By Caitlyn Oscarson, LMFT and Erica Russell, LPCC, LMFT

OCD Foundation’s Behavior Therapy Training Institute 2015

From January 30th to February 1st, we had the pleasure of attending the International OCD Foundation’s Behavior Therapy Training Institute at UCLA. The Behavior Therapy Training Institute (BTTI) is an intensive three-day training for clinicians who are treating clients with Obsessive Compulsive Disorder. As one of the most prestigious training opportunities for OCD treatment providers, limited space was available, so we both felt very lucky and honored to be in attendance. The faculty of the training included some of the nation’s most well-respected experts in OCD treatment, including Dr. Alec Pollard, Dr. Gerald Tarlow and Dr. John Piancentini. It also included special presentations on pharmacotherapy (or medical treatment) and behavioral therapy for tic disorders, by Dr. Jamie Feusner and Dr. Susanna Chang.

The training began with an overview of the assessment and diagnosis of OCD and other OC Spectrum Disorders (Hoarding Disorder, Body Dysmorphic Disorder, Trichotillomania (Hair-Pulling) Disorder and Excoriation Disorder (Skin-Picking Disorder) and then focused in more intensively on treatment approaches.

Exposure and Response Prevention (ERP)

Our clients who are being treated for OCD are probably familiar with the term “exposure and response prevention” (ERP), which involves purposely exposing oneself to an obsession trigger and then preventing any compulsive behaviors or thought actions that might neutralize anxiety. One of the most helpful topics discussed at the training was the importance of approaching obsession triggers in the appropriate way during exposure and having a clear plan for response prevention. We learned that in order for exposure to be as effective as possible, clients should approach obsession triggers in a manner that eliminates all avoidance, neutralization or distraction. This means that if an individual did an exposure involving touching a doorknob, to increase the effectiveness of that exposure it would be important for the individual to not only touch the knob, but then rub his hands on his body and agree not to do any hand-washing or hand-isolating for a specified period of time. It also means that the individual would want to be sure not to have any source of distraction or reassurance that might reduce his anxiety, since experiencing the anxiety and allowing it to decline naturally is what exposure is all about.

Re-Exposure is the Key

The experts also raised the importance of finding creative ways to re-expose if anything interrupts an exposure. For example, if the client who did the doorknob exposure needed to use the restroom and thus had a legitimate reason to wash his hands, it would be important for him to re-expose himself by touching that doorknob again after washing. When doing an exposure to something outside of your home, it can also be helpful for clients with contamination OCD to carry a “contamination rag”, which is a piece of cloth that you would use to wipe whatever surface or substance to which you exposed yourself. That way, if you go home and have reason to wash your hands, you can immediately re-expose yourself to the earlier exposure by wiping the contamination rag on your hands and body.

How to Cope with Anxiety and Distress During Exposures

Another question that often comes up with our clients being treated for OCD is how to cope with the anxiety and distress that can arise during exposures. The OCD experts explained that any coping strategy that helps you engage in exposure can be helpful as long as it doesn’t promote avoidance from feared situations or get in the way of learning new things about the OCD triggers. Ideal strategies will “take the edge off” your anxiety enough to help you engage in the exposure exercise without distracting you from confronting your fears. Therefore, there are no universally “bad” or “good” types of coping strategies. Some suggested strategies such as diaphragmatic breathing and mindfulness are probably familiar to you. Another recommended strategy is to create coping statements or scripts that reflect your beliefs and values and remind you that is it okay to be uncertain. It can also be helpful to focus on all the reasons you want to work on OCD so you feel motivated to participate in exposures.

The Role of Distraction

Some clients ask if it is okay to use distraction techniques, that is, ignoring an upsetting thought, situation or trigger, and focusing your attention on something like reading, talking to a friend, doing a task around the house, watching TV etc. The experts at the BTTI emphasized that distraction won’t help you learn new ways of coping with your OCD, but it also won’t make anything worse in the meantime. So, while it would not be recommended to use distraction all the time, it can be a helpful way to cope with triggers outside of designated exposure time.

How To Get Help for OCD

The Cognitive Behavior Therapy Center of Silicon Valley specializes in Obsessive Compulsive Disorder (OCD) in adults, children and teenagers. With our convenient location just a half mile from Highway 85 and the Saratoga Avenue exit, we serve the Silicon Valley communities of San Jose, Saratoga, Mountain View, Santa Clara, Sunnyvale, Los Gatos, Los Altos, Cupertino and Campbell, CA. We also have a CBT Online Video Therapy Program for clients in California who live to far away to drive for our specialized therapy in person. Contact us at (408) 384-8404 for more information on how we can help you manage you OCD.