How Do I Know If I Need Help with OCD?
Making the decision to start any type of therapy can be difficult. Starting treatment for obsessive compulsive disorder is not exception. You might ask yourself, how do I know if OCD therapy is what I need? And how will I know if the treatment for OCD I am receiving is right for me? There are many things to consider.
People will often reflect on the symptoms they have been experiencing. And consider whether these symptoms are impacting their daily functioning and quality of life. When obsessions and/or compulsions are time consuming and lead to frequent disruption in your day-to-day functioning, it may warrant a further assessment of whether symptoms are meeting criteria for Obsessive Compulsive Disorder.
In order to receive a professional diagnosis, you will want to meet with a healthcare professional with proper training. Psychological diagnoses are provided by physicians and psychologists. This can be very helpful before you begin your obsessive compulsive disorder treatment.
According to The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), OCD has various subtypes based on the presence of obsessions/compulsions in the patient.
The various types of intrusive thoughts that one might experience in the context of OCD may include:
- Contamination or germ-related obsessions
- Harm-related intrusive thoughts
- Symmetry or ordering obsessions
- Sexual-intrusive thoughts
- Perfectionistic thinking
In response to these obsessions, individuals may develop a variety of compulsions. These may include:
- Cleaning or washing compulsions
- Mental review or “figuring it out” compulsions
- Checking compulsions
- Reassurance-seeking or confessing “bad thoughts”
- Needing to complete tasks in a specific way or in a manner that feels “just right”
Some individuals may also experience health-related concerns as part of their OCD. Individuals might worry that they will develop a serious medical condition. Or that a test result was read inaccurately and something was missed. They might then engage in compulsive reassurance seeking from medical professionals or loved ones. They might wonder if they need specific treatment for health anxiety. This would be important to assess with the therapist you meet with.
The good news is that treatment for obsessive compulsive disorder involves the delivery of skills and tools for you to change your relationship to your anxious thoughts. This would also be the focus in treatment for health anxiety. When you meet with your therapist you can discuss these concerns and see what will be the best fit for your presenting concerns.
The list above is not exhaustive and OCD can actually be about anything and everything! Both adults and teens with OCD will often experience the same types of OCD symptoms. Therefore, treatment for OCD has a similar format for both adults and youth.
Some individuals choose to begin therapy for OCD when their intrusive thoughts are distressing and their compulsions (in response to the obsessions) become time consuming and significantly interfere in their life. As part of the treatment of OCD, you can also have your family members meet with an OCD therapist. This can be very helpful as we know that OCD often lives within the family and can cause relational distress.
Within the family context, individuals with OCD will often ask family members to help with their rituals. This is true of teens with OCD as well as young adults living in the home. This can also happen when a partner asks their spouse or loved one to accommodate their OCD. This usually means asking a loved one to perform the ritual for you or support you in carrying it out.
Although loved ones often do this out of caring and compassion, it is not helpful for the individual who is experiencing OCD. While in OCD counselling, an OCD therapist will usually bring family members into session (as needed and with consent) to explain the process of exposure therapy for OCD. They will also provide language that can be used as the family learns to “talk back” to the OCD during treatment for obsessive compulsive disorder.
Should I get OCD Therapy?
If you have decided that your symptoms of OCD are interfering in your life, it might be time to look into starting treatment for OCD. Online therapy for OCD can be highly effective. OCD counselling will then involve targeting triggering things in the very environment that they are often occurring (i.e., your home).
At FTPS, we have an experienced team of mental health clinicians who are able to work with you on your symptoms of OCD. We also have clinicians who work directly with adolescents and teens and can engage in treatment for OCD with them. We offer OCD treatment in both 1:1 individual therapy settings as well as group therapy formats. Both of these formats for treatment for obsessive compulsive disorder have been found to be effective.
What Types of Therapy are there for OCD?
You might also wonder, what is the best OCD treatment? There are different types of therapies for OCD. However, you want to make sure that you receive therapy that is effective. At FTPS, we only provide OCD therapy that is evidence-based.
These are the types of therapies that we will offer to you:
ERP-Based CBT for OCD
By starting treatment for OCD, you will learn many important skills and strategies. An evidence-based approach for obsessive compulsive disorder treatment is Cognitive Behavioural Therapy, with an emphasis on ERP. By engaging in Cognitive Behavioural Therapy for OCD, you will learn a lot of skills that you can use on your own, in-between sessions. These skills will help you to change your relationship to your intrusive thoughts and your anxiety.
Here are the types of skills you will learn:
- Psycho education about OCD and anxiety
- The experience of anxiety is uncomfortable, but it is not dangerous
- Connections between thoughts, feelings and behaviours
- How to face situations and thoughts that you fear
- Doing Exposure and Response Prevention – in-session and on your own
- Challenging thoughts that underlie core fears within your OCD
OCD therapy, using CBT approaches, has been found to be effective for adults and adolescents. If you engage in this type of therapy, you can be confident that you will be receiving an intervention that has been shown to help individuals with varying types of OCD presentations. Following your assessment, you will often then identify tasks for an exposure and response prevention hierarchy.
Your ERP hierarchy will allow you to identify things with your therapist that you have been avoiding. You can plan out how you want to start to engage with these things again. It is important that the exposure work you do is both meaningful and adds value back to your life. These are essential discussions to have with your therapist during therapy for OCD.
Throughout obsessive compulsive disorder treatment, you will also learn about your core beliefs and fears connected to your OCD. Discovering these fears will help you to better understand what is driving your OCD behaviours and why you continue to engage in them. This is a very important part of therapy as well.
I-CBT for OCD
Another type of CBT approach for OCD is called Inference-Based CBT. This is an evidence-based treatment that is based on the idea that obsessions are inferences about “possibilities”. For example, “I might be a paedophile” or “I might be contaminated”. We might experience these obsessional doubts because we distrust our senses and rely on our imagination rather than what is happening in this moment in reality. When we are able to connect with reality, there is no actual basis for the doubt we are experiencing. When engaging in this type of treatment for OCD, you will learn about differences between uncertainty, “typical doubt” and “obsessional doubt”.
When obsessional doubt emerges we can easily get confused between what is real and what is just existing within our imagination. Our obsessions will continue until we can “resolve” them by carrying out compulsions and rituals. When we become convinced that the obsession doubt is real, we enter into a place called the OCD bubble and we begin our rituals and compulsions. This allows us to feel that we are protecting ourselves or others from what it might be that we fear the most. During this type of treatment of OCD, you will learn about “possibility” versus “probability”. This can help you to not enter into the OCD bubble.
In I-CBT, you will work with your therapist to resolve this obsessional doubt. This is accomplished by initially learning that obsessional doubts are actually different from other types of uncertainty. Typical doubts arise from uncertainty that others might agree is reasonable. However, obsessional doubts are found to emerge as a result of our OCD, not because of what might actually be happening in the “reality” of the moment and situation.
When you learn I-CBT for the treatment of OCD, you will learn about your obsessional story and create alternate stories that challenge the process of your OCD thinking. Throughout your treatment, your therapist will help you to trust in your 5 senses to allow for a different reasoning process to occur. You will also learn about the vulnerable self; what you fear you might be without your OCD) and the true self; who are you, actually?
You will learn to trust yourself during I-CBT therapy for the treatment of OCD. You will learn not to engage in compulsions and rituals in order to feel better. I-CBT has been found to be effective for OCD and is worth exploring for your first therapy experience or if other types of OCD counselling approaches have not been effective for your OCD.
No matter what approach you choose, your OCD therapist will ensure that you are working towards your goals and begin to lead a more fulfilling life.
What are OCD-Related Disorders?
OCD-related disorders share some aspects of OCD in terms of their features and symptoms experienced. However, they also have some features that are unique.
Below we have listed some common OCD-Related disorders, focusing on both similarities and differences to OCD:
- Hoarding Disorder: individuals with hoarding disorder as well as OCD might spend time collecting items and organising them in particular ways. However, an individual with hoarding disorder does not view this time or collecting as being excessive. They will often cite sentimental attachment to numerous items and objects that other individuals might not view in that way. For more information on presentation and treatment for hoarding disorder, see the IOCDF hoarding centre website.
- Body Focused Repetitive Behaviours (BFRBs): individuals with BFRBs as well as OCD will do repetitive behaviours – often as a result of feeling uncomfortable. However, individuals with BFRBs will report that the repetitive behaviours feel good (soothing) and it might happen in response to stress. Treatments for BFRBs have a slightly different focus than that for OCD. For more information on BFRBs, the TLC Foundation for Body-Focused Repetitive Behaviours is available. Common BFRBS may include repetitive skin picking (on different areas of one’s body), hair pulling (i.e., scalp hair, eyelashes, body hair) or even nail biting.
- Body Dysmorphic Disorder (BDD): individuals with BDD will report excessive preoccupation with “defects” or “flaws” that they believe that they have. However, these are generally not noticeable to other people. Regardless, the perception of these things leads to ongoing checking, reassurance seeking, excessive grooming and, sometimes, surgical intervention. Individuals might avoid social situations as well. Although individuals with BDD will engage in repetitive checking (similar to those with OCD). the content of the thoughts is often different than what we would observe in OCD.
What are Treatments for OCD-Related Disorders?
At FTPS, we work with many individuals presenting with BFRBs – often excoriation disorder as well as trichotillomania. Other BFRB presentations may include nail biting and teeth clenching. Treatment for trichotillomania (i.e., treatment for hair pulling) and treatment for excoriation disorder (i.e., treatment for skin picking ) share similarities.
Interventions are often based on Cognitive Behavioural Therapy treatment approaches. These include habit reversal training (HRT) and comprehensive behavioural treatment (ComB). The integration of tools from Acceptance and Commitment Therapy (ACT) and dialectical behaviour therapy (DBT) can also be helpful for individuals.
Some key features of treatment for hair pulling (i.e., treatment for trichotillomania) and treatment for skin picking include:
- Awareness training through logging and present moment awareness
- Learning about stimulus control or implementing barriers to engaging in the BFRBs
- Learning about the use of competing responses instead of BFRBs
- Understanding the sensory experiences an individual has when engaging in BFRBS and creating individualized approaches to manage the BFRB being reduced/eliminated
- Awareness of thoughts, feelings and behaviours related to the occurrence of the BFRB and challenging those thoughts
- Recognizing common environments (internal and external) in which BFRBs occur and changing those environments when possible
- Discussion of acceptance and tolerance of urges to engage in BFRBs and strategies to make space from these urges and not “give into them”
- Discussion of values and committed action – what is important to you and what would you be willing to make space for in terms of uncomfortable feelings in order to be able to reduce or eliminate the BFRB behaviours
- Learning distress tolerance strategies that can allow for you to more readily defer BFRB behaviours
How Can I Find OCD Therapy?
Does FTPS provide OCD therapy near me? We provide it throughout Ontario and BC, so please reach out to us if you live anywhere in those regions! We provide therapy for OCD for adults, teens, parents, families and couples. We also provide OCD therapy in both an individual and group format.
We also provide therapy for BFRBs, including treatment for skin picking and treatment for hair pulling (i.e., treatment for trichotillomania). Our team works with adolescents, teens and adults who are experiencing these types of symptoms.