Once you’ve done the hard work of finding a therapist, figuring out the financial stuff, and securing an appointment, you already know that treating obsessive-compulsive disorder requires a good amount of planning and a ton of determination. And although this work gets more rewarding when you’re seeing a clinician regularly and feeling the results each day, it still requires planning.
We’ve talked a lot about how OCD treatment means getting used to discomfort by spending a lot of time feeling uncomfortable. Most people don’t think of planning as an especially fun activity in any context; even fewer relish the chance to plan out all the times they’ll be intentionally making themselves uncomfortable by facing whatever they fear most. It can be really tedious, so why go through the trouble of coming up with a plan for OCD recovery?
Most importantly, going through cognitive-behavioral therapy and especially exposure and response prevention (ERP) without a plan can result in a lot of unnecessary distress. These forms of treatment require structure, because they’re about identifying certain sets of symptoms and methodically working through them. Someone should always know why they’re going through a particular exposure, and how it’s intended to help them live better.
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The goal isn’t just to put yourself through distress; it’s to target specific obsessions and triggers that have been bothering you, and then confront them until they don’t bother you nearly as much. And this process of habituation to distress (getting used to it) can only occur if someone isn’t using compulsions to escape the discomfort– making it essential that compulsions are identified.
There also needs to be some understanding of how compulsions will be prevented. These are responses that have been reinforced countless times, and it’s not realistic to assume we can suddenly discontinue them. That’s why making decisions before we’re in the midst of an exposure is vital to its success.
Planning also helps you understand how long this process might take. Nobody wants to do behavioral therapy forever, and a plan will help you understand whether or not things seem to be progressing according to your goals.
You’ll follow your own unique plan– everyone’s needs are different, and the following should be understood as an extended example of how things can work, not as a template for your own treatment plan. This isn’t meant to be a stand-in for working with a clinician. So if your clinician’s suggestions differ from these, it’s typically best to go with what they say. But having a sense of how things might progress can be useful because it helps us feel less overwhelmed about the things to come.
We generally assume that we know ourselves well, but when our obsessions and compulsions have been carved for months or even years into the patterns of our life it can be surprisingly hard to tease them apart from other aspects of our day. It’s even hard to imagine, sometimes, that life can be any different from the way it’s been.
That’s why the first, and probably most important, step in creating an OCD treatment plan is simply to identify a number of things that have been bothering you. First, you might ask yourself why you sought therapy in the first place; this will often reveal some of the things that belong near the top of your list.
Then, working with your therapist, you can explore the various aspects of your life– work, school, social life, hobbies, family, relationships, etc.– and explore the behaviors that have been keeping you from doing the things you’d like to do within these categories. Because OCD treatment is fundamentally about learning to behave differently so you can live better despite the thoughts arising in your mind, it’s important to start with a sense of things you’d like to be able to do. What would you do if you weren’t struggling with OCD?
A typical next step is to start identifying your obsessions and compulsions throughout the day. This sounds a bit overwhelming, and it might help just to jot bothersome things down throughout the day as they happen. The goal here isn’t to capture a comprehensive list of your symptoms. It’s to get used to the idea that noticing what’s happening is a crucial step in the quest to change what’s happening.
Let’s say I’m at the gym and someone else is lifting a lot of weight. I suddenly have a thought: I could walk over and push the weight down on them. I feel sure this thought must be dealt with urgently. All of this happens so quickly– and suddenly I’m obsessing, wondering if I’m a horrible person and fretting about how it’s only a matter of time until I do something like this. In this case, I would notice what’s happening and take a quick note:
At the gym. Intrusive thought of hurting someone. Obsession: “Is it only a matter of time until I lose control and hurt someone?” Distress 8/10. Compulsion: Repeatedly telling myself I would never do something like that.
Taking out pen and paper whenever something emerges can be both impractical (like in the middle of a gym) and a little embarrassing if you’re around other people. If this process doesn’t work for you, it can be easier and less obtrusive to make a quick note on your phone. The goal is to link together events, obsessions, the amount of distress they cause, and compulsions.
Once you’ve listed a number of situations, you’re off to a great start. It can be tempting to try to write down everything that’s ever bothered you, so just keep in mind that you’ll be revisiting this list regularly– adding or subtracting things to meet your needs.
Here’s how more of that list might look:
At the grocery store. Heard someone saying that someone had robbed a nearby bank last night and suddenly wondered if I might’ve done it even though I didn’t remember. Obsessions: “Could I have robbed them while I was sleepwalking or something? Am I the type of person who would do that? Can I really trust my memory?” Distress 7/10. Compulsion: Looked through my text messages over and over from last night to make sure I wasn’t at the bank, and searching a local news website to make sure they weren’t looking for me.
While waiting for the train Standing near the tracks as the train arrived and suddenly thought about how I could jump in front of the train. Obsessions: “Do I really not want to be alive? Would I do something like that?” Distress 9/10. Compulsions: Stood far away from the tracks while holding on to something, and searched Google on my phone for signs of being suicidal to make sure I don’t fit the description.
Once you’ve identified some of your symptoms, you can begin to make a plan for recovery. We’ll be offering some helpful tips on the second half of this process in part two, which will appear on this blog very soon. In the meantime, keep in mind that maintaining balance is important.
Keep both eyes out for part two! If you have any questions, we’re @treatmyocd on Facebook, Twitter, and Instagram.