Can We "Cure" OCD?

I’d like to first of all welcome all the new subscribers who’ve signed on to this blog in the last week or two. I hope the fact that we had some new subscribers indicates that people are finding what I’m writing here useful.  One of the recent subscribers asked me to address the issue of can we cure OCD and so that is a topic of this week’s blog post.

Can We “Cure” OCD?

The short answer to this question is, I believe, at this point in time no, but there is more to the story.  The more my clients understand the basic principles of exposure with response prevention, the less of an impact their OCD is going to have on their daily functioning. The more they can recognize their OCD triggers and the better able they are to not respond to those triggers, over time OCD will have less impact. Two metaphors that I often used to illustrate what we’re shooting for by doing exposure and response prevention, are the following. You want to keep the front door and back door open and let the thoughts just slide right on through  or try to have a “Teflon mind” as opposed to a “Velcro mind”. Both metaphors convey the idea that you don’t want to get stuck on thoughts, figure out what they mean, evaluate/think about what you should do in response to these thoughts, etc. But simply keep moving forward and act as if the thoughts don’t matter. If you can follow these directions then, in a sense, you are “cured” from OCD because it has ceased to impact how you live your life.

A simple example might be a person who is concerned about a doorknob being contaminated and as they approach opening a door will have thoughts like “I wonder who last touched that doorknob and what germs/bacteria might have been on their hands?” And  “If I touch that doorknob I’m probably going to get sick.” Before treatment this individual would likely then either avoid touching the doorknob, use their sleeve or perhaps a paper towel to open the door or perhaps even wait until somebody else came along who could open the door for them.  After treatment is complete, the goal would be to allow whatever thoughts are going to show up to simply be there, recognize them as coming from OCD, perhaps even thank your mind for the warning, ignore the thoughts and then open the door. I would even suggest to my client that they continue to expect these kinds of thoughts to show up as opposed to hoping that these thoughts will simply stop or try to get rid of them if they do show up because efforts to control thoughts usually backfire and result in more of the unwanted thoughts. You want to act as if the thoughts are no longer important. 

When they enter treatment for their OCD many of my clients are hoping to find the “magic bullet” that will allow them to be, some time in the future, completely free of their obsessions and compulsions. I don’t  believe this is a realistic option. In addition, I think believing this is possible actually interferes with treatment. It’s completely understandable to me that my clients would want these unwanted thoughts to simply go away and stop bothering them, but when they have this as the goal and it doesn’t happen, they often get more discouraged and have a hard time following through with treatment. I think my clients who make the best adjustment possible to having OCD are the ones who are able to accept the fact that while they can’t get rid of their OCD, there is a lot they can do to manage it and significantly reduce the impact of the OCD on their daily functioning. 

I’ve compared managing OCD to exercise before. If you want to stay in shape you must exercise regularly and in a similar fashion if you want to keep your OCD at bay then you must “exercise” (do exposures) regularly. Accepting this is an important step in coming to terms with the OCD and getting better at managing it. Early in treatment exposures are usually done more frequently than in the later stages of treatment. Nonetheless, it’s important to keep doing some exposures over time to prevent the OCD from reasserting itself. OCD will try in a variety of more or less sneaky/insidious ways to reenter your life, “Well I’ll just do this one time for now” or “It’ll only take a moment to check this one more time” etc. These kinds of “permission giving thoughts” are important to be vigilant for, recognized as attempts from the OCD to reassert itself and consistently resisted.

So going back to the original question “Can We Cure OCD”? While I don’t think we have the methods yet to completely eliminate OCD, it’s very possible by following the principles mentioned above, to dramatically reduce the impact of OCD on one’s functioning and the less you follow OCD’s “rules”, in a sense the more “cured” you are.