Written by: Amy Herter, LMFT

Obsessive Compulsive Disorder (OCD) doesn’t play fair

If you have experience with OCD, you may have noticed that arguing with OCD doesn’t seem to work. When people diagnosed with OCD are in a calm state of mind, they often recognize that their OCD is not logical. Oftentimes, traditional problem-solving skills do not work with OCD and can even make it worse. One problem with arguing with OCD is that it will continue inventing new evidence to keep you engaged.

Arguing with OCD can increase OCD symptoms for several reasons. OCD feeds off of doubt and uncertainty and makes people feel like they need to figure things out with complete certainty. OCD constantly asks the “what if” question, and arguing with it feeds into this cycle. Arguing also often becomes compulsive. It increases mental compulsions and compulsive checking.  

When Therapy Argues with OCD

Some people with OCD may have had experiences with psychotherapy that did not help their OCD symptoms. It is important to choose a psychotherapist who has experience and knowledge of OCD. Talk therapy that focuses on reducing anxiety and fear without teaching OCD-specific skills can lead to compulsive reassurance. When this happens, the therapist can unintentionally participate in a cycle of compulsive reassurance that feeds the OCD. Initially anxiety is reduced, but like other compulsions, more and more reassurance is needed in order to reduce anxiety.  

Focusing on OCD in a way that directly engages with it and argues with it often creates more symptoms. Therapy that focuses solely on challenging OCD thoughts can lead to compulsive checking and the belief that OCD can be figured out or solved through debate. It can also reinforce the idea that when anxiety appears, you should analyze and argue with the thoughts. People with OCD often already realize that OCD is not logical or consistent with who they are, so additional analysis rarely provides helpful insight.  

Therapies Designed for OCD

Exposure and Response Prevention (ERP) is a type of Cognitive Behavioral Therapy used to treat OCD. ERP involves exercises that expose you to feared thoughts, images, or situations while resisting compulsions. A key part of this therapy is learning to accept uncertainty. The overall goal is to recognize OCD and resist debating  with it or engaging in compulsions.

I-CBT + ERP for OCD   

I-CBT, Inference based Cognitive Behavioral Therapy, is another type of psychotherapy used for OCD. This therapy helps you identify the obsessional doubt, reasoning patterns, and tricks used by OCD. While this type of therapy focuses more on the specific reasoning used by OCD, the goal is not to argue with OCD. Instead, the goal is to recognize the beginning stages of OCD, which involve obsessional doubt, and avoid engaging with it. This is sometimes explained as avoid crossing over the bridge into compulsions and obsessions (called the OCD bubble).

ACT for OCD

Acceptance and Commitment Therapy (ACT) is another approach used to help people with OCD. This therapy teaches people to observe OCD thoughts without engaging in them. It also helps individuals refocus their attention on personal values and goals that do not involve OCD.

Overall, it is important to find a therapist who is experienced in treating OCD. They should help you reduce engagement with OCD and increase your focus on the life you want to live without OCD. This process can be tricky but it usually involves learning to recognize OCD and respond to it differently.