Exposure and Response Prevention for OCD

I was recently hired as an “Exposure and Response Prevention Coach” (ERP Coach) at a psychological health center to help individuals with Obsessive Compulsive Disorder (OCD) overcome their thoughts, compulsions, fears, and anxiety, and I have had quite an awakening to what a complex and variable condition it is. As someone who has worked with people on the autism spectrum, I am quite familar with the phrase, “When you’ve met one person with autism, you’ve met one person with autism.” This means that while individuals with autism generally have similar underlying symptoms (e.g., resrictive and repetitive behaviors; fear of schedule change; social awkwardness, etc.), how these traits manifest is incredibly different from person to person. Now that I am working up close with OCD clients/patients, I find myself saying, “When you’ve met one person with OCD, you’ve met one person with OCD.”

While in school, I found that OCD was generally taught briefly in passing. We would learn about anxiety disorders, then get a slide or two on OCD, as it was once lumped under anxiety disorders in the previous DSM versions (in the DSM 5, OCD finally has its own section). This is a shame, as OCD is more common than autism (about 1 in 40 have OCD; 1 in 68 have autism), which gets far, far more attention.

So, because OCD doesn’t get much coverage, let me explain the condition quickly and how I help those with OCD as an ERP coach. OCD consists of obsessions, which are intrusive thoughts such as, “That guy shook my hand yesterday, and I think I heard him sneeze after, so if I don’t wash my hands before eating, I’ll get sick.” Compulsions are the behaviors that follow obsessions in order to relieve the anxiety, for example, “That guy shook my hand, I’m going to get sick..so now i’ll wash my hands.” Except the anxiety is only briefly relieved, the obsessions quickly come back, followed by the compulsions over and over until the individual feels satisified enough to continue on with his/her day (e.g., someone with OCD might wash their hands up to 100 times a day). This is a general explanation of OCD of course, and as mentioned, there are so many presentations and subtypes, but hopefully this basic premise makes sense (Perhaps remember Howard Hughes in “Aviator” washing his hands so much his skin was peeling).

As an ERP coach, my job is to spend about an hour with these individuals putting them in situations that resemble the situation they fear most. For instance, if they have fears about making mistakes, I will work on getting them to purposefully make mistakes (e.g., “two” spelled as “too”) while writing with a pen and challenging them to go on writing without ripping up the paper and starting over and living with the anxiety they feel. Individuals with OCD tend to seek assurance, so while it’s easy and instinctual to want to say something like, “Don’t worry, you’ll be okay,” it’s much better to be honest and say, “You might be okay, you might not; you have to trust yourself enough to get by dealing with uncertainty” (sidebar: this is a great way to talk to people without OCD, right?!). Being a coach has been very challenging as you have to know when to ease up, and when to push a bit more, while being compassionate enough to see that these individuals are suffering.

Okay, I’ve rambled enough. If you think you have OCD, or think someone else might, please look into it! People with OCD are often so ashamed and good at hiding their condition, they rarely seek help. Here are some books and links I’ve been reading:

Wikipedia: OCD

“The OCD Workbook

Imp of the Mind

Getting Control: Overcoming Your Obsessions and Compulsions