Evidence-Based Therapy for OCD
What is Obsessive-Compulsive Disorder?
Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by persistent, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that individuals feel driven to perform. These obsessions and compulsions can significantly interfere with daily functioning and lead to psychosocial distress. Obsessions and compulsions driven by anxiety and atypical difficulty with uncertainty. Obsessive-Compulsive Disorder is maintained by ritualistic behavior, including mental rumination and avoidance.
The Obsessive-Compulsive Spectrum
OCD has several related disorders that can be thought of as part of an OCD spectrum. Although the disorder was formally given it’s own category and removed from the Anxiety Disorders section of the DSM (Diagnostic and Statistical Manual of Mental Disorders) in 2013, many experts consider anxiety disorders as existing along the OCD spectrum due to the prevalence of intense worries and fears often combined with compulsive reassurance seeking, difficulty with uncertainty, and avoidance behavior.
Some of OCD’s related conditions don’t necessarily include magical thoughts, anxious distress, or fears something bad may happen, but instead involve repetitive or ritualistic behavior. Body-Focused Repetitive Behaviors (BFRB), such as Trichotillomania and Excoriation Disorder fall into this category, as does compulsive overconsumption of digital media or what some call “internet addiction,” although not a formal diagnosis recognized in the DSM at this time.
Common Ways OCD Manifests
Common obsessions include fears of contamination, fears of harming oneself or others, fears of losing control or losing something of great importance, or worries about symmetry, orderliness, and bodily functions. Compulsions often manifest as repeated hand washing, checking behaviors, arranging items in a particular manner, avoidance, and mental rituals such as rumination, counting or praying in an excessive manner outside of a religion’s generally accepted norms.
What Causes OCD?
The exact cause of Obsessive-Compulsive Disorder is not fully understood, but at this time it is believed to be a combination of genetic, neurological, and environmental factors. Individuals may have a history of other mental health conditions like depression, which can exacerbate symptoms.
Effective Treatment for OCD
Treatment for OCD typically involves a combination of therapy and, in some cases, medication. Exposure and Response Prevention (ERP), a form of cognitive-behavioral therapy, is considered the gold standard for treating OCD. ERP helps individuals confront their fears in a controlled and therapeutic manner, decreasing the anxiety triggered by obsessions and reducing the need to engage in compulsive behaviors.
Recovery With Professional Help
If anxiety and compulsions cause distress and decrease your quality of life, it may be time for professional help. Obsessions and compulsions have a way of making our lives small and robbing us of deeper social relationships and experiences. Compulsive rituals and avoidance are short term solutions and over time serve to maintain and increase the discomfort we’re trying to avoid.
You might fear your loved ones will be harmed or you’ll lose something of deep importance to you. You might fear you’ll accidentally do something awful or that you’re a horrible, immoral person. You might try to get things just right, but it’s never enough. No matter how many times you do the ritual or avoid the thing or the place, the peace doesn’t last.
I (Teva) offer highly effective exposure-baed treatment tailored to meet the unique needs of each person struggling with OCD. I see clients in person primarily in Ventura, CA or via Telehealth for online therapy throughout the state. My compassionate approach helps you feel supported and understood as you work towards starting a new chapter.
Therapy can help with a range of common OCD presentations
Contamination
Religious scrupulosity, secular morals
Just right, perfectionism, symmetry
Sensorimotor, somatically-focused
Harm, taboo
Fear of going crazy
Health anxiety
Perinatal, postpartum
Relationships
Body-Focused Repetitive Behavior (BFRB)
Body-focused repetitive behavior (BFRB) refers to a distinct group of disorders that are characterized by the recurrent, compulsive behaviors that specifically target your own body. Some of the most common examples of BFRBs include hair pulling, known as trichotillomania, skin picking, which is referred to as excoriation disorder, and nail biting, technically called onychophagia.
Coping With Anxiety, Boredom, Stress
BFRBs often serve as a coping mechanism to manage underlying issues such as anxiety, stress, or other forms of emotional discomfort. Individuals experiencing BFRBs may find that engaging in these actions provides them with temporary relief or distraction from negative emotions, momentarily easing their psychological burden. However, over time, such actions can lead to significant physical, emotional, and social repercussions, including visible physical injury, heightened emotional distress, and impaired functioning in daily life.
Evidence-Based Treatment Options
Effective treatment options for BFRBs often include cognitive-behavioral strategies that emphasize understanding individual triggers and developing healthier coping mechanisms. Techniques like Habit Reversal Training (HRT) can assist individuals in recognizing their urges and developing competing responses that deter the unwanted behaviors. Additionally, mindfulness practices can also be quite beneficial, as they promote awareness of body sensations and emotions, allowing individuals to experience them without judgment.
Therapy can support managing BFRBs through personalized treatment plans that incorporate a variety of evidence-based practices tailored to your unique needs, along with planning for relapse prevention. As with any behavioral issue, early intervention combined with a supportive therapeutic environment can lead to more effective and favorable outcomes.
Trichotillomania
Trichotillomania, which is commonly known as hair pulling disorder, is a complex mental health condition characterized by an overwhelming and often irresistible urge to pull out one's hair, which ultimately leads to noticeable hair loss and significant emotional distress. This compulsive behavior can impact various areas of the body, including the scalp, eyebrows, and eyelashes, and frequently results in not only physical damage but also emotional challenges such as heightened anxiety and low self-esteem. Many individuals who struggle with this disorder experience temporary feelings of relief or gratification during the act of hair pulling, which can serve to perpetuate the cycle of behavior and make it increasingly difficult to stop.
Treatment for trichotillomania typically involves a combination of therapeutic approaches, including Cognitive Behavioral Therapy (CBT) and Habit Reversal Training, to aid individuals in managing their urges and developing healthier coping strategies that promote overall well-being.
FAQs
Do you have in person availability for therapy?
Yes, I have in person in availability in the beach town of Ventura, California, near Camarillo, Santa Barbara, Ojai, and Thousand Oaks. Online therapy is provided via HIPAA compliant Zoom and I see clients all over the state of California, including Los Angeles and the Bay Area.
What is your approach to treating OCD?
I use exposure and values-based modalities that have strong empirical support for recovery from OCD and specific phobia anxiety disorders. My approach centers client’s culture and sense of agency. I primarily utilize:
Exposure and Response/Ritual Prevention (ERP), a form of Cognitive Behavioral Therapy
Motivational Interviewing
Existential, meaning, and values-based principles combined with ERP
SPACE (Supportive Parenting for Anxious Childhood Emotions)
Is Exposure-based therapy trauma-informed?
Yes, the consent-based, gradual, and flexible nature of ERP where exposure pacing is determined by the client’s comfort level, may be suitable for clients with a trauma history. Current studies suggest OCD and PTSD may be treated concurrently using ERP and Prolonged Exposure (PE). Comorbid mental health disorders may also be treated sequentially. The American Psychological Association (APA) has designated Cognitive Behavioral Therapy and Exposure-based therapy as the first line treatment for trauma.
Will I have to engage in exposures that are against my religious beliefs?
No. As an ERP therapist who strives to practice cultural humility and cultural competence, I would not intentionally ask you to do anything that was against your religion or deeply held beliefs. Since treatment planning is collaborative, you will help design exposures aligned with your values. I work with many people of faith and respect the diverse beliefs and practices of my clients.
Can I keep my other therapist to process my childhood adversity or weekly challenges while in treatment with you for OCD?
Yes. You can keep your existing therapist to talk through weekly difficulties and to process other issues like developmental trauma and adverse childhood experiences, if you prefer. Please note, if you are using insurance to pay for therapy, you will need to check their policy on having two therapists. To provide the best care, I may request to consult with your other therapist about your treatment (with an appropriate release).
How many therapy sessions will I need for OCD recovery?
Recovery is a highly individualized process, so it’s not possible to quote an exact number of sessions. The length of time for a successful course of ERP treatment depends on variables like severity of symptoms, cooccurring mental health conditions, life stressors, commitment to change, how frequent you come to therapy, how much home practice you do outside of therapy, and our working alliance. Outside of research settings, ERP is generally 20-35 once or twice per week sessions. The number of sessions varies based on your needs and personal circumstances.
Do you see children and adults for treatment?
Yes. I treat child and teen anxiety, obsessive-compulsive spectrum disorders, and compulsive screen with evidence-based therapeutic modalities. I treat children and teens whose parents are able to commit to collaborative treatment.
“So even if the hot loneliness is there, and for 1.6 seconds we sit with that restlessness when yesterday we couldn't sit for even one, that's the journey of the warrior.”
— Pema Chodron
