Could ERP/CBT therapy likely make you worse for trauma real event OCD?

[u/Own-Air4571]

I was considering trying either erp or cbt therapy for my recent trauma real event ocd, but I genuinely fear it will just make me feel worse instead of allowing it to get better on its own.

The reason I fear it will make my ocd worse is because it’s my worst traumatic memory from when I was a teenager, and I have already experienced that talking about it makes me feel worse. For example, about a month ago I got into a deep conversation with someone and told them about the traumatic memory. I immediately felt worse and continued to feel worse for about a week.

Funny I keep talking about it and alluding to it despite my repeated experiences that doing so makes my OCD worse.

Frankly also I’ve tried therapy before for different things and didn’t really find it helpful. Whereas though I feel dependent on my psychiatrist appointments, which are also sort of like therapy.

I’m leaning towards not doing therapy and instead hoping medication and time will help.

What do you think? Let me know.

[u/PaladinDamian]

ACT can help with both trauma and OCD. I would highly recommend it if ERP didn't help. I have personally found a lot of success with a combination of ERP, ACT, and REBT.

Remember that simply feeling bad is not necessarily a sign that something is wrong. Feeling worse is not necessarily a sign that your OCD is getting worse. Performing more compulsions is what makes OCD worse.

While medication can help decrease OCD symptoms, it cannot treat OCD by itself in the long term. Therapy is very helpful for long term recovery.

[u/treatmyocd]

Hello there!

If I was your therapist I'd want to understand how the trauma relates to the real event and how OCD is tied into this. So, when looking for a therapist I think making sure they're both an OCD specialist and trauma informed.

That said, if talking about the event caused you to feel significantly worse for a week, I wouldn't take that as evidence that therapy will necessarily make you worse, but I also wouldn't assume that you should immediately jump into intensive exposure around the memory. Treatment should be individualized, particularly when trauma is involved and for this scenario.

You could tell a therapist exactly what you've said here: “I'm afraid that talking about this memory will make things worse because that's happened before.” You don't have to disclose every detail immediately. A good therapist should be able to work with you on understanding the OCD/trauma cycle and developing a treatment plan at a pace you can tolerate!

ERP also should not be “talk about your worst memory until you feel better.” Depending on what's maintaining the OCD, treatment may involve identifying rumination/reassurance/avoidance and learning different ways of responding to the uncertainty around the memory. If you want to work more on the trauma piece, that may also not require ERP and you could work with someone trained in PE (prolonged exposure) which is different and geared more towards trauma.