When OCD treatment doesn't work

So you tried the treatment and it's not working, right?  I don't know how many times I've heard this throughout my career. Nate, I did the exposures or I used the mindset that you gave me and it just didn't work.  When I dive deeper into what this actually means…I find that the person's definition of recovery is much different than mine. 

 This is what I mean. We are so used to doing a behavior and getting an immediate result. So if I had an intrusive thought that I don't want but it keeps coming back anyway, my first initial reaction might be to push the thought away. In some cases pushing this thought away actually worked. It works temporarily. Because I bet you thought is on its way back and maybe even stronger.

 If we compare this to having a headache, what's the time you can take some type of medicine and the headache goes away? It worked.

 This tends to be our definition for  most things. When it comes to treatment, this definition just simply doesn't work. It's like me saying hey today I went to the gym, I lifted weights for an hour, I ran on the treadmill, and what the heck.  why do I not look any different?  Not only that but now I'm sore. My legs are weak.   and I'm tired,  come to think of it…. it didn't work. Instead, it actually made things feel worse.

 Is the important part. Whether you have OCD, anxiety or depression or some other mental illness,  treatment will often look like this. You will be practicing some things that will make you uncomfortable. They are going to be out of your normal routine. You will likely feel worse before you feel better. Why is that?  Because you're probably facing something you haven't faced in a really long time. The hundreds of times you've avoided something you are now facing head-on. Of course, it's going to feel uncomfortable. And when you're done the anxiety could actually still be there. The distress doesn't always go away.

 What OCD recovery looks like

 So when somebody tells me tried the treatment and it didn't work, their definition of “work” means,  my anxiety is still there. I still feel depressed. I'm still unmotivated. I'm still scared of this thing.

 And yes, that is okay to continue feeling a lot of those things because just like going to the gym you have to do these things often. Every day. The results come without you even knowing they came. I often hear individuals say, I didn't even realize I'm not scared of that thing anymore.  or I haven't had the spot in a really long time but I've been so busy doing other things I didn't even realize I haven't had these thoughts.

When we are looking for that quick fix, we are often going to see disappointment. It is a long-term strategy. 

My 7-year-old daughter the other night was telling me how she was scared of a story that she heard. I gave her the advice to allow the story to keep coming back to her mind, instead, we are going to do something different about how you're responding to it. Every time certain trigger words came into her mind we celebrated. We said yay I'm so excited that the thought came back. I hope it stays all day.

After practicing this for a few minutes, she looked at me and said I'm so scared I don't think this is working. And what I told her was, it is okay to be scared. We grow when we do things scared. We do not progress if we're choosing to hold back.  She said, but I'm going to have a nightmare.  so we celebrated it. Any threat that comes to our mind we can often pretty much act like we don't care unless we see immediate Danger.

 Create goals for OCD Treatment

 Whatever treatment strategies you are using keep this in mind. Individuals often need to create a realistic goal of what recovery means for them. Often,  I have people create goals based on how many times I can try the treatment, not if it reduced their anxiety. 

 Here is a realistic mindset for recovery. Someone might say, I'm going to face this fear the correct way using exposure and response prevention and pay attention to where my anxiety is at.  So I am an eight out of ten of anxiety. I'm going to continue facing this fear for  20 minutes. Whatever happens at the end of these 20 minutes is what happens. My anxiety might go up it might go down.  Either way my brain has learned something different. I'm going to repeat this in a few hours. I can check my anxiety levels but this isn't a measure of My Success.

 Because what will happen is that the 8 out of 10 of anxiety, turns to seven,   then at 6,  then a five,  then a 4, then a 3, then a 2, then a 1 —  but this does not happen overnight. Just like working out at the gym, it takes time.  We focus more on the time that is spent than how it's making you feel at the end of it all.

So if you were using exposure and response prevention where you are facing a fear, at the end of all this you might celebrate if you're still feeling anxious. And you boast about how you faced a fear.

 If you are using behavioral activation for depression, you boast about how you're doing something out of your routine. You're not continually checking to see if you're happier.

 Ultimately our job is to continue moving through life no matter what. The things that get in our way are the things we can always work on.

 
How to know if OCD treatment is working?

 So then how do you know when something actually isn't working?  Well, you are trying it often.  you're doing it the correct way.  you're trying as hard as you can and you're still noticing that is a difficult task for you. Maybe you've taken some steps and gone even lower on the anxiety scale.  you are still finding it difficult. Or your brain is telling you that there is no way you're ever going to face this fear. There could be a lot of negative unhelpful thoughts as well.  But the part that I look at the most is consistency. It's okay for people to fail. To give into compulsions every once in a while. I often see a point or someone I tried and tried and tried really gave it your best effort and they are still not functioning. This to me, is when something “isn’t working” and when I see a medicine come into play. It can help somebody with the treatment process when they are struggling. 

So the definition of treatment success can be different for each person.  Expect to continue feeling anxiety for a while, depression for a while, and uncomfortable for a while. Don't let that derail your treatment. 

 We are often controlled by the way that we are feeling.  When we feel anxiety we often feel anger.  when we sell depressed we often feel like nobody likes us. Feelings feelings feelings. Do you know that your mood affects your mental health?  Go watch my video mood swings to help you understand yourself better and how you feel. 

 And let me know in the comments what your recovery goals are going to look like.