Confronting Anxiety: The Power of Self-Compassion, Mindfulness, and Exposure and Response Prevention
By: Madeline Trenholm, MSW, LICSW
What do clients who struggle with OCD do? What does OCD treatment look like?
Self-Compassion
An introduction to OCD treatment consists of several coping skills that will prepare you to deal with your intrusive thoughts, shame, self-esteem, and self-doubt.
Often, people with OCD have thoughts that resemble their worst fears coming true.
But, OCD will attach to your worst fears and make you believe them.
The first part of treatment is to utilize mindful self-compassion in order to help you not be so hard on yourself. People struggling with OCD tend to believe “If I’m having this thought, it must mean I want it to happen” and then believe they must want it to happen. “I must be a horrible person, otherwise why am I thinking about this?”
But, OCD is ego-dystonic, meaning referring to thoughts and behaviors that are conflicting or dissonant with the needs and goals of the ego, or further, in conflict with a person’s ideal self. In other words, just because you think about it does not mean you want it to happen.
Mindfulness and OCD
The second part of coping is being able to work on being a mindful observer of your thoughts, emotions, and behaviors, especially when obsessions arise. According to nocd.org, “Mindfulness requires you to be aware of intrusive thoughts or triggers, accept and possibly internally analyze any discomforts caused by such thoughts and resist the urge to respond with compulsions. In both practices, you’re taking a deeper and longer look at your first reactions or thoughts and purposefully working not to respond to them. In mindfulness, this action takes your brain out of fight-or-flight mode and gives you the time and space to fully process, relax your mind and gain more control over your compulsions.”
Practices to help you create distance between you and your thoughts and asking yourself “is this a helpful thought?” or even labeling your thoughts as just that – thoughts – can allow you to not engage with them.
Another part of treatment is being aware of your obsessions and compulsions. After you experience an obsession, it is helpful to keep a log of what you tend to do after you have this thought. Do you avoid certain situations that make you anxious? Do you engage in any mental rituals to neutralize your thoughts? What other compulsions do you engage in to not feel the uncertainty of the focus of your obsessions? Not answering the question that OCD is posing is part of the key of OCD treatment. Compulsions seem to quell the anxiety, but actually prolong it in the long term.
Exposure Response Prevention (ERP)
inally you will create a plan with your therapist to engage in Exposure and Response Prevention treatment.
Exposure and Response Prevention is a specialized cognitive-behavioral therapy (CBT) technique designed to tackle anxiety disorders, particularly OCD. It is based on the principle that confronting one’s fears head-on can be a transformative experience. ERP consists of two key components:
- Exposure: This involves deliberately confronting the situations, thoughts, or objects that trigger anxiety. The therapist works with the individual to develop a hierarchy of feared stimuli, starting with less anxiety-provoking situations and progressing to more challenging ones.
- Response Prevention: Here, the individual refrains from engaging in their typical anxiety-driven responses or rituals. This is the crucial element that differentiates ERP from other forms of exposure therapy. By not engaging in their compulsions or avoidance behaviors, individuals learn that they can tolerate the distress and that their anxiety will naturally decrease over time.
This consists of creating an exposure hierarchy to help you pick real or imaginary scenarios to gradually expose you to your fears and then not engage in any compulsions to help reduce the anxiety. What this does is allowing your fear and anxiety to habituate. Habituation is the process of the brain being accustomed to a stimuli, allowing you to not feel such intense anxiety to a certain thought or experience. Although this might sound scary, this will help you to live the life you want, regardless of fear!
