Obsessive Compulsive Disorder and Anxiety

Last week I got to attend a dinner for an agency called OCD and Anxiety Centers.
I was invited because they often get referrals for people who turn out to be autistic, and the “obsessions/compulsions” are actually something much more complex and fundamentally different than the mental illness, OCD.
The CEO’s wife and two children have OCD and he shared that his career since medical school had shifted to treating this life-crippling disorder through de-sensitization training in a support group setting, paired with DBT.
Fascinatingly, he described how the obsession is not actually “the thing”. In other words, it doesn’t matter WHAT the obsession is; the amygdala is simply misfiring and the brain has settled on a particular theme on which their anxiety is focused.
Compulsions arise because of the intense anxiety surrounding the theme and a ferocious urge to protect themselves, either from doing something horrific, or from something horrific happening to them or their loved ones.
For example, there is something called POCD, or pedophilic OCD. A person with POCD will have an intrusive sexual thought about children and will be so repulsed and terrified that they might harm a child that they have developed a compulsive ritual to ensure that they are not a pedophile and that they will not act on the thought.
Pedophilia is simply the theme their brain has settled on when the amygdala misfires.
They are certainly NOT a pedophile.
The groundbreaking support group setting allows people with OCD to work through the terrifying anxiety WITHOUT engaging in their ritual so they can train their brain A.) that they are safe without their ritual, and B.) that they have the tools to get through the brain misfire. It is done with others who share a similar struggle to de-stigmatize the condition and provide the traditional benefits of support groups.
The DBT serves to move them TOWARD the anxiety instead of avoiding it through rituals.
I asked the director if she had considered ACT, as this process seemed in line with it, but she said they had their “secret sauce” already.
I thought it might be helpful to teach patients that their desire to avoid the shame/anxiety thought was actually keeping them in a state of suffering and that they actually WERE aligned with their own values, even though their self-soothing techniques were actually ineffective and fundamentally harmful.
In any case, the work they are doing is impactful AND they have great research to back it up and show their success!