One of the most difficult things about OCD is the treatment. It’s not talk therapy; there’s not a ton of “Tell me about your problems, and I’ll listen and reassure you that things are fine.” It’s kind of the opposite actually, and it’s called Exposure and Response Prevention, or ERP.
The theory behind ERP is logical and simple: The patient faces his or her fears until they don’t scare her anymore. Doing this is not so simple. To effectively battle your OCD, you have to consistently do things that make you feel terrified and uncomfortable. Anxiety becomes your world. It’s pretty awful.
I’ll give you few examples.
When I was an already insecure teenager, I developed a crippling fear of breaking mirrors. Seven years of bad luck sounded like an eternity of misery to me. And I wasn’t worried about the type of bad luck where you lose a poker hand on the last card or it rains the one day you forgot your umbrella. I was (and still am, really) scared of something far more sinister than that. I’m not completely ready to talk about that fear in detail, but it’s strong and the driving force behind my OCD. Anyway, I kind of froze up around mirrors as anxiety took over, and I’d change my behavior in order to be painfully careful. I’d walk softly so that I wouldn’t rattle the floor and thus the walls and then somehow knock a mirror of its perch on a wall. I’d try not to make any high-pitched noises, because I’d watched movies where a scream could break glass. I’d check smudges to be sure they weren’t cracks that I’d somehow caused.
So what was my treatment? My therapist had me break mirrors, essentially my biggest fear, regularly. We’d do it in his office. He’d have my mom buy lots of little makeup cases and then assign me the “homework” of breaking them at home. He made a little packet of broken mirror chunks for me to carry around in my pocket. He sprinkled “mirror dust” all over the inside of the car I drove. It was awful.
For ERP to work, the patient has to be all in. I don’t think that I was. I kept finding little ways to sort of weasel out of completely doing the therapy. I’d uncomfortably sit on a tiny portion of the driver’s seat that I convinced myself was free of “mirror dust.” I’d try to get other people to hold the packet of mirror chunks. I’d ask people for reassurance that I was fine. I wasn’t supposed to do any of that, and so the treatment didn’t work that well.
Say a person is intensely afraid, more than most people, of the number 666. Say she avoids it all all costs: if she buys something at the pharmacy and the total is $6.66, she’ll choose not to buy it and purchase the item somewhere else, even if it’s more expensive. If her credit card number has three 6s, she’ll throw it away and get a new one. Etc. Her therapy might include making all her passwords contain 666, or to always carry $6.66 in cash, so that she cannot escape the discomfort. Everything she does online is tainted because her password has the evil number. The hope is that she develops a sort of immunity to the fear and anxiety.
ERP looks at an OCD patient like the brim of a baseball hat bent too far in one direction: to get it back to center, you have to bend it too far the other way. And the bending hurts.