I want to spend some time today talking about treatment options for Relationship OCD (ROCD.) I won’t spend much time explaining the condition as you can read my Guide to ROCD here, if you have not already done so. Rather I want to outline all the treatment options, focusing mostly on therapy, as I am a psychologist, and how to seek help if you are ready for treatment.
Understanding ROCD
ROCD is characterised by:
- Persistent and intrusive doubts about your partners suitability for you, or with your feelings, or their feeling towards you.
- Obsessive thoughts focusing on the partner’s perceived flaws or the relationship’s viability.
- Compulsive behaviours, such as constant reassurance-seeking, avoidance of certain situations, or incessant comparison with other relationships.
- Significant distress and impairment in daily functioning due to these obsessions and compulsions.
How ROCD Differs from Normal Relationship Doubts
Normal relationship doubts are usually situational and transient. In contrast, ROCD-related doubts are pervasive and irrational and lead to substantial anxiety and compulsive behaviours. The intensity and persistence of these doubts differentiate ROCD from typical relationship concerns.
Common Misconceptions about ROCD
- It’s just normal relationship anxiety: OCD, of which ROCD is a subtype is a clinical condition requiring professional treatment. You can read more on relationship anxiety here.
- Only people with weak relationships experience ROCD: ROCD can affect anyone, irrespective of their relationship’s strength.
- ROCD means the relationship is doomed: With appropriate treatment, individuals can overcome ROCD and maintain healthy, fulfilling relationships.
ROCD Self-help Course
Dr Ryan’s online course for ROCD
Treatment
Cognitive-behavioural therapy (CBT)
CBT is a well-established, effective treatment for Obsessive obsessive-compulsive disorder (OCD) . When you are looking for treatments, look for treatment for OCD, not Relationship OCD, as focusing on therapy for ROCD will yield a very narrow result. Relationship OCD is a sub-type of OCD, so it makes sense the treatment you want is for OCD.
You can read more on CBT here, but I shall outline briefly how it works for ROCD.
When you start CBT you shall learn about
- Identifying and Challenging Obsessive Thoughts: Myself, or another therapist will show you how to identify the intrusive thoughts related to your relationship. By examining the evidence for and against these thoughts, you shall learn to question their validity as opposed to taken them as gospel and representative of your relationship.
- Cognitive Restructuring: By identifying and challenging negative thought patterns, you will get a more balanced and realistic perspective. This involves learning to question the evidence supporting these thoughts and replacing them with more helpful ones.
- Behavioural Experiments: You have probably heard about the homework with CBT, behavioural experiments are set as homework and I’ve written an article on how they help. During the homework experiments you will test out negative beliefs through real-life experiences to gather evidence that contradicts them. For example, if you believe your partner is unfaithful, you might be asked to carry out something that challenges this belief, such as spending quality time together or discussing trust openly.
- Exposure and Response Prevention (ERP): Many people are not aware that ERP is an integral part of CBT so I shall discuss it a bit more below.
Exposure and Response Prevention (ERP)
ERP is a critical CBT technique for ROCD. It involves gradually exposing individuals to anxiety-provoking thoughts or situations without allowing them to engage in their usual compulsive behaviours. For instance, a person might be asked to focus on their doubts about their partner without seeking reassurance. Over time, this reduces the anxiety associated with the obsessions and weakens the compulsive response.
Cognitive Restructuring Techniques
Cognitive restructuring helps individuals identify and challenge distorted thought patterns related to their relationships. For example, an individual might learn to question the validity of their obsessive doubts and develop more balanced, realistic thoughts about their relationship. Techniques might include keeping a thought diary, practising balanced thinking, and using evidence-based evaluations to counter irrational beliefs.
Acceptance and Commitment Therapy (ACT)
Overview of ACT and Its Application to ROCD
ACT is another effective therapeutic approach for ROCD, focusing on accepting difficult thoughts and feelings rather than attempting to eliminate them. It encourages mindfulness and commitment to values-driven action, helping individuals live fulfilling lives despite their ROCD symptoms.
ACT helps individuals observe their thoughts without judgment and accept the presence of anxiety. Mindfulness practices, such as meditation and present-moment awareness, reduce the impact of obsessive thoughts and increase overall well-being. By focusing on their core values, individuals can act in ways that align with their goals and desires, rather than being driven by their OCD symptoms.
Other Therapeutic Approaches
- Schema Therapy: Addresses deep-seated patterns and beliefs that contribute to ROCD symptoms. It helps individuals understand and change long-standing cognitive and emotional patterns.
- Interpersonal Therapy (IPT): Focuses on improving interpersonal relationships and communication, which can alleviate ROCD symptoms by addressing relational conflicts and enhancing emotional support.
- Psychodynamic Therapy: Explores unconscious conflicts and past experiences that may contribute to current symptoms. It aims to increase self-awareness and insight into how these factors influence behaviour and emotions.
Medication
As a psychologist, we do not prescribe, at least not here in Ireland, but medication is an option for some people with OCD, so I shall outline the options belows.
Medication can be a helpful adjunct to psychotherapy, particularly for individuals with severe symptoms. It can reduce the intensity of obsessive thoughts and compulsive behaviours, facilitating engagement in therapy.
Common Types of Medication Used (SSRIs, SNRIs)
Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are commonly prescribed for ROCD. These medications help balance brain chemistry, reducing OCD symptoms and improving mood and anxiety levels.
When Medication Might Be Considered
Medication is typically considered when:
- Symptoms are severe and debilitating.
- Limited progress is made with psychotherapy alone.
- Co-occurring conditions, such as depression or generalized anxiety disorder, are present.
Importance of Consulting a Psychiatrist
Consulting a psychiatrist is essential for a comprehensive assessment, appropriate medication prescription, and monitoring of effectiveness and side effects. Professional guidance ensures the safe and effective use of medication for ROCD.
Complementary Therapies
Mindfulness and Meditation
Mindfulness practices, such as meditation, can help individuals become more aware of their thoughts and feelings, reducing the impact of obsessive thoughts and enhancing overall well-being.
Exercise
Regular physical activity can improve mental health, reduce anxiety, and provide a healthy outlet for stress. Exercise also promotes better sleep and overall physical health, improving mood and resilience.
Support Groups
Connecting with others who have similar experiences can provide emotional support, reduce feelings of isolation, and offer practical coping strategies. Support groups can be found online or in-person and can be a valuable resource for both individuals with ROCD and their partners.
Importance of Self-Care
Self-care activities, such as adequate sleep, healthy eating, and engaging in hobbies, can improve overall well-being and resilience against stress. Prioritizing self-care helps maintain mental and physical health, which is crucial for managing ROCD.
Finding the Right Treatment
Factors to Consider When Choosing a Treatment
When selecting a treatment, consider:
- The severity of symptoms.
- Personal preferences and comfort with different therapeutic approaches.
- The availability of qualified professionals.
- The potential benefits and drawbacks of different treatment options.
Importance of Finding a Qualified Therapist
Working with a therapist experienced in treating OCD and ROCD specifically is crucial. They can provide specialised, evidence-based interventions tailored to the individual’s needs and help navigate the complexities of ROCD.
The Role of the Partner in Treatment
Partners play a significant role in supporting individuals with ROCD. Their involvement can include:
- Education: Learning about ROCD to better understand the condition and its impact.
- Communication Strategies: Practising open, empathetic communication to support their partner without enabling compulsive behaviours.
- Seeking Support: Finding support for themselves, either through individual therapy or support groups, to manage their own stress and emotions.
Potential Challenges and Setbacks in Treatment
Treatment for ROCD can be challenging, and setbacks are common. Maintaining a long-term perspective, being patient with the process, and seeking ongoing support when needed are essential. Developing resilience and understanding that progress may be gradual can help individuals and their partners navigate these challenges.
Relapse Prevention
Identifying Potential Triggers
Understanding and identifying potential triggers for ROCD symptoms is crucial. These may include specific relationship-related situations, stress, or changes in routine. Awareness of triggers allows individuals to anticipate and manage their responses more effectively.
Developing Coping Mechanisms
Developing and practising coping mechanisms can help manage ROCD symptoms and reduce the likelihood of relapse. These might include mindfulness exercises, cognitive restructuring techniques, and healthy lifestyle habits.
Maintaining Ongoing Treatment or Support
Continued engagement in therapy or support groups, even after significant improvement, can provide ongoing support and prevent relapse. Regular check-ins with a therapist can help address any emerging issues and reinforce coping strategies.
Coping Strategies
Techniques for Managing ROCD Symptoms
- Mindfulness Exercises: Practising mindfulness can increase awareness and reduce the impact of obsessive thoughts.
- Journaling: Keeping a thought diary can help track progress and identify triggers and patterns.
- Distraction Techniques: Engaging in activities that shift focus away from obsessive thoughts can be helpful.
Building a Support System
Having a network of supportive friends, family, and professionals can provide emotional support and practical assistance in managing ROCD. Open communication and mutual understanding within this support system are crucial.
Self-Compassion and Self-Care
Practising self-compassion involves treating oneself with kindness and understanding during difficult times. Engaging in self-care activities, such as hobbies, relaxation techniques, and spending time with loved ones, can improve overall well-being and resilience against stress.
Stigma and Shame
Addressing Stigma and Shame
Stigma and shame often accompany mental health conditions like ROCD. These feelings can prevent individuals from seeking help and exacerbate symptoms. It’s important to recognise that ROCD is a legitimate mental health condition that requires treatment, just like any physical illness. Seeking support without shame and understanding that needing help is a sign of strength, not weakness, is crucial.
Offering Reassurance
Offering reassurance to individuals with ROCD that their experiences are valid and that effective treatment is available can reduce stigma and encourage them to seek help. Normalising conversations about mental health and promoting understanding can help combat stigma and create a supportive environment.
Conclusion
Recap of Treatment Options
There are several effective treatment options for ROCD, including CBT, ACT, medication, and complementary therapies. Finding the right treatment involves considering personal preferences, symptom severity, and the availability of qualified professionals.
Seeking professional help is crucial for managing ROCD symptoms and improving relationship quality. With the right treatment, individuals can overcome ROCD and lead fulfilling lives.
ROCD can be a challenging condition, but with appropriate treatment and support, individuals can achieve significant improvements. There is hope for recovery and the possibility of maintaining healthy, loving relationships.
Resources for Readers
- Mental Health Organisations: National OCD charities and local mental health services.
- Support Groups: Online forums and in-person support groups for OCD and ROCD.
References:
- Abramowitz, J. S., & Jacoby, R. J. (2014). The Psychological Treatment of Obsessive-Compulsive Disorder. Cognitive and Behavioral Practice, 21(3), 332-342.
- Twohig, M. P., & Levin, M. E. (2017). Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression: A Review. Psychiatric Clinics, 40(4), 751-768.
- Koran, L. M., Hanna, G. L., Hollander, E., Nestadt, G., & Simpson, H. B. (2007). Practice guideline for the treatment of patients with obsessive-compulsive disorder. American Journal of Psychiatry, 164(7_suppl), 5-53.
