OCD Treatment NYC: ERP Therapy For New Yorkers

by Dr. Nancy Miller, PsyD

The International O.C.D. Foundation estimates that around 1 in 100 adults suffers with OCD [1]. In NYC alone, that’s thousands of individuals experiencing symptoms of OCD.

New Yorkers are fortunate enough to live in a city where ERP (Exposure and Response Prevention) – which is considered to be the most effective treatment for OCD – is relatively prevalent, meaning treatment is available.

Learn more below about common symptoms of OCD – including some that are likely to occur in New Yorkers who have OCD – as well as what you can expect from OCD treatment in NYC.

What is OCD?

When a person suffers with Obsessive Compulsive Disorder (OCD), they experience obsessions and compulsions. Obsessions are recurrent, unwanted and extremely distressing thoughts, urges, or images. Compulsions are repetitive behaviors or mental acts, also known as rituals, that are aimed at reducing or undoing the emotional terror triggered by the obsessions. While rituals provide short-term relief, they will always backfire because rituals are like OCD’s oxygen; they keep OCD alive.

Examples of obsessions may include fears that you may loose control and  harm someone, over-concern with contamination, feeling things are “just not right,” fears that your bad thoughts might come true, fears that you are not truly in love, and sexual fears such as the fear of molesting children or the fear of being homosexual when you’ve always identified as heterosexual.  

Examples of compulsions may include reassuring oneself, trying to suppress upsetting thoughts, excessive checking, excessive cleaning, and seeking reassurance from others. Also, people who suffer with OCD avoid many situations, people, and events that trigger their obsessions.
Related: Types of obsessions and compulsions

I have unwanted thoughts. Do I have OCD?

Interestingly, people who don’t suffer with OCD also experience thoughts, images, and impulses that are similar in content to what OCD sufferers experience. After all, the mind is highly creative and it is normal for it to generate unpleasant distressing thoughts.

The difference is that people who suffer with OCD have more of these intrusive ideas; the ideas are more upsetting; and the person may think about these thoughts in a way that amplifies their distress.

While a person without OCD can acknowledge the intrusive thoughts as irrational and dismiss them, a person with OCD cannot. Instead, the thoughts cause intense feelings such as fear, shame, and guilt and these emotions drive people to perform rituals that are excessive, time-consuming, and cause impairment in social, occupational, academic, and/or family functioning.

Related: Symptoms of OCD

What are examples of OCD compulsions and rituals?

In response to obsessions, OCD sufferers naturally engage in rituals that are aimed at reducing the emotional distress associated with the obsession or preventing a frightening outcome associated with the obsession. Rituals can be both observable and unobservable by others.

Common observable rituals include:

  • Seeking reassurance from others
  • Washing
  • Ordering
  • Checking
  • Confessing
  • Searching Google for answers
  • Avoiding threatening items, activities, people, or situations

Unobservable rituals occur mainly in the sufferer’s mind, and involve mental acts like:

  • Reassuring one’s self
  • Trying to suppress thoughts
  • Praying
  • Replacing bad thoughts with good thoughts
  • Distracting oneself
  • Counting
  • Mulling over information to attain certainty or an answer

Struggling with OCD in NYC

Research does not support that OCD is more common in NYC than in other areas. However, there are some obsessions that can arise in response to New York living. For example, a person might obsess that they are going to spontaneously push someone onto the subway tracks. Or they might worry that they’re going to cause a fire in their apartment building by leaving the stove on. That said, OCD challenges are universal. Whether you live in New York or elsewhere, OCD demands certainty, when in fact, certainty is impossible to guarantee.

Common OCD challenges that I see in my private practice in NYC include:

  • Fear of harming others, such as fear of losing control and acting aggressively, fear of being attracted to and molesting children, fear of causing a fire, fear of hurting someone’s feelings, and fear of having bad thoughts that can cause harm to others.
  • Fear of being attracted to the same sex when the person has identified as heterosexual his or her whole life.
  • Relationship fears, such as fear of being in the wrong relationship or not being truly in love.
  • Fear of being immoral, and not living according to one’s values.
  • Fear of contracting an illness and being responsible for transmitting it to loved ones, or being exposed to toxins that may cause a serious illness.

In New York, as well as elsewhere, ERP is the preferred treatment for Obsessive Compulsive Disorder.

Exposure and Response Prevention (ERP): The gold standard of treatment for OCD

Exposure and Response Prevention is the gold standard for OCD treatment, helping clients directly face their fears, and eventually reduce or eliminate their compulsions.

Exposure and Response Prevention (ERP) is mainly based on two scientific principles:

  1. When you expose yourself to things you fear – and you don’t ritualize – your fear naturally, over time, will most likely go down. This is referred to as habituation. When people ritualize, they attribute their safety and fear reduction to the ritual. They never learn that they can, in fact, tolerate distress – and that their fear tends to subside on its own. The more you face your fear triggers without ritualizing, the more likely your emotional distress diminishes when you come in contact with those triggers in the future.  Rituals signal to the brain that a situation is indeed dangerous and invites the OCD brain to continue to warn us of this danger. When you face your fears and stop performing rituals, your distress most likely will diminish.
  2. The fear system in the brain learns through experience. You can’t simply tell your brain’s threat detection center to stop setting off false alarms. When you face your fears without ritualizing, you may learn that your fears are unlikely to happen, and that you can tolerate your anxious thoughts and feelings. People begin to see that rituals are not necessary to be safe, and that they can indeed handle the uncertainty associated with the exposure.

Exposure therapy entails facing your fears, and violating your expectations about those fears. In other words, you may learn that when you don’t ritualize, what you fear is unlikely to occur, and that you can handle more risk and anxiety than you predicted you could. This is referred to as inhibitory learning or safety learning. By engaging in ERP effectively and consistently, over time your brain will ideally access your new learning, and no longer process the thought or situation as threatening.

In some circumstances, medication can be used alone or in conjunction with ERP to treat OCD. Medication may help lower the frequency and intensity of obsessions so that sufferers have a higher likelihood of successfully engaging in ERP consistently.
Related: What Happens In Exposure And Response Prevention Therapy Sessions? Here’s What You Can Expect

What not to look for in an OCD therapist:

On the other hand, there are many treatment approaches that are not evidenced based, and can be ineffective and even harmful. These include approaches like:

  • Gathering evidence to convince the OCD sufferer that their fears are irrational
  • Thought stopping
  • Using relaxation to reduce OCD
  • Talk therapy that speculates about the connection between OCD symptoms and the past

Many of my clients wish they started ERP therapy sooner. While they find the treatment challenging, they also find the gains to be rewarding and life changing.

OCD treatment in NYC: Prioritize fit with the therapist, and take advantage of the city’s resources

Residents of New York City are lucky in that there are an exceptional amount of experts and institutional support. As such, when searching for a psychologist to help you manage your OCD, you have the option to set up an initial consultation with a couple of providers, so that you can choose the best fit.

A psychologist who specializes in treating OCD will be extremely familiar with all types of obsessions, including those that people feel ashamed to talk about.  Aim to be honest about your OCD with your psychologist so you can experience the value of sharing your thoughts with someone who is knowledgeable and empathic to help reduce your shame and so that you can effectively work together to reach your treatment goals.

Take advantage of the resources available for OCD in NYC

There are many OCD specialists who offer individual, outpatient therapy in Manhattan. Websites such as the IOCDF.org & Zencare.co offer help in finding a provider in your desired location.  

There are also OCD treatment centers and hospitals in New York City that offer more intensive treatment, group therapy, and lower fee treatment options, and conduct OCD research.

Mount Sinai Hospital: Mount Sinai Hospital provides an OCD and Related Disorders Program, which offers comprehensive diagnostic evaluations and outpatient services and have lower fee treatment options with doctoral students.

Columbia University Center for OCD Treatment and Related Disorders: Columbia University’s  OCD Research Program uses cutting edge research in order to better understand OCD and provide patients with the latest innovative treatment options.

Child Mind Center Intensive OCD Program: The Child Mind Center provides a 4-week Intensive OCD Program for children and adolescents.

Reeds Center: The Reeds Center offers individual, intensive, and group therapy for the treatment of OCD and also offers lower fee treatment options with master's level therapists and early career psychologist.  

The Center for Cognitive Behavioral Therapy offers individual and group therapy for the treatment of OCD and also offers lower fee treatment options with master's level therapists and early career psychologists.

Whether you’re living in New York or anywhere else, OCD follows the same rules. Working with a therapist who is friendly, caring, and – crucially – knowledgeable about what works can make a world of difference in your treatment.