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Hi Dr. Szymanski!

OCD sufferer here, thanks for taking the time to do this AMA. A couple of questions:

1) It seems my biggest struggle is uncertainty, and my brain feels like it can't handle any hint of it. My obsessions lead into compulsions that search for that brief feeling of certainty. Why is uncertainty so acceptable for some and so difficult for others?

2) It took me several attempts to find a therapist that actually seemed to know what they were doing with treatment (ERP). Why do you think so few therapists are taught more about OCD in school/training?

3) What's your most memorable "obsession" that a client has told you about? Watching the documentary Unstuck, I thought the little boy talking about his biggest fear of becoming a body builder was adorable, but I can appreciate that it was his worst nightmare.

Thanks for the response - your answer to #3 is a good reminder that the problem isn't the obsession, but the compulsions.

Exactly... After a few sessions with other therapists, I thought that if these sessions are making things worse, that's probably a bad sign.

No disrespect to alternative therapies, but I had one person I was referred to, fully licensed, having me stare at crystals and stuff. She also told me that my obsessions were "secret, encrypted messages" from my subconscious.

The psychodynamic therapy treatment my first therapist used was kind of rough for OCD - like "let's question everything about your childhood." Which cast a ton of doubt on what, I believed until that point, was a pretty awesome upbringing/childhood. I feel very fortunate to have had my gut tell me to do a bit more research and find a therapist trained in treating OCD.

Hey! I just want to say, as someone who went through 6-ish months of ERP to turn some of my biggest fears (9s or 10s on the hierarchy) into little nuisances (2s or 3s), it's really hard work, but SO worth it. I'm not avoiding situations that I would have six months ago, and am really enjoying larger portions of my day/week now.

If I could describe it simply, ERP for me was like a graph mostly going up, with dips along the way, but towards the end, I'm in a much better place. My symptoms aren't gone, OCD doesn't get "cured," but you can turn it into an annoying little bug, and less of a big, terrible monster. I'd say my OCD symptoms have improved at least 70%, and I'm in much more of a maintenance mode to keep my progress intact these days.

A few notes that I found helpful:

Be very upfront with your therapist about how your exposures are going. If they're too hard, there's no shame in stepping back a bit. My therapist told me about a patient who was so afraid of knives that even writing the letter "K" was a compulsion-inducing trigger, so you can appreciate that some ERP starts way down the ladder.

While you want to avoid the trap of "needing to do ERP perfectly," it is important to check in to make sure that it doesn't turn into "exposures with compulsions." This is probably a sign that the exposure is too hard if you can't stop the compulsions. I fell into this trap a number of times throughout treatment. Our brains are very sneaky when anxiety is on the line. When my therapist or I caught that behavior, we'd take one step back and work on some easier exposures to make sure the "response prevention" part was happening.

Give yourself a lot of grace! This is a very hard treatment, and there will be a lot of stumbling, there will be days where you're convinced it's not working, or that you're back at square one, but that's not the case, you'll be surprised how much better you're doing in even a few months.

Good luck!