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Key points
- Those with OCD often face uncertainty, setbacks, and plateaus throughout treatment.
- Some of the issues those with OCD face in treatment arise for the first time only after significant treatment progress is made.
- Awareness of OCD’s trickery in the end-game can help individuals stay committed to treatment and fully achieve their recovery goals.
The gold standard therapy for OCD is exposure and response prevention (ERP) – a treatment designed to reduce avoidance and rituals as a means of coping with distressing triggers. This involves going into situations that cause anxiety (exposure) without resorting to compulsions (response prevention).
A typical course of therapy will involve 10-20 sessions of graduated ERP, beginning with easier targets and progressing to more difficult ones.
Treatment results depend on completeness. When individuals go all the way with ERP and hit all, or at least most, of their targets, they achieve remission. Remission leads to recovery when progress is sustained long-term (for one year according to expert consensus).
However, going all the way is no simple feat. Those with lived experience understand that OCD can be a disorder of many tricks and traps. Just when you are hitting your stride and finding sustained relief, OCD can make you feel like Michael Corleone: “Just when I thought I was out, they pull me back in!”
Ironically, achieving new heights in therapy can introduce challenges to one's recovery goal because OCD exploits unfamiliar territory to bait sufferers in new ways. Here are three common traps that OCD uses to tempt relapse in the homestretch—to reengage people in rituals when they are almost at the finish line. Being aware and alert to these temptations and rationalizations will help individuals achieve long-term recovery from OCD.
1. The clarity trap: Your mind is so clear. There must be something wrong.
The most ironic trap that OCD sets is to turn progress into a concern. When ERP reaches a threshold of relief, sufferers may experience a clear mind for the first time in ages. Imagine what it might be like to battle unrelenting intrusive thoughts for years or decades and then suddenly notice that the thoughts are gone. The stillness can be kind of strange. Not bad strange, just new. But that’s all that OCD needs to set the clarity trap: Why is your mind so clear? Is this normal? There must be something wrong.
Solution: If this happens to you, recognize it for what it is: A new source of uncertainty causing a desire for reassurance. Don’t give in. This is just another opportunity for ERP. Lean into it. Let your mind entertain uncomfortable possibilities without performing rituals. Tell yourself: Maybe my mind will go blank or stop working. I can’t control it, so I’ll accept it and stick to the ERP plan.
2. The cheat-meal trap: You’re doing so well; you deserve a comforting ritual every now and then.
ERP is hard work. Anyone who commits to this therapy should feel proud of any progress they make. Pat yourself on the back and treat yourself to a reward. However, be careful about the cheat-meal trap. This occurs when OCD suggests that a little dose of reassurance is deserved, like a cheat meal on a diet.
Although ERP and diet goals have certain similarities, they are also different in important ways. A planned cheat meal can facilitate goal attainment by giving dieters a welcomed break. However, cheating with rituals has a tendency to undermine OCD-recovery goals. Rather than providing a restorative release from self-restraint, a cheat ritual functions more like a loose thread that unravels.
This is because rituals tend to open new concerns rather than resolve old ones. The problem isn’t slipping up or reaching an emotional limit during an ERP session and taking a break. Rather, it is the rationalizing that a ritual can be good to hold on to in small doses.
Setbacks and plateaus are virtually guaranteed in any course of ERP, and one should not judge oneself when this occurs. But one should remain resilient to the tempting rationalization that progress merits rituals.
Solution. Memorize the phrase treat, not cheat. Treat yourself to something special. You deserve to celebrate what you’ve achieved. Just don’t make it a ritual.
3. The functionality trap: You are functioning normally now; time to stop.
A major focus of ERP is to restore the functioning that OCD has taken, whether it’s academic and career success, satisfaction in one's relationships, or just personal happiness. Functional disturbances range widely from mild (e.g., washing rituals causing tardiness at work) to severe (e.g., being unable to leave the house for fear of contamination).
Restoring function is usually the impetus for seeking therapy and doing ERP. It is, therefore, quite natural that as a client progresses and achieves all of their functionality goals, OCD would exploit the progress to set a new trap by suggesting that they've done enough.
In truth, restoring functionality is necessary but sometimes insufficient to achieve clinical recovery. Individuals who stop with a few rituals left over are more likely to relapse than those who go all the way. Why? Because it keeps the internal OCD framework alive just enough to develop into a more sticky problem as new life challenges arise.
Solution. One hundred percent ERP is better than 95. After everything that you’ve accomplished, it is likely that the last compulsive remnants are not going to be overwhelming challenges. You already know what to do, and you’ve already sidestepped one OCD trap after another. Think about it: What is the benefit of stopping now and sparing yourself a small amount of discomfort when this increases the risk of relapse weeks or months down the road?
It’s true that some people do well at 80-95 percent remission and sustain that for a long time. But when 100% is attainable, you might as well go for it and prove to yourself that you can shut down OCD completely.
