When my son Dan was first diagnosed with obsessive-compulsive disorder, he, like so many others, did not receive proper treatment. Wrong therapy, wrong drugs. His OCD spiraled out of control and less than a year later it was so severe he could not even eat.
So when he entered a top OCD residential treatment program, my husband and I finally breathed a sigh of relief. Dan was on his way! The therapy used in this program was exposure and response prevention (ERP), the recommended psychological treatment for OCD.
By all accounts from his social worker, Dan settled in quickly at the program and was already working hard: facing his fears (exposures) and refraining from engaging in his compulsions (response prevention). And from what we were told, he was making good progress.
We were so pleased and excited! We couldn’t wait to see Dan and almost ran into the building for our first weekly meeting. How wonderful it would be to see him not so tormented by this horrible disorder!
Well, what we found was not what we imagined. Dan had lost more weight and had black circles under his eyes. He was noticeably nervous, anxious, and jittery, and appeared to be in even worse condition than when he first entered the program.
What went wrong?
What my husband and I didn’t realize at the time is that ERP therapy, by its very nature, raises anxiety. Our son was being asked not only to face his greatest fears, but to refrain from engaging in the thoughts or actions that he believed (at least on some level) kept him, or those he cared about, safe.
Let’s take an example. A common obsession in OCD is worrying about the possibility of hitting someone while driving. Maybe a person with this obsession might avoid driving, but if he has to drive, he makes sure to go back and check every time he thinks he might possibly have hit someone. This compulsion temporarily reduces our friend’s anxiety, but actually strengthens his OCD.
Enter ERP. Now he not only has to face his fear of driving, he has to force himself not to turn the car around to make sure he hasn’t hit anyone. This causes a spike in anxiety, which is actually an integral part of ERP therapy. While the anxiety will be intense, it always resolves at some point. It might take a long time at first, but each time this person drives without checking, the anxiety will typically take a little less time to dissipate until finally, the person with OCD is no longer tormented by this obsession. He has learned to live with the uncertainty of the situation.
Back to Dan. So while we didn’t know it at the time, my husband and I should have been happy to see him so anxious. As he himself told us, “I feel horrible, but that’s good.” That meant he was truly immersing himself in his ERP therapy, and it was working. It’s a tough battle, but as I’ve said many times before, I’ve never met anyone who has regretted doing ERP therapy. The only regret is not having done it sooner.