Treatment for Intrusive Thoughts & Perinatal OCD
Especially with early intervention, there is highly effective treatment available for perinatal OCD. If you are facing significant disturbances (learn more about OCD here) or feel really distressed and not quite yourself, we encourage you to look into next steps below. Ask questions about your treatment options or consult with a mental health professional. Your GP or OBGYN may have recommendations for trusted specialists in your area or online.
Some typical starting places for OCD treatment may include: relaxation and stress reduction training, psychoeducation, scheduling positive activities, de-catastrophization, and implementing scheduled worry. A counsellor can help you make a plan for what approaches may be most appropriate, depending on the severity of the OCD, as well as your unique needs.
You are NOT Your Thoughts
The most important thing we probably share with our OCD clients in therapy is that thoughts do not define you. You are NOT your thoughts. The sometimes random, non-sensical, or disturbing thoughts that your brain produces is not in any way a reflection of who you are, what you value, or what could happen in the future. And actually, these thoughts are a lot more common than you may realize.
Any shame or guilt that you may be experiencing as part of your perinatal journey are likely not serving you, but only getting in the way of being able to get supportive treatment. We encourage you to read on about specific treatment options for OCD, and possible next steps towards feeling more like yourself.
Exposure and Response Prevention (ERP) Treatment for OCD
ERP is a gold standard for OCD treatment generally (International OCD Foundation). This treatment aims to reduce the reassurance-seeking or safety behaviours that individuals will engage in, sometimes without realizing it, in an attempts to reduce their anxiety.
In ERP, a client works with a counsellor to first, intentionally increase exposure to the thoughts, images, objects or situations and create anxiety and fuel the obsessions. Then, they are supported in choosing not to follow through on the urge to act on their compulsion once the fear is triggered.
This approach tends to work because the individual learns (incrementally) a couple of things: 1) that they can have a disturbing thought and still have control over their response to it, and 2) that their fear does not come true if they do not engage in the compulsion.
Mindfulness for Perinatal OCD
Mindfulness is simply tuning into the present moment, on purpose. Overall, mindfulness-based approaches can work well to support someone with perinatal OCD. This takes practice, as the anxious mind will be drawn to wander into well-established thinking patterns. But by spending more and more time in the present moment, you will naturally decrease the amount of time that your brain in spending in worry or future-oriented thinking. Mindfulness can be practiced simply through connection with your breath, focusing on sensations in your body, or tuning into other sensory information in your environments (sounds, smells, tastes, touch, etc).
Often we would recommend starting with something that you already do, like washing the dishes or taking a shower, and trying to tune into your senses and describe what you are noticing. Related to mindfulness, is Acceptance and Commitment Therapy (ACT), which we will go into next.
Acceptance and Commitment Therapy (ACT) for Perinatal OCD
The theory behind ACT, as the same suggests, is to aim to find acceptance of inner experiences, such as obsessions and anxiety, as part of being human. So, ACT intentionally does not try to reduce these thoughts, but rather aims to change how they are responded to.
ACT focuses on letting intrusive or anxious thoughts come and go without interfering with the way one lives their life. An individual experiencing OCD can improve their functioning, without a change in severity or frequency of obsessions or anxiety (although this is a typical biproduct of ACT).
With the help of a counsellor specializing in perinatal OCD, you can work to distance yourself from your thoughts and develop what is called the Observing Self. By noticing your thoughts but detaching from them, you’re still allowing them to be there in a non-judgmental way, but using language that demonstrates that you are separate from them.
Biological Contributions to OCD
Research has demonstrated links between OCD and insufficient serotonin, combined with high levels of dopamine (Koo et al, 2010) which helps transmit messages between the front part of the brain and deeper structures of the brain.
It’s unclear though whether this is a cause or an effect of the condition, however the generally accepted theory is that there are significant and sudden changes to hormones, during pregnancy, postpartum, and nursing (or nursing cessation) that have an interaction on other hormones and/or neurotransmitters, specifically dopamine and serotonin
Do I Need Medication for my Perinatal OCD?
We get many questions from clients about medication and most are initial quite adverse. Our stance when considering what is best is to help clients to look at the possible risks or costs of untreated OCD, especially if it has been unresponsive to psychological treatment, such as those described above.
Of course, we are not medical professionals, and we encourage you to speak to your GP, OBGYN, nurse practitioner, or psychiatrist about specific medication options including any concerns that you have (such as side effects).
Brain scans have shown that in some individuals, the brain circuits involved in OCD become more comparable to scans of those who do not experience OCD, when treated with medications affecting serotonin levels (serotonin reuptake inhibitors, or SRIs).
For some women, medications may focus on helping her to sleep. Especially for postpartum folks, increasing sleep duration and quality can make a significant difference to mood, reduce anxiety levels, increase functioning, and enhance resiliency and coping. For this reason, medication that targets sleep can be a useful part of treatment for perinatal OCD.
Combination of Medication & Therapy for Perinatal OCD
Depending on severity and other factors, what we can share as clinicians is that many clients find that the combination of a therapeutic dose of medication, alongside therapy, can be especially impactful. Sometimes medication can provide a quieting effect – clients often describe that they experience less intensity of thoughts, urgency to act on them, or attachments to outcome. Medication may also help address coexisting challenges, such as symptoms of depression (appetite, motivation, self-care, overall outlook on life).
In other words, the symptoms become less distressing and then the individual has mental space to explore other parts of their life, build coping skills, and find meaning of their postpartum experience. It can also lead to other reported impacts, such as a closer intimate relationship, increased ability to accomplish daily tasks, and feeling overall more joy.
Some Treatments can be Counterproductive for Perinatal OCD
For OCD specifically, some of the core techniques used in treating some other mental health challenges, including depression, can actually be counterproductive in OCD. For example, common CBT technique like Thought-stopping and Examining the Evidence tend to not be recommended, as they can actually reinforce obsessive thinking and compulsions. They do not help an individual build up their tolerance for uncertainty or healthy detachment from thoughts, which are typically need to break out of the obsessive-compulsive loop (International OCD Foundation).
The Postpartum Depression & Anxiety Workbook
Take control of your postpartum mental health with our popular Postpartum Depression & Anxiety Workbook. This is an easy-to-read guide, with therapist-designed exercises and techniques to help you manage intrusive thoughts, work through anxiety, and build self-care strategies. This is the roadmap to feeling more like yourself!
Ready to Get Started with Counselling?
You don’t need to go through this alone. We have a team of counsellors that can help you work through anxiety, OCD, or postpartum adjustment. Our in-house therapist Sara specializes in perinatal anxiety and OCD. If you’d like to work with her, you can learn more on her bio page here.
Crisis Resources for Perinatal Mental Health in Canada
Canadian Crisis Hotline (phone or text): 9-8-8
Pacific Postpartum Support Society: 1.855.255.7999
Postpartum Support International (helpline): 1.800.944.4773
Postpartum Support International (website): www.postpartum.net
