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  • Catherine Benfield

Why Nuance is Important when we Talk about OCD

Updated: Apr 3


Olivia sitting in the center of a see saw with people yelling yes on one side and no on the other. The see saw is balanced.


Hello wonderful people! It's not often that I write an opinion piece but I think it suits this subject. For a while now, I've been seeing some discussions about OCD online that have left me feeling confused, and if I'm feeling confused, the chances are someone new to the world of OCD and recovery is feeling confused. So let's talk about it.


I've been an OCD advocate for eight years now and I'm still amazed by some of the discussions I see on social media surrounding OCD and mental health. I mean, I get it, those of us with OCD, myself included, are often prone to a bit of black and white thinking, but I've been seeing a real lack of nuance in discussion amongst medical professionals and advocates and I find that worrying for two reasons:


  1. It suggests an inflexible approach to discussing mental health.

  2. It could shame or encourage people out of doing things they find helpful.


Those of us with OCD deserve to have all the information available to us about treatment, outcomes and recovery so we can make informed decisions.


Part of this article will talk about questioning sources of information, so let's start by talking about this post as a source. Please remember that I am a primary school teacher and experienced OCD advocate and not a mental health professional. If you need any advice based on the contents of this article, please make sure you talk to a medical professional and please, absolutely do NOT make any changes to your medication or recovery work as a result of what I'm discussing here. This is an opinion piece and not meant to be used as advice. Keeping yourself safe is the most important thing!



Right, lets get going!



Is recovery from OCD possible?


In the space of a week I've seen someone argue that a full recovery from OCD is not possible AND someone else argue that a full recovery from OCD is possible! In fact, over the years, I've seen this debated loads of times and every time the person talking about it is stating their opinion as fact.


I don't think this discussion is all that helpful or nuanced. It doesn't take into account peoples differing opinions on the definition of recovery; what it means to each person, what the success criteria is. How do you know you've made a full recovery? It's different for every person. Some people see recovery as never ever having an OCD symptom again. Others see it as having less symptoms, manageable symptoms, longer gaps between symptoms or less distressing and impactful symptoms. If you see comments online about full recovery, please remember it depends on the person writing and their views. Also be aware that very often they are giving opinions as facts.


I should add that I totally understand how desperately we want to know that a full recovery is possible, and it may well be depending on who you ask, but remember that people can live awesome lives even with some symptoms of OCD present. If you see claims that OCD is chronic or for life, that sounds scary! Remember even if you are dealing with the odd symptoms over the longer term, you will get better and better at managing your symptoms and experience happiness, joy, awe.... all the things that help us to thrive!



Should self-care activities be recommended for OCD?


We've all heard the horror stories of people turning up to A and E in a mental health crisis only to be recommended a 'nice hot bath' or a 'mindful walk'. When someone is really struggling with their mental health this is an incredibly invalidating and distressing way of treating them. It is neglectful and goes against literally every piece of mental health legislation going.


Yet...


Self care strategies are widely known to help support someone's well-being and encourage positive mental health. Many people use self-care activities as preventative strategies and/or as a way of supplementing the NICE (National Institute for Health and Care Excellence) recommended treatments for OCD such as Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP).


Recently, in the online space, I've seen people mentioning how inappropriate it is to suggest things like yoga and mindfulness for improving mental well-being and personally I don't think blanket statements like that are helpful. Yes, it's inappropriate to suggest self care activities as a replacement for medical and psychological intervention, but suggesting it is inappropriate to mention it at all? Personally, I don't agree.


I was taught abdominal breathing when I was in crisis care and it made a huge difference to both my recovery and life. I also found mindfulness helpful. Although please note that I tried both strategies under the watchful eye of a qualified therapist. If you feel you need to, please seek medical advice before trying these yourself.



You should/shouldn't try medication!


There are soooooo many comments online about which medication is best for OCD and just as many discussing whether it is safe to take medication for OCD and guess what? It's ANOTHER conversation that would benefit from some nuance! Medication works for some people, it doesn't work for others. Some people may experience side effects, others may not.


The only person who should be helping you have this conversation is your medical professional. Alongside this you can do some of your own research, just make sure it's from trusted sources* such as:



*Each country has it's own set of guidelines so please make sure you are researching through the relevant sources. Also, your medical professional should be able to point you in the direction of additional documents to help you decide whether medication is the right decision for you.


Actually, while I'm mentioning the NICE guidelines, they are a handy thing to keep nearby... knowing the NICE guidelines is a great way for you to make sure you are getting the correct care for OCD.



The helpfulness of talk therapy for OCD


I have seen people comment on social media that under no circumstances should we have talk therapy for OCD and that it is unsuitable for OCD. By talk therapy here they mean the types of therapy that discusses the past, talks about your childhood, talks about your experiences with OCD. They say this because it goes against the NICE recommended gold standard treatment for OCD which is CBT with ERP and/or medication. CBT and ERP are very much 'doing' therapies.


The reason I find it unnuanced when people say you absolutely shouldn't have talk therapy for OCD is because I've had grief therapy to help me cope with the time I lost to severe OCD and it helped. This grief therapy was not based on CBT or ERP, and over my years of advocacy, I've heard from lots of people who found talk therapy helpful for OCD.


I guess the points people criticising talk therapy for OCD are making, is that:


1) talk therapy may not be helpful if it is the only therapy you are having.

2) it is also a problem if your medical professional doesn't understand the NICE guidelines for OCD treatment and sends you to the more traditional types of talk therapy straight away without offering CBT/ERP/medication

3) traditional talk therapy can potentially make OCD worse


Of course, all of the above are completely valid and important points but again there's little nuance in the conversations I've seen on this topic, so it's well worth doing some further research on this yourself.


Personally, CBT and ERP changed my life. So did medication. But I also found talk therapy helpful. If I'd seen that unnuanced comment about OCD and talk therapies prior to starting grief therapy, it may have blocked me trying something that really helped.


The issue of talk therapy in the UK is complicated even further now because the process of self-referral to psychological services which used be called Improving Access to Psychological Therapies (IAPT) is now called... guess what??? NHS Talking Therapies! That's not complicated at all, is it?! So please remember this if you see people online saying not to do talking therapies for OCD - it is literally now the name of the psychological services you apply for psychological support through in the UK.



Cognitive Behavioural Therapy Helps Everyone


I'm going to say it one last time folks... CBT is in the NICE guidelines for treating OCD and there is a real emphasis in conversations online that it works for everyone. This isn't true. Whilst some CBT treatment may not work because it wasn't quite the right time to start, or because the patient-therapist relationship wasn't working optimally, for some people CBT just doesn't work and whilst it would be great if it did, there are other options available. I've found quite a bit of toxic positivity online surrounding CBT, and have even seen people suggest that others keeping trying to access it after seven or eight previously unsuccessful attempts of CBT.


Would I want to keep being pushed into the same type of therapy for the fifth time after approaching it with an open mind four times and not finding it helpful? No I would not. Would it make me feel like a failure if people kept encouraging me to try to same therapy which I didn't find helpful? Probably.


Again, a discussion with your medical professional and doing some of your own research here may help you make decision. I found this page and the links inside it helpful.



In summary:


Getting help for OCD can be a complicated business. It's a condition surrounded by misconception and stigma. It is a condition that even many medical professionals are under-trained in and because of this conversations online can get heated and opinions can be passed on as fact. If you've spent anytime on Twitter you will definitely know this! :D


Most people involved in discussions about OCD online are extremely passionate and have often faced stigma and misinformation and are desperate for that not to happen to other people. I think this can sometimes encourage a lack of nuance. I do believe it comes from a place of love and concern. I'm sure I've been guilty of it many times myself.


The main thing I would love for you to take away from this post is the knowledge that the absolute best practice for you to get information and support is though research through accredited and reliable sources, and through discussion with your medical professional.


I've tried to source the information I've mentioned here to support you, so please check the links out when you have time.


I hope this has helped.


Sending you all loads of love,


Cat x



Further Reading

Wondering where to start looking for OCD support? Try here!


Interested in books, resources and informational bout OCD? Look no further than here! This is one of the most comprehensive lists available for OCD.



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