Taking Your Life Back from OCD
Relapse Prevention
Part 5
You’ve taken your life back from OCD…congratulations! Your thoughts and
feelings start to become genuinely your own, instead of being driven by fear. You
have the energy and motivation to pursue your dreams and live your life to the
fullest.
As you go into recovery from OCD, it’s good to keep in mind that relapse
prevention is a process, and living how we want to live requires some
maintenance, as Dr. Jonathan Grayson describes below:
“Your OCD was like a garden full of weeds. You’ve gone through
treatment and worked incredibly hard cleaning out the weeds and planting
what you want – your garden is beautiful, but weeds will grow. You
have to decide how much effort you want to put into keeping it beautiful,
because you can let it get overgrown with weeds again.”
So how much effort is required? To address that question, let’s look at some
definitions and then some givens:
Definitions
• What is a relapse? A relapse occurs when your symptoms go back to the
level they were when we started therapy for an extended period. This
means that if you took the Y-BOCS during a relapse, you’d score about the
same as you did the first time you did the assessment in therapy.
• What is a lapse? A lapse occurs when OCD symptoms temporarily flare
up. During this time you might find yourself giving in to a compulsion or
two. Another word for “lapse” is slips.
As you can probably guess, in relapse prevention our goal is to prevent a full-
blown relapse. Before we talk about how to put together your relapse prevention
plan, let’s take a look at some givens, or assumptions, about OCD recovery.
Givens of OCD Recovery
Everyone in recovery from OCD has lapses from time to time.
This is true because everyone has weird thoughts occasionally, even people
without OCD, and once in a while, when you have a weird thought, it might “get
stuck.”
As you live your life, you will be naturally doing exposures every day.
By facing triggers you used to avoid and not doing compulsions, you are actually
doing maintenance exposure. The more you approach what you used to avoid,
both physically and mentally, the easier these things will become, until they don’t
even feel like exposure anymore. You will just be living your life.
Doing some structured exposures on an ongoing basis will also be
necessary.
Remember, exposure is a type of safety learning, and it competes with danger
learning—it does not replace it. Over time, safety learning diminishes in strength
if it is not reinforced and then the danger learning can take over again, leading to
lapses and potentially relapses.
You may ask, “But if I’m doing exposures naturally in everyday life, why do I
need to do structured exposures, too, especially if I’m feeling fine?” Doing
structured exposures is like getting a vaccination. You don’t feel sick when you
get the shot, and that’s the whole point—you get the vaccination so that you
won’t become sick! You do structured exposures every now and then to continue
build your resilience to OCD.
Further, sometimes the exposures we do in everyday life may not be enough. We
may need to push it a little more to remind our OCD who is in charge. For
instance, if you have contamination OCD, your natural exposure is perhaps to
only wash your hands after you use the restroom, and no more. But every once in
a while, you eat off the floor, too, because that pokes your OCD and reminds it
you are in charge.
Do you see the difference? You wouldn’t eat off the floor normally, so that
exposure wouldn’t happen in everyday life unless you made the conscious choice
to do it. By poking the OCD, saying, “I want to do this because I want to be
anxious because that’s how I continue to keep my life my own!” you are making
yourself more resilient and strengthening your recovery from OCD.
Building Your Relapse Prevention Plan
Learn about the recovery process
Knowledge is power, and learning about OCD recovery will help you to protect
the investment you’ve already made in your recovery. Take 20 minutes to read
the two articles/chapters below.
• Chapter 15, “In Recovery for Life” in Freedom from Obsessive-Compulsive
Disorder, Updated Edition.
• Go to www.ocfoundation.org and put “relapse prevention” in the search
box (the little magnifying glass) in the upper right hand corner. Read the
article called “Relapse Prevention in the Treatment of OCD” by James
Claiborn, PhD, ABPP.
Do exposure naturally
As described above, approach what you used to avoid as a part of everyday life.
Decide how often you’d like to do structured exposure
I have not been able to find any research empirically stating how often exposure
needs to be done, and this is probably because everyone’s needs are different.
Perhaps start out doing exposure as often as you were coming to therapy (for
instance, weekly, or every other week, or monthly). Make an appointment in
your calendar just like a therapy appointment, and when the time comes
remember: you want to do this, because you want to stay better!
Keep track of how often OCD is bothering you
Write down when you have what you would consider a lapse as defined above.
When you notice that lapses are happening more frequently than you would like,
that’s when you know you need to increase the frequency of your structured
exposures. Over time, you will learn how often you need to do structured
exposures to maintain your recovery.
Remember to embrace concepts that support your recovery
• The universe is friendly. OCD wants us to be hyper-vigilant and think
the world is out to get us. Choose to see the world differently, as Jeff Bell
describes in When in Doubt, Make Belief in Chapter 4.
• Self-compassion. When you are compassionate with yourself, you
strengthen your recovery. Don’t talk to yourself like OCD talks to you, as
that just provides a foundation for OCD to return. See Dr. Kristin Neff’s
Self-Compassion and my Aha! Moment about her book for more on how to
be kind to yourself.
• Gratitude. In David Steindl-Rast’s TED Talk called “Want to be happy?
Be grateful,” he says that while it might seem that happiness would make
us grateful, the opposite is actually true: that gratefulness makes us
happy.
• Mindfulness. What’s amazing is that we are all given something
incredibly valuable each and every day. This precious gift is given freely,
without strings attached, and yet we don’t even notice it’s there: the
present moment. OCD wants you to live in the past or the future. Try to
use mindfulness live in the present moment. Visit my Mindfulness
Resources page on my website to learn more and to see David Steindl-
Rast’s TED Talk.
