Hello, OCD Warriors. I know that many of you have been hanging around the podcast for a little while, and you hear us talk about inference based cognitive behavioral therapy and you’re thinking, I am just not sure about all this, because on the one hand I hear a lot of people say exposure and response prevention.
That’s a treatment that I should be using. That’s what I should be going after. It’s called the gold standard for OCD treatment. How do I know if ICBT is really right for me, or I didn’t even know what either of those things mean?
Hello and welcome to Christian Faith and OCD with Carrie Bock. I’m a Christ follower wife and mother. Licensed professional counselor who helps Christians struggling with OCD get to a deeper level of healing. When I couldn’t find resources for my clients with OCD, God called me to bring this podcast to you with practical tools for developing greater peace.
We’re here to bust through the shame and stigma surrounding struggling with OCD as a Christian, sharing hopeful stories of healing and helping you replace uncertainty with faith. I’m here to help you let go of the past and future to walk in the present abundant life God has for you. So let’s dive right into today’s episode.
If you are completely new to OCD therapy and you’re trying to find treatment options, this will be a great podcast episode for you. Or if you’ve been around for a little while and you just, maybe you’re looking at trying something different, but need to know if it’s legit or is a good fit for you, then this episode is for you as well.
I’m gonna break down a four points of how you know if ICBT is right for you. The first one is maybe you’ve been through ERP and you just haven’t seen the results that you’re wanting. So if you aren’t familiar with exposure and response prevention, this is a common first line of defense for OCD treatment.
ERP is actually based on behaviorism and concepts of habituation. Now you have to understand that ERP was originally created for phobias. We create this exposure hierarchy for someone who is afraid of spiders and. First we show them a picture of a spider, and then we have maybe them and a spider and aerium on the other side of the room, and then we get slowly closer to it, and then by the end of treatment, this is not happening all at once.
Obviously, it’s a slow and steady process for people as they get more and more used to the spider and their anxiety level comes down, then maybe at the very end of the exposure hierarchy. You would have someone like hold a spider. So this is just an example for treating a phobia. However, it was then adapted for OCD, and there’s some problems with that because OCD is different than a phobia.
Phobias might develop as a result of negative past experiences or a belief that someone has something maybe that they’ve been told. OCD is a lot more complex reasoning process. When you come to work with as many people that are dealing with OCD as I have, and you listen to their obsessional reasoning process, you’re like, oh yeah, in OCD land.
Like that makes sense. Like I understand how you got to that conclusion. And what we’re doing in ICBT that I do is we’re rewinding, dismantling understanding. That reasoning process of how you got from point A to point B to where the compulsion now makes sense. And if we can unravel that and slow it down and understand it, then we can essentially help you rewire the way that you’re thinking about life and how to get back in a non obsessional reasoning process, which you use all the time when you’re not in the midst of OCD.
Back again to ERP. ’cause I’m trying to help you understand the differences between how someone with ERP is approaching OCD versus someone’s using ICBT is approaching OCD. For ERP, they’re really focused on waiting out the anxiety. So they would say, have the obsession. Sit with uncertainty. Sit with the anxiety that comes up when you have that obsession.
Don’t try to fight it. Just let it be there. Sit with the anxiety. Don’t do anything about it. Don’t try to deep breathe through it. Don’t try to resolve it. Don’t try to argue with it. Literally, just let it lie. As you do that, that anxiety level is going to come down. So you’re trying to interrupt this obsessive compulsive loop, and that anxiety is in the middle.
When you have the compulsion, there’s a little bit of relief, but actually the act of doing the compulsion just strengthens the obsession. That’s the obsession compulsive cycle in a nutshell. What I find seeing people who have worked with an ERP therapist and then have come to me, is that some of them actually made some good progress in ERP therapy while they were in it.
Okay. Some of them will tell me, yeah, I could do the exposures in session when I was with my therapist. But then once I got outside of session and I was living in my own day-to-day life, it was a lot harder for me to follow through on that. And you know how challenging that can be if you’ve been in therapy.
When your therapist says, Hey, go do the thing. And you’re like, I know I was supposed to do the thing this week and I didn’t do it, and then there’s that feeling of failure. Maybe that comes up and hopefully you have a good relationship with your therapist where you can kind of work through that stuff and say, okay, let’s kind of pull back, figure this out.
Regroup. It’s okay. Start over. That’s all right. If you have a good therapist, there’s a lot of grace and there’s a lot of compassion, a lot of understanding, and also a lot of slight kicks in the butt occasionally too, right? Like there’s this balance of being really compassionate and also trying to push people towards change and growth.
I used to have a supervisor that says it’s a little holding and a little hitting. We don’t actually hit anybody just for the record. Or maybe you’ve had some ERP therapy before and you felt like, yeah, I could do the smaller exposures, but I just didn’t feel like I could do the larger exposures for other people.
I’ve heard them say everything just feels like a 10. I just don’t feel like I can do any of it. And so there’s all these just different challenges that can come with it. ERP has about a 20% dropout rate. There are a lot of people that are just quite frankly, afraid of the therapy. Obviously, we don’t want people to be afraid of the therapy if it’s something that they need.
So this is a challenge that this community has, right? It’s like there’s a lot of people that have heard ERP is really scary. It’s really hard, and they’re like, oh no, I can’t do it. I’m not gonna do that. You have about 20% of people who start and then drop out and. According to the book, resolving OCD, he has some stats in there.
And now this is a self-help ICBT workbook that 60 to 70% of people who go through the ERP do see some level of improvement of symptoms, but 30 to 40% do not. Well, of course you feel a little bit rough if you’re in that 30 to 40% category because. Okay. I was like told this is the gold standard here. Right?
And I’m not getting better. That’s a really big blow. And you probably paid a bit of money to get that therapy. ’cause a lot of times those therapists don’t take insurance to deal with OCD. There are various factors, of course. Um, the training of the therapist, did they just start practicing this particular modality?
Have they been doing it for a little while? Your level of severity is that matched with their level of training. And then 60 to 70% of people that go through ERP 40 to 50% of those will see complete remission. So let’s start back with and say we have a room full of a hundred people that are gonna go through ERP.
I’m not even gonna count the dropouts at this point. Okay. So putting the dropouts aside, the people that actually went through completed ERP therapy, a hundred people 65 are gonna get better. That’s 60 to 70%. I just cut it in half. 65, let’s say, of the people get better. 45% of those people would be 29 out of our original a hundred who are in full remission.
Yikes. 29 out of a hundred. I mean, we do have to understand that OCD is a chronic condition that waxes and wanes throughout lifetime. We know people are often gonna have some level of obsessions that are coming in their mind, but the issue that I have is that people have been told in the OCD community, there is only one right way to go about treatment, and that’s something that I really take issue with because it’s just not true.
It is fair to say that ERP has probably been researched the most. It’s been around longer than ICBT, and so there has been more research done around it. Icbt has had some research as well, and you’re certainly welcome to look at Icbt online. There are scientific papers on there if you were into reading those.
I’m not super into reading research because for me, research is a very artificial level of environment and they’re often treating one thing, whereas people come to me with multiple different issues. Often it’s not just that they have OCD. They also have relationship issues, and they have family of origin issues, or they have had significant trauma that’s feeding into the OCD, et cetera, et cetera.
This is just a carry thing probably. I don’t find studies incredibly helpful because a lot of people get ruled out before they ever make it into the study. And I don’t say this to disparage anyone from engaging in exposure and response prevention because it has helped hundreds and thousands of people who would otherwise still be suffering.
And so if you are one of those people that I. Has really benefited from it, and you believe that’s what you need to continue doing and that’s your conviction, then by all means, keep doing that and keep working towards your recovery in a way that works for you. What I would wanna say is that for anybody out there that is feeling hopeless.
Or feeling like, you know what? I have been through multiple rounds of ERP. I’ve been through maybe a therapist that was less experienced, and then I went out and found a therapist with even more experience in ERP, and I just feel like I’ve kind of been there, done that, and I’m not better, or I’m really having challenges with it.
I would say don’t live in shame or don’t feel like. Oh, I’m just a person that’s hopeless and I’m not gonna be able to be helped. That is not true at all, and we’ve seen some great success with people that have done ERP and then learned ICBT, and they’ve been able to just approach their treatment differently in a way that was more helpful or more tailored to them.
All right. Point number two is that ICBT may be right for you if you don’t wanna expose yourself due to the content of your obsessions. Now for things like Scrupulosity or something where you’re having to do a lot of imaginal script writing, and this is a challenge that we have, and Dr. Connie Hanney and I talked about this a few episodes back about the hope for Scrupulosity is that these imaginal script writings cause people to write down things that are not true about themselves, that are not true about God.
Imaginal scripts about going to hell or God being angry with him, and it just doesn’t really seem to align with our faith. Imaginal script writing might occur for people in other areas like homosexual OCD or pedophilia OCD. Maybe there is a exposure and response prevention therapist that is telling you to do certain things.
That go against your faith system that are not providing faith sensitive exposure. So they may say, well, go ahead and look at that homosexual porn. Or, go ahead, you’re afraid of lusting. Go ahead and look at that pornography. I’ve talked about this before, but the International OCD Foundation, which is a secular organization by the way, actually has really great information on their website about doing religiously sensitive exposures.
So they do talk about how your exposure should not be going against your faith. They do really encourage their clinicians that aren’t familiar with someone else’s faith to really consult with their pastor, priest, et cetera, whoever their religious leader is for guidance on what’s appropriate as far as exposure.
So I do really appreciate that coming from a secular organization, however. My experience in talking with people is that some Christians have been asked to do things in ERP that were not religiously sensitive exposure. So if that’s you, talk with your therapist about that, maybe guide them in a certain direction or.
Just get out of there. If your discernment alarm is going off, God gives that to you for a reason that, Hey, I don’t need to be doing this. Even if you are using ERP for something like contamination and fear surrounding getting sick, I hear about people in ERP who are doing things like eating gummy bears off of a toilet seat.
I understand the concept of habituation and not being afraid to do certain things, and I understand at some level that some of these exposures are kind of like really meant to be over the top in order to test the anxiety. So if I’m super anxious about this and I tell myself I’m gonna get sick, and then I do the thing.
I don’t get sick. Then that kind of tells your body like you are, okay, but when are you ever gonna need to do that in your real life? You are not. So my clients are not having to do weird things like touch the trash or, and lick their hand or eat gummy bears off of the toilet seat. Or do something and then not wash their hands in ICBT.
You get to live your everyday life. Like that’s what we want people to move towards is to reason in a way where you can go about your day-to-day life like someone would who doesn’t have OCD. I’m not asking you to do anything like over the top third point ICBT might be right for you. If you are looking to examine the logic behind your OCD reasoning process.
ERP is really focused on just the behaviorism aspect. Have the obsession, let it be there. Don’t engage in the compulsion, wait out the anxiety, sit with the uncertainty. It’s not really focused on how you got to where you are and really getting at what I feel like is the root issues. So when someone’s theme shifts, then it’s like they’re having exposed themselves to a whole host of new things.
Right. And it doesn’t seem to me, is just what I’ve seen from others that have had ERP. It doesn’t seem like the habituation follows through with the different themes. So it’s like if someone starts out with a contamination, they do some ERP around that, they get some type of bearing, but then it shifts over into relationship rumination.
I. They’re just really at a loss about how to deal with that, because it seems like such a completely different thing. You went from a tangible compulsion, maybe to an intangible compulsion like rumination or reassurance seeking something like that. Whereas with contamination, it was a lot about avoidance or washing hands, doing just very tangible type things.
With ICBT, I have a lot of clients who are very logical thinkers and they’re problem solvers. They think on things at a very deep level, and they like this idea of, let’s examine the reasoning process of how I got to this place in the first place. How did I get to the point where doing all of these compulsions makes sense, even though I know it completely defies common sense?
Or this is something like I quote shouldn’t be hung up on, like, why am I so hung up on this? Because it produces a lot of shame. But then when you go through the initial modules of ICBT and you break it down. I’ve had clients say, wow, this just feels really validating because I just thought I was being ridiculous this whole time.
And now I realize like how OCD is using things like facts to support its argument. I’m sure that you know all kinds of facts about whatever your theme is because you’ve Googled it or you’ve talked to people or you’ve looked it up. I mean, you’ve thought it to death. What ICBT does is we’re not trying to argue with it.
We’re just really trying to understand it, understand how you came to this point, and then, like I said earlier, just unwinding that and going, okay, how is this inferential confusion process? Different from how I reason and make decisions about other things. Like someone will say, well, I’m really concerned about catching the flu this season.
And I mean, there could be flu particles on this shopping cart, or there could be flu particles on that door handle. And you say, okay, well, but there’s a lot of things that you’re not necessarily concerned about contracting, maybe. Someone that has these types of concerns, they probably can tell me statistics about how long the flu virus lives on something, what it takes to kill it.
And OCD will use these little facts to support its ideas about a situation. And I always say you can’t argue with the facts. There’s no point in trying to argue with them. I would say that we can identify most of the time that the facts are completely outta context. They don’t necessarily have to do with your specific situation.
OCD also uses a lot of personal experience to support its ideas and claims. Well, we can’t really argue with something that happened to you. It happened to you and it was probably bad, and you probably don’t want it to happen again. The thing is that now OCDs hopped on that and has gone way overboard in trying to prevent the bad thing from having.
ERP isn’t necessarily looking at where these intrusive thoughts are coming from other than to say, they would probably say, Hey, OCD latches onto things that are important to you that you value. We definitely agree with that, but ICBT says, these intrusive thoughts aren’t as random as you think that they are, that they come from somewhere.
They don’t just originate out of nowhere. They aren’t as random. Maybe as we have believed in the past that they were. My last point is that ICBT might be right for you if you are willing to immerse yourself in the work. And I specifically used the word immerse for a reason, because there is a lot to learn.
There is a lot to pieces to put together. And someone made a really good analogy recently in our Facebook group for clinicians about how it’s kinda like a puzzle. You’re not even sure what it’s gonna look like. You don’t necessarily have the picture in front of you, and you’re putting these little pieces together.
In the beginning, you may not necessarily see how they fit and then. A couple pieces come together, it’s like, oh, okay. I could see that, but I’m not really sure how that fits in with over here. But then over time, as you continue to put those pieces in, things become clearer and clearer. I usually tell the folks in Christian’s learning ICBT that it’s like building a bicycle and then learning how to ride it.
You have to have all of these pieces, and then you have to understand how they work together, and then you have to actually put it into action, like the action behind it of riding the bicycle. It’s not an easy therapy. It’s not like, oh, hey, here’s 12 steps to your whole new life. You really have to. Learn it, digest it, and then there’s different layers of understanding to it.
And I think even for me practicing it and teaching it to others, like I’m continually growing in my knowledge. We just had two self-help books for ICBT come out that have honestly blown our minds because it’s all of the same information. It’s just communicated differently than we’ve had it before. If you want to look those up, they are resolving OCD volume one and resolving OCD volume two.
You can buy them on Amazon. They’re quite huge. It’s a lot to go through on your own. You might just be kind of intimidated and not wanna open the book just by looking at how big it is. I wish that they were a little bit simpler, maybe, and easier in terms of how they look, but. They’re designed to be pretty comprehensive for you to digest on your own or to go through with a therapist, especially if you’ve been in OCD land for a while and your OCD is untreated and it’s pretty severe, it’s gonna take you a lot of work to get out of it.
Either way, I don’t care if you use ERP or if you use. ICBT. If you have a high Y box two score, you’re either gonna need some intensive treatment or you’re really going in there and hitting it hard. Or you are gonna need some extended time to really digest the stuff. Know it, to learn it. Repetition, like repetition, repetition.
When I teach this material, anybody that’s kind of been in there with me would tell you, Carrie does a lot of review. She repeats some things. She shows you the exact same slide and maybe says it in a little bit different way, or says, Hey, remember this slide and how we talked about this. Here’s another example of how this shows up.
Hopefully this gives you a little bit more information and a little bit more of an idea about whether or not you feel like ICBT is right for you. I think with any OCD treatment you have to be ready to do the work. ’cause like I said, it’s not easy. It is work. I’m not gonna sugarcoat that for you. I’m not gonna say, oh yeah, in six weeks you’ll have a whole new life and new you and you just won’t be obsessing anymore.
Not saying that, I realize we’re in a microwave society and we want it better, faster now. I often have to tell my students, slow down. Learn the material, it will come take one step at a time. If you want to join Christian’s learning ICBT, we have it out now as a fully self-help product where you can go through it in 12 weeks.
You will have six months access to it. So if you wanna do one lesson every other week, that’s a possibility for you as well, certainly. But you can go through all 12 modules. At your own pace, or you can add it in addition to seeing a therapist, just to deepen your knowledge base. And if you feel like you want more coaching and more support, you can certainly join us in the fall in mid August.
I’m gonna start teaching those live. So if you think it would help you to have the accountability, it’s gonna be Mondays at 4:00 PM Central Standard Time, and all of this information is going to be at careba.com/training. We’ll put that for you in the show notes. Whatever you decide to do for your OCD recovery, when you are ready to dive in and do the work, just remember that there is always hope in Jesus Christ.
God loves you very much. And desires peace over all of you, and that is what I am praying for you. Until next time, may you be comforted by God’s great love for you. Christian faith and OCD is a production of By the Well Counseling. This podcast is for informational purposes only, and should not be a substitute for seeking mental health treatment in your area.
