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OCD Treatment Options: Which is the Best?

Recovery isn't one size fits all.

Escrito por James Taglienti

OCD Treatment Options: Which is the Best?

01 James has struggled with OCD themes like suicide and existentialism.

02 After working with three types of treatment — mindfulness, ERP, and ACT — he shares his experiences and how effective each was for his particular themes.

As a general matter, OCD can be broken down into a simple thought pattern: a person has an intrusive thought, the thought produces intense anxiety, and the person engages in checking and controlling behaviors to help reduce the anxiety. 

If you enter OCD treatment with the intention of “controlling” your anxiety or “curing” your OCD, then treatment will become compulsive. Therefore, the goal of treatment should be how to live a meaningful life according to your values despite all of the horrible thoughts in your head. 

1. MINDFULNESS

Mindfulness is the practice of bringing your focus and attention to the present moment. It helps prevent OCD sufferers from ruminating on the past and the future – something we’re great at. And constant rumination is a compulsion that is commonly overlooked.

The most common mindfulness practice is meditation. My favorite meditation practice is the body scan. I light an incense, set a timer for how long I want to meditate, and sit still. During my meditation, I focus on my breath, my five senses, and most importantly, how each part of my body feels. What do my feet feel like on the ground? Are my shoulders set forwards or backwards? This practice actively forces my mind to concentrate on the present instead of ruminating on my intrusive thoughts

You can practice mindfulness anywhere. For example, when you’re driving, how does your foot feel on the gas pedal? What color is the car in front of you? How does the music on the radio sound? Actively engaging with the present forces us out of our minds and into the world.

Mindfulness has been extremely effective for me. It shows me that thoughts are fleeting, and constant rumination is what makes OCD worse because it gives the thoughts power. Mindfulness is especially helpful for Suicidal OCD. I could choose to ruminate on the multiple ways to kill myself or whether I am clinically depressed. Or I can bring myself to the present and actively engage with my surroundings. The latter is more beneficial for my overall mental health and well-being.

2. EXPOSURE RESPONSE PREVENTION

ERP. This is something that we hear the OCD community discuss over and over again. It is the “gold standard” of treatment. However, in my own experiences, I haven’t found ERP to be effective in isolation. And certainly not for existential and suicidal OCD. 

ERP is the practice of exposing yourself to your intrusive thoughts and actively making the choice not to engage in the compulsive behavior associated with them. For my suicidal OCD treatment, my ERP looked like this: I would write the phrase “I want to kill myself.” Then, I would follow up with “since I want to kill myself, I need to make a plan” and so on. The goal was to prevent myself from ruminating on the questions while sitting with the anxiety of writing them. 

Although it was somewhat helpful, it didn’t truly help me live effectively with my existential and suicidal thoughts. ERP became a compulsion. If I did my ERP, then I would be cured! Or if I wrote enough of these statements, then I would be able to control my anxiety. Therefore, I would say that although ERP is a useful tool for most people, it was not effective for me.

3. ACCEPTANCE AND COMMITMENT THERAPY

Acceptance and Commitment Therapy or ACT is the practice of accepting the presence of our thoughts, and instead of acting on those thoughts, actively committing to behavior that is in line with our values. 

Before practicing this therapy, you have to write down your core values. And if you don’t have any values that you can think of, you can borrow some from other people that you admire. Some of my values are “supporting myself,” “getting a legal education,” and “physical health/fitness.” For example, if I have the intrusive thought, “I should drop out of law school,” I accept the thought for what it is — a thought — but act according to my value of getting a legal education. This practice can work with any of your values.

In my opinion, ACT is the gold standard for not only OCD treatment, but also for anyone seeking to practice positive mental health. OCD makes us think that all of our thoughts are true. Since we thought it, it must mean something. This isn’t the case. Thoughts come from our lived experience, including associations and patterns that our brains have created. There is nothing unique about a thought and it says nothing about your character. 

As a sufferer of OCD, my brain is going to constantly present new intrusive thoughts. However, if I make the choice to “ACT” according to my values, then I show my brain that it does not have the power. 

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Overall, my recommendation is to try different approaches and see what works best for you. Each method has their own benefits, so keep an open mind. And remember, we are all on this journey of healing together, so don’t be afraid to reach out and ask other people about their experiences.

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