I have been misdiagnosed as having OCD. Fortunately, I was acquainted with THREE psychopharmacologist s who explained the personality "type." I have also been around people who actually had OCD. They have my sympathy! I have seen them cry, and understood how uncontrollable their thoughts and habits really are. 😥😢
I would say reassurance is an important part of graded exposure, in that only by stepping into their discomfort zone can a person then be reassured their fears were not realised. In this way, they are supported to keep systematically expanding their comfort zone.
However, I agree that reassurance at or within this comfort boundary (which is what I think you're referring to Owen) does not result in progress and may actually end up reinforcing it.
I really like your takes Dr. Muir, and this post is no exception. I liked it so much I decided to summarize the thesis in my own words:
The most effective psychotherapy for OCD is exposure response prevention.
I have read and witnessed first hand that ERP for OCD has a drop-out rate of 50%. That must leave an impression on the undertrained, they must wonder why they ought to push half of the patients away.
Because OCD is unlikely to respond to placebo, using warmth and positive regard without ERP may hook an OCD’er into the wrong therapy costing time, money, and distracting from the actually useful stuff.
Untreated OCD is a significant risk factor for suicide. Therefore, “wheel spinning, vehicle not moving” therapy represents a risk to the patient.
Desensitization is the opposite of reassurance, and is a key part of effective therapy. Exposure + confidence = competency.
Good therapists boost resilience, not dependency. I think there are many well-intentioned yet poorly equipped counselors who were essentially taught (or not disabused of) the notion that therapy = "professional validation/reassurance." It is not that, and is so much more: the equipping of a patient with greater distress/ambiguity tolerance.
I have been misdiagnosed as having OCD. Fortunately, I was acquainted with THREE psychopharmacologist s who explained the personality "type." I have also been around people who actually had OCD. They have my sympathy! I have seen them cry, and understood how uncontrollable their thoughts and habits really are. 😥😢
These things are complicated! It’s important to understand how much more information, over time, can change an impression!
I would say reassurance is an important part of graded exposure, in that only by stepping into their discomfort zone can a person then be reassured their fears were not realised. In this way, they are supported to keep systematically expanding their comfort zone.
However, I agree that reassurance at or within this comfort boundary (which is what I think you're referring to Owen) does not result in progress and may actually end up reinforcing it.
thanks for the comments! My hope was to highlight the issue for general audiences, who might not be aware this is an issue.
I really like your takes Dr. Muir, and this post is no exception. I liked it so much I decided to summarize the thesis in my own words:
The most effective psychotherapy for OCD is exposure response prevention.
I have read and witnessed first hand that ERP for OCD has a drop-out rate of 50%. That must leave an impression on the undertrained, they must wonder why they ought to push half of the patients away.
Because OCD is unlikely to respond to placebo, using warmth and positive regard without ERP may hook an OCD’er into the wrong therapy costing time, money, and distracting from the actually useful stuff.
Untreated OCD is a significant risk factor for suicide. Therefore, “wheel spinning, vehicle not moving” therapy represents a risk to the patient.
Desensitization is the opposite of reassurance, and is a key part of effective therapy. Exposure + confidence = competency.
Good therapists boost resilience, not dependency. I think there are many well-intentioned yet poorly equipped counselors who were essentially taught (or not disabused of) the notion that therapy = "professional validation/reassurance." It is not that, and is so much more: the equipping of a patient with greater distress/ambiguity tolerance.
and this is why we love members of the frontier psychiatrists community like you, Jeremy.