Obsessive Compulsive Disorder (OCD)
​​Many people with OCD know their fears don’t make sense — yet still feel unable to stop responding to them. Thoughts may feel vivid, urgent, or morally threatening, even when part of you knows they are unlikely or irrational.
OCD is characterized by intrusive, unwanted, and distressing thoughts, images, and urges. Obsessions may focus on contamination, harm, responsibility, morality, relationships, health, or intrusive thoughts that feel disturbing or out of character.
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In response to these intrusive elements, a compulsive physical or mental act is performed to neutralize the distress.
However, the relief provided by the compulsion is limited, and the compulsion itself often comes at a great cost as it is repeated more frequently. OCD typically results in a significant detriment to one's work or school performance, self-care, relationships, and general quality of life.
Exposure and Response Prevention
(ERP)
ERP is the gold-standard evidence-based treatment recommended for OCD. It consists of confronting feared situations or stimuli (both in real life and via imaginal exposure) while refraining from performing compulsions. This allows you to learn that you do not need the compulsions in order to feel better, and ultimately frees you from OCD's grip of control.
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ERP is collaborative and carefully paced. Exposures are planned together, guided by your values and goals, and adjusted over time. While treatment is challenging by design, it is never about forcing or surprising you.
At Grey Havens Psychological Services, all our clinicians are members of the International OCD Foundation (IOCDF) and are fully trained and proficient in ERP. Treating OCD is what we do best. It constitutes about 80% of our practice.
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The treatment of OCD with ERP consists of five phases:
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Assessment
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Education
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Hierarchy Formation
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Exposure
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Maintenance
Assessment
During your first appointment your therapist will conduct a clinical interview and use the gold-standard assessment tool for OCD: the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).
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​This allows us to specify the level of symptom intensity and identify the breadth of how symptoms are presenting. This information is crucial to help us design an individualized treatment plan for you.
education
After assessment, we spend the following 1-2 sessions making you an expert on OCD treatment.
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We discuss the neurobiological etiology of OCD and the theory behind ERP so that you have the confidence that ERP will work for you.
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You wouldn't allow a doctor to operate on you without knowing what they were going to do or how it was supposed to help - you deserve the same informed treatment for OCD.
Hierarchy
ERP involves challenging progressively harder exposures. We start with very easy items and advance to more difficult ones as you develop tolerance and strength.
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We usually spend 1-3 sessions collaboratively creating your individualized exposure hierarchy. We target things OCD makes you do that you don't want to be doing, and things OCD no longer lets you do.
Exposure
An average number of sessions in this phase is about 30. However, some people need much less and some may need more.
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During the exposure phase we will begin conducting exposures together during sessions, and you will also be given specific exposure goals to complete as homework between sessions.
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As you progress, we shift to meeting every two weeks to give you more time to build independence​.
Maintenance
Once you have completed your course of ERP and OCD is no longer active, you are ready for maintenance!
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This phase usually consists of 1-3 final sessions where we discuss how to prevent OCD from returning, and how to manage it on your own if it tries to creep back into your life.
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Now it is time to celebrate that you are back in control of your life!