-lived, as the obsession soon recurs, and the cycle is repeated.
OCD is no longer categorized as an "anxiety disorder" but a complex, multi-dimension condition with different themes. The four most common of these symptom groups and dimensions of OCD are:
- Doubting and Checking (locks, appliances, written work or emails)
- Contamination and Washing (handwashing, sanitizing or avoiding)
- Symmetry, Just Right , Need for completion (visual or sensory perfectionism)
- Repugnant Thoughts, images involving harm or sexual themes presenting as "what if" statements that people confuse with actual intent or desire to act, when, in fact, they are doubts.
How common is OCD
Population studies indicated that OCD affects roughly 3 out of 100 people (likely underestimated) with typical age of onset spanning early childhood to late teens, although uncommon, in women, symptoms can start during menopause.
Severity
OCD is classified as a chronic condition with symptoms ranging from mild-moderate to severe and debilitating. Although, OCD is often life-long, there is now an innovative treatment, with roots in Cognitive and Behavioral Therapy known as Inference-Based Cognitive and Behavioral Therapy I-CBT that offers hope for significant remission where symptoms, when they do recur, can be easily managed
Treatment
Exposure and Response prevention (ERP) and Cognitive and Behavioral therapy (CBT) have been the established treatments for OCD together with medication since the 1960s. Although ERP in particular is considered the gold standard of treatment, it has been shown to be less effective-and sometimes counter indicated for more complex forms of OCD such as obsessions involving sexual and harm themes.
How common is OCD
Population studies suggest that OCD affects roughly 3 out of 100 people (likely underestimated) with typical age of onset spanning early childhood to late teens, although uncommon, in women, symptoms can start during menopause.
Severity
OCD is classified as a chronic condition with symptoms ranging from mild-moderate to severe and debilitating. Although, OCD is often life-long, there is now an innovative treatment, with roots in Cognitive and Behavioral Therapy known as Inference-Based Cognitive and Behavioral Therapy I-CBT that offers hope for significant remission where symptoms, when they do recur, can be easily managed
Treatment
Exposure and Response prevention (ERP) and Cognitive and Behavioral therapy (CBT) have been the established treatments for OCD together with medication since the 1960s. Although ERP in particular is considered the gold standard of treatment, it has been shown to be less effective-and sometimes counter indicated for more complex forms of OCD such as obsessions involving sexual and harm themes.
I-CBT
Fortunately, an innovative and more effective Cognitive Therapy approach, Inference Based Cognitive and Behavioral Therapy (I-CBT), created 25 years ago initially by Dr. Kieron O'Connor, and further developed over the years by his associate, Dr. Frederick Aardema, has revolutionized the treatment of OCD.
I-CBT posits that obsessions are not just intrusions that are misinterpreted, rather they errors in reasoning, characterized by doubt-or discounting-of what is real or perceived in favor of what is imagined or extremely implausible. Locked doors might be unlocked, a clean surface might be contaminated, an organized shelf might cluttered or an unwanted image of doing harm might represent the intent to harm. Obsessional "thoughts" and/or images or "intrusions" are recurrent, unwanted and disturbing.
In the 'OCD bubble' people think and act in response to imagined stories and discount what is perceived and known to be real
During treatment, clients are taught to identify what I-CBT refers to as the "crossover" from what is perceived and real to what is imagined. They also learn about a key thinking error called inverse inference where people reach conclusions based on what they imagine vs what is perceived or known as we normally do. I-CBT has pinpointed the "reasoning devices" that trick people, with OCD into believing the stories or narratives that spring from imagination instead of trusting their senses and common sense.
Once in the "OCD bubble" people are compelled to behave or think a certain way to protect themselvess from the feared imaginary outcome. When people with doubt and checking OCD see that a door is locked they are tricked by their imagination into doubting what they perceive and are, thus, compelled to lock the door again. When people with OCD act on a compulsion or "neutralize" fear in some way, the imaginary story, that is, the obsession, becomes "lived In". People with OCD know that compulsions might deliver brief relief but fail to deliver change and make the obsession stronger. In I-CBT clients learn that compulsions only strengthen because there is no resolution to obsessional doubt: You cannot lock a door that is already locked, and that by trying to lock it you merely reinforce the imaginary idea that the door is unlocked.
Clients are guided to use knowledge of OCD reasoning to deconstruct the obsessional narratives and then create alternative or real stories. By repeatedly taking apart the pieces, obsessions start to weaken and fall apart. At the same time, clients are practicing what ICBT refers to as reality sensing: letting what the senses perceive gudie behavior and thought. If a door is locked, you trust your sense and move on. By sensing reality, over time the mind resets and clients are able to leave obsessions behind and live in the world that is
By the end of therapy people, recover their relationship with life. Many of my clients find themselve more present in relationships and work. Free of the hell of OCD, they are motivated to explore that they previously feared, seeking out new endeavors ways of living or sometimes new careers
Becoming a Client
Phone Screening
To understand your specific needs and whether we might be a fit to work together, I offer a free phone screening. I gather initial information about the condition and symptoms for which you are seeking treatment, why you have made this decision now, co-existing conditions, past treatment as well as your motivation and commitment to change. I also I briefly explain the CBT approaches I use, including Inference-Based Cognitive and Behavioral Therapy (I-CBT) The screening is also an opportunity for prospective clients to ask questions and get a sense of who I am and how I work.
One Initial Assessment Session
If the phone screening suggests that there could be a fit, I usually propose one initial assessment session to get more information about your symptoms as well as your relationship and family histories. At the end, I share initial diagnostic impressions along with a sketch of a treatment plan and paths we might take if we agreed to go further.
Useful Resources
obsessions start when we confuse what is real and perceived with imagined stories and doubts that discount direct evidence- when what is becomes what if..
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