Elizabeth Ellis Ohr, Psy.D. is a licensed psychologist who practices evidence based treatment for anxiety disorders.
Are you really so OCD?
Obsessive Compulsive Disorder (OCD) is referred to often in order to explain someone that is either neat and orderly or particular about a certain aspect of their life. Individuals with a diagnoses of OCD know that the disorder is much more than wanting to have your house look a certain way or liking your clothes organized in the closet.
People with OCD suffer with for significant periods of time during the day with thoughts, images or impulses that are scary and upsetting. These images, don’t quite fit with their personality or reflect anything that they actually wish to happen, however, the mere presence of the thought is strong enough to invoke fear that what they are thinking about may actually happen. In response to the thought, individuals with OCD then engage in behaviors or mental tricks to avoid the thought and attempt to push away the fear associated with the thought. These behaviors or mental tricks, also known as compulsions or rituals, cause distress, interfere with work, family, and friends, and take up a large portion of time.
OCD is commonly portrayed as someone fearing germs, liking things neat, and washing their hands. Sometimes OCD does look that way, however, most of the time people with OCD have thoughts that can be very disturbing and compulsions can go far beyond hand washing.
Luckily, there are effective treatments for OCD, such as medication and Exposure and Response Prevention Therapy. Medications typically include Selective Serotonin Reuptake Inhibitors. Exposure and Response Prevention (EX/RP) is a therapy aimed at addressing the fears in a way the person feels they can tolerate without the need for compulsions. EX/RP is often a time limited therapy (15-20 sessions) aimed at making the client an expert in anxiety. Clients typically get relief early on in treatment and the positive effects of treatment are long term.
For more information on effective treatment for OCD, questions to ask potential providers and strategies to get reimbursed by insurance visit iocdf.org.
When is anxiety considered a disorder?
Anxiety is a completely normal part of our experience. We all worry from time to time (some more than others). So when does anxiety become a disorder?
Usually if it is getting in the way of social, school, work, or family functioning and is taking up a significant portion of time it may be considered an anxiety disorder.
Anxiety disorder sufferers have a tendency to view the world as a dangerous place and fear they may be unable to cope when difficultly arises. Anxiety disorders are maintained through behavioral patterns of avoidance and through safety signals or behaviors.
1. Avoidance
Anxiety tells its sufferers to avoid realistically safe situations that are perceived as dangerous. By avoiding safe situations sufferers fail to learn the thing they fear is unlikely to occur. Avoidance also maintains beliefs that the sufferer is not able to cope with difficult situations. Chances are they've already handled some difficult situations successfully. By ceasing to avoid, suffers can learn that they are capable of handling situations that realistically have a low probability of occurring.
2. Safety behaviors
Anxiety sufferers have a tendency to develop behaviors to make them feel more secure in challenging situations. The difficulty with some of the behaviors is that why may not necessarily add to safety and they reinforce messages about a perceived dangerous world and ones ability to cope. Safety behaviors prevent an individual from taking in information that disconfirms their fear.
By decreasing avoidance and safety behaviors anxiety sufferers can learn that things they are afraid of are unlikely and they can handle difficult situations despite the fear that they may not be able to.
How I became a exposure therapist
Featured in national Psychologist May 2019
When I first heard about exposure therapy I was sitting on a bench with a mentor who told me that her son had a needle phobia. She described the therapist showing pictures and watching of needles videos of needles. I thought it sounded cruel.
Some time later, I was heading in the same direction as a fellow psychologist. He was not sure where to go, I walked with him leading him in the right direction. He practiced exposure therapy and offered for me to attend a training. A year later, I touched base with him to see if the offer still stood. I attended the Prolonged Exposure Therapy training at the Center for the Treatment and Center of Anxiety at the University of Pennsylvania. It seemed daunting. I asked to volunteer and treat patients so I could learn the treatment. My request was generously accepted.
I videotaped every session which were subsequently viewed by all psychologists in group supervision the CTSA clinic. I made mistakes. I was corrected. I was thrilled that my clients were getting better and I still felt a potential for failure. While I received a lot of constructive criticism, it was criticism nonetheless. I was sure they would tell me to stop volunteering there and I would soon no longer be welcomed. Staying true to the principles of exposure therapy, I decided to keep going until my feared outcome happened. A week later, I was offered a job.
CTSA trained me in exposure therapy. I learned how to treat all anxiety disorders, including exposure and response prevention therapy for OCD. I received extensive amounts of supervision. I learned how to successfully treat individuals because I took a chance and took an opportunity that was offered and I kept going despite a fear of failure. That is exactly what I ask my clients to do.