What is OCD Treatment Like? An Interview With a Client.
If you google “OCD treatment,” you’ll find a lot of articles about the diagnosis, but it’s hard to find information about what treatment feels like. So let one of my awesome clients tell you about it! Meet Carleigh: she’s an incredible exposure therapy champion who generously agreed to share her experience with OCD treatment. She’s made incredible progress in therapy, and I think she’s an inspiring example of how much anxiety can improve when you commit to treatment.
*Disclaimer: I think this goes without saying, but Carleigh consented to share her information in this blog. *
In case you’re unfamiliar with the OCD diagnosis I’ll give you a quick explanation: OCD is an anxiety disorder marked by patterns of obsessive thoughts and compulsive rituals. Carleigh experiences a lot of contamination based and harm OCD. This means she gets intrusive thoughts about getting sick and dying from touching a contaminated object. She also gets intrusive thoughts about accidentally harming someone she loves. Obsessions function as people's worst fears, which is why they cause such extreme anxiety. Compulsions include behaviors like washing hands or following specific routines.
Take a look at this page if you want a detailed description of the anxiety cycle everyone with OCD gets trapped in. The only treatment for OCD is Exposure with Response Prevention (ERP or exposure therapy for short). ERP is the process of gradually exposing yourself to feared stimuli without using compulsive rituals. It sounds terrifying at first, but as Carleigh will explain, it’s actually pretty awesome.
*I have edited the interview for clarity*
Kelsey: Were you born anxious?
Carleigh: My family said I’ve always been really high strung. As long as I can remember, I’ve been concerned with doing things the exact right way… One of my earliest memories is hiding under a table and crying because I got an 89 on my report card!
Kelsey: When did you first notice your OCD?
Carleigh: I didn’t know what it was until college. The earliest (event) I can remember was in junior high. I had a pre test-taking routine. I thought, “if I don’t do my routine, I’m going to fail the test, drop out of school, and live under a bridge.”
Kelsey: What is the difference between going to a therapist who knows OCD and one who doesn’t?
Carleigh: It’s really frustrating to deal with any mental health professional who doesn’t understand OCD. I think it’s still very misunderstood. They see anxiety and try to treat it through distraction or coping skills. The only way to treat OCD is exposure therapy. Even a really great therapist won’t be able to help you if they don’t do exposure therapy. You need someone to hold you accountable, but also walk you through exposures. I had no idea what to do.
Kelsey: How did you find your therapist? (me!)
Carleigh: Online. I’m obviously a little neurotic, so I spent a month researching therapists in my area!
Kelsey: What were some of your fears about starting treatment?
- I’m going to hate my therapist.
- She’s going to think I’m absolutely insane.
- I am never going to open up to her because the crap inside of my head is too crazy for anyone to deal with.
- I’m unfixable.
- they’re going to hospitalize me.
Kelsey: If those were your 5 things, what was your first session like? You must have been pretty anxious when you first came in.
Carleigh: I was. I tried to be open and blunt. I won’t lie and say I liked it. I didn’t want to be there. But it wasn’t as painful as I thought. Because you didn’t look at me like I was insane. It was nice to be able to say that I have all these thoughts, like about killing people or germs invading my body and eating me from the inside out - you know, normal things! And you just said, “yeah, of course! That’s totally normal!” So that helped.
Kelsey: What was it like having your experience validated and told your thoughts are common for OCD?
Carleigh: Amazing! I thought, “I’m not actually crazy! There’s something chemically wrong and I’m not the only person who has this!” You hear that a lot of people suffer from OCD and that it’s common, but [it doesn’t feel common] when you’re dealing with it.
Kelsey: What did you think about ERP when I presented it to you?
Carleigh: I thought you were crazy! In order to make me less anxious about touching handrails, you want me to go touch more handrails!? But I obviously wasn’t getting anywhere with my own way of coping, so I did it. And at first I hated it, but of course, you feel better and can feel your anxiety lowering. And I thought, “wow, this bitch isn’t crazy!”
Kelsey: Is it accurate to say that the idea of doing an exposure is worse than actually doing it?
Kelsey: After explaining the treatment to people, I usually have to say “I promise you, it’s not as hard as it sounds.”
Carleigh: Yeah, because when you hear “I want you to touch that handrail,” your mind doesn’t hear “I want you to touch that handrail.” Your mind hears, “I want you to catch every STD on the planet that every person who has ever touched that handrail had. And then I want you to die from it. Can you do that?”
Kelsey: That’s a great example! It’s really important to note that OCD can feel just as real as if someone actually held a gun to your head. But at the same time, you know it doesn’t make sense.
Carleigh: That’s the most frustrating part about OCD. I know logically that I am not about to reach across my car and murder my boyfriend. There’s no way that could happen. But everything in my body is telling me that’s what’s happening. Every signal I’m getting is saying, “you’re about to do this, you have to stop it!” It’s not rational.
Kelsey: When did you realize ERP was helpful?
Carleigh: The first realization I had was, after doing a lot of work on handrail exposures (touching public handrails without washing my hands), I left my apartment and unintentionally touched the handrail. And I thought, “that didn’t feel so bad.” I didn’t think it was going to kill me. As you sit with exposures, you can physically feel your chest un-tighten, stomach unknot and muscles relax. So my big realization came when I was sitting in your office and I could physically feel my anxiety lower. So feeling that was like, “oh shit! this is working!”
Kelsey: Can you describe what you actually do during an exposure? A really common thing you’ll hear in therapy is “just sit with it.” Which really doesn’t mean anything to anyone who isn’t a therapist. So can you explain what it means for you to sit with your anxiety?
Carleigh: I breathe deeply with my eyes closed. I have to sit with my feet on the ground and my hands beside me because one of my compulsions is fidgeting. So I have to stop myself from doing that. And then I check in with various points of my body. [Carleigh described a mindfulness exercise in which she moves her attention back and forth from the sensation of anxiety to other physical sensations in her body]. On average, it takes me 5-10 minutes for my anxiety to return to baseline.
Kelsey: What do you wish you had known about OCD treatment before you started?
Carleigh: That I was doing it wrong the whole time! I wish I hadn’t wasted time in college while I was developing my OCD by not doing ERP. My life is so much better than before I came to you.
Kelsey: If someone told you they were seeking treatment for their OCD, what would you tell them?
Carleigh: Great! Make sure your therapist knows how to treat OCD. And do everything they say. And don’t lie to them! Anything you think you need to keep to yourself because it’s too crazy, just know they’ve heard worse. They’ve always heard worse. You can’t shock them. And if you do, bravo! Also, if you feel like you’re having trouble with your treatment, be honest about it.
Kelsey: What’s your advice for success in exposure therapy?
Carleigh: You HAVE to schedule it. If I don’t schedule it, I won’t do it. So put it on your calendar and set aside time to complete exposures every week. And sometimes I will also schedule self-care for afterward. Like if I have a really intense exposure, I might be totally exhausted after. So having a plan for taking care of myself really helps.
Kelsey: There are some people who get their OCD to a place where they don’t notice it. But more often than not, people come to a peaceful acceptance with OCD where it stops creating problems in their lives. Hearing this, people sometimes think, “Is ERP worth it?”
Carleigh: Absolutely! I am still dealing with OCD. And it’s not going to just go away. But OCD isn’t always a bad thing! It’s really helped me sometimes. I don’t want to sound cliche, but my apartment is CLEAN AS HECK! Always! My office is organized to a T - which my boss loves. I found a job that really works for me because it is so structured and everything has to be done in a particular way. I’m able to use my OCD as a strength to be great at that job. And it helps me accept something that I don’t always like as a part of myself. I like that a lot.
When I first came here, I had dropped out of law school and was living with my parents. I was basically on suicide watch all the time. I was horribly depressed. I couldn’t function because my obsessions took over my life. And now, I have a great job I love and my own apartment. Most of my obsessions just mildly annoy me now. I have to do a lot of maintenance to make sure I don’t fall into old habits, but I’m way better off. I’m much less anxious. It used to be that if I went to the gas station and didn’t use hand sanitizer, I would spend the rest of the day fearing I was going to die. It was all I could think about. And now, it’s so much better. It’s insane how different my life is since coming here. I still get OCD thoughts, but now I just move on from them.
Kelsey: What do you wish the general public understood about OCD?
Carleigh: I wish people knew that it’s a serious thing. And those of us who are living with it are really kicking butt! Because it’s really hard to live with your mind turning against you. And I think there are a lot of people out there who no one knows has OCD. No one at my work knows I have OCD. I want [people] to realize I am not a crazy person, but I am struggling with something. And that deserves respect.
I love working with Carleigh. As hopeless as she felt when I first met her, she really just needed to learn a few tools for managing her OCD. Once she got the hang of ERP, she made rapid progress. I hope her story helped answer some questions about what exposure therapy really feels like.
Do you have questions about OCD or exposure therapy? Let me know in the comments!