The sticky brain filter in OCD
OCD can be hard to explain to people, but the author Natasha Daniels shares a really helpful and clear illustration of OCD as a stuck filter in her excellent Crushing OCD Workbook for Kids. To expand on her illustration, every day we all have thousands of thoughts. A great many of these thoughts are senseless, meaningless and sometimes strange. When driving through town and hitting a small pothole we may briefly think “what if that was a person”, or when cutting vegetables at home, “I could easily stab someone in my family with this knife”. For someone without OCD, these thoughts briefly come into our awareness, pass through our brain’s filtering whose job it is to figure out which thoughts are important ones that we need to attend to, get marked by the filter as unimportant, and then pass out of awareness and we move on with whatever we happen to be doing at that time. However, for someone with OCD these thoughts can get stuck in the filter.
How Does Exposure Response Prevention (ERP/ExRP) for OCD Work?
One of the really frustrating things about living with OCD is that the ways we try to cope with having OCD tend to become the compulsions that make OCD worse. In order words, we struggle to deal with obsessive thoughts that cause anxiety, such as a fear that touching things will make us sick (contamination type OCD), or the uncertainty about whether we might be going to hell (scrupulosity type OCD), or the fear that maybe we hurt someone in the past (harm type OCD). Then we come up with creative ways to deal with the intense fears and uncertainty, like washing our hands after touching something, or saying repeated prayers, or seeking reassurance about our past behavior. But it is exactly those creative ideas that become the compulsions that take up increasing effort and time in our lives, and which edge out more and more of the things that give us pleasure. Also trying to avoid the kinds of experiences that trigger our fears can gradually make our lives smaller. Going to therapy with people who are untrained in working with OCD can also make OCD worse since well-meaning therapists will teach coping skills, offer reassurance, or help analyze and reality-test past experiences using methods like Cognitive Behavioral Therapy (CBT), but those actions can also worsen compulsions or become compulsions themselves.
Understanding OCD
Over the past few years with the increasing popularization of mental health therapy, many therapy terms have entered common language. This has had a positive effect in many ways with the increasing normalization of self-care and healthy boundaries. However, there has also been increasing confusion, such as in the dilution of the meaning of serious mental health conditions, over self-diagnosis of these conditions, and resulting confusion in what these conditions actually are and the extent to which people suffer from them (consider the many articles that start with “I cured my depression by…”, which make major depressive disorder sound a lot less serious and easier to recover from than it actually is).