OCD can be really tough to treat. On average, people don’t come to treatment for 7 years after the onset of symptoms. That’s a ton of time for the disorder to take a strong grip on someone’s life. OCD involves obsessive thoughts, things that pop into a person’s mind and won’t leave. Often, these thoughts involve some bad outcome such as a fear that something negative will happen. To control or neutralize these thoughts, people engage in compulsions, behaviors that they feel they must do in order to prevent something bad from happening. These compulsions can be absolutely anything. It could be cleaning, moving limbs in a certain way, saying phrases in your head, or making others do things. When these compulsions are repeated over time they become rituals.
When trying to beat OCD, it is critical to try and resist compulsions. This is called response prevention. Many people who don’t understand the disorder just think people with OCD should stop doing all of them and they’d be fine. After all, their life would be so much better if they would ”just stop it”. But it’s not as easy as that. And it’s incredibly invalidating and insulting to their intelligence to suggest as much. If it were as easy as just stopping, no-one would ever have OCD and all treatment manuals would only contain three words: Just. Stop. It.
The most evidence-based treatment for OCD involves gradual, prolonged, and repeated exposures to a person’s fears while also blocking compulsions in the same way. This is called Exposure and Response Prevention Therapy. Sometimes I think of this like trying to build muscles. If you go to the gym (i.e. do exposures) you’ll build strength. However, if you eat a bunch of chocolate afterwards (i.e. do compulsions) you’ll undo all the hard work that you did. Progress really depends on resisting those compulsions. But how to do this?
To do response prevention, people have to slowly try to resist the hold that OCD has over them, building up their strength to fight back over time. This can take many forms, and I call all of them “spoiling” compulsions. Because most people with OCD can’t just stop their compulsions, we have to try and spoil them instead. In the table below I’ve outlined what I think are the main ways that a person can spoil compulsions.
These methods can help fight OCD. The more they are used the easier it will become and the more a person will get from doing exposures.
Thanks for reading!