The best combo

After years of therapy, I have finally found my ideal combination of techniques: exposure and response prevention (ERP) + acceptance and commitment therapy (ACT).

ACT combines acceptance and mindfulness strategies with commitment and behavior change strategies.

For me, the most effective process of ACT is called cognitive defusion (yes, that's how it's spelled). Cognitive defusion helps you cope with intrusive, unwanted thoughts by having you recognize that these thoughts are just... thoughts!

Whenever I have an intrusive thought or image, I say to myself, "that's just a thought." This simple phrase is actually so powerful. When I say this phrase, it's as though a switch in my head is hit. Once the switch is hit, the OCD part of my brain that pumps out irrational thoughts is replaced with the stronger logical part.

ERP is necessary in OCD treatment to decrease the anxiety/distress caused by the obsession; this is done by sitting with the obsession and not engaging in a compulsion or ritualization. Staying exposed to the obsession and preventing the compulsive response leads to habituation.

Exposures take a lot of time and energy, and constant exposure throughout the day can be damaging. Therefore, targeted exposures should be executed at a set time and place. As you become use to ERP, you might start to do impromptu exposures in addition to the structured ones discussed in therapy. However, this independence comes with experience. Please don't push yourself farther than what was agreed upon in your session; take it one step at a time and let yourself be OCD outside of your targeted exposures.

When I am unable to practice ERP in the moment of my intrusive thoughts, I resort to the ACT statement of, "that's just a thought." I even have a sticky note on my wall with the phrase.

ERP/ACT are evidence-based in the treatment of OCD. If you'd like to read more about it, let me know and I can throw some resources your way.

Shoutout to my therapist for being the best one I've had.

And as always, have a lovely day.