Acceptance (not approval) in OCD Treatment

This blog post might be tough to read. I hope you’ll stick with it until the end. It starts hard. But it finishes on a hopeful note.

I hope you’ll let me remind you of a fact that you already know:

Bad things happen in the world. 

It’s always been that way and it probably always will be. 

I’m not reminding you of this fact because I like to. I don’t like that bad things happen and reminding you of this isn’t fun. 

But healing from OCD requires a foundation of respect for the truth and honesty. And the truth is that the universe is not a perfectly safe place.

The Unyielding Nature of OCD

Those of us with OCD are constantly reminded (via our intrusive thoughts and obsessions) that bad things could happen to us (or the people and things we care about). When we become aware of bad things that might happen (usually via our intrusive thoughts), we become anxious. It hurts. We want to do something, anything, to keep the bad things from happening. So, we complete our compulsions. 

It’s true that, sometimes, after we complete a compulsion, we believe we’ve kept ourselves safe and get some momentary relief. But only for a short while. Then the intrusive thoughts and anxious feelings come back. And, deep down, we know, no matter how many compulsions we complete, we still can’t 100% guarantee safety.

Thus, our life fills up with more and more compulsions, taking more and more time. Our obsessions and compulsions interfere with our ability to focus. They cause us to avoid things we’d like to do. They often get in the way of our relationships. Because of these downsides, part of us wants to get over our OCD.

The Persuasiveness of OCD-Related Thoughts

But this is where our OCD-related thoughts can become very persuasive. These thoughts sound something like: 

“Listen, I know it’s really painful to have OCD. I know it takes up a lot of time. And I know you lose out on a lot of things in your life because of OCD. But, if you get rid of OCD, then the really, really bad things might happen. OCD is keeping you safe from those really, really bad things happening. So, even though life is hard for you now, isn’t it a worthwhile bargain to keep OCD around to prevent the really, really bad things from happening?”

That sort of message can feel very compelling.

The Missing Element: Willingness

In my private practice, almost all my clients have a very good understanding of what OCD is, how it works, and the rationale for exposure and response prevention treatment. 

And yet, some of my clients continue to complete the compulsions (and avoidance behaviors) and, thus, continue to struggle with OCD. 

What’s missing in these cases isn’t usually knowledge about OCD or OCD treatment. It’s willingness -- the willingness to challenge OCD. And the willingness to challenge OCD means a commitment to taking calculated risks. 

For most of us with OCD, the instant we think about not completing our compulsions, the OCD will begin telling us how risky it might be. If we don’t do our compulsions, bad things might happen in the outside world, like getting sick, hitting a pedestrian, stabbing someone, or leaving the stove on. If we don’t do our compulsions, bad things might happen within our internal world, like getting stuck with unwanted, distracting thoughts and painful, anxious feelings for a long time. Maybe forever. 

Are these events likely? No. Are they possible? Yes. 

So, if we’re serious about overcoming our OCD, we must accept that, however unlikely, bad things might happen and then not complete our compulsions (or avoidance behaviors) anyways.

Embracing the Challenge

Why might we be willing to feel so uncomfortable and take this risk?

There could be many reasons. But one of the most important is usually this: If we don’t challenge our OCD, then there’s a very high likelihood we might live our entire lives being controlled by OCD. 

Research has shown that OCD almost never goes away on its own. So, if we don’t challenge our OCD, it’s likely here for good and we’ll live our entire lives being controlled by it. Even if we’re fortunate enough to live a long life, is it really right to call that “living”? Is it really right that trudging through each day, dominated by fear, gathering the crumbs of relief that our compulsions give us, is “living”? 

I’d call that surviving at best. And “torture” often feels like a better description. And who would want to get to the end of their life, look back, and realize “Oh my goodness, I never really got a chance to live. I just survived day by day, spending most my time worrying, analyzing, ruminating, checking, and being terrified. I spent most of my life controlled by OCD.” 

The Alternative Path

So, what’s the alternative?

To accept (but not like or enjoy) that bad things might happen to us (or the people and things we love) and really lean into our OCD treatment anyways.

Yes, it’s true that bad things might happen if we don’t do our compulsions. But it’s also true that bad things might happen even if we do complete our compulsions. And at least one bad things has already happened: We’ve been afflicted with OCD!

If the bad things might happen anyways, let’s control what we can control, and that’s this:

We don’t have to complete our compulsions even though our thoughts and feelings are screaming at us to. It’s really hard at first. But, with time and practice, this gets easier and easier. All of my clients who reach remission from OCD tell me something very similar. They say something like, “ERP treatment was hard. I wanted to heal from the OCD instantly and easily. ERP wasn’t either of those two things. But I trusted the process and kept going and, just like you said it probably would, things got a lot easier over time and now I’m so much better.”