Podcast 283: The O of OCD: Featuring Thai-An Truong, LPC, LADC Overview: The "O" of OCD (obsessions) is treated differently from the "C" (compulsions.) Thai-An Truong teaches us what really works! Compulsions can be treated with Response Prevention. The techniques for treating the Obsessions include Flooding, Cognitive Techniques, Motivational Techniques for Outcome and Process Resistance, the Hidden Emotion Technique, and more. OCD (Obsessive Compulsive Disorder) consists of frightening thoughts, or obsessions, plus rituals people do in an attempt to prevent or undo the danger. So, for example, if you go to bed and have the thought, “what if I left the burners on the stove turned on,” you might get up and check the burners. Doing this once could be considered normal. But if you do this repeatedly, you definitely have the symptoms of OCD. Rhonda wanted me to share how I treat the obsessions in OCD (Obsessive Compulsive Disorder), also known as "pure O." I often say I wasn’t looking to treat OCD, but OCD found me, since I do a lot of work with postpartum women struggling with feelings of depression and anxiety, they are actually about 2.5 times more likely than the general population to develop OCD. We're not sure why, but my theory is OCD attaches to the things we value the most (e.g., health, children’s well-being), and not much is valued more greatly than our baby. “Pure O” is actually a misnomer. We think that some people with OCD only have obsessions, without the rituals, because they have lots of mental rituals that people can’t see. So therapists wrongly conclude that they just have a “pure O” variety of OCD. We usually think of compulsions in OCD as mainly behavioral (e.g., handwashing too prevent contamination or checking the mail box repeatedly when you put your letter in to make sure it didn’t get “stuck”), but mental compulsions (rituals) are also very common. Obsessions are the thoughts or images that cause distress; compulsions, in contrast, are the behavioral or mental acts people engage in to try to decrease the distress. Mental acts, compulsions, and rituals can include: Praying Counting Repeating words silently Recalling events in detail Repeating a mental list to ensure safety Mentally reviewing the past like a video Self-assurance: “I’m okay, nothing bad will happen.” Saying the number 4 to reduce the distress of seeing 6, associated with the devil Thinking of a positive image to replace the disturbing obsession/thought Those are just common examples, but there are many more. Dr. Edna Foa, who has done a lot of research on OCD and the effectiveness of Exposure and Response Prevention (ERP) for the treatment of OCD states that patients who have ONLY obsessions or ONLY compulsions are unlikely to have OCD. Over 90% of people with OCD reported having both obsessions and behavioral compulsions/rituals. When mental rituals were included, just 2% reported “pure O”. Foa, E., et al (2012). Treatment That Works: Exposure and Response Prevention for OCD, Second Edition, p. 12 She states we need to assess patients carefully to weed out other disorders: Only O may be depression or GAD. Only C may be trichotillomania, Tourette’s syndrome, autism, schizophrenia – all can display repetitive and ritualistic actions. Trauma can look like OCD. For example, a woman who was raped obsessed about harm coming her way and compulsively checked the doors and windows in her apartment. She may need trauma treatment instead of OCD treatment. Specific Phobias: fear of animals (dogs, snakes, etc), heights, needles, storms, flying, driving, etc. Paraphilia: pedophilia, voyeurism, exhibitionism, etc. Dr. Burns’ EASY Diagnostic System can be a great tool for pinpointing these and many other diagnoses. How I’ve helped clients: A step-by-step approach: Disclaimer: This is not meant to be a substitute for therapy. It is frequently most helpful to have a therapist work with you through this process. Initial Assessment: Dr. Burns EASY