People who have anxiety and OCD seek treatment to find relief from the terrible pain of worry and intrusive thoughts. They are not thinking of OCD relapse, they just want to get well. Successful treatment with CBT with ERP can make a world of difference. I think of a woman I’m working with now who came to me having lost her dream job because her OCD prevented her from doing her work and she was fired. She and I have met for 20 sessions. She has been brave and done exposures that were unimaginably hard for her when we first got started. This week in a session she called herself a “badass” and I noticed that she seems like a whole different person from the lost, tear-soaked woman I met several months ago. I told her I was finally getting to meet her, and she laughed said to me without missing a beat “nice to meet you!”
This is not a rare story. What is most important is what will happen next. What we must do is work on her ability to accept that she will have bad days and even full setbacks. Anxiety and OCD are well treated by CBT with ERP, yes, but what is key is making sure that suffers know that they must continue their good work with the skills they have learned. Sometimes they will need a therapist to help them, but most of the time they can learn how to handle setbacks on their own or with the help of friends and family. Bad days and setbacks are not a life sentence, this is a manageable problem. Knowing these tough days will be part of life at times – and often at the worst times, because that’s just how our brains work – is crucial to continued wellness.
I worked with a man several years ago who had been to a residential treatment program for his OCD years before, and was almost entirely free of symptoms when he returned home. When I saw him he had had a terrible OCD relapse and was one of the most severally ill people I have ever worked with – he was on disability and spent most of his waking hours performing compulsions. His clothes were old and ragged and his apartment was filthy because his OCD would not let him wear new clothes or clean. When I asked about what happened after the successful treatment he told me simply “the treatment didn’t work.” I pointed out to him that he said that on the contrary that he had been the freest from OCD he had been in his life when he came home from treatment. He told me that the symptoms returned and he was crushed that they were back.
This was not a treatment failure, this was relapse prevention failure, and it happens far too often. Help prevent OCD relapse by teaching your clients to recognize the early signs of relapse and make a plan to turn things around quickly. Help your clients as they move toward treatment termination to understand that it’s normal to have bad days and setbacks. Help them write a letter to their future self, detailing all the ways they have improved and the things that helped them. Help them connect with others who suffer from similar problems and with the current research and treatment through national organizations like the International Obsessive Compulsive Foundation and the Anxiety and Depression Association of America. Normalizing that ups and downs are both parts of wellness, not a failure, will help sufferers be resilient with whatever lies ahead.