The 5-Step OCD Recovery Primer
I’ve been wanting to put something like this together for a long time - basically a “primer” on key topics that everyone should read and understand as they go through their OCD recovery journey. This is not meant to be an exhaustive and fully detailed recovery plan, but more of a rough outline covering the key topics and steps along the way. I’ve created the 5-Step Primer below, with links to other blog posts I’ve written on the various topics, which will help keep things organized and direct you to the most relevant topics. Use this as a resource to help structure your own personal recovery plan and/or to help supplement any formal therapy you are receiving from a licensed mental health professional. As a disclaimer, I am not a certified psychologist or psychiatrist, but I believe this 5-Step Primer will be helpful for anyone going through the OCD recovery journey.
Can ERP Become a Compulsion?
I was inspired to write this blog post based on a conversation I had with someone about ERP, particularly when it comes to forcing yourself to face triggers/exposures (the “Exposure” part of ERP) so that you can then practice eliminating the compulsions tied to those triggers (the “Response Prevention” part of ERP). When first starting therapy and practicing ERP, this is a pretty typical exercise. You sit down, identify your triggers (sometimes ranking them in a hierarchy from “most” to “least” triggering), identify the compulsions you would typically perform in response to those triggers, and then try purposefully putting yourself into exposure situations so that you can work on preventing those compulsions.
Do You Need a Therapist?
A question that I see commonly asked on OCD help forums and social media communities is: do I need a therapist to recover from OCD? Whether due to the cost of treatment, availability (or lack thereof) of qualified professionals, or even the perceived social stigma of “having to get help for a mental illness,” many people seem reluctant or unable to get a therapist to help them recover from OCD. Hence the question - is a therapist really required?
It’s a bit of a complicated topic, which is why I wanted to dedicate a blog post to it. No, a therapist is definitely not required. Many people (including myself!) have recovered from OCD without seeing a therapist. Can a good therapist be helpful and beneficial on your OCD recovery journey? Absolutely, and if you can find a knowledgeable and qualified professional, they are worth their weight in gold. But - and here is a big caveat - seeing an unqualified therapist, or someone who is not specialized in treating OCD, can actually make your disorder worse - so be very careful when selecting a professional for treatment.
Recovery is an Action
A common question that I see from OCD sufferers is: “How long will it take before I achieve recovery? How long do I need to practice ERP/ACT before I consider myself recovered?”
My (somewhat cheeky) answer is: you can be recovered now! Recovery is a choice that we make; it is an action that we do. We can choose to do compulsions, or we can choose to spend our time and energy focused on value added actions. One choice takes us deeper into OCD, and the other choice towards the path to recovery.
The “Mission Accomplished” Fallacy
The title of today’s blog post comes from the (now infamous) speech that former US President George W. Bush gave on May 1, 2003, declaring the end of major combat operations in Iraq whilst a giant “Mission Accomplished” banner was displayed proudly in the background. Looking back in hindsight, this was a major gaffe as the United States’ involvement in Iraq would drag on for nearly another decade, with thousands of more deaths, both soldier and civilian. Declaring that the job was done so prematurely ended up aging incredibly poorly in retrospect.
What does this have to do with OCD recovery? It relates to the tendency that some people have to abandon their ERP and ACT work once they start feeling better, without necessarily having fully recovered from OCD.
How to Practice ERP - Stairsteps Model
I’m not sure if the “Stairsteps Model” is an officially recognized term used by therapists when it comes to practicing Exposure Response Prevention (ERP), but it’s how I like to term the process of gradual overload - that is, over time, gradually exposing yourself to heavier and more stressful triggers so your brain can learn to better handle OCD triggers and improve your mental capacity.
I believe that when OCD sufferers first start out with ERP, they often believe two major fallacies:
1) ERP MUST be an all-or-nothing approach - either I do 0 compulsions (SUCCESS) or I do compulsions (FAIL)
2) I have to tackle my biggest, worst triggers and fears first - if I’m not practicing ERP on a trigger that is a 10/10 on my anxiety scale, then I’m not doing ERP right
Both of these assumptions are FALSE and will actually harm your ERP progression (and hence, OCD recovery) more than they will help. Let’s explore, shall we?
Graphing my OCD Recovery with Data
One question that I often see from OCD sufferers is: “How long will it take me to recover? What does the journey to OCD recovery look like?” So I thought that it would be helpful for readers of my blog to explain my own OCD recovery journey, the process, and some of my key learnings on the way.
I am a data junkie. I process and analyze lots of data as part of my day job. When I’m training for marathons, I analyze information about my heart rate and mile splits. So a more data-driven approach to OCD recovery felt natural to me, because I could hold myself accountable to actual results, and also be able to understand any underlying trends or patterns about how my progress was going.
Before going further - I want to set the disclaimer that this was my own recovery journey, and what worked for me personally. Even if the underlying principles of OCD recovery (e.g. ERP) are the same for everyone, your own personal recovery journey might look different. Some exceptional people might recover in 1 or 2 months of dedicated ERP. Some people may take longer. As you can see from my chart below, it took me approximately 5 months. I say this because I don’t want to discourage anyone if they feel like they are making progress too slowly - OCD recovery can and will differ from person to person. If someone says, “I recovered in a month!” and you’ve been struggling with ERP for a year, don’t assume that you are doing something wrong or feel discouraged. OCD recovery is highly personal to each individual and you shouldn’t benchmark your own progress against someone else’s. No matter what, you should trust in the process and trust that a dedicated CBT regimen like ERP or ACT will help you recover, no matter how long it takes.