04/25/2026
WHEN THE ONLY WAY OUT IS THROUGH
-Ally Orsi, LCSW
Most people feel worried from time to time they may review things they have said or done throughout the week, and think about them for a few days. Others may dwell on things that are not relevant, but review them anyway in their mind replaying what they wish they had said. This is Is sometimes due to an anxiety disorder known as Generalized Anxiety Disorder, “GAD”. This condition Is also exhausting for the person going through it as they may feel anxious even upon waking and have no idea why. We call that, “free-floating anxiety”. People with GAD often worry About past, present, and future situations.
One way you can know if your worry is in need of treatment is to consider how it is affecting your life. Is it causing you trouble in major life areas? Is it making your life unbearable for your quality of life less. Time goes by and your mind on a hamster wheel where you never seem to escape.
Obsessions by contrast, Include repetitive irrational thoughts, one in which the person attempts to prove to themselves imaginary things did not happen, and is not reasonable. Often the fears go on all day and the person is caught up in rituals that may even take hours. It is the type of emotional enslavement. Repetition becomes debilitating. They seek reassurance repeatedly which is a form of checking. Some may have magic numbers or other things that limit their functioning. OCD is not considered an anxiety disorder. It has its own category.
Ultimately, this is not a matter of “will power”. The threat detection in the brain is impacted. There may be urges to follow rituals. It is your neurobiology presenting your problem. It is an often misunderstood condition. But, if you have ever had a superstition, such as a black cat crossing your path, you might imagine in the very slightest way how a person with an OCD feels and thinks. But imagine that superstition 1000 times worse and being unable to convince yourself is not true. And a period of thinking or doing things that are irrational in order to feel better briefly.
All of these conditions pertain to the human emotion, fear. Although the brain may recognize that the thoughts are irrational, the cycle of thinking continues until the person exhausts themselves. People have varying degrees of insight into whether their thoughts are rational.
All are treatable although some cases may be more difficult due to other factors. Often, OCD is accompanied by other conditions. These may have medications that can help. In the case of most anxiety disorders, cognitive behavioral therapy is helpful, sometimes in conjunction with other modalities of treatment. OCD requires Exposure Response Prevention behavioral treatment, as well as a strong general behavioral skill set, and strategies with CBT.
The main concept in ERP is not to “avoid” your fear. You need it to run from bears. It isn't even about stopping the symptoms as they occur. It is about enduring just enough anxiety to the point you are durable emotionally and psychologically. Whereas the symptoms were previously intolerable, they become like background noise. In ERP treatment, the goal is for you to experience enough measured “doses” of discomfort to cause what is called, “extinction”. The fear ceases to work on you anymore.
But the wrong treatment is a lot like trying to run when you have not run before. Someone who has run a lot can probably run miles. Someone who has never run before will need to start gradually. And the treatment will involve gradually exposing you to your fears, while resisting compulsive behavior. This is to prove to your mind that the behavioral experiment is what is true. The experience of nothing bad happening reinforces logical response. With treatment it is not unusual to have long periods where you do not have worries or obsessions.
My treatment generally improves symptoms to a noticeable level after six sessions. OCD treatment rarely lasts longer than 12 weeks of weekly sessions with homework. Often, therapy can be done online as this provides guidance during exposures. Most treatment is a combination of in office and online.
Exposure and Response Prevention (ERP) therapy for OCD. Telehealth available statewide in Arkansas, with in-person sessions in Little Rock.
