If you love someone with obsessive-compulsive disorder (OCD) or an anxiety disorder, it’s natural to want to help them feel better, but knowing how to help them in truly beneficial ways can be difficult. When someone we care about is in distress, it can bring up similar feelings of distress in ourselves that might push us to try to get relief for them and us. This can lead us to reassure them repeatedly, avoid certain topics, do tasks for them, or change our routines to keep their anxiety from spiking. This is called accommodation, and while it may bring short-term relief, it can actually make symptoms worse in the long run due to the cyclic nature of these types of diagnoses.
Accommodation occurs when friends, family members, and even therapists make changes in their own behavior or in the environment to reduce a person’s anxiety or help them avoid triggers. Some common examples include things like answering endless “What if…?” questions to reassure them, avoiding certain words, places, or activities so the loved one doesn’t feel distress, completing tasks for them (e.g., making phone calls, checking doors, washing items), and adjusting your own schedule to align with their compulsions or avoidance. These actions are often done out of love and concern, but they unintentionally feed the cycle of OCD and anxiety and exacerbate symptoms over time.
In the moment, when anxiety spikes, it can feel overwhelming and even unbearable to the person experiencing it. Accommodation often works immediately to lower distress, at least somewhat, for both the sufferer and the helper. This creates a short-term “win” and feeling of relief, making it tempting to keep doing it. Unfortunately, the brain learns: If I avoid this trigger or get reassurance, I can feel better, and because our brains work via reinforcement, over time this teaches the nervous system to expect avoidance or reassurance instead of learning to tolerate discomfort.
In OCD and many anxiety disorders, avoidance, compulsions, and safety behaviors are the fuel that allow the disorder to thrive. Accommodation functions a bit like adding gasoline to that metaphorical fire, as the system of accommodation might mimic the same reinforcement that is produced via avoidance. For example, if a young person is feeling anxious and overwhelmed about going to school, and in an effort to provide relief, their loving parents accommodate them by allowing them to stay home for a few days. This will undoubtedly bring on some relief, and perhaps even appreciation from their child, but in the background their young brain encodes this as beneficial to their survival. This reinforcement in addition to the increasing list of responsibilities such as homework and tests that were missed, is likely to make going back to school after this break feel even harder and more overwhelming. Additionally, this can cause more distress in the household as schedules are thrown off and responsibilities increase. (Please note: sometimes there is good reason for our kids to take a mental health day from school)
The cycle looks something like this: 1) Trigger → Person feels anxious or uncertain. 2) Accommodation → Helper changes behavior to reduce distress. 3) Temporary Relief → Anxiety/Distress goes down in the moment. 4) Long-Term Cost → Brain learns that triggers are dangerous and can’t be faced without help, making future anxiety stronger and more frequent. The result? More anxiety and distress, more avoidance, and an ever-shrinking life for the sufferer, and possibly for the whole family.
When Accommodation Can Be Appropriate & Helpful: While reducing accommodation is often one of the goals in treating OCD and anxiety disorders, there are important exceptions. When someone has co-occurring conditions — such as an intellectual or developmental disorder, Autism Spectrum Disorder, or other challenges affecting communication, flexibility, or daily living skills, some degree of accommodation may be necessary. In these cases, accommodation can often still be seen through the lens of scaffolding: a temporary, supportive structure that helps the person function and access treatment while gradually building independence. This is representative of the hierarchical and gradual movement seen in Exposure Response Prevention (ERP): the key is to provide just enough support to make participation and progress possible, while slowly reducing that support as skills and tolerance grow. This way, accommodation remains a bridge toward greater autonomy rather than a permanent barrier that reinforces anxiety.
Breaking the Cycle Without Withdrawing Support: The goal isn’t to stop caring or leave someone to “sink or swim.” It’s to shift from protecting them from anxiety to helping them face anxiety in a safe and supported way. To do this successfully, it is important to educate yourself about OCD and anxiety disorders. Understanding the cycle makes it easier to resist the pull of accommodation, and there are some great resources and books out there that can help! (I’ll include some of my favorites at the bottom of this post.) It is also important to work with a trained therapist. Ideally, one who uses Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT). These evidence-based approaches help people face fears without giving in to compulsions or avoidance. It may also be helpful to have your own therapist who can help you receive support and encouragement and plan for reducing accommodation while engaging in more helpful strategies. With such support and insight, you can then set boundaries while remaining compassionate. You can say, “I care about you and I know reassurance feels good in the moment, but I want to help you break free from this cycle.” From here you can encourage gradual exposure: support your loved one in taking small, manageable steps toward feared situations, and celebrate their courage, not their comfort.
Accommodation is rooted in kindness, but it can unintentionally prolong suffering. By replacing accommodation with encouragement and evidence-based strategies, and by using scaffolding techniques when necessary that will gradually reduce accommodation, you can help your loved one build resilience, reduce symptoms, and reclaim the parts of life anxiety has taken away. At Nashville OCD & Anxiety Treatment Center, we specialize in helping individuals and families recognize these patterns and replace them with tools that foster long-term recovery. If you or someone you care about is caught in the cycle of accommodation, reach out. We can probably help.
As promised, here are some books you might find helpful related to this subject:
1. Breaking Free of Child Anxiety & OCD: A Scientifically Proven Program for Parents – Eli R. Lebowitz, PhD
2. Treating Childhood and Adolescent Anxiety: A Guide for Caregivers – Eli R. Lebowitz, PhD & Haim Omer
3. When a Loved One Won't Seek Mental Health Treatment: How to Promote Recovery and Reclaim Your Family's Well-Being – C. Alec Pollard, PhD & Melanie VanDyke, PhD
