OCD is associated with guilt, shame, disgust, anxiety and depression.
Not everyone needs to augment their ERP with interventions designed to address guilt, shame, disgust, and depression; however, it’s worth considering if you have had multiple frustrating experiences with treatment. There are certain classes of individuals who have to be particularly savvy when conceptualizing their OCD symptoms and selecting appropriate interventions. At greatest risk for potential clinical mismanagement are individuals with:
- Predominantly mental rituals
- “Pure O” OCD
- Harm obsessions (e.g., hit and run OCD, fear of harming others or self, fear of losing control and acting on an unwanted thought)
- Sexual obsessions (e.g., fear of being attracted to an unwanted person or object, fear of being attracted to something socially unacceptable, fear of violent imagery)
- Scrupulosity (e.g., worry about going to hell, committing unpardonable sins)
For individuals with these forms of OCD, addressing the entire sequelae of OCD is paramount. ERP should be embedded in CBT that targets guilt, shame, disgust, depression, and other important features of the disorder. Depending on the person, exposure hierarchies should be developed to explicitly target these features (e.g., develop a guilt hierarchy or a disgust hierarchy). When possible, it is also very helpful for individuals to understand how certain neurobiological phenomena contribute to their symptoms (e.g., the neural basis for guilt). This can help a person learn to better label emotions and not confuse guilt (which is a functional emotion) with other guilt-like emotions that are experienced due to OCD-related hyperactivity in certain neural pathways.
There is nothing new or radical about this approach; in fact, it’s just good, responsible practice. Sadly, this approach is implemented far too infrequently; most psychologists just don’t know how to do it properly. The state of OCD treatment in South Florida is improving, but sadly, individuals in the West Palm Beach, Miami, and Fort Lauderdale communities still have limited options for effective treatment.
I will revisit this topic again in other posts. In the meantime, begin to consider the multifactorial nature of your symptoms. Make sure that your therapy is addressing all the areas needed to improve your quality of life. Just as you can get more skilled at managing anxiety, you also can get more skilled at managing and reducing other unwanted aspects of your OCD.
Questions? Comments? Leave a comment at the original post at the link below.
OCD guilt, shame, disgust, anxiety & depression: Why treatment sometimes fails (and what to do about it) was originally published on Dr. Steven J. Seay, Ph.D., Licensed Psychologist, our Director’s blog.
