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There is little awareness of evidence-based treatment around OCD for practitioners outside of the OCD community, so it is so important to see an OCD specialist who is trained in ERP. Therapies that might be useful for other conditions, such as trauma therapy, EMDR, hypnotherapy, talk therapy, and psychotherapy are not recommended for OCD and can actually make the condition worse.

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According to the IOCDF, the Exposure in ERP refers to exposing yourself to the thoughts, images, objects and situations that make you anxious and/or start your obsessions. While the Response Prevention part of ERP, refers to making a choice not to do a compulsive behavior once the anxiety or obsessions have been “triggered.” Many therapists also combine ERP with Acceptance and Commitment Therapy (ACT), as individuals seek to live into their values. In addition, there are specific medications prescribed by a specialist that can enhance and supplement treatment.

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Obsessive-Compulsive Disorder is characterized by obsessions, which are repeated, unwanted intrusive thoughts...and compulsions, which are behaviors aimed at reducing the discomfort associated with these thoughts. Common obsessions can relate to contamination, health, harm, hyper-responsibility, false memories, religious scrupulosity, moral scrupulosity, relationships, sexuality, and beyond. There are thousands of compulsions (both physical and mental) to alleviate the stress associated with whatever the current obsession is, such as checking, avoidance, mental review, counting, reassurance-seeking, and beyond.

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Obsessions and compulsions look very different for each person, and many do not experience the cute and helpful types you see in movies and TV shows. Rather, most individuals experience unique, taboo obsessions...as OCD tends to latch onto the things that are most important to each person. And yet, the obsessions are fundamentally imaginary. You can trust OCD obsessions about as much as you can trust filters and lenses on snapchat!

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As much as a person with OCD knows their obsessions are irrational deep down, they crave absolute certainty about all situations. The high level of insight around this irrationality paired with the seeming inability to stop carrying out compulsions makes the disorder that much more painful. These books can help encourage you to accept the uncertainty through ERP while choosing to live your life with joy.

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Think of your anxiety as an alarm system. If an alarm goes off, what does it mean? The alarm is there to get your attention. If an intruder is trying to break into your house, the alarm goes off, wakes you up, gets you to act. To do something. To protect yourself and your family. But, what if the alarm system went off when a bird landed on the roof instead? Your body would respond to that alarm the same way it would if there were an actual threat such as an intruder.

OCD takes over your body's alarm system, a system that should be there to protect you. But instead of only warning you of real danger, that alarm system begins to respond to any trigger (no matter how small) as an absolute, terrifying, catastrophic threat.

When your anxiety "goes off" like an alarm system, it communicates information that you in danger, rather than "pay attention, you might be in danger."

Unfortunately, with OCD, your brain tells you that you are in danger a lot, even in situations where you "know" that there is a very small likelihood that something bad might happen. This is one of the cruelest parts of this disorder.

Now consider that your compulsive behaviors are your attempts to keep yourself safe when that alarm goes off. But, what does that mean you are telling your brain when you engage in these behaviors? You are reinforcing the brain's idea that you must be in danger. A bird on the roof is the same as a real intruder breaking into your home.

In other words, your compulsive behavior fuels that part of your brain that gives out these many unwarranted alarm signals. The bottom line is that in order to reduce your anxiety and your obsessions, you have to make a decision to stop the compulsive behaviors.

However, starting Exposure and Response Prevention therapy can be a difficult decision to make. It may feel like you are choosing to put yourself in danger. It is important to know that Exposure and Response Prevention changes your OCD and changes your brain. You begin to challenge and bring your alarm system (your anxiety) more in line with what is actually happening to you.

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International OCD Foundation | Exposure and Response Prevention (ERP)

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Cognitive Behavior Therapy (CBT) Finding A Therapist Cognitive Behavior Therapy Medicine Insurance Overview Cognitive Behavior Therapy, also called CBT, is an effective treatment for OCD. About 7 out of 10 people with OCD will benefit from either CBT or medicine.

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Finding a therapist who can diagnose and effectively treat OCD is a challenge to many patients and families. Some estimates indicate that it can take up to 14-17 years from the onset of symptoms, to getting an appropriate diagnosis and effective treatment for OCD. Why the delay?

Hiding symptoms. Some people choose to hide their symptoms, often in fear of embarrassment or stigma. This causes many people with OCD to not seek the help of a mental health professional until many years after the onset of symptoms.

Not enough public awareness of OCD. Until recently, many people did not know there was even a name for their disorder and with no name, they assumed there was no treatment.

Lack of proper training in health professionals. People with OCD often get the wrong initial diagnosis from health professionals and may wind up seeing many doctors and therapists over the course of several years before finally getting the right diagnosis.

Difficulty finding local therapists who can effectively treat OCD.

Not being able to afford proper treatment.

The 2013 APA Practice Guideline for the Treatment of Patients with Obsessive Compulsive Disorder recommends beginning treatment with a type of cognitive behavior therapy (CBT) called exposure and response prevention (ERP), which has the strongest evidence supporting its use in the treatment of OCD.

When you search for a therapist in the IOCDF Resource Directory, you may get more than one result for your area. There are many factors to now consider when choosing the right therapist for you. In addition to the practical matters, such as whether they accept your insurance, is their office convenient for you, and so on, you also need to make sure that your new therapist is someone who you will feel comfortable working with. Below are some tips to helping you find the best possible treatment for you!

Tips for Finding the Right Therapist

Remember that some therapists are better at treating OCD than others. It is important to interview therapists to find out if they know how to do exposure and response prevention (ERP) therapy well. Their responses to your questions are a good guide to what you want to know about a new therapist. Your initial consultation may be done over the phone, or in person, but either way, remember:

You have a perfect right to ask questions. This is your life and health!

If the therapist is guarded, withholds information, or becomes angry at your requests for information, you should probably look elsewhere.

If the therapist appreciates how important a decision this is for you and is open friendly and knowledgeable, you may have a gem of a therapist!

Your relationship with the therapist is important. Especially since they will potentially be asking you to do things that you find uncomfortable as part of your treatment.

Here are some good questions to ask as you consider whether the therapist is a good fit:

"What is your attitude towards medication in the treatment of OCD?"
If they are negative about medication this is a bad sign. While not for everyone, medication can be a very effective treatment for OCD.
Click here to search the Resource Directory for a therapist today. These tips have been adapted from "How to Choose a Behavior Therapist" by Michael Jenike, MD

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International OCD Foundation | How to Find the Right Therapist

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How to Find the Right Therapist Finding a therapist who can diagnose and effectively treat OCD is a challenge to many patients and families. This page will give you: Tips for interviewing therapists A checklist of questions you should ask Intensive therapy options

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Obsessive compulsive disorder (OCD) can take all the fun out of life. You feel like you're stuck in an endless loop, doing rituals to try keep distressing thoughts out of your head. But they keep coming back, and fighting with OCD seems to make it stronger.

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"A journey of a thousand mile begins with a single step." - Lao-tzu

Experience teaches us that life has its ups and downs. Sometimes, when the "downs" come, it can be tough to remember that your troubles will pass. Pain, loss, and trauma - whether physical or emotional - can cause stress, anxiety, and depression. These feelings erode self-esteem and make the "downs" feel severe and overwhelming. At such times, knowledgeable support from a learned, experienced psychologist can go a long way towards lightening your load of burdens. A personalized program of clinical therapy can help you visualize your own path toward a peaceful, optimistic outlook.

Here at my Atlanta office, I see clients struggling with a variety of conditions. These include -but are not limited to- depression, stress, generalized and social anxiety, trichotillomania, obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). I am also an active member of the International Obsessive Compulsive Disorder Foundation, which has privileged me with specialized training by our country's most acclaimed OCD experts.

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"A journey of a thousand mile begins with a single step." - Lao-tzu Experience teaches us that life has its ups and downs. Sometimes, when the "downs" come, it can be tough to remember that your troubles will pass. Pain, loss, and trauma - whether physical or emotional - can cause stress, anxiety, and depression.

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Interns

Hope Counseling Centers are staffed by interns from Richmont Graduate University. Richmont students are highly trained and prepared to address whatever issues you may be facing. Interns are also supervised by licensed professionals. The rate for interns is $50 per session.
To schedule an appointment with an intern call (404) 266-0695 ext. 6110

Staff

Hope Counseling also has Staff and Faculty who are licensed professionals that are available by appointment. Fees for service vary, and appointments can be made by contacting counselors directly at the numbers listed below.

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Our Counselors - Hope Counseling Centers

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Hope Counseling Centers are staffed by interns from Richmont Graduate University. Richmont students are highly trained and prepared to address whatever issues you may be facing. Interns are also supervised by licensed professionals. The rate for interns is $50 per session. To schedule an appointment with an intern call (404) 266-0695 ext.

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Josh S. Spitalnick, Ph.D., ABPP, is a Licensed Psychologist, Board Certified in Behavioral and Cognitive Psychology (ABPP), and Owner/Clinical Director of Anxiety Specialists of Atlanta, an outpatient clinic in Dunwoody, GA. In his clinical practice, Dr. Spitalnick specializes in the delivery of Cognitive-Behavioral Therapy (CBT) to treat , anxiety and mood disorders, health anxiety, specific phobias, stress and trauma, medical complexities, and difficulties in relationship functioning. He works with children (as young as 3) as well as adolescents and adults. He has notable subspecialties in pediatric anxiety (separation anxiety, sleep difficulties, selective mutism, , etc), and OCD subtypes that are less commonly seen (harm OCD, moral scrupulosity, relationship OCD, sexual orientation OCD, etc).

The owner of two businesses (his clinical practice and a healthcare-focused software development company) and a consultant to other small healthcare companies, Dr. Spitalnick also enjoys working with C-level executives, businesses owners, professional athletes, and tv/movie/media personalities who find themselves struggling to navigate such exciting yet challenging career paths, whether its dealing with performance anxiety, the uncertainties associated with lucrative career decisions, the sense of imposter syndrome, or the common fear of failure/success.

Within the clinical community, Dr. Spitalnick serves in a consulting capacity to various anxiety specialty clinics, he presents locally and nationally on advances in Exposure and Response Prevention (ERP), and exposure therapy along with the science behind treating anxiety and OCD. He remains active as a research scientist specializing in developing and evaluating technology and software that emphasizes evidence-based interventions and training platforms, with current funded projects addressing Chronic Tic Disorders and training professionals who support Alzheimer's patients. Dr. Spitalnick has been a Principal Investigator or Co-Investigator on over 15 federally-funded (NIH, NIMH, CDC, USAF) interventions and programs to address a variety of important anxiety and health-related interventions, including transdiagnostic pediatric anxiety, social anxiety in youth, PTSD/TBI, STD/HIV risk prevention, weight loss, food-based allergies, sleep disorders, pain management, resilience training for healthcare workers, and substance use disorders, to name a few.

He is active in the Atlanta community in volunteer roles, serving as a Board Member for OCD Georgia (the state based affiliate to the International OCD Foundation), co-chair of mental health initiatives at local religious and educational organizations, and he holds an appointment as Adjunct Assistant Professor in Psychiatry at Emory University's School of Medicine where he trains physicians and other health care providers in the delivery of CBT.

Dr. Spitalnick has been a featured expert on The OCD Stories for Health Anxiety and for Understanding OCD in Children, Natasha Daniel's (LCSW) Anxious Toddlers Parenting Survival Network, the International OCD Foundation's OCD/COVID-19 Online Townhall for OCD, Social Isolation, and Social Anxiety, Chrissie Hodges's OCD Gamechangers Fireside Chats, Uppercut, ABC News, Fox 5 News, NBC News, London Times, American Medical News, The Times-Georgian, The Discovery Channel's Brink Series, NPR: The Kojo Nnamdi Show, Emory Magazine, American Psychological Association's Webcast Portal, 11alive.com, myfoxatlanta.com, CNN.com, ScienceDaily.com, PsychCentral.com, Orlando Sentinel, and a variety of other local, regional, and national print, television, and online media outlets.

Dr. Spitalnick is also the co-host of Shrinking the Issues, a LIVE mental health podcast tackling real topics with science, compassion, and lots of laughter. Each episode brings the listening audience to the discussion, answering real questions from real people, hoping to provide sound guidance and professional insights with the hope of simply making "tomorrow...a little bit easier." It airs LIVE every Tuesday night, 8pm EST via the podbean app, and available for listen after the show on Podbean or Apple Podcasts.

Having lived in Atlanta for over 40 years, Dr. Spitalnick is passionate about his local professional and collegiate sports teams (Go Dawgs!!), and he's hoping for a championship sometime soon. He loves stand-up comedy and has followed the best of the best in stand-up since his teenage years (Ellen Degeneres is his all time favorite and having lunch with her remains on his very short bucket list). Dr. Spitalnick is a percussionist of over 30 years, listens to music as much as time permits, and is major follower of the band Phish.

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Dr. Josh Spitalnick - Clinic Director - Anxiety Specialists of Atlanta

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Josh S. Spitalnick, Ph.D., ABPP, is a Licensed Psychologist, Board Certified in Behavioral and Cognitive Psychology (ABPP), and Owner/Clinical Director of Anxiety Specialists of Atlanta , an outpatient clinic in Dunwoody, GA.

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Jordan Elizabeth Cattie, PhD - Atlanta, GA - Psychology - Request Appointment

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Find information about and book an appointment with Jordan Elizabeth Cattie, PhD in Atlanta, GA. Specialties: Psychology.

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International OCD Foundation | Find Help

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Find OCD resources through the IOCDF Resource Directory. Use our Resource Directory to search for treatment providers specializing in OCD, support groups, clinics, and IOCDF local affiliates, and global partners.

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In episode 247 I chat with Dr Steven Phillipson. Steven is a licensed clinical psychologist who specializes in Cognitive-Behavioral Therapy for OCD. Steven is the Clinical Director at the Center for Cognitive Behavioral Psychotherapy in New York.

In this episode I chat with Steve about why some people get more from Exposure and Response Prevention Therapy (ERP) quicker than others, what is ERP and why it works, what are some common reasons that complicate the success of ERP, he gives plenty of OCD theme examples, when the need to do therapy right can become a secondary obsession itself, the idea of irrelevance, how the therapeutic relationship can affect treatment outcomes, the importance of homework, the importance of doing response prevention when doing exposures, why it's ok if you don't get anxious when doing an exposure, mental compulsions, educating significant others, an ideal mindset for doing ERP, why starting too high up the ERP hierarchy may not be a good thing, why building on success in therapy is helpful, how desperation and control can interfere with therapy, and much much more. Hope it helps.

The podcast is sponsored by NOCD. To find out more about NOCD, their therapy plans and if they currently take your insurance head over to https://go.treatmyocd.com/theocdstories

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In episode 247 I chat with Dr Steven Phillipson. Steven is a licensed clinical psychologist who specializes in Cognitive-Behavioral Therapy for OCD. Steven is the Clinical Director at the Center for Cognitive Behavioral Psychotherapy in New York.

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A FREE Mindfulness-Based Podcast

Your Anxiety Toolkit is a podcast dedicated to providing Mindfulness-Based tools for Anxiety, Obsessive Compulsive Disorder (OCD), Depression and the Mental Struggles that go along with these disorders.

Check it out on iTunes or Stitcher.

Click here to Listen

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A FREE Mindfulness-Based Podcast Your Anxiety Toolkit is a podcast dedicated to providing Mindfulness-Based tools for Anxiety, Obsessive Compulsive Disorder (OCD), Depression and the Mental Struggles that go along with these disorders. Check it out on iTunes or Stitcher. Click here to Listen

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OCD | A Penny For Your Intrusive Thoughts

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Our project lets people with OCD anonymously share their isolating intrusive thoughts to help others know they are not alone.

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Mental Health Advocacy & Education | Made of Millions Foundation

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Made of Millions Foundation is a 501c3 nonprofit organization on a mission to change how the world perceives mental health.

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Because of the toll the current coronavirus situation could take on people with OCD, Reid Wilson, PhD; Kimberley Quinlan, LMFT; and I have developed the following tips for managing OCD fears about coronavirus. We hope they will help you feel empowered and supported, so that even in this uncertain time, you can keep OCD from running your life.

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Aha! Moments about OCD I'm always thinking about how books, movies, and events apply to people suffering from OCD and related disorders, anxiety or depression. Which means that I'm also thinking about how they apply to me.

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To build community, develop and fund innovative avenues for help, and inspire hope for people with OCD. At the 2019

OCD Gamechangers strives to constantly connect with the OCD community. Here you will find a list of upcoming events. We

OCD Gamechangers is just getting started! We appreciate every donation and look forward to helping the OCD community in every

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To build community, develop and fund innovative avenues for help, and inspire hope for people with OCD. At the 2019 OCD Gamechangers strives to constantly connect with the OCD community. Here you will find a list of upcoming events. We OCD Gamechangers is just getting started!

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Welcome! Hard Quirk is a virtual community of individuals with lived experience of obsessive-compulsive disorder (OCD), committed to building awareness, educating others, serving as OCD advocates, as well as empowering and supporting people living with OCD and their social support systems.

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This book is a compelling and powerful portrayal of the inner workings of OCD. Shala paints a vivid portrait of life with this debilitating disorder as well as a candid depiction of what it takes to overcome it and thrive. Is Fred in the Refrigerator? is a masterfully written memoir-meets-educational-meets-inspirational tale that I couldn't put down.

Ashley Smith, PhD, coauthor of Childhood Anxiety Disorders

Shala is a good friend and one of my heroes. In this memoir she bares her soul and the result is an inspirational story of hope for those with OCD. My patients are often concerned about their ability to do the hard work of overcoming OCD; it often seems to them that perhaps those who succeed in treatment are somehow better. Shala's recovery is not a sugar-coated fairytale. Her pain and suffering are real and her story riveting. Everyone with OCD will be able to see themselves in her struggles and her journey will provide them with the hope that the road to recovery is one that they, like her, can travel.

Jonathan Grayson, PhD, author of Freedom from Obsessive-Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty

An amazing story of terror and resilience. Fred is at once a gripping portrayal of an unrelenting disorder and a guide for doing battle with it. It is one of the clearest descriptions of the experience of OCD and how one can learn to defeat it. A fascinating read filled with hope and inspiration. You'll cry, you'll cheer, and you'll put your shoulders back with Shala as she conquers the OCD demon.

Randy O. Frost, PhD, Harold and Elsa Siipola Israel Professor of Psychology at Smith College and coauthor of the New York Times bestseller Stuff: Compulsive Hoarding and the Meaning of Things

Shala's very articulate descriptions are fine examples of aspects of body obsessions, known as body dysmorphic disorder. Her own struggles illustrate so well how completely these types of insidious ideas can intrude on a person's consciousness and take over their actions. Her delightful prose will be a great help to many who seek to understand their own experiences through reading about those of a fellow sufferer.

Gail Steketee, PhD, MSW, Professor, Boston University School of Social Work

Shala brilliantly captures the relationship between the mind of a person with OCD and the OCD itself. She shows the reader why calling the OCD's bluff is worth it, and her defiance against this disorder is, for lack of a better word, infectious. For a memoir, it is refreshingly not just about her, but about all of us with this kind of mind.

Jon Hershfield, MFT, director of The OCD and Anxiety Center of Greater Baltimore and author of Overcoming Harm OCD

With exquisite candor, Shala reveals how her inner BDD demon, "the salesman," cunningly manipulates and distorts her self-perception. Having walked hundreds of miles to raise awareness about BDD, I am awed that Shala covers the same distance metaphorically with elegant prose and in much less time. Since I have lived in the arena of this cruel disorder with my son Nathaniel, I know that Shala's insights about how she fights back will give courage and hope to sufferers and caregivers.

Denis Asselin, founder of Walking With Nathaniel

Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life is a true depiction of the turmoil and disruption caused by OCD followed by the hope one can get when they finally receive the help that they need to manage their illness. As you hear the intimate details of Shala's life story you will be educated, inspired and moved. This book illustrates the incredible results of ERP therapy for OCD and the life changing benefits of moving into advocacy and sharing our OCD story.

Elizabeth McIngvale, PhD, Assistant Professor, Baylor College of Medicine and founder, The Peace of Mind Foundation

Is Fred in the Refrigerator? is a true story that reads like a novel. Shala's rocky journey to recovery will act as a guide to navigate people towards recovery and away from the pitfalls that face those lost in their own minds. Although Shala's story is sadly one that many people with OCD face due to the lack of understanding of OCD both in the generic public but also among healthcare professionals, her story is a testament to her spirit and determination to find a way in spite of this.

Stuart Ralph, The OCD Stories

What starts as a gripping horror story turns into a book filled with stellar advice and inspiring action for those who suffer from obsessive-compulsive disorder (OCD) and other mental illnesses. Is Fred in the Refrigerator? is a stunning story of growth, perseverance and hope. Shala beautifully details how mental illness shaped her life, taking us with her on her brave journey through perfectionism, shame and fear. This book is the perfect combination of entertainment, education and validation for those who are on their journey to recovery from OCD, but also for any human being who wants to live courageously and joyfully. Bravo, Shala!

Kimberley Quinlan, LMFT and founder of CBTschool.com

Shala has crafted a masterpiece detailing the suffering and pain associated with OCD, while providing hope and inspiration to those affected. Her writing style - which is a perfect combination of educational and inspirational - is certain to make this book a must-read for those embarking on their journey in beating OCD as well as for those closest to them.

Eric Storch, PhD, McIngvale Presidential Endowed Chair & Professor, Vice Chair & Head of Psychology at the Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine

I have known Shala for many years. I have learned her story of OCD and her growth into an OCD therapist. After this book, I really know Shala and have an even better understanding of the day to day difficulties and struggles a person with OCD must overcome to just get out of bed, go to work, or be social. If you have had trouble understanding just how interfering OCD can be in one's life, you won't after reading this book. Thanks Shala.

Patrick McGrath, PhD, author of The OCD Answer Book: Professional Answers to More Than 250 Top Questions about Obsessive-Compulsive Disorder

In this book, Shala Nicely, a consummate storyteller, takes the reader on a journey inside the mind of someone who struggles with OCD. You are immediately transported into her life, which is crippled by OCD, ultimately finding yourself cheering her on as she learns of the appropriate treatment for her disorder. You are with her as she does battle with her internal demons, and emerges empowered and victorious, having faced down her OCD, and having learned that she is, and always has been, the stronger force on this battlefield. It is a story of inspiration and hope, providing insight for therapists, and encouragement for those with firsthand experience of the disorder. It will serve as a great introduction to those just learning about OCD, or as a treasured addition to those building their OCD libraries.

Allen H. Weg, Ed.D., founder and director of Stress and Anxiety Services of New Jersey and author of OCD Treatment Through Storytelling: A Strategy for Successful Therapy

Is Fred in the Refrigerator? is one of the best books ever written about obsessive-compulsive disorder (OCD). It reads like a page-turning novel. Shala brings the reader into her world, and she helps the reader truly understand how OCD operates in one's mind as well as how to lean into it, externalize it, and develop the skills to live a fulfilling life. This book provides the reader with key elements that would greatly benefit everyone with OCD as well as their friends and family who are trying to understand this debilitating disorder. It's so helpful to have a book that tells the story of OCD from the person experiencing it who has also become an expert in treating it. Ultimately, the book instills hope, compassion, and the motivation to thrive in the face of OCD.

Becky Beaton, PhD, founder & clinical director of The Anxiety & Stress Management Institute and cofounder, OCD Georgia

Shala Nicely has a story worth telling and she tells it brilliantly! Shala bravely shares some of her most intimate struggles with OCD and BDD and brings us into her world of unrelenting and often terrifying intrusive thoughts. Her writing cuts to the quick when describing the suffering that lies beneath the exterior that others see. If you struggle with similar problems or want to better understand them, you'll appreciate Shala's candor. But she also goes steps further, sharing what she learned from some of the best teachers in our field about how to accept and even welcome uncertainty and imperfection. Her wealth of knowledge, humor, and gift of storytelling shine a much-needed light on how to successfully pursue and embrace the treatment you need. Bravo Shala!

Joan Davidson, PhD, codirector of the San Francisco Bay Area Center for Cognitive Therapy, and author of Daring to Challenge OCD: Overcome Your Fear of Treatment and Take Control of Your Life Using Exposure and Response Prevention

Many excellent books have been written about OCD. Some promote compassion by articulating the challenges of a life tormented by this condition. Others inspire as they chronicle the struggle to recover. Some educate about treatments that can change lives and others bridge resources to those in need. Is Fred in the Refrigerator? does it all. Shala Nicely's story is at once compelling and enlightening.
C. Alec Pollard, PhD, founding director, Center for OCD & Anxiety-Related Disorders and Professor Emeritus, Saint Louis University School of Medicine

Shala Nicely is an OCD survivor, author, advocate and cognitive behavioral therapist specializing in the treatment of OCD and related disorders in Atlanta. She is author of Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life and coauthor with Jon Hershfield, MFT, of Everyday Mindfulness for OCD: Tips, Tricks and Skills for Living Joyfully. She is cofounder with Jeff Bell of Beyond the Doubt, an initiative dedicated to helping people learn to thrive through uncertainty. Shala is an advocate for The Adversity 2 Advocacy Alliance and blogs for Psychology Today, offering an inside perspective on life with OCD.

Jeff Bell is an author, mental health advocate, and radio news anchor. His two books, Rewind, Replay, Repeat and When in Doubt, Make Belief, have established Jeff as a leading voice for mental health awareness and "Greater Good" motivation. He served for eight years as a national spokesperson and board member for the International OCD Foundation, and he co-founded the nonprofit A2A Alliance to showcase and foster the power of turning adversity into advocacy. He and Shala co-founded Beyond the Doubt, an initiative dedicated to helping people learn to thrive through uncertainty. Jeff currently co-anchors the KCBS Afternoon News in San Francisco.

Reid Wilson, Ph.D., is author of Stopping the Noise in Your Head: The New Way to Overcome Anxiety and Worry and the classic self-help book Don't Panic: Taking Control of Anxiety Attacks. He is co-author of Stop Obsessing! and Anxious Kids, Anxious Parents, as well as Playing with Anxiety. He is a Founding Clinical Fellow of the Anxiety and Depression Association of America (ADAA) and Fellow of the Association for Behavioral and Cognitive Therapies. In 2014 ADAA presented him with the highest national award given in his field. He offers self-help resources at anxieties.com and NoiseInYourHead.com.

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is fred in the refrigerator?: taming ocd and reclaiming my life

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biography & autobiography / personal memoirs

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self-help / compulsive behavior / obsessive compulsive disorder

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Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life

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Amazon.com: Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life eBook: Nicely, Shala, Bell, Jeff, Wilson, Reid: Kindle Store

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Everyday Mindfulness for OCD: Tips, Tricks, and Skills for Living Joyfully

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Amazon.com: Everyday Mindfulness for OCD: Tips, Tricks, and Skills for Living Joyfully eBook: Nicely LPC, Shala , Pollard, C. Alec: Kindle Store

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The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts

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Amazon.com: The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts eBook: Baer, Lee: Kindle Store

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What is it?

We've all had intrusive thoughts - upsetting ideas or images that pop into our mind for no reason. Like the thought of steering your car into oncoming traffic, or blurting something offensive out in the middle of a meeting. Most people are able to brush these thoughts off and forgot about them. But for some, they play on an endless loop, causing tremendous amounts of anxiety.

This is called obsessive compulsive disorder, or OCD. OCD is a condition that causes unwanted intrusive thoughts (obsessions) that a person tries to minimize by engaging in some form of mental or physical action (compulsions). These thoughts can be about anything - sex, religion, violence, health, the meaning of life. When left untreated, they run rampant and can be extremely debilitating for those experiencing them.

Compulsions are a person's way of stopping these thoughts from spiraling. They can manifest as visible rituals, like hand-washing and counting, or invisible rituals like avoidance behaviors, mental ruminations or mental checking. People with invisible compulsions often refer to their version of the disorder as Pure OCD or Pure O.

The World Health Organization has OCD ranked as one of the top 20 causes of illness-related disability worldwide for people 15-44 years of age. It is estimated that 1 in 100 children have OCD. The condition affects people of all genders, ethnic groups and socioeconomic statuses, with women having a slightly higher prevalence rate than men.

What are the symptoms?

The two primary symptoms of OCD are obsessions and compulsions. Obsessions are disturbing, repetitive thoughts that flash across a person's mind hundreds or thousands of times a day. These thoughts can be unwanted, scary, bizarre, gross and even funny. The nature of a person's thoughts is often related to the things they care about most in life. For example, a religious person may experience intrusive thoughts about assaulting god.

Compulsions can also come in many different forms. Some people engage in physical compulsions to minimize their anxiety. Common examples include counting, tapping and excessive washing. These are often called "rituals." But for others, compulsions are invisible. They happen inside their minds and can't be picked up by others. CBT therapy refers to them as "internal verbal behaviors". For example, if someone has an obsession that they said something offensive during a conversation, they may replay that conversation in their head over and over again, or avoid interacting with that person the next time they see them.
Common Obsessions:

Intrusive Thoughts

Unwanted Thoughts

Repetitive Thoughts

Racing Thoughts

Violent Thoughts

Sexual Thoughts

Blasphemous Thoughts

Common compulsions:

Avoidance

Reassurance Seeking

Checking

Hand Washing

Excessive Prayer

Counting

Comparison Seeking

Excessive Guilt

What are some common warning signs?

OCD is a complex disorder that affects every sufferer differently. Contrary to popular belief, it is not all about handwashing and organization. While there are similarities across cases, individual manifestations tend to mirror specific anxieties based on a person's unique life experience. Because of this, OCD is often classified into different subtypes. These are not diagnoses. They are labels or categories for understanding the many forms OCD can take. Some sufferers only experience one theme, others experience multiple or have themes that change overtime.

What causes OCD?

Like most mental conditions, there is no one cause of OCD. It is often the byproduct of numerous, overlapping factors such as:

Genetics

Certain people are more likely to develop OCD and related conditions if they have a family history of them.

Brain circuits

Anxiety disorders have been linked to activity in an area of the brain called the Amygdala. The Amygdala is home to our Fight-or-Flight response. It's thought that people on the anxiety disorder spectrum may have overactive or malfunctioning Amygdalas. You can learn more about that here. There may be other issues at play as well, such as misfiring stress hormones (like cortisol and adrenaline) or dysfunctional serotonin systems. These problems are all part of the Hypothalamic Pituitary Adrenal (HPA) Axis - a complex system of interactions that take place between the hypothalamus, pituitary gland and adrenal glands.

Past Trauma

Traumatic experiences are thought to impact the likelihood of developing anxiety disorders later in life. For example, someone who grew up in a turbulent home may be more anxious than someone who grew up in a supportive one.

Environmental

Being in high stress environments for extended periods of time can trigger anxiety disorders. In some cases, previous drug use may "unlock" OCD.

How is it treated?

There are two primary treatment methods for OCD - psychotherapy and medication. Healthy lifestyle habits can also help people cope. Maintaining a balanced diet, 8 hour sleep schedule, mindfulness regimen (like yoga, meditation or art therapy classes) and staying physically active, can ease the severity of symptoms. However, for many people with serious and prolonged OCD, these adjustments won't be enough to fully address their disorder.

When it comes to therapy, a form of Cognitive Behavioral Therapy (CBT) called Exposure and response prevention (ERP) is considered the gold standard. ERP exposes people to the thoughts, images and objects that trigger their anxiety, and gives them the tools they need to stop engaging in compulsions.

In more severe cases, medication may be used alongside therapy to help minimize anxiety. The main family of medicines used to treat OCD are known as Selective Serotonin Reuptake Inhibitors, or SSRIs. SSRIs enhance your natural serotonin activity and are used to treat major depressive disorders and anxiety conditions. Well known examples include Lexapro, Prozac, Paxil, Zoloft and Luvox.

However, SSRIs aren't the only kind of antidepressant. Alternative options like serotonin-norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs) might be a better fit for certain people. In some cases, a doctor will prescribe mood stabilizers or antipsychotics in addition to an antidepressant.

Learn more about OCD treatment below.

How can I help a loved one with OCD?

It can be hard to know how to react when someone you love isn't doing well. Do they want to talk about it, or would they prefer to keep their experiences private? Will you push them away by starting the conversation?

There are no easy answers to these questions. Every person handles their mental health differently. That said, we all want to feel loved and supported. Showing someone that you're invested in their wellbeing can make a world of difference. Here are some ways to do so:

Educate yourself: Read up on symptoms, treatment options, and healthy living recommendations. Try and understand what your loved one is going through so you are better equipped to talk to them about it. This will also make you a valuable resource when it comes time to find treatment.

Encourage healthy living: Sleeping well, eating nutritional foods, staying active and limiting substance use can be game changers for someone with anxiety. If they're surrounded by people who promote this kind of lifestyle, they're more likely to form healthy habits of their own. Try joining a fitness class together, or cooking meals at home using healthy ingredients.

Advocate treatment: Asking for help can be hard. Societal stigma often keeps people from opening up to others about their symptoms. Support your loved one by helping them research different treatment methods, or doctors in their area. If they'd like, go to a few sessions with them. Remind them that there's nothing weird about getting help, and that you're proud of them for following through.

Listen: It's common for people battling anxiety to feel alone. Make time for meaningful conversations. Ask them how they're doing. Let them talk and make sure to not discount their emotions. It is not your job to fix them, just to be there.

Don't tell them to calm down: People with anxiety are often told to "get over it", "worry less" or "chill out." These statements downplay the emotions they're feeling, and won't help lessen their symptoms. Let them vent without judging.

Set boundaries: You want to be understanding of their symptoms, but that doesn't mean you have to put up with everything. Make rules for what you will and won't tolerate, in particular, the kinds of compulsions you won't give in to. Stick to these boundaries and follow through on consequences when they're broken.

Be patient: Don't take it personally if they lash out at you, don't answer text messages or socialize less. They are battling something that's very hard to overcome. Their distance has nothing to do with who you are as a person. Keep showing up for them even when it feels like it's not helping. The act alone lets them know that they have people in their life who care.

What other resources are out there?

Want to learn more, find a doctor, join a support group or speak to a counselor? The below resources might be able to help:

RELATED TOPICS
Mindfulness Comorbidity Relationships

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Obsessive-Compulsive Disorder | Made of Millions Foundation

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We've all had intrusive thoughts - upsetting ideas or images that pop into our mind for no reason. Like the thought of steering your car into oncoming traffic, or blurting something offensive out in the middle of a meeting. Most people are able to brush these thoughts off and forgot about them.

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Understanding Exposure Therapy

What is ERP?

ERP, or Exposure and Response Prevention therapy, is a form of Cognitive Behavioral Therapy. It is considered the gold-standard for OCD treatment, as well as related anxiety disorders like PTSD and Social Phobia.

ERP works by slowly exposing people to the thoughts, images and objects that trigger their anxiety. They repeat these "exposures" over and over again, without acting out compulsions to neutralize or stop the fear. Overtime, the anxiety associated with these triggers starts to subside.

ERP practices should be used inside and outside of therapy for the greatest impact. The more its techniques are roped into a person's everyday life, the stronger their coping mechanisms will become. It is recommended that people master ERP in a controlled, clinical setting before attempting to practice it on their own.

Choosing Exposure Response Prevention (ERP) Therapy

Dr. Phillipson explains the benefits of Exposure and Response Prevention Therapy.

Is ERP the same as CBT?

All recommended therapies for OCD fall under a model of treatment known as Cognitive-Behavioral Therapy, or CBT.

CBT works by challenging negative thinking patterns and behaviors. It's rooted in the idea that our attitudes greatly impact how we think and behave. In CBT, a therapist helps a person replace negative thinking patterns and behaviors with more positive ones. It is rooted in the idea that symptoms of mental disorders can be minimized by learning new ways to process information and develop healthy coping habits.

The two most trusted therapies for OCD - ERP and ACT - are both types of CBT therapy. There are other types of CBT available. You can learn about them here.

How does ERP work?

To start, a therapist will work one-on-one with their patient to identify primary triggers and related compulsions. In other words, what are the main sources of anxiety and how is a person responding to this anxiety in unproductive ways?

Once those are established, they'll work together to create something called a "fear" or "exposure" hierarchy. This hierarchy is a checklist of activities that increase in intensity as a person makes progress.

To create a fear hierarchy, a person will identify an obsession that they're struggling with. They'll then set a goal they'd like to reach related to their obsession. This goal should be realistic and specific. If it's too broad or aspirational, a patient might get down on themselves for not reaching it. For example, a person with Harm OCD should not set the goal of "never being anxious." Anxiety is a natural part of life and cannot be completely avoided. A better goal, would be "enjoying cooking at home without fixating on the presence of knives."

Once that goal is set, a therapist will create a hierarchy of exposure activities that will help their patient reach this goal. These tasks will be performed one-by-one until their anxiety starts to subside. After each task, they'll make note of their anxiety levels before moving onto the next activity.

For example, a person with Contamination OCD might have a fear of swimming in public pools because they are worried they'll contract a life-threatening disease. A fear hierarchy for them might look like this:

Fear

Being contaminated by life-threatening diseases at public pools

Goal

Enjoy time at the pool without experiencing intense anxiety

Fear Hierarchy:

Task 1: Drive by the local pool each day for one week and pay attention to all the people swimming.

Task 2: Watch YouTube videos of people swimming in crowded, public pools.

Task 3: Bring your sibling to the local pool and watch them swim.

Task 4: Bring your sibling to the local pool and walk around without shoes on.

Task 5: Go with your family to the pool and get your feet wet.

Task 6: Go with your family to the pool and wade in up to your chest.

Task 7: Go with your family to the pool and dunk your head under water.

Task 8: Go with your family to the pool and spend 5 minutes in the water.

Task 9: Sign up for a 50 minute one-on-one swim session at the pool.

Task 10: Attend a pool party and swim with friends.

When a person reaches the end of their fear hierarchy, they should have substantially minimized the anxiety associated with their trigger. That said, they won't be cured of their anxiety. Many patients will go through this process over and over again, targeting different triggers each time. Along the way, they'll develop healthy coping mechanisms that make their managing anxiety in real-time easier and less stressful. It's important to remember that fear hierarchies are subjective and should be created with the help of a trained professional, before being attempted outside of therapy.

What should I expect from ERP?

Most effective OCD treatments require hard work and dedication. ERP is no exception. For it to work, you have to put time and energy into the process. That said, therapists are sympathetic to the difficulty of ERP therapy, and will work with you to establish a pace that feels right.

ERP is different from traditional therapy because it focuses less on talking through issues and more on addressing them through action. That's not to say you won't discuss your exposures - there's plenty of analyzing that gets done through conversation. Just prepare yourself for the uniqueness of ERP therapy and how it differs from talk therapy.

If you're starting ERP therapy, here are a few things you can expect:

Homework: You'll be asked to fill out worksheets or practice techniques outside of therapy. Make sure to commit to these assignments. They are crucial to progress.

Doubts: Many people spend their first few weeks, or even months, wondering how much of an impact their treatment is having. ERP takes time. You must be willing to be patient in order to see results.

Discomfort: ERP is supposed to make you uncomfortable. Don't let this scare you off. If you're anxious, it's likely working.

Self-awareness: In order to be successful at ERP, you have to be willing to analyze and critique yourself. Prepare to discuss your emotions and the tasks at hand. Hold yourself accountable when necessary.

Discipline: ERP takes real work. And for its effects to last, you have to practice outside of your weekly therapy session. Don't let yourself falter.

Is ERP hard?

Depends on who you are! No two journeys are the same. Every sufferer has their own opinion on the methods that work and don't work for them. That said, no one should expect therapy to be easy. All options take time, energy and dedication. They require a real desire to get better. If you're searching for a quick fix, you're going to come up short.

If you're feeling overwhelmed by your treatment journey, focus on the here and now. Therapy only needs to be as intimidating as your next session. Don't think in terms of weeks, months and years. Think "I have X number of days until my next session, and X number of assignments to get done. That's not so bad!"

How do I perform exposures outside of a session?

Once a person has grasped the concept of ERP, they'll likely be asked by their therapist to start implementing exposures outside of scheduled sessions. This might sound intimidating, but it means that progress is being made!

It helps to create a plan for yourself. A lot of people will use apps to schedule their exposures so that they can stay on track. When they receive a reminder, they'll step away from what they're doing to practice their exposure. Some people can do them at work, others might need to do them at home. Whatever works best for you is the right call. If you're doing them in public spaces, make sure you have a game plan in the event that your anxiety spikes. Is there a bathroom near by that you can retreat to? Do you have the ability to take a walk or find quiet space to reset?

Some people like to tell their family, friends, romantic partners or bosses that they are practicing ERP. Having allies in recovery is important. They can help you stay accountable, on track, and supported while you're working through something really tough.

Lastly, use your therapist as a resource. They want to help. If you feel you need it, ask for advice on completing worksheets and exposures. If something goes wrong during an activity, let them know. Don't be afraid to open up and ask for help.

Are there more resources I can check out?

Of course! What we've provided is really only an intro to ERP. There is so much more to be explored. Below you'll find other sites, worksheets, videos and books that can help you better understand and practice ERP.

Webpages

Worksheets / Toolkits

Organizations

Books

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ERP Therapy | Made of Millions Foundation

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ERP, or Exposure and Response Prevention therapy, is a form of Cognitive Behavioral Therapy. It is considered the gold-standard for OCD treatment, as well as related anxiety disorders like PTSD and Social Phobia. ERP works by slowly exposing people to the thoughts, images and objects that trigger their anxiety.

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What is OCD? | International OCD Foundation

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Obsessive compulsive disorder (OCD) is a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings.…

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Even though I've always felt anxious and specific things really bother me, I never thought I might have OCD. But after years of building up, my symptoms reached a point where I couldn't ignore them any longer.

I just started working with a psychologist, but I'm not sure if it's working. I'm also hoping to find out what else I could be doing to make my treatment more effective so I can get back to my life.

Even though I've always felt anxious and specific things really bother me, I never thought I might have OCD. But after years of building up, my symptoms reached a point where I couldn't ignore them any longer.

I just started working with a psychologist, but I'm not sure if it's working. I'm also hoping to find out what else I could be doing to make my treatment more effective so I can get back to my life.

I have had OCD since I was around 5 years old. As I've gotten older, the symptoms have intensified, the themes of my obsessions have changed, and OCD has almost destroyed my marriage.

NOCD helps me when I am in the middle of uncertainty. Instead of reaching to others for reassurance, I can sit with my distress until it passes. My therapist highly recommends the NOCD app and we go over how I've been using it.

I have had OCD since I was around 5 years old. As I've gotten older, the symptoms have intensified, the themes of my obsessions have changed, and OCD has almost destroyed my marriage.

NOCD helps me when I am in the middle of uncertainty. Instead of reaching to others for reassurance, I can sit with my distress until it passes. My therapist highly recommends the NOCD app and we go over how I've been using it.

I have struggled with severe anxiety since I was a child and was in and out of therapy throughout middle and high school. After college, I began experiencing very graphic intrusive thoughts and was diagnosed with OCD a few months later.

NOCD has given me a place where I'm able to easily access tools and a community that make me feel more at peace. I discovered it after finishing treatment with an OCD specialist.

I have struggled with severe anxiety since I was a child and was in and out of therapy throughout middle and high school. After college, I began experiencing very graphic intrusive thoughts and was diagnosed with OCD a few months later.

NOCD has given me a place where I'm able to easily access tools and a community that make me feel more at peace. I discovered it after finishing treatment with an OCD specialist.

A therapist in your pocket

It's like a therapist in your pocket... there are daily tasks that help you overcome your fears and compulsions, a discussion group, and customizable symptom trackers
December 2017

Helpful in so many ways!

It's helpful for people with OCD in so many ways! It's great if you want to look into your obsessions and compulsions and think about what exposures can help you overcome them
November 2017

People helping people

I can't explain how helpful it is to know that you're not alone. The discussions are great and I'm so happy I discovered this app. People helping people. It's so refreshing
January 2019

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Even though I've always felt anxious and specific things really bother me, I never thought I might have OCD. But after years of building up, my symptoms reached a point where I couldn't ignore them any longer. I just started working with a psychologist, but I'm not sure if it's working.

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What's a trigger?

Tons of things happen to us throughout the day. Certain things we barely even notice, while others make us feel happy, angry, sad, or however else. A trigger is one of those things in our environment (or sometimes in our own minds) that cause us to experience a certain thought or to feel a certain way. For instance, if you're recovering from the grief of losing a loved one and you begin to feel sad when you hear their favorite song on the radio, that song is the trigger for your emotional state.

This trigger doesn't exactly cause the feeling, because there are other things contributing to this process (like the way you already felt, or the thoughts that might come in between the trigger and the feeling), but it's still the trigger in that moment. It's important to note that the trigger is not always easy to identify. Sometimes you might have a lot of unpleasant thoughts and feelings for seemingly no reason at all.

What are intrusive thoughts?

An intrusive thought is a thought, image, or urge that seems to pop up in your mind out of nowhere. Sometimes these thoughts seem completely random, and other times they might be traced back to some type of trigger. Intrusive thoughts sometimes seem really harmless. But other times they're confusing, frightening, or even debilitating.

Here's the big secret about OCD: these thoughts that bother people so intensely? Everyone has them.

Surveys of people without OCD reveal that they experience many of the same thoughts that completely derail people who have OCD. It's hard to say whether or not people with OCD have these thoughts more often, but what we do know is that people with OCD react to these thoughts very differently. We'll talk more about this in the next section, but let's start with just a few examples of intrusive thoughts.

Intrusive Thoughts: Some Examples

I'm about to jump in front of the train

I could grab that cop's gun and shoot myself

I could just kill myself

I should walk over and push that person

I should insult this person I don't know

I could cut myself with this kitchen knife

I should jump off this bridge right now

I could push my friend off this bridge

I could kill my child right now

I'm going to punch my brother right now

I want to see my sister naked

I want to kiss my uncle

I could steal from this store right now

I could grab the money from that tip jar

I probably got HIV when I got a blood test

I've messed up everything in life

The person I'm dating isn't right for me

There's someone better for me

I'll just tear my clothes off right now.

I'm more attracted to that person than to my partner

Life has no meaning

My niece is attractive

That child is attractive

I could be gay

I could be straight

I'm living a sinful life

I'm not a good person

Breathing is strange, I should stop breathing

Blinking is weird, I don't like that people blink

Images of the above (you "see" it happening)

My family will be murdered

I could suddenly vomit in class

I should drive off the road right now.

I could run that person over right now.

Why not crash into that barrier?

I should just scream right now.

I'm going to tell my boss he's an idiot right now.

I might dump this coffee on my boss's head.

What's a catastrophic assessment?

Everyone has had some of these intrusive thoughts, or similar ones: they pop into your head, and they're strange or alarming. Most people might think for a few seconds about the unpleasant thought and then go on with their day. What's different for people with obsessive-compulsive disorder is their inability to just let the thoughts pass by. Someone with OCD will have an intrusive thought, vastly overestimate its importance, and spiral into obsession.

Many people use intrusive thought and obsession interchangeably, but they're not quite the same. As we saw above, everyone has intrusive thoughts. Like everyone else, people with OCD symptoms experience mental illness and get different types of intrusive thoughts; only some of these become obsessions. This helps us understand why someone with OCD can be unbothered by most intrusive thoughts but completely derailed by others. Just because someone has OCD, does not mean they're bothered by everything.

Let's look at a common example: you're driving along the highway, and you have the thought: I should drive off the road and smash into that barrier over there. Someone without OCD thinks: Wow, that was weird. Of course I don't want to do that. And then they drive along and forget it ever happened. But someone with OCD might think: Oh god, not this again, I'm going to drive off the road, this means I want my life to be over, I don't really want my life to be over, I need to make sure I don't drive off the road, but maybe I do want to drive off the road?

The intrusive thought is the same for both, but the assessment of that thought is different. Unable to just move on, the person with OCD makes a catastrophic appraisal of the thought- that it's important or dangerous and requires their attention- and so the obsession begins.

What are obsessions?

In the above example, the person with obsessive-compulsive disorder feels an almost unbearably strong need to prove to themselves that they don't actually want to drive off the road. Obsessions emerge from people's strong feeling that they always need to be vigilant to different negative possibilities. In this case, it feels like the thought must mean that the person really does want to drive off the road, and so if they let their guard down their mind will take over and drive them off the road into the barrier.

Once an intrusive thought takes hold and starts becoming a source of distress, it has become an obsession. Obsessions are unwanted and repetitive thoughts, urges, and images that quickly spiral from an initial disturbing thought and usually lead to a lot of distress. While closely linked to intrusive thoughts both in theme and nature, obsessions only arrive after the initial thought has been assessed in a certain way. In a way, a central problem of OCD is the belief that every thought is meaningful.

Let's look at another example of this process:

How Obsessions Get Started

Situation
Sam is babysitting his neighbor's kids on a Friday night. As usual, the kids need to take a bath before bed. They're young enough that Sam needs to help them.

Trigger
The kids begin to get undressed for their bath.

Intrusive Thought
Suddenly Sam thinks: I could be sexually interested in these kids.

Assessment
(Sam's belief that every thought points to something real and important)

Obsessions
Oh no, could I really be sexually interested in young kids?
Am I the type of person who would be like that?
Could I really be a pedophile?
Are these kids in danger when I'm around?
How can I be sure that I'm not like that?
I need to make sure that I'm not really that kind of person.

We use the word "obsessed" in our culture to describe things we're really interested in. He's obsessed with her, she's obsessed with checking her Instagram. But that's not really how an obsession works for someone with OCD. They're not interested in their obsession in a typical way. Rather, they tend to feel forced to think about it over and over. This makes sense, as an intrusive thought tends to become an obsession because it's the most disturbing thing their minds could've thrown at them. And disturbing things can be hard to just accept or ignore.

Since obsessions are closely tied to the initial intrusive thought that brings them on, they can really spin out in any direction from any thought like the ones listed on the previous page. Just as there are infinitely many intrusive thoughts, there's no limit to the obsessions that people experience. However, people with OCD aren't really bothered by every thought that pops into their head. Instead, their obsessions usually emerge in response to intrusive thoughts within just a few themes at any given time.

What kind of distress can occur?

Emotional and physical pain in people with obsessive-compulsive disorder is by no means limited to the obsession stage. The pain might momentarily be soothed by compulsions, but it usually comes back even worse. And compulsions can create new types of distress, too. Distress is present throughout the obsessive-compulsive cycle, but we're talking about it here because the main goal of compulsions is to get rid of the distress that obsessions cause.

Because people with OCD spend most of their day feeling like they have to make sure something bad won't happen, a number of emotional symptoms can arise. Among the most common are trouble focusing, irritability, anger, frustration, jumpiness, guilt, shame, feelings of dread, and a sense of hopelessness.

People with OCD also experience a wide variety of unpleasant physical symptoms. Remember how you've felt right before taking an exam in school or getting test results back from a doctor? That feeling of being "amped up" is similar to what a person with OCD feels almost all the time. Their brain says "Time to be alert!" and their body responds by feeling constantly on edge. This can lead to exhaustion, an inability to sleep, digestive problems, muscle tension, dizziness, shortness of breath, and much more.

Sometimes the emotional and physical symptoms work together in another kind of vicious circle- you begin to worry, notice you're feeling worse, and then worry about feeling worse. Many people with OCD also develop symptoms of other psychiatric disorders, like depression and substance use, and then they have to manage multiple conditions at once. These tend to occur at significantly higher rates in people with OCD than in the general population, perhaps because of the amount of distress they experience.

People can also end up with any number of bodily symptoms from their compulsive behaviors. Someone with a hand washing compulsion can destroy the skin on their hands over time. Another person, refusing to eat because of an obsession about choking or contamination, may become extremely thin and develop medical complications.

People are typically aware, to varying degrees, of the irrationality of their thoughts and behaviors. Many people with OCD know that their thoughts aren't real and that their behavior might seem strange to others, but they can't stop despite these insights. But others do believe that their obsessions might come true, and that their compulsions are preventing this. It's important not to be too quick to say, "Your thoughts don't matter! You just need to learn to sit with them," because many people do feel like their thoughts are important. Plus, many people have had the same symptoms for years. It takes time to feel alright about letting your guard down for a bit.

225 N Michigan
Suite 1430
Chicago, IL, 60601

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What Is OCD? Symptoms and Meaning of OCD and How OCD Works?

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Tons of things happen to us throughout the day. Certain things we barely even notice, while others make us feel happy, angry, sad, or however else. A trigger is one of those things in our environment (or sometimes in our own minds) that cause us to experience a certain thought or to feel a certain way.

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By Elizabeth McIngvale, Ph.D.
Treatment Provider Search

The International OCD Foundation (IOCDF) hosts a wonderful treatment provider search that can be used when looking for an OCD provider in your area:

Treatment for OCD

Exposure with Response Prevention also known as ERP is the gold standard treatment for OCD. ERP is a specific form of Cognitive Behavioral Therapy (CBT) for OCD. The basic principles of ERP for OCD is to face your fears without engaging in rituals (exposure + ritual prevention). ERP is challenging and might sound much simpler than it often is. This should be done in a slow and systematic way and a hierarchy (a list of your fears in order of least anxiety-provoking to most anxiety-provoking) is often used to help you plan exposures from your lowest levels working your way up to your high-level exposures. ERP and hierarchy building should be done with an OCD specialist. Exposures should be something that anyone is willing to do, should not be a surprise to the person with OCD and often are done together with the individuals and their clinician.
Important ERP steps:

Understand your OCD and OCD symptoms

Identify a fear to work on

Develop an OCD hierarchy for your fear

Rank exposures for your fear on a scale from 1-10

1 should be at the bottom of your hierarchy and should be the least anxiety-provoking exposures and 10 is at the top and should be the most challenging exposures

Begin exposures with ritual prevention

Systematically work your way up your hierarchy starting with the lower level exposures and working your way up to the high-level exposures.

Exposures should be done without rituals. If it is too difficult for you to do an exposure without ritualizing, start with a lower level exposure which you can do without rituals.

An exposure should be repeated multiple times without any rituals. Once an exposure no longer causes distress/anxiety (you find this exposure boring) you can move up to the next higher-level exposure

Continue this approach until you reach the top of your hierarchy at which point you can move onto another OCD hierarchy if you have one or can begin relapse management for your OCD

ERP should be practiced daily. It is important even when you are in the management stage, that when you feel triggered, or have the urge to ritualize you practice and engage in ERP.

Repeated exposures with ritual prevention will allow you to habituate to a fear. Anytime you engage in a ritual both the fear and OCD cycle are reinforced.

Levels of Treatment:
Intensive Outpatient Program (IOP) -Typically 3 hours a day/5 days a week with a length of stay of 6 to 8 weeks however each program and individual's treatment may differ

Partial Hospitalization Program (PHP) -Typically 6 to 7 hours a day/4 to 5 days a week with a length of stay of 4 to 6 weeks however each program and individual's treatment may differ

Residential -Reside on-site at the location of treatment, the average length of stay can be between 30 and 90 days for adults; and ranges from 2 weeks to 5 months, with a typical stay lasting 6-8 weeks for Children/Adolescentshowever each program and individual's treatment may differ

Additional Articles and Resources:
How is OCD Treated?
DISCLAIMER: The content found here is intended to serve as educational content and is not intended to replace therapy. For treatment-related questions, please be sure to work with your local provider or contact a local clinician.

Choose a title below to view related OCD videos

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By Elizabeth McIngvale, Ph.D. Treatment Provider Search The International OCD Foundation (IOCDF) hosts a wonderful treatment provider search that can be used when looking for an OCD provider in your area: Find Help Treatment for OCD Exposure with Response Prevention also known as ERP is th

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You might've noticed that exposure and response prevention, or ERP, is the most commonly recommended form of therapy for obsessive-compulsive disorder (OCD). And along with serotonin reuptake inhibitors (SRIs), it has consistently been shown to be the most effective treatment.

OCD is a common psychiatric condition characterized by intrusive, distressing thoughts and repetitive behaviors aimed at reducing that distress.

This means people with OCD do certain things over and over because they're trying to get rid of really unpleasant feelings- not because they want to behave compulsively, or because they necessarily think their behavior is rational.

What is ERP?

ERP is a type of behavioral therapy that exposes people to situations that provoke their obsessions and the resulting distress while helping them prevent their compulsive responses. The ultimate goal of ERP is to free people from the cycle of obsessions and compulsions so they can live better.

Response prevention is key, because anything that gets rid of distress makes it impossible for us to get used to it. When people don't turn to compulsions, they learn how to accept their obsessions instead of acting desperately to neutralize them. The thoughts are still difficult sometimes, but they no longer seem like a huge problem.

This process of getting used to something is what psychologists call habituation. As patients habituate to the feelings their obsessions bring up and reduce their reliance on compulsions, they spend less time and energy avoiding pain.

ERP is fundamentally about shifting one's orientation to unpleasant thoughts and feelings- not about getting rid of them.

When we feel able to handle discomfort, obsessions (which used to create a sense of profound uncertainty) are no longer reinforced by avoidant behaviors that teach them the content of their every thought is both important and reflective of their true nature. And when we don't feel an overwhelming need to be certain about ourselves, the future, and our standing in the world, we can live with less unnecessary suffering.

Developed in the 1970s, ERP is recommended by the American Psychological Association and many other organizations for its wealth of scientific backing.

Why is ERP the recommended treatment for OCD?

Studies show that everyone experiences some of the intrusive thoughts involved in OCD. Maybe you've thought I could drive off the road right now or What if I don't actually love my significant other? People without OCD are usually able to write off distressing thoughts as strange and random occurrences, but those with this condition feel compelled to neutralize them. Obsessions and compulsions reinforce one another because it seems like a thought that had to be avoided with a compulsion must have been pretty important (and worthy of more fear). In most cases OCD symptoms do not resolve on their own.

A cognitive approach- traditional CBT, for example- asks patients to challenge their obsessions. This can actually reinforce the belief that thoughts are significant and that we're morally responsible for the content of our thoughts. Although cognitive interventions can be useful in many ways, recent studies comparing ERP and CBT suggest that ERP is more effective specifically for OCD.

Any behavior that engages with the obsession- e.g. asking for reassurance, avoidance, rumination- reinforces it. By preventing these behaviors, ERP teaches people that they can tolerate their distress without turning to compulsions. It thereby drains obsessions of their power. Especially when paired with medication and other types of therapy, ERP is consistently demonstrated to be the most effective form of treatment for OCD.

How does someone actually do ERP?

There's a good chance we'll be writing more about this soon, but the best way to see how ERP works is to check out the NOCD app on Android and IOS. We built it from the ground up to provide ERP tools, and worked with top experts to make sure it's closely aligned with the version you'd get in a therapist's office.

Isn't ERP kind of messed up?

You're not alone if you think therapy that asks people to do things that really bother them is kind of unfair or strange. And this suspicious comes from a place of empathy- why make people go through pain? Isn't it okay to be anxious about things, and why wouldn't you be bothered by something as disturbing as a thought about harming your own baby?

Is it strange to think that you could treat a psychiatric condition by doing things like telling yourself over and over that you might lose control and become a pedophile? Yes, and it's not the kind of thing most of us would like to spend our time doing. But let's say you're so bothered by one fleeting thought like "I might be attracted to my 3-year-old nephew" that it makes you physically sick. You think all day about it, write mental lists of reasons you're a good person, arrange your drive to work so you don't pass any elementary schools or day care centers. But then the thought pops up when you see a toddler on a billboard, or when a coworker brings their kid in one day. You stop going to visit your sister and nephew, coming up with different excuses every time they ask. The thoughts torture you, and it seems like your whole life revolves around avoiding any thought about how you might have been attracted to a kid.

This is the kind of stuff that gets people into ERP. It's not really about someone who has one quick thought about pedophilia- we all have thoughts we'd rather not have. Rather, this is a form of treatment for people whose lives are stuck because of their thoughts. That's why patients are willing to push through the pain and strangeness, and why clinicians are willing to temporarily make the pain worse so things can get better.

In ERP a fair amount of distress in inescapable, and that's an unfortunate fact. But clinicians and advocates of ERP, like the NOCD team, suggest it because the pain of treatment usually ends up insignificant compared to the drawn-out suffering of untreated people who go through their lives in anguish over thoughts that aren't actually worth a ton of attention.

ERP is about shorter-term pain for long-term gain. But it has to be done carefully, with an experienced clinician you respect and trust. It's good to weigh the pros and cons beforehand: What do you value, and how can ERP help you get there? What are your goals? And what are your limits for the amount of distress you're prepared to go through? How long do you want to be in treatment? How's your support system outside of therapy? These questions can help guide you as you decide whether or not ERP is the right fit for now.

An important note here: pedophiles are viewed in our society as some of the worst people imaginable, and this shame undoubtedly weighs on people anguishing over their thoughts. But the key separator between a pedophile and someone whose OCD centers around pedophilia is that someone with what therapists call "pedophilia OCD" doesn't enjoy those thoughts. In fact, they can become the bane of their existence. A pedophile may feel shame too, and may not be without remorse, but probably won't experience these thoughts as contrary to their values or who they really are. For both people with OCD and the rest of us, it's important to understand the differences between thinking about something and wanting to do it.

Another important note: although pedophilia obsessions seem like an extreme case, they're not. OCD takes all kinds of disturbing and difficult forms. Further, there's no evidence that someone with more typically "disturbing" obsessions (e.g. pedophilia, harming other people) suffers more than another person with something that would seem more trivial to others. In OCD there's no such thing as an obsession that feels trivial, or distress that isn't valid.

You can learn more about ERP and try it out in the NOCD app!

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What Is Exposure and Response Prevention (ERP) Therapy? Why ERP For OCD Treatment?

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You might've noticed that exposure and response prevention, or ERP, is the most commonly recommended form of therapy for obsessive-compulsive disorder (OCD). And along with serotonin reuptake inhibitors (SRIs), it has consistently been shown to be the most effective treatment. OCD is a common psychiatric condition characterized by intrusive, distressing thoughts and repetitive behaviors aimed at reducing that distress.

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It should be noted that all of the following procedures are still currently being researched. While there is evidence to suggest that they could potentially be helpful in reducing OCD symptoms, they are not concretely proven to do so. These should be utilized as a last resort when all of the evidence-based treatment methods for OCD have already been accessed. For more information on evidence-based treatment methods for OCD, please click by Michael Twohig, PhD This article was initially published in the Spring 2010 edition of the OCD Newsletter. .
What is its Effectiveness and Should I Look Into It?

Acceptance and Commitment Therapy (ACT, said as one word and not spelled out) is a form of Cognitive Behavioral Therapy (CBT) in the same way that Exposure and Ritual Prevention (ERP), Cognitive Therapy, and Dialectical Behavior Therapy are forms of CBT. All of these interventions share certain therapeutic or philosophical elements that put them under the CBT umbrella, rather than other umbrellas (such as psychoanalysis or humanistic psychology, for example). Some of the defining elements of CBT interventions including ACT involve:

Viewing behaviors as shapeable or changeable through environmental manipulations, rather than seeing behaviors as solely biological or neurological in nature, and thus responsive to psychotherapy;

Focusing on the way the client interacts or responds to events (including thoughts and feelings) in his or her life rather than intrapsychic events, developmental milestones, or personality characteristics; and

Testing the effectiveness of its interventions, as well as the processes through which they work.

There are some places, though, where ACT may be different than more commonly practiced forms of CBT. The most commonly used and supported forms of CBT for OCD are ERP and ERP with cognitive challenging (the term ERP will be used to cover both in this article). The ultimate goal of ERP is greater functioning of the client, and it appears that most ERP models focus on reducing obsessions and associated anxiety so that greater functioning can be achieved. Subjective Units of Discomfort (SUDS) scores are collected throughout therapy. Measures of OCD severity place equal emphasis on the frequency and severity of obsessions and compulsions. This focus is also evident in ERP where equal time is spent focusing on reducing obsessions and compulsions. ACT is purported to be different than ERP in that it focuses less on the reduction of inner experiences (such as obsessions), and more on altering the way they are experienced. ACT sees inner experiences, such as obsessions and anxiety, as part of our lives. Obsessions and anxiety are not inherently bad events, but they are treated that way by most of society. ACT focuses on finding a way to allow obsessions and anxiety to come and go without interfering with the way one lives his or her life. Thus, greater functioning can be achieved without a change in severity or frequency of obsessions or anxiety. This is a position that is shared with other forms of CBT but possibly emphasized to a lesser extent.

Individuals diagnosed with OCD or therapists who work with these clients may have a "negative" reaction to the idea of living with obsessions and anxiety. If you experienced the same reaction when you read the last paragraph, just notice that reaction and answer these questions:

Has attempting to control or regulate obsessions and anxiety worked over the long-term?

Has this lessened the obsessions and anxiety in a meaningful way?

Finally, has your life become more open and fulfilling as a result of these attempts to regulate obsessions and anxiety?

If you answered "yes" to all of these questions, then keep doing what you are doing. Follow your experience; it is more honest than your mind. If you answered "no" and what you are doing is not lessening these obsessions, your life feels more restricted, and you are getting further from where you want to be, then some of the concepts from ACT might be useful for you.

One of the central concepts of ACT is that there is a big difference between what one thinks or feels, and what one does. ACT is based on the model that the things people think and feel, or the bodily sensations that one has are not under that person's control in any meaningful way. But, what a person does while thinking, feeling, or experiencing a sensation is under his or her control. To illustrate this, answer these
two questions:

1. For $1,000 could you prevent yourself from having an obsession over the next 24 hours, and

2. For $1,000 could you stop yourself from engaging in your compulsion(s) over the next 24 hours?

Most people would probably Experience their obsession but would find a way to avoid engaging in the compulsion(s). This exercise illustrates that while obsessions and compulsions often occur together, they are not technically tied to each other. We can experience obsessions and not engage in compulsions. Also, compulsions are much easier to control than obsessions. This is partially why ACT focuses on what one does and less so on what one thinks or feels.

People generally work to control obsessions and related anxiety because they are ]experienced as dangerous, threatening, uncomfortable, or some other "negative" valuation. But there is another aspect to obsessions and anxiety that is overlooked - they are just thoughts in one's head and are feelings that one experiences. Humans are constantly thinking and feeling, but most of the time we do not grab on to any of these events. ACT aims to teach us ways to experience obsessions and anxiety as just thoughts and feelings that we may or may not respond to. When obsessions and anxiety are experienced in this way, it is much easier to respond flexibly to these experiences.

The focus of ACT for OCD is to help clients get to a place where they can openly experience thoughts, feelings, or bodily sensations, not be overly impacted by them, and continue to move in directions in life that are meaningful. The benefit of this approach is that a reduction in obsessions and anxiety is not necessary to begin changing one's actions. From the ACT point of view, the problem with OCD is not that obsessions and compulsions occur, but that every time an obsession occurs the compulsion follows. ACT aims to teach the flexibility to engage in an unlimited number of responses when the obsession is there. There is a way to keep working, play with the kids, eat dinner, talk with a friend, or engage in whatever the chosen activity is ,while experiencing the obsession. This involves experiencing obsessions for what they are (just words in one's head and words are not dangerous), making room for them as just another experience, and moving forward in directions that are meaningful while the obsessions are there. If this is practiced enough, eventually it becomes easy and the precise thought or feeling that shows up does not interfere with one's actions. There is a way to experience obsessions AND do what is important in life.

Is ACT for OCD Effective?

The effectiveness of ACT for OCD has recently been tested in a large trial funded through the National Institute of Mental Health (Twohig et al., 2010) In this study, eight one-hour sessions of ACT for OCD with no in-session ERP were compared to Progressive Muscle Relaxation (PMR), with assessments taken at pre-treatment, post-treatment, and at a three month follow-up. PMR was viewed as a control condition in this experiment, so most of this review will focus on the results for the ACT condition. In this study, 79 adults (41 in the ACT condition) diagnosed with OCD were treated. All types of OCD were included in this study (hoarding, primary obsessions, checking, cleaning, etc.) and there were very few exclusion criteria, thus, hopefully representing a fairly realistic sample of participants. The treatment was found to be highly acceptable. Only 12% of the sample in the ACT condition refused or dropped out, which is quite low for OCD treatment trials. All participants in the ACT condition rated the treatment as a 4 or greater on a 5 point scale, with 5 being the most positive score. These findings are meaningful because low drop-out and high acceptability are difficult to achieve in the treatment of OCD. ACT was more effective than PMR in the treatment of OCD, with clinically significant change in OCD severity occurring more in the ACT condition than PMR, using multiple criteria and including all participants, even those who dropped out (clinical response rates ACT post=46-56% and ACT follow-up 46-66% vs PMR post=13%-18% and PMR follow-up 16-18%). ACT also had a greater effect on depression and resulted in greater improvements in quality of life than PMR. These findings are in addition to previous smaller studies showing that ACT'sffectiveness for OCD (Twohig, Hayes, & Masuda, 2006a), skin picking (Twohig, Hayes, & Masuda, 2006a), and ACT plus habit reversal in the treatment of trichotillomania (hair pulling) (Twohig & Woods, 2004; Woods Wetterneck & Flessner, 2006).

Should I Look into ACT for OCD?
Michael P. Twohig, PhD, is a licensed clinical psychologist in Utah and an assistant professor at Utah State University. He received his PhD from the University of Nevada, Reno and completed his clinical internship in the CBT track at the University of British Columbia. His research spans a variety of areas including, the treatment of obsessive compulsive disorder and OC-spectrum disorders, substance use, mechanisms of action, and multicultural issues. He has published over 50 scholarly works, including two books An ACT-Enhanced Behavior Therapy Approach to the Treatment of Trichotillomania (with Woods) and ACT Verbatim for Depression and Anxiety (with Hayes). His research is funded through multiple sources, including the NIMH.
ACT for OCD is a newer treatment and the research is quite limited compared to the work that has been done on ERP and ERP with cognitive procedures (often referred to as CBT). ERP with or without cognitive procedures should be the first line of treatment someone seeks out. ACT procedures integrated into exposure therapy may be useful for people who are struggling with ERP. Finally, if exposure procedures are not useful, ACT may be considered as an alternative treatment. ACT is specially appropriate for people who have been unsuccessful at regulating or controlling obsessions and anxiety -especially after full trials of other treatments. It is also well-suited for people who are very tied into their obsessions and feel like they have very little control over their reactions to obsessions. There are a growing number of therapists who are trained in the use of ACT for OCD.

References

Twohig M. P., Hayes S. C., & Masuda A., (2006a). "Increasing willingness to experience obsessions Acceptance and commitment therapy as a treatment for obsessive-compulsive disorder," Behavior Therapy, 37: 3-13.

Twohig M. P., Hayes S. C., & Masuda A., (2006b). "A preliminary investigation of acceptance and commitment therapy as a treatment for chronic skin picking," Behaviour Research and Therapy, 44: 1513-1522.

Twohig M. P., Hayes S. C., Plumb J. C., Pruitt L. D., Collins A. B., Hazlett-Stevens H & Woidneck M R. (2010). A randomized clinical trial of acceptance and commitment therapy vs progressive relaxation training for obsessive compulsive disorder. J Consult Clin Psychol,

Twohig M P. & Woods D W (2004). A preliminary investigation of acceptance and commitment therapy and habit reversal as a treatment of trichotillomania. Behavior Therapy, 35: 803-820.

Woods D W. Wetterneck C T. & Flessner C A (2006). A controlledvaluation of acceptance and commitment therapy plus habit reversal for trichotillomania. Behaviour Research and Therapy, 44: 639-656.

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International OCD Foundation | What is ACT?

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What is Acceptance and Commitment Therapy, What is its Effectiveness, and Should I Look Into It? by Michael Twohig, Ph.D. Michael P. Twohig, Ph.D. a licensed clinical psychologist in Utah and an assistant professor at Utah State University. He received

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If it's possible to think, then it's possible for OCD to latch onto it.

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If it's possible to think, then it's possible for OCD to latch onto it.

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If you suspect it "might" be OCD, choose to treat it as OCD.

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If you suspect it "might" be OCD, choose to treat it as OCD.

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Along the road to recovery, there are many moments of "ugh...I'm back to square one." This is part of the journey.

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Along the road to recovery, there are many moments of "ugh...I'm back to square one." This is part of the journey.

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One day, you will tell the story of how you overcame what you went through...and it will be someone else's survival guide.

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One day, you will tell the story of how you overcame what you went through...and it will be someone else's survival guide.

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The struggles you face with OCD are the foundations for the development of "you," which you wouldn't have experienced had you not gone through this.

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The struggles you face with OCD are the foundations for the development of "you," which you wouldn't have experienced had you not gone through this.

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Your future self is thanking you for the recovery journey you are on now.

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Your future self is thanking you for the recovery journey you are on now.

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Thoughts are thoughts...and everyone has them.

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Thoughts are thoughts...and everyone has them.

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International OCD Foundation, Boston, Massachusetts. 25K likes. We are an international non-profit organization for people with Obsessive Compulsive Disorder (OCD) and related disorders, as well as...

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By Dr. Elizabeth McIngvale

Obsessive-Compulsive Disorder (OCD) is a treatable neurobiological disorder characterized by recurrent, unwanted intrusive thoughts (obsessions) and repetitive behaviors (compulsions/rituals) such as counting, checking, praying, and cleaning. These compulsions are performed in an effort to relieve the anxiety caused by the obsessions. OCD obsessions and compulsions can be extremely time-consuming, causing significant emotional distress and may greatly interfere with day-to-day functioning and interpersonal relationships. Individuals with OCD may go to great lengths to hide their obsessions and compulsions due to embarrassment and shame. It is estimated that one in every 40 adults, and one in every 100 children suffer with OCD.
Facts about OCD:

The exact cause of OCD is unknown, although research shows there may be a genetic component.

OCD impacts 1 in every 40 adults and 1 in every 100 children.

OCD affects approximately 2% of the population.

OCD usually appears in childhood, adolescence, or early adulthood.

There is effective treatment for OCD.

OCD affects Women and Men equally.

On average, it takes 9 years for an OCD sufferer to get the proper diagnosis and treatment.

Avoidance:
It is important to note that avoidance can be just as detrimental as rituals when it comes to giving the OCD power and contributing to the OCD cycle. Although there may be many places and situations, which you avoid due to your OCD, with proper treatment you can engage, return to and resume activities (thoughts, people, places or things) you have previously been avoiding. When engaging in Exposure and Response Prevention (ERP) it is important that you work to eliminate avoidance behaviors (both avoidance of exposure situations as well as avoidance of touching/cross-contaminating certain things) in order to make optimal progress in your treatment.

DISCLAIMER: The content found here is intended to serve as educational content and is not intended to replace therapy. For treatment-related questions, please be sure to work with your local provider or contact a local clinician.

Choose a title below to view related OCD videos

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By Dr. Elizabeth McIngvale Obsessive-Compulsive Disorder (OCD) is a treatable neurobiological disorder characterized by recurrent, unwanted intrusive thoughts (obsessions) and repetitive behaviors (compulsions/rituals) such as counting, checking, praying, and cleaning. These compulsions are performed in an effort to relieve the anxiety caused by the obsessions.

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Not Alone Notes mails free, handwritten letters to others with OCD to remind them they aren't alone, encourage hope, and dispense resources.

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Riley's Wish Foundation seeks to encourage purposeful actions to serve those battling obsessive compulsive disorder (OCD). Our goal is to foster unity among persons suffering from OCD, and to educate the public about the disorder while affecting change in OCD awareness and treatment. One particular focus of the Foundation is to help people with dual diagnosis of addiction and OCD.

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Riley's Wish Foundation seeks to encourage purposeful actions to serve those battling obsessive compulsive disorder (OCD). Our goal is to foster unity among persons suffering from OCD, and to educate the public about the disorder while affecting change in OCD awareness and treatment.

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Children with anxiety or OCD are likely to exhibit symptoms in the school setting. For this reason, it's important to understand the signs and symptoms of Anxiety and OCD and to be able to differentiate between normal vs. abnormal behavior.

Anxiety in Kids

Everyone experiences anxiety at some point in their lives, from the very young to the very old. In school, students may get nervous during a fire drill, before a test or presentation, or when saying goodbye to their families in the morning. It is normal and common for students to get anxious in situations like these. When a student's anxiety starts to creep out of specific situations and into their everyday life, they might have an anxiety disorder.

Anxiety, as it relates to mental health conditions, is defined as chronic and/or generalized worry, fear, or nervousness that students express a lot of the time. In other words, the anxiety the student feels is not driven by specific situations - they feel anxious most of the time, regardless of what is happening in their life. In these cases, anxiety noticeably impacts a student's behavior in school and at home, their ability to participate in class, their learning, and/or their ability to perform assigned tasks.

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Anxiety Signs and Symptoms | Anxiety In The Classroom

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Children with anxiety or OCD are likely to exhibit symptoms in the school setting. For this reason, it's important to understand the signs and symptoms of Anxiety and OCD and to be able to differentiate between normal vs. abnormal behavior. Everyone experiences anxiety at some point in their lives, from the very young to the very old.

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I'm a Licensed Clinical Psychologist in California. My clinical work started first as a school psychologist and then as a clinical psychologist. I have significant experience working with children, adolescents, and adults with OCD, trauma, anxiety, and emotional regulation problems. I'm the founder of the East Bay Behavior Therapy Center, a boutique practice, where I run an intensive outpatient program integrating Acceptance and Commitment Therapy (ACT) and Exposure Response Prevention (ERP) to support clients getting unstuck from OCD.

I'm the author of the following books:

- ACT beyond OCD: An Acceptance and Commitment Therapy Workbook for adults

- The ACT Workbook for Teens with OCD: Unhook Yourself and Live Life to the Full, is dedicated to all the teens she worked with and were struggling with Obsessive-Compulsive Disorder (OCD).

- Parenting a troubled teen: using acceptance and commitment therapy, written for parents or caregivers raising teens struggling with "feeling too much, too quick, and acting too soon."

- Escaping the emotional roller coaster: ACT for the emotionally sensitive, a self-help book for adults struggling with having an emotional switch that goes on and off, anytime, anywhere.

I'm the co-author of the book Mind and emotions: a universal protocol for emotional disorders" that has received a "Self-help seal of merit" from the Association for Behavior and Cognitive Therapists (ABCT)."

I attend local, national, and international conferences on a regular basis in order to keep up with current clinical research and deliver up-to-date therapy services to my clients. In addition to my doctoral training, I have been nominated Fellow of the Association of Contextual Behavioral Science; I'm a graduate of the International OCD foundation Behavior Therapy Training Institute (BTTI) for the treatment of pediatric OCD and adult OCD; and I have completed an intensive training in Dialectical Behavior Therapy (DBT). Over the last 17 years, I have been learning, practicing, and teaching Acceptance and Commitment Therapy (ACT).

I'm dedicated and committed to get my clients "unstuck" from overthinking or avoidance problems, guide them to figure out what they care about, and coach them to do stuff that matters to them.

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I'm a Licensed Clinical Psychologist in California. My clinical work started first as a school psychologist and then as a clinical psychologist. I have significant experience working with children, adolescents, and adults with OCD, trauma, anxiety, and emotional regulation problems. I'm the founder of the East Bay Behavior Therapy Center, a boutique practice, where I run an intensive outpatient program integrating Acceptance and Commitment Therapy (ACT) and Exposure Response Prevention (ERP) to support clients getting unstuck from OCD.

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About us

OCD Georgia is the Georgia affiliate of the International OCD Foundation (IOCDF). We increase awareness about OCD and effective treatments, provide information and resources to Georgians with OCD and related disorders, and offer opportunities for individuals, family members, and treatment providers to connect within the community.

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OCD Georgia is the Georgia affiliate of the International OCD Foundation (IOCDF). We increase awareness about OCD and effective treatments, provide information and resources to Georgians with OCD and related disorders, and offer opportunities for individuals, family members, and treatment providers to connect within the community.

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Katie A. Cullum, Ph.D., is a Licensed Clinical Psychologist who specializes in treating OCD, anxiety disorders, emotion dysregulation, and relationship difficulties. She utilizes evidence-based interventions, including: Cognitive Behavioral Therapy (), Exposure with Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), Integrative Behavioral Couples Therapy (IBCT), and Emotionally Focused Couples Therapy (EFT). Dr. Cullum is particularly interested in working with adolescents and adults with OCD and/or difficulty regulating intense emotions, as well as couples seeking to enhance communication and emotional connection within their relationship. She values collaborating with clients to help them identify and move towards what matters most to them.

Dr. Cullum is passionate about increasing access to evidence-based care through her involvement in clinical, training, research, and outreach activities. She holds an appointment as an Adjunct Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Emory University's School of Medicine. In this role, she trains psychiatry residents and serves as a founding member of Caring Communities (an interdisciplinary group of mental health professionals who have mobilized in the face of COVID-19 to provide support groups, debriefings, tip-sheets, education, and more) as well as the Diversity and Inclusion Subcommittee (DISC). Dr. Cullum serves as a Board Member of OCD Georgia, the local affiliate to the International OCD Foundation.

Dr. Cullum is actively involved in the scientific community and has authored research papers on youth mental health, the intergenerational transmission of depression, and parenting interventions for mothers with depression. Currently, Dr. Cullum's research focuses on the treatment of OCD and related disorders and enhancing care in the context of public health crises, such as COVID-19. She has given lectures and trainings to psychology graduate students and residents on a range of topics related to the assessment of OCD and therapy interventions, such as DBT.

Originally from Texas, Dr. Cullum has made Atlanta home. In her free time, she enjoys spending time with loved ones (including plenty of time outside with her dog, Scout), running, practicing yoga, listening to music, and painting.

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Dr. Katie Cullum - Anxiety Specialists of Atlanta

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Katie A. Cullum, Ph.D., is a Licensed Clinical Psychologist who specializes in treating OCD , anxiety disorders, emotion dysregulation, and relationship difficulties. She utilizes evidence-based interventions, including: Cognitive Behavioral Therapy (), Exposure with Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), Integrative Behavioral Couples Therapy (IBCT), and Emotionally Focused Couples Therapy (EFT).