OCD treatment: Finding our “new normal” in ERP work

I recently read two systematic review articles describing the impact of the Covid-19 pandemic on individuals with OCD. Systematic reviews are a type of article where the authors carefully search for all of the research on a topic, and then combine it in a scientifically rigorous way. One article focused on  young people and the other was for all age groups. This blog will discuss some of the findings as well as next steps for ERP therapy. 

Findings from these studies highlight that Covid-19, overall, appears to be associated with a worsening of OCD symptoms in young people and adults alike. Importantly, worsening of symptoms was found not just for  OCD contamination-related concerns. This would not be surprising, since we are all worried about infection right now. But there was also an impact seen in other types of OCD. It was suggested that the Covid-19 pandemic served as a broad stressor with wide reaching impact.

Treatment was found to be a protective factor in one of the reviews. Having the support and ongoing strategies for fighting against our anxiety and uncertainty is powerful. Therefore, ensuring access to treatment is more important than ever. One way that treatment has become more accessible is through virtual care. This has been discussed in more than one of our previous blogs. 

What is ERP treatment in the new normal?

As a psychologist, I have worked with many individuals who have described increased symptoms of OCD since Covid-19. Individuals have said that their sanitization procedures became “legitimised” by the world once the Covid-19 pandemic struck. No longer were they alone in wiping down groceries. No longer were they the only ones sanitizing groceries and packages. Handwashing (at every opportunity) became the norm. This was true more than ever in the early stages of the pandemic. When the world did not know what was happening, we all turned to the only measures that made sense. Clean, wash, sanitize, repeat. 

Individuals who had previously overcome their OCD symptoms and were no longer triggered by germs and contamination found the rules were changing. Prior to the pandemic, they were told to allow for germs to be present and wash only when absolutely necessary. But that was no longer the case. Now everyone was washing all the time. For individuals with contamination-related concerns, these messages were now reinforcing their OCD tendencies. This made it more difficult for people who were trying to push against OCD tendencies.

For those with other OCD-related concerns and mental health issues in general, Covid-19 has proved to be a significant stressor. Young people were facing isolation from friends, lack of structure without school and ongoing lockdowns and isolation. Adults were facing financial strains and relationship distress due to lockdown. Everyone has been facing uncertainty. Every time we think we are out of the woods, a new variant seems to arise. The game is altered once again. Living with uncertainty has been a task the world has been faced with.

What is the future of ERP therapy? 

We are now tasked with delivering ERP in a new world. Messaging for ERP used to be to push oneself to the most extreme. Get down in the dirt with your OCD! Eat off the floor, wash your hands only if you have to, cross contaminate yourself at every chance you get! Live your life with as much contact with germs as you can imagine! However, even in the “before times”, did we follow no guidelines? Was it truly a free for all? Absolutely not! 

We just adhered to different guidelines. We always worked to the limits of our previous public health guidelines. It is just that they used to look different. As commented in one of the articles, therapists have always had some discomfort with pushing people to these limits. We must ensure that therapists working with individuals with contamination-related OCD are comfortable themselves engaging in ERP to the limits of public health guidelines – now more than ever.

• What does this look like? Therapists should review appropriate public health guidelines with their clients. This is your roadmap to ERP work. 
• Are these guidelines perfect? No. They are often somewhat vague and written for the general population. I often tell people to ask themselves a few important questions before they engage in behaviour they are questioning: “Is that behaviour being done in the service of your OCD?” and “Is that behaviour bringing you closer to what matters to you in life…or further away?”

We must get comfortable with OCD and Covid-19. Hand washing guidelines exist – we can follow them – no more than needed. Do we need to shower when we come in from the outside? No. Do we need to wipe down groceries? No. Individuals and therapists alike can engage in this exposure work together. Virtual therapy allows for clients to do this work within their homes and within their community as they take their therapist along with them for coaching.

Things are not the same as before. We know more than we did before. We have an opportunity to engage in treatment that can provide ongoing support for OCD and tackle the stressors that the Covid-19 pandemic has brought to us. The time is now.

Reach out to us at Forward Thinking Psychological Services™. We are ready to work with you on your symptoms of OCD. We will bring you closer to a life that is of value to you. We look forward to hearing from you!