Alternative Therapies for OCD:

OCD sucks. 

The good news is: it usually responds well to therapy (better than it responds to medication for a lot of people, too).

The even better news is: there’s more than one therapy to choose from, all of which have been shown to help with OCD.

In this blog post, we’ll talk about 3 effective therapy methods for OCD recovery: the Four-Step Method, ERP (Exposure and Response Prevention) but with a twist, and ICBT (Inference-Based Cognitive Behavioral Therapy).

Let’s get started!

The book certainly explains it better than I ever will, but in a nutshell, it’s all about relabelling your OCD thoughts as what they are (obsessions and compulsions, and not reality), reattributing them to OCD, then refocusing on another activity that you find pleasurable for at least 15 minutes, and ultimately revaluing the importance of the OCD thoughts.

Here’s an example of what that looks like for me:

OCD thought: I didn’t wash my hands well enough. 

Before I started therapy, I would believe this 100% and rewash my hands. But here’s what happens now, using the Four-Step Method:

1 – Relabel: This thought is an obsession. It is not real. I do not need to do anything.

2 – Reattribute: This thought happened because I have OCD.

3 – Refocus: Instead of washing my hands (eg. doing the compulsion), I will now go do something I enjoy, like a puzzle, for the next 15 minutes.

4 – Revalue: The thought I had that my hands were not washed well enough was an obsession, and it was not real. My hands were washed well enough. I did not need to rewash them or perform any compulsion. OCD tried to trick me. This thought was not important, and I am glad I refocused on another activity that was enjoyable for me.

That’s it!

I know it’s easier said than done, and sometimes you just have to do the compulsion, but what’s great about this method is that if you do the compulsion and you label it as such, you’re still taking a step further in your recovery because you still did step 1 & 2: you relabelled the action as a compulsion, and reattributed it to OCD. Tell yourself you’ll win next time and won’t do the compulsion!

Practice really helps getting better at this, too. If you’re skeptical about this working for you though, I’d highly recommend giving the book a try because they go in much more depth, give a lot of solid examples, and they have data to back up how and why this works. 

The book in itself was honestly very eye-opening for me and gave me a lot of hope when I was in one of my lowest moments with OCD where I thought no treatment would ever work, because I had a bad reaction to SSRIs and I was too scared of traditional ERP (and still am, honestly – I do ERP differently, but more on that later).

But traditional ERP is not all there is out there! 

The Four-Step Method is actually really helpful when I do exposures (the Refocus step really makes a difference, instead of just sitting in my anxiety endlessly), and what made me able to start doing them in the first place. It’s a helpful self-therapy tool you can use while you do other therapies as well, like ERP.

Speaking of ERP, let’s talk more about it.

(And how you can do ERP without sitting in your anxiety endlessly.)

Exposure and Response Prevention (with a twist)

Alright, I’ll be the first to say that I used to think ERP as whole was ridiculous and horrible. To be fair, every time I heard about it, it was always horror stories like “lick the bottom of a shoe” or “go to the bathroom, have a bowel movement, don’t wash your hands and then make a sandwich”, and, well. That’s a no from me, and probably a no from you. 

There’s also the fact that during ERP, you’re supposed to do absolutely nothing else but sit with your anxiety. And I don’t know about you, but the longer I sit with anxiety, the worse it becomes, and the more catastrophic my brain starts to think.

That’s the case for a lot of people, and why a lot of us are scared of traditional ERP.

But that’s not what ERP should be. Done right, the exposures (and response prevention, aka not doing the compulsions) can be really helpful, but in my opinion, they need to be chosen by you (aka not licking shoes unless that’s what you want to do), and you shouldn’t just sit with your anxiety endlessly, you should refocus into another activity that you enjoy and value. 

To get started, what worked best for me was to make a list of things I wanted to do, but was too scared to. That’s the keyword here: I wanted to do it. That motivation is what helps go through ERP. Without it, and if the exposures don’t make sense to you, they’re really just a form of torture that sucks. But when you’re seeing the exposures as something you want to do because you want to gain more freedom in your life, it’s so much easier. It’s still scary and stressful yeah, but you’re working toward a bigger goal: freedom from OCD. 

Because at the end of the day, what’s scarier? Living in the OCD prison your whole life, or, a few calculated exposures? In the long run, OCD is much scarier, at least to me. But that’s something that takes a while to accept.

For example, I had to accept that I live in a world with germs. Germs are everywhere. You can’t avoid it, as much as OCD may want to. 

I’ll be honest, that thought made me wonder what’s the point of life for a long time. Like an emotional two year old, I just refused to live in a world where I had to accept that germs were a part of life. You see, OCD had falsely promised me for a long time that if I just listened to it and did everything it wanted, I could live a germ-free life.

But that’s not true, unfortunately. So, accepting that germs exist is a pivotal part of my recovery. And every day, I have to make a choice: is wanting to avoid germs worth living in a prison for the rest of my life? 

For most of us, the answer is no. For a while, the answer for me was yes. Avoiding germs was all that mattered, no matter the cost.

If your answer is still yes, that’s okay. It can take a while to get to a no, but eventually, you’ll get there. For me, it took 4 years. I’m sure it can take even longer for a lot people. Some days, I even fall back into the “yes, I need to avoid germs and stay in the prison” mindset especially when I’m stressed or get an OCD flare-up, but overall, my answer’s still no, and I hope yours will be too.

Because honestly, doing exposures (at your own pace, and refocusing on another activity instead of just sitting with anxiety endlessly) is so worth it. I really thought it would just be horrible from beginning to end, but your sense of accomplishment when you do exposures (and successfully prevent compulsions, of course) really makes a big difference. Even if it’s super difficult (and most times it will be), it’s a step forward in stepping out of the OCD prison and so worth it. 

I do have to mention a small caveat here and say that I am medicated at the moment (for those who are curious, I’m on 1 mg of risperidone as I’m writing this), so doing exposures is probably easier than if I was unmedicated. If you need that boost at first to get started, it’s completely natural. I have to go off these medications for my physical health, so soon I’ll be doing exposures without medication (getting rid of the medication is an exposure in itself for me, honestly), and I’ll make another blog post about the differences I’m seeing. 

Medication or not though, ERP is worth it if you do it according to your own list of exposures you want to do, and if you go at your own pace. That’s also why I wanted to do it by myself, and not with a therapist at first, so I could make sure I do it at my own pace and for exposures I saw value in doing (i.e. not licking shoes). However, if you have a good therapist (which I now do!), they should also want you to go at your pace (and hopefully, not lick shoes). 

A great thing I’ve been doing to see a visual evolution of my exposures is to note them down on my phone and put a little check emoji (✅) beside each one I do, as most of them I have to do multiple times. It’s really motivating to see how many check emojis I have. The entire page is green! You could use a notebook to do this as well and use a specific color and see how the page fills up! It’s really motivating and it’s also a good way to keep track of your progress. Sometimes I look at some of the exposures that used to really scare me and now I do them effortlessly and almost forget that they used to be on my list of exposures. 

All in all, ERP is really worth it if you go at your own pace and are the one choosing the exposures, and making sure there are things you want to do. 

ICBT: Inference-based Cognitive Behavioral Therapy

Ah, ICBT… I kept the best for last. Truly, finding out about ICBT has changed my life. Ironically, it’s ICBT that gave me the courage to start ERP! 

I started ICBT by myself with the help of their free worksheets on their website (though I recommend doing those with a therapist – you can find one here), because at the time I was still too scared to work with a therapist (I feared they’d force me to lick shoes, ha). However, ICBT is not at all about exposures, and doesn’t focus on compulsions at all.

On the contrary, it focuses on obsessional doubt, and crushing that doubt so you don’t feel the need to perform a compulsion to begin with.

I was so relieved at the time to find a therapy that wouldn’t force exposures on me that I started doing the modules right away, and joined a peer support group. (Here’s one on Facebook, if you’d like to join.) 

It was life-changing! Truly. ICBT really focuses on re-learning how to trust yourself, how to realize that OCD is in the imagination and how to focus on the here and now, as well as your five senses. OCD makes us distrust ourselves all the time, so ICBT is great to help with that. 

It goes above and beyond and this is really  a short version of all ICBT can do, so I would really encourage you to check out their website and learn more.

Here’s what helps me the most right now about ICBT:

1) Focus on the here and now, the present moment. Since OCD is often in an imagined catastrophized future, focusing on the here and now grounds you in reality. It’s easier said than done and requires practice, but it really helps! 

2) Asking myself: do I have direct evidence in the present moment of whatever my obsessions are currently about?

This one is a bit tricker, but so effective. Here’s an example:

I have contamination OCD (as you could probably tell) and one of my themes is fear of fecal bacteria. 

Since a lot of people don’t wash their hands after going to the bathroom, my OCD wrongfully assumes that every surface outside of my house is “contaminated” with a dangerous level of fecal bacteria (I say dangerous level here, because as it turns out, almost everything has fecal bacteria on it to a non-dangerous level). 

So, when I’m about to touch a surface that evidently scares me because I don’t know what germs might be on it, I ask myself: do I have direct evidence that this surface is “contaminated”? 

The answer is, more often than not, no. 

There are some exceptions (eg. you go in a public bathroom and there’s actual fecal matter on the seat, for example), but most of the time there will not be direct evidence that a surface is “contaminated.” We can’t know what’s on that surface. That’s the uncertainty that OCD latches onto to bring us into the imaginary. 

That’s where you ask yourself if there is direct evidence in the present moment, and if the answer is no, then you move on. 

Easier said than done, again. This takes practice, but is really helpful.

I’m sure I will add on to this list as I dive deeper into ICBT therapy, but for now, this concludes this blog post. I hope this was helpful and gave you hope about OCD recovery and that there are treatments out there that work. If you have to tweak them so it’s helpful to you (like I’m doing with ERP), then by all means, do it! Therapy is not an exact science. It’s all about getting started and giving it a try, and adapting it as you go to what’s most helpful to you.

I use all 3 therapies in my daily life, and you can too. You don’t have to stick to just one! I find that mixing all three gives me the best results. 

If you’re not sure where to start, shoot me a message on Instagram and we can talk.

Happy to help!

~ Jade