ERP for OCD while having ADHD

Hi, everyone. Having a rough go of things today and am in need of some support from members undergoing ERP while also having an ADHD/ADD diagnosis. Can anyone provide some insights on how to effectively do ERP when I have ADHD? It seems like the two disorders love to use my brain as a battle zone when I’m trying to practice an exposure, and it makes it difficult to sit and focus on what I need to do. Recently, it’s been the case where I start an exposure & OCD is like “Are you sure you’re even doing this right? Stop the exposure, read about how to do it the right way just to make sure you’re getting the most out of this & don’t come back until you’ve done so.” Meanwhile, ADHD is spiraling out of control and won’t let me sit down to focus on the exposure. It’s like I’ll plum forget I’m even doing one in the first place and will move on to something else! It’s frustrating because it’s almost as if I draw a blank on what I should be doing despite having it in writing directly in front of me, but searching up the “how” has almost become compulsive.

User type: Therapist

Date posted: 4d

I too have ADHD. OCD, ADHD, and Autism is being neurodivergent. We process information differently. With ADHD and exposures, we want to use tools to help us stay focused such as timers, using the homework feature in the NOCD app that times and guides us through the exposures, use post its, or a composition book and write "exposure on ________, active. Wait for timer to beep" as example to help keep us focused. Exposures are only exposures when we also do the response prevention and the talking back to OCD (RPM) within the exposure. I would suggest to give yourself grace, it takes practice, use the tools, and if you stray - then remind yourself "OK, I noticed I got distracted. Let me return to the exposure" We seek progress NOT perfection. If you did the exposure with your therapist, then you already know how to do it. I suspect the anxiety from the "are your sures" from OCD also create the urge to find a distraction due to distress, discomfort, and anxiety. Ask your therapist to do the exposure with you and then "resist' the urge to search how. That is definitely OCD rather than ADHD. Then, when you do the exposure, when OCD says, "are you sure your doing it right", your response could be: "I don't know, maybe, maybe not. But I am still doing this exposure"

tinydancer

User type: OCD Conqueror

Date posted: 4d

If you have problems sitting still while doing ERP, why not take a walk? I’ve had ADHD diagnosed since 2nd grade and I’ve learned to not fight it. If twiddle toys and movement help you focus, go on and utilize it. As for your exposure (and everyone’s) it’s not going to be perfect. Aiming for a perfect exposure is OCD talking. OCD is so sneaky! Also, be kind to yourself. It’s totally ok if you are getting 80% benefit from an exposure instead of 100%. Anything is better than 0%. You are trying and that definitely counts for something. Start your exposure, if compulsions or distractions come up: feel the discomfort, forgive yourself, and move on. Easier said than done of course. There is no perfect way to do an exposure. There is no perfect way to do treatment with ADHD. Feel the feelings of discomfort and practice self compassion. Good luck!

NatSwai

User type: OCD Conqueror

Date posted: 4d

I don’t have an ADHD diagnosis but I have my suspicions. I didn’t have the opportunity to practice this with my therapist because I didn’t recognize it at the time but I recall having the exact same problems when doing ERP at first. It was incredibly discouraging. I read online that an ERP specialist external to NOCD recognized this as a great time to treat that as OCD itself and use it as an exposure to the imperfection. You’re likely afraid if you do it wrong it won’t work, etc. So maybe you’re doing it wrong, maybe you’re not. Reading about it in the moment probably will be a compulsion. But consistency matters more than perfection is what everyone says

al01

Date posted: 2d

@NatSwai Yes! I definitely have the fear that if I’m doing it wrong, it won’t work. Almost like the OCD monster is like, “Ha! You’re not getting away that easily! 👹”

Anonymous

Date posted: 4d

I have ADHD and Perfectionism OCD and I’m in grad school. It’s so hard to get myself to start doing ANYTHING because of ADHD and once I start I am obsessing over “ am I doing it the right way” and researching how things are done correctly. The combo is absolutely paralyzing. I am forcing myself to do things lately even if I don’t know for certain that it’s “the right way” just to get through it and I figure they’ll correct me later if it’s not. Very much easier said than done but it’s something I’m working on

al01

Date posted: 2d

@Anonymous This is definitely what I’m dealing with too. It’s so frustrating! Thank you for your empathy & reply!

Anonymous

Date posted: 4d

Im diagnosed with both and was thrown off by something similar to what you're describing when I started ERP. I eventually asked my therapist when its okay to stop focusing on the exposure because I was struggling to know when that lack of focus was a compulsion or something else I should be aware of. We reasoned that if changing focus feels like a fight against distress I should try to maintain focus. But if it feels like a fight against boredom, thinking about something else is okay as the sitting with distress part might be over and the exposure is no longer stimulating enough to hold my attention over other things I'm interested in. Because of this I also very quickly went to doing level 7-9 exposures, versus working up from 4. Lower level triggers just weren't stimulating enough to keep me focused. Not sure if this applies to you but just sharing just in case.

al01

Date posted: 2d

Thank you everyone for the thoughtful replies! There were some really great nuggets of advice in here. I’ll keep these in my back pocket for future reference. ❤️

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