In my work with people who suffer from OCD (obsessive compulsive disorder), I am always excited to see progress in their treatment. It is cause for celebration when a client is able to reduce therapy sessions and begin to think about life after treatment. It becomes a wonderful opportunity to discuss questions like: Is my OCD treatment complete when I don’t have regular therapy visits? Do I still have to use the strategies I learned after finishing active treatment? What is the risk of relapse and are there ways to reduce this risk?
They are excellent questions and in themselves demonstrate the client’s improvement, determination and dedication. The ability to think ahead and plan accordingly for any potential relapse shows the progress my clients have made. The answers to these and other questions can be found by learning about relapse prevention planning for OCD.
The Importance of OCD Relapse Prevention Planning
While the goal of relapse prevention is to help people maintain the gains and recovery that have occurred during treatment, it is helpful to start thinking about relapse prevention early in the treatment process. Relapse prevention is key to a well-planned cognitive behavioral treatment (CBT) approach for OCD.
Relapse prevention planning includes three main components: 1) helping people learn about the common trajectory of OCD, 2) defining the term “relapse” and the factors that influence it, and 3) developing a structured and individualized to promote relapse prevention.
Common Path of OCD
Although OCD is considered a chronic condition, it can be well controlled with effective treatment, including medications and targeted therapy. Exposure and response prevention (ERP), the key component of CBT for those with OCD, helps the individual learn to modify their response to their obsessions and compulsions. This in turn helps to strengthen the management of your symptoms and thus improve your quality of life.
While the initial goal in seeking treatment may be to reduce the immediate severity of symptoms, the actual mission is often greater. As a doctor, my goal is to help the person learn how to make the strategies a “way of life,” long after they finish formal treatment. Understanding relapse and preventing it requires planning ahead, often from the start of treatment.
Lapses and Relapses – Knowing the Difference
Taken from substance use research, there is a difference between having a relapse and a lapse. Relapse It means that there is a significant decrease in progress or a high degree of slippage, almost returning to the same severity as before starting treatment. In contrast, a lapse It means having an increase in symptoms, a flare, or some degree of slippage, but not a relapse. Failures are considered natural, even expected, while the risk of relapse can be much lower if you actively use relapse prevention strategies and a plan.
Mistakes should be seen as opportunities, not frustrations or failures. They serve as useful warning signs that may even decrease the likelihood of a relapse. In case of mistakes, it is also important to practice self-compassion. Failures offer the opportunity to grow more and live longer than OCD!
4 steps to follow
To maintain the momentum of treatment progress, I like to refer to these four steps that can help develop an individualized relapse prevention plan with your provider:
Step 1: Make a list of the tools in your toolbox. What are the strategies, concepts and activities you learned to support your progress? Think broadly! Include tools that help with general stress management and self-care, as well as tools that work specifically with OCD.
Step 2: Consider a general framework for planned and proactive use of these strategies, including planned exposures, to keep OCD management and self-care “muscles” strong.
Step 3: Identify the warning signs of an error for yourself. What’s starting to happen? Are there changes in your sleep, behaviors, sensations, or appetite? Is there a stronger urge or greater likelihood of engaging in compulsions?
Stage 4: What is your action plan when you notice this? Be specific! How will you incorporate your tools in a more active or structured way during this time? Who will you contact for support and what does this support look like?
Whether working with your therapist or on your own, these steps can be an invaluable resource when completing a formal course of treatment. I also recommend sharing your plan with your support system and reviewing it periodically.
References
- Claiborn, J. (undated) From the Experts: Relapse Prevention in the Treatment of OCD. OCD International Foundation. Obtained in January 2024, from https://iocdf.org/expert-opinions/expert-opinion-relapse-prevention/.
- Hiss, H., Foa, E., & Kozak, M. (1994). Relapse prevention program for the treatment of Obsessive Compulsive Disorder. Journal of Consulting and Clinical Psychology, 62, 801-808.
- Well, S. (undated) Taking your life back from OCD. Obtained in January 2024, from https://www.shalanicely.com/wp-content/uploads/2016/08/Relapse-Prevention.pdf.
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