How Our Expectations Influence OCD


Before we get into this I just want to say that we should be a little wary if labels. Whilst it is very tempting to try and give everything a name and a story, sometimes labels can become self fulfilling prophecies. Even with OCD, I try to remind people that yes, you might be struggling with obsessive compulsive disorder, but try not to allow yourself to be defined by it. 

In my experience labels are helpful in explaining the set of problems that you might be struggling with, to realise you are not alone and to seek out the appropriate support. But if we hold on to it too tightly, it can hold us back. 

The same could be said about our expectations of whatever treatment we might be trying. If we go into the treatment with negativity, not really beleiving that it’s going to work for us, then it may well end up being harder for us to make the progress we want. Whilst if we go into the process with a positive attitude, the counter may also be true. 

Take for example two different people with the same problem with their ears. Say that they are both experiencing a persistent ringing in their ears that doesn’t subside naturally. Depending on the expectations of treatment for this condition, the two peoples experience of it maybe very different. For someone who believes that there is going to be some treatment that works, they distress is going to be considerably lower than the person that beleives the problem is untreatable and that they are going to be like this forever. 

If we are positive it’s more likely that things are going to turn out positively.

The role of expectations

A 2017 study entitled ‘The Role Of Expectations In Mental Disorders & Their Treatment’ states that “Expectations lead to brain activities that sensitize for the expected experience”. It seems that through the mere belief or disbelief in an approach, treatment or practitioner we can influence the success of the intervention. 

The researchers go on to claim that  “Expectations about treatment success are the most prominent predictor of outcome, both in psychopharmacological and psychological interventions, and they are considered to be a major determinant of placebo effects”. 

Wow, when you think about it, this is pretty incredible. They are basically saying that not only are expectations important, but they are the most prominent predictor for a successful outcome. There are all sort of conclusions you can make about this and it is another very real example of the incredible placebo effect in action.


This is why when choosing someone to work with it’s incredibly important to find someone that you trust, someone that chimes with you and that you have faith in. Someone might have incredible expertise in their field, but if for some reason you have reservations about them or their approach, it might be better to shop around and find someone who you feel that connection with. 

Try to trust that in the end you will be successful.

It also demonstrates to us why some people can struggle when doing ERP. As you know only too well, people with OCD obviously struggle with not performing their compulsions as they have the negative expectation that not performing them will could cause all sort of disastrous things. The objective of ERP is to challenge people to face those expectations head on by gently exposing themselves to the feared obsessions and learning that they can actually deal with the anxiety that this produces. 

Negative Expectations

The problem is that for some people, these obsessions have been going on for a very long time and their negative expectations are well worrn. This obviously doesn’t mean that they are stuck though. A skillful therapist will help them to reframe these fears in a gradual and positive way, but the more the client can try to believe in the process, the more likely it is that it’s going to work. 

Now if you struggle with OCD and you tend to overthink things, then perhaps you might be thinking, but what if I don’t believe in any of the therapies, or what if I have doubts about them, are they still going to work? One of the problems with OCD is that we tend to catastrophize. In my experience, the answer to this questions is yes, the approaches are still going to work, but through thinking negatively we can slow the process down. 

The doubting disease

If you have OCD, then you are going to have doubts, it’s not known as the doubting disease for nothing and sometimes we can question the treatment we may be following. But just being aware of this is enough to help you to suspend that judgement and to give the treatment process a go. 

Despite your doubts try to keep bringing your attention to what’s going right.

Sometimes it involves just taking a leap of faith, trying to believe even if it feels like you have lots of doubts. This is something that I had to do in my early days of recovery as I was in a very negative place and doubted that I could ever come out of it. If that’s you then see if you can try to manage those doubts and try to focus your attention on positive beliefs about the treatment you are currently following. Even if you don’t quite 100% believe it, this approach can really help you to get the placebo effect on your side. 

Find the right person

Try not to underestimate the importance of finding the right professional to work with, someone that makes you feel comfortable, who really understands OCD and that has had success working with people with OCD is going to give you confidence in their approach which will help you to have more positive expectations and therefore hopefully, more positive outcomes. 

I also know from anecdotal experience that doing things life the WIM Hof method, i.e. taking an ice bath, can be made incredibly more easy to deal with when we visualise our success before hand. When leading Wim Hof workshops I encourage people to see their success in the ice, to see themselves remaining calm and positive, taking control of their breathing and being confident. This nearly always helps people to have a successful experience in the ice once they actually get it. 

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