When Mindfulness Isn’t Enough: Why OCD Requires Expert ERP Therapy

If your check engine light turned on in your Volvo, would you take your Volvo to a Jeep dealership? A Ford dealership? Or a Tesla dealership?  Of course not!  While Jeeps, Fords and Teslas are all great car brands, if you have a specific type of car, you need to go to the experts to get it fixed.  This is true for specializations in healthcare like foot pain and going to a podiatrist instead of a neurosurgeon and for someone with OCD going to a general therapist. 

I’ve often been told by clients struggling with OCD that they went to other therapists in the past who listened but didn’t offer helpful tools to combat OCD.  Sometimes the clinicians didn’t specifically identify the OCD and other times they did but they didn’t offer the tools to help the client move forward. In our profession, we desire to cheer and encourage other clinicians as we are all in this helping field together.  However, not all therapists are adequately trained in OCD treatment and while they likely have the best of intentions, are causing more harm than help. Why? Because treating OCD patients requires special training and expertise beyond what is learned in grad school or even what is learned in treating general anxiety. General anxiety and OCD aren’t the same; therefore, they need to be treated as the unique disorders that they are. 

What’s the difference between anxiety and OCD?

There are definitely similarities and some overlap but anxiety and OCD are not the same disorders. And while we won’t go into every specifier that differentiates the two, we will list several specific differences that make each unique.  First, the focus of the disorders is different. Anxiety disorders are focused on worrying about real-life stressors.  These stressors are normal concerns that are given an excessive amount of attention to things like one’s grades, relationships, job, etc. OCD comes from unwanted, often unpleasant and intrusive thoughts, images and urges that are typically irrational and not aligned with the person’s values.  OCD is usually, if not always, irrational. For example, an A+ student might worry that even though they studied for hours, if they don’t start and stop when the clock is at an even number, they will fail their test. As one can see, an anxious thought can be rational, even if it’s blown out of proportion like, “what if I fail this test and don’t get into my dream college?” while OCD would say, “If I don’t say goodnight in the “right” way to my parents the night before the test, I’ll fail it and then never go off to college.”  The anxious person can sometimes recognize that their worry is excessive, yet they often can justify it, while someone with OCD knows that their obsessions and compulsions aren’t rational, yet they can’t resist it. 

As you can see, OCD and anxiety are different and you can probably imagine that the methods used to treat one versus the other would be different too.  While clinicians can use various techniques for anxiety, there is only one “gold standard” for treating OCD and its Exposure and Response Therapy (ERP). ERP teaches clients to face their obsessions and tolerate the discomfort without doing the behavioral or thought compulsions that their OCD demands of them.  For the student mentioned earlier, this means not telling his or her parents goodnight in the “correct” way and allowing themselves to experience the discomfort that comes from not following through with the compulsion.  For someone with OCD, there are various levels of exposures and with ERP, we are able to help clients identify those different levels.  Over time, the client completes all the exposures but they start from the least intense and over time, using a very specific process, move forward one at a time. 

Oftentimes, ERP methods are skimmed over in graduate school which is why it’s important for clinicians who treat OCD to have additional training and ongoing training to provide ERP to patients.  Working with kids with OCD involves family whereas working with a single adult might sometimes include the participation of a roommate.  Utilizing support structures and having them empower and not further enable is critical so having ERP training helps clinicians confidently teach the support structure and collaborate with them as a united team together.  

Anxiety disorders are treated using various methods that, when used alone, can actually be unhelpful for a client such as mindfulness alone only increases someone’s obsessions and compulsions.  Mindfulness is a powerful tool but when a client with OCD only talks about obsessions in therapy with a non-ERP-trained therapist and then is assigned to be mindful and journal about fears between sessions, the OCD will actually get worse.  

As someone with OCD and a clinician who is passionate about treating patients with OCD, it’s exciting to see the powerful changes that occur when the correct tools are used.  As a team, we have monthly ERP consultation meetings, offer weekly supervision, and encourage ongoing professional training so that every clinician working with OCD is able to offer the best resources possible to our clients.  If you or someone you love has OCD and is tired of feeling stuck, we’d love to offer a free consultation call to discuss the unique situation and ways that we can best partner with you in the therapy process going forward using the gold standard of care! Reach out today to learn how we can help you break free from the cycle of obsessions and compulsions.