OCD is treatable. ERP and ACT are evidence-based treatments for OCD with a high success rate. Many of my clients have achieved dramatic symptom reduction. Once you learn ERP/ACT skills in treatment, you can use them on your own and step down or stop treatment.

Treatment success for OCD doesn’t just mean you stop doing compulsions. It also means that your overall levels of fear and distress go down, your urges to perform compulsions decrease, and your mental compulsions (e.g. overthinking, vigilance) also decrease. In short, you’ll be calmer, happier, and think about your OCD a lot less.

If you’re able to engage meaningfully in weekly psychotherapy and use ERP and ACT skills outside of sessions, you should expect your symptoms to decrease significantly within the first three to six months. However, treatment success can vary with the severity of your symptoms, the amount of time you’re able to devote to working on your skills outside of sessions, and the extent to which you’re able to apply those skills.

OCD treatment is based on the idea that fear and distress are continually reinforced by avoidance. When you perform what we call “safety behaviors,” also known as “compulsions” or “rituals”—things you do that bring your fear level down—you reinforce that fear. Over time, as you continue to perform safety behaviors (like washing your hands, avoiding the number “3,” or thinking back to make sure you didn’t hit someone with your car), your fear continues to increase because you’ve taught your brain that it’s dangerous to experience the fear brought on by those situations.

However, your brain is capable of learning to feel safer distressing situations, too. In therapy, you’ll learn the skills to decrease your use of safety behaviors and overcome avoidance of the kinds of everyday situations that usually cause you distress. With time and practice, your brain will learn to feel safer in these situations, and your safety behaviors will get less urgent.

OCD treatment doesn’t just require you to be exposed to situations that cause you fear. Here are a few important factors that treatment will introduce to your exposures:

1. Consistency. Therapy involves not just sporadically experiencing things you’re afraid of, but consistently not avoiding them for a long period of time.

2. Variety. The most effective treatment involves experiencing a fearful stimulus in many different scenarios, not just one or two. Variety helps you generalize feelings of safety.

3. Safety behavior reduction. When you experience fearful situations right now, you’re probably performing safety behaviors (a.k.a. compulsions or rituals). For example, if you’re afraid of driving but have no choice but to drive, you might check your mirrors compulsively or ask for reassurance from your passenger. These behaviors bring down your fear level in the moment, but in the long term, they the exposure much less effective. In treatment, you’ll learn to recognize safety behaviors and avoid them so your brain can truly learn to feel safe without safety behaviors.

“Pure O” is another way of saying that your OCD usually manifests itself in mental compulsions, not physical ones. For example, instead of avoiding sidewalk cracks or sanitizing your kitchen, you might compulsively review your memories, push “bad” thoughts out of your head, or ruminate about whether something is true or untrue.

But mental compulsions are just that: compulsions. Just as you can learn to avoid physical compulsions, you can learn the skills to avoid mental compulsions. With practice, your intrusive thoughts will become less severe and distressing.

No problem! It’s possible you don’t. Or it’s possible you fit the criteria for another disorder, such as Generalized Anxiety Disorder. The good news is that the skills you’ll need to learn to effectively reduce your OCD symptoms are widely applicable. They’re the same skills I use to treat anxiety, trauma, and other problems. If you have intrusive thoughts that bother you or cause you to do things you don’t want to do, you can benefit from treatment.

No. You’ll be in control of your treatment process the entire time. In fact, I won’t ever tell you what kinds of exposures to perform. Instead, you’ll be helping to design your treatment plan and come up with meaningful exposures from scenarios you encounter in your everyday life. Most, if not all, of your exposures will take place outside of session. I’ll never insist you do anything that you feel is too uncomfortable or unsafe.