For many of us with OCD, we develop avoidance compulsions around socializing. Even those of us who do not have a social anxiety presentation of OCD can feel alienated from others because we fear judgement for our behaviors.

Anxiety at its core is an unhelpful triggering to the sympathetic nervous system. Our sympathetic nervous system is our Fight Flight Freeze response, which is biologically important but usually, in modern times, alerted during non-dangerous situations.

For those dealing with Obsessive Compulsive Disorder, planning can become a compulsion that temporarily soothes the fear of the unknown. OCD tries to attain certainty about the future, and this can come in the form of plans. Some planning is necessary and useful, but over-planning detracts from our ability to be in the present.

Over-control of details in the environment, schedule, or in one’s person, is a compulsion. This compulsion is a defense response from a fear of being unsafe. These people are labeled by those in their inner circle as “micro-managers” or “very particular.” In OCD treatment, we let go of one thing at a time, until many things float outside the circle of management/control.

For most of us, OCD is far more entrenched than we even realize when we begin treatment.  Exposure homework gets avoided week after week, and our clients’ progress is slow.  Regular repetition of therapy exposures is the quickest path to healing!  At-home exposure coaching basically helps adults and children actualize the goals of therapy between sessions.  

More and more human beings are experiencing panic attacks during these changing, uncertain times.  However, few know the difference between panic attacks and panic disorder.  Here’s how to differentiate.  

Committed Action is a form of therapeutic goal setting that naturally springs from an exercise of clarifying values.  Values help you understand directionally where you want to go and committed action is a concrete presentation of how you want to get there.  Committed action is a declaration to more fully live out your values.  

Obsessional slowness is a commonly misunderstood form of OCD that often presents around showering, getting dressed, or preparing to leave the house.  Basic daily tasks must be done with a deliberateness that often leads to excruciating prep time (s.a. morning routines that begin at 5am) or chronic lateness or truancy.  Obsessional slowness often comes from the OCD compulsion to not stop until something is “just right.” 

Many children refuse and avoid therapy, especially when first suggested. I urge parents to be patient but not give up.  If a child refuses/avoids even meeting a therapist, there is a strong chance that they really need to be there.  

Whenever we embark on any process of change, it is useful to ask the question: when will we know we have reached our destination? Setting mental health goals, and specific markers to help us check in along the way, is especially useful when attempting to change a behavior.

Emotional acceptance is a foundational concept of mindfulness, as well as exposure therapy.  But why would you choose to accept difficult emotions instead of fight to eliminate them? Obsessive Compulsive Disorder fundamentally springs from an intolerance of distress and a constant need for a sense of safety and control.  Acceptance of emotions not only plays a part in reducing OCD symptoms; but also ultimately leads to an even more important asset: self-acceptance.   

Cognitive Behavioral Therapy (CBT) is widely known but rarely applied among mental health practitioners. While evidence shows it is highly effective, it feels less pleasant than other, more soothing forms of therapy. It can be hard work to engage in true CBT treatment. So why would you choose it?

While I encourage everyone experiencing OCD to match with an Exposure Response Prevention (ERP) Coach and Therapist to begin their healing journey, some may benefit from trying out some self-directed exposures to understand the basic principles of ERP.

Self-Harm OCD is a tricky concept for clients and clinicians alike, because it can be easily confused for true intent to self-harm. OCD sufferers themselves are not fully sure if suicidality or desire to self-harm comes from intrusive thoughts, or truly represents their desires.

One of the first compulsions we may work on in exposure therapy is the urge to double, or triple check, when we know we have completed something well. Our smart brains are fully aware of the memory of having completed a task, but our OCD brain comes in and plants the slightest seed of uncertainty.

One of the contradictions of Obsessive Compulsive Disorder (OCD) is a persons’ relationship to objects. For some with OCD, minimalist possessions are necessary to achieve symmetry and order. In other forms of OCD (which can be co-occurring with symmetry OCD), objects represent some level of certainty. Holding onto an object can mean we are not parting ways with a memory we do not wish to forget, or that we will regret not having the object in the future. Holding on to an object can also be a safety mechanism.

A common homework challenge for Exposure Response Challenge is compulsion breaking around cell phone use. While most modern humans have some over-checking with their phones, those of us with OCD can have critical anxiety behavior that revolves around this otherwise enjoyable device.

Many folks with OCD struggle with any potential for lateness. Some are chronically late due to compulsions needed to leave the house, but most deeply fear the shame of arriving somewhere even a minute or two late. Exposure Response Prevention can help.

Well-executed OCD treatment is very distinct from standard psychoanalytic therapy. Clients are often surprised at the different energy and must readjust their expectations.

For children younger than ten, talk therapy is not a viable option.  Kids who are sensory seeking, hyperactive, or anxious are even less able to focus on an emotions-centered conversation.  Emotional awareness must be built more creatively, with toys, games, and the use of other physical representations of feelings.