From Diagnosis to Management: Navigating OCD with Combined Treatments

Obsessive-compulsive disorder (OCD) is a complex mental health condition characterized by a cycle of unwanted, intrusive thoughts—known as obsessions—followed by repetitive mental or physical actions called compulsions. If left untreated, this cycle can disrupt a person’s daily life, relationships, and overall well-being. 

At Bloom Health Centers, providers support patients by prescribing medication to reduce the intensity of OCD symptoms. They often refer patients to NOCD, a leading platform for OCD treatment, for exposure and response prevention (ERP) therapy, to help them build long-term skills alongside medication.

Aliya, a patient living with OCD and anxiety, shares how working with both Bloom Health Centers and NOCD helped her face her fears and reclaim her life.

Aliya’s Story

Before starting treatment at Bloom Health Centers, Aliya had been receiving cognitive behavioral therapy (CBT), a type of talk therapy, to treat generalized anxiety disorder (GAD). “I would pick at my skin a lot and was very particular about certain things,” says Aliya. “I would also wait for the perfect time to do certain things, which would never come. I had a hard time making decisions because my parents always did, so I feared that I would do something wrong.”

When she started experiencing panic attacks and sleep disturbances, she realized that CBT wasn’t enough. “It just wasn’t very helpful for me, and at some point, I felt like I was just talking to a friend,” she says. “I wanted to understand why my brain was working the way it does, why I’m thinking the way I do, and how to fix it and cope with it.”

Aliya began working with Sabrina Salem, DNP, PMHNP-BC, a provider at Bloom Health Centers, to incorporate medication into her treatment plan. She began taking 100 mg of Zoloft, which helped get her panic attacks under control, but she was still struggling with her OCD symptoms. Aliya requested further help from Salem, who suggested NOCD.  

“I told her that [NOCD Therapy] could be something that’s very beneficial to her, as it could alleviate the anxiety associated with why she was doing these specific rituals or routines, and break the thought pattern she was in,” says Salem. 

Aliya took her provider’s recommendation and spoke to NOCD’s intake team about ERP therapy. “I did the consultation and really liked how there was an actual program and a step-by-step process to recovery,” she says.

With the support of her NOCD Therapist, Aliya began ERP, a targeted therapy for OCD, that helped her gradually face her fears and resist performing compulsions.

“When I first started ERP, my therapist had me learn what OCD meant and what it can manifest into, and that type of information was so valuable to me,” says Aliya. “Learning the vocabulary for what my brain was doing was life-changing. From there, we put together all of the stuff that I struggled with, and she was able to trigger those things in me, and I would have to work through them.”

In just three months of ERP therapy at NOCD, Aliya’s OCD and anxiety significantly reduced, and she was able to lower her medication dosage. “I was at 100 mg for Zoloft, and now I’m at 50 mg, and I’m feeling just fine,” she says. “I’m pretty sure I’m not going to need it anymore soon.”

Aliya’s experience with ERP therapy is one of the several success stories Salem has heard from her patients. “In my experience, it’s helped them avoid layering on more and more medication for symptom relief,” she says. “It’s allowed them to either maintain the doses they’re on, or even start to pull back on some of the medicines they’re on.”

The Role of Medication in OCD Treatment

Certain medications, such as selective serotonin reuptake inhibitors (SSRIs), are often prescribed to reduce the severity of OCD symptoms. These medications can also help manage co-occurring conditions, such as GAD, depression, and post-traumatic stress disorder (PTSD). 

In many instances, prescribers may not only recommend medication to treat OCD symptoms, but also to help patients more effectively engage in ERP therapy. Because exposure exercises can bring up a lot of distress and anxiety, medication can make the process more manageable. 

As patients work through ERP and build resilience to reduce anxiety and OCD symptoms, their prescribers can slowly taper off medications, just like in Aliya’s case. 

“The hope is that if you combine therapy with medication management visits, then we can keep the doses lower,” says Salem. “I have a few patients who have been able to pull back on some of the as-needed medications, and they’re doing better because they’ve had the therapy.”

Starting ERP Therapy Through NOCD

With Salem’s recommendation, Aliya was able to get her life back from OCD and focus on the things that matter the most to her. However, her story is only a small glimpse into what ERP therapy can entail. 

Here’s a look at the process of starting treatment with NOCD:

1. A Structured Intake Process

After a provider referral is sent over, patients meet with NOCD’s intake team for a quick 15-minute call to assess whether ERP is a good fit. The team helps match the patient with a therapist based on location, insurance, and specific preferences (e.g., gender, religious affiliation, LGBTQIA+ identity, etc.). Once matched, they’re scheduled for a twice-weekly treatment plan with support between sessions.

Because therapy can be intimidating for many patients with OCD and anxiety, Salem appreciates that NOCD customizes treatment to each individual’s needs. “Exposure therapy is not easy, so knowing that it can be personalized and tailored to where they’re currently at can hopefully ease some of the fear factor,” she says. 

2. Setting Up the ERP Treatment Plan

Before starting ERP exercises, the NOCD Therapist works with the patient to identify their fears, intrusive thoughts, and compulsions. Then, they help patients gradually face their fears head-on while resisting the urge to engage in compulsive behaviors. Over time, ERP helps individuals develop the tools to accept uncertainty and regain control from OCD.

3. Finding the Right Therapist

OCD treatment is not a one-size-fits-all approach, and NOCD offers many opportunities for patients to share feedback and adjust care when needed. “You’re given opportunities to give feedback [to the NOCD team] if the therapist is not a good fit for you, and to try someone else if it’s not working,” Salem says. 

Because ERP can be anxiety-inducing, especially for those who are already unsure about starting therapy, it’s essential to have a supportive therapist. “It’s hard to get patients to try medication and then adjust it if it’s not working, and it’s even more difficult to have patients attend therapy, even if they might want to, because they’re fearful, so they don’t start it as soon as they should,” says Salem. “I want them to know that therapy at NOCD can be tailored to their needs.” 

4. Tracking Progress Over Time

ERP therapy at NOCD is designed to evolve with the patient’s progress, making it a flexible form of care. Therapists assess what the patient is ready for, both emotionally and practically, and structure the frequency and intensity of exposure exercises and sessions accordingly.

NOCD Therapists use tools like the Subjective Units of Distress Scale (SUDS) and regular check-ins to track progress. These updates not only influence the therapy plan, but also medication changes. “Any adjustments are made when they’re done with ERP therapy,” says Salem. “If I were planning to increase or add something and they’re in therapy, then I assess what their current status is every time I meet them.”

ERP therapy is a collaborative effort between the therapist and the patient. “I was treated like a partner [at NOCD], not just a patient,” says Aliya. “I felt like I was at the same level with my therapist.”

Take the First Step Today

OCD can be a debilitating condition, but by combining medication and ERP therapy, you can regain control and lead a better quality of life. Aliya’s story is one of many, and it shows that with the right treatment and support, healing is not just possible—it’s within reach.

“Before I started ERP, I was so afraid to mess up, so I chose an easier and more stable career for my mental health,” says Aliya. “ERP helped me get used to uncomfortable thoughts, ideas, and feelings, and that was when my career path completely changed. I’ve been able to apply what I’ve learned to other aspects of my life, too.”

If you’re living with undiagnosed OCD, know that you’re not alone, and help is available. Contact Bloom Health Centers to schedule a consultation and start your journey with ERP therapy at NOCD.