Brief Overview

Has your consideration of treatment entailed an approach of approach and then avoid; repeat?  It is understandable to feel hesitation, fear, and even to return to thinking, "I can manage this on my own."  You might be right on managing on your own, but typically when potential patients inquire about services they have reached more than a mild acuity and feel miserable.  The suffering seems intolerable and treatment can no longer wait.  Once you inquire, you might find that an OCD specialist has a waitlist.  To best understand why a specialist is worth the wait, please see the Treatments tab.  This is why it is very important to inquire as soon as possible, before your symptoms worsen.  You can save yourself some of the prolonged suffering.

Also, please be sure you are ready to commit to treatment before inquiring.  This treatment is not one that you can discuss in sessions only and get better.  Progress REQUIRES completing homework between sessions (about 5 days a week for planned homework, but skills are practiced daily).  This means having discussions with your family about being able to dedicate time to your treatment real-life practice.  Please take time to review the information on this website. 

1. Inquire with an OCD specialist.  If there is a waitlist, ask to be added.  Please do not wait.  When Dr. Curiel has a waitlist, it is typically 1-2 months, but sometimes there are random openings or spots that become available more quickly than expected.  Dr. Curiel does not tend to see patients for longer-term issues or with longer-term treatments; therefore, spots open up regularly.

• Reduce your stress level wherever you can.  Perhaps saying no to some things to make your schedule easier, ask for time and space away from a difficult stressor, take time out each night - even if it's 10 minutes to recharge and reset.  
• Practice good sleep hygiene and stimulus control as disrupted sleep and fatigue spike OCD symptoms and it is harder to push through.  https://www.timeofcare.com/sleep-hygiene-and-stimulus-control-counseling/
• Take care of yourself and keep up your hygiene as best as possible.  Identify life hacks that are good for you and make things easier to accomplish (e.g. eat foods that fuel your body in a healthy way, schedule your to-do items into your calendar instead of making a list so you can be realistic with how much time they will take and what you can get done, lean on your support system, limit social media, pick out clothes the night before, food prep over the weekend, keep medication and hygiene items by the bed in case you get tired so they still get done).  If you are on medication, take your medication as prescribed and use reminders.  If you can, get your most stressful tasks taken care of, even if it means asking for help.
• Exercise with the approval of your doctor.  Although it does not stop intrusive thoughts, it could help your daily baseline level of anxiety.  https://www.verywellmind.com/exercise-may-be-an-important-ocd-self-help-strategy-2510630
• The International OCD Foundation (IOCDF) website is a trustworthy website for information for you to learn about evidence-based treatment.  https://iocdf.org/  Another is the Anxiety and Depression Association of America (ADAA).  https://adaa.org/.  For skin-picking or hair-pulling, bfrb.org
• Adults: if you have intrusive thoughts about death, harm, or sex, the book Imp of the Mind is recommended.  https://www.amazon.com/Imp-Mind-Exploring-Epidemic-Obsessive/dp/0452283078.  Parents:  if your older teens are having intrusive thoughts about death, harm, or sex, you might consider previewing the book to see if you feel comfortable sharing it with them.  It explains why humans have ugly, frightening, bizarre, and untrue thoughts and normalizes the experiences with stories of others' intrusive thoughts.  Caution:  there are very sensitive topics in this book, but is used when a patient's brain is already triggering these types of thoughts.
• Family members, here is some information:  https://iocdf.org/expert-opinions/expert-opinion-families-what-you-can-do-to-help/
• About half of Dr. Curiel's NEW outpatients take medication, while the other half with more moderate symptoms do not.  Many people want to try treatment without medication.  Sometimes that is possible and other times an individual ends up needing medication.  There are particular medications and doses noted by experts on the websites below.   Dr. Curiel finds that many who are initially frightened or believe the stigma of taking medications wait until they feel awful and their symptoms feel intolerable.  And when they contact a psychiatrist, there is wait.  And once they finally get to their intake appointment, they have to start at the lowest dose and then wait 4-6 weeks for its full effectiveness.  This does not include the time it takes to taper up to the effective dose ranges for OCD (which are reported to be higher than for other forms of anxiety).  The once hesitant patients are always so grateful that they started the medication and ask themselves, "why did I wait so long?"  Consider it is like getting glasses; you have no idea how good things could be until you start that intervention.  Medication helps slow down intrusive thoughts, takes the edge off of daily anxiety, improves concentration, and makes treatment a little easier.  Carve out any outside influences, evaluate if benefits could outweigh costs, and remember you do not have to suffer as much as you are and you deserve to feel better.  Not to mention the dual indication helping depression, which is very common with OCD.  Here is more information: 

1. Adults:  https://iocdf.org/about-ocd/ocd-treatment/meds/. 
2. Kids:   https://www.google.com/search?q=kids+iocdf+meds&rlz=1C1ONGR_enUS966&oq=kids+iocdf+meds&aqs=chrome..69i57.2714j0j9&sourceid=chrome&ie=UTF-8
3. BFRBs:  https://www.bfrb.org/learn-about-bfrbs/186-medications-for-body-focused-repetitive-behaviors and https://www.bfrb.org/learn-about-bfrbs/123-n-acetylcysteine-for-trichotillomania-skin-picking-and-nail-biting

•  Dr. Curiel asks that if her patients start with medication prescribed by a primary care doctor (which may be a quicker way to get started) that they eventually transfer care to a psychiatrist, as mental health is their specialty (Dr. Curiel can recommend psychiatrists that understand OCD in the MO and KS area).  Please note that if you have tried medications before, it is possible you may not have been on the right one for you, for OCD, and/or the higher dose that is required.
• You might consider one of the evidence-based workbooks to begin learning about OCD and practicing skills.  You'll want to make sure it mentions exposure and response prevention at a minimum.  You might also find some helpful supplemental skills with acceptance and commitment therapy.  For example:  https://www.amazon.com/Getting-Over-OCD-Second-Self-Help/dp/1462529704/ref=asc_df_1462529704/?tag=hyprod-20&linkCode=df0&hvadid=312089933244&hvpos=&hvnetw=g&hvrand=2161933843578755801&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=1014485&hvtargid=pla-514264085997&psc=1
• There might be a local support group listed on the IOCDF website that you could attend.  https://iocdf.org/find-help/?_listing_types=iocdf_provider%2Ciocdf_support_group%2Ciocdf_clinic
• If you felt strong enough, you could try to omit some "easier" compulsions or avoidances to get some practice (e.g. not having the remote volume on a particular number, ordering food from your favorite restaurant that you have been avoiding, watching a clip of a show that you used to be able to watch but now find triggering, discontinuing excessive researching online for certainty or reassurance).

Give yourself the grace of time.  The good news is that in many instances treatment is short-term, but you will still need to give yourself the time to learn about OCD, the factors that feed it, how to change your responses, and also strengthen your ability to face situations you have been avoiding.  You have been through a lot.  Please be kind to yourself.