OCD is a formidable opponent. It’s the sharpest prosecutor, the meanest bully, the dirtiest thug. Arguing, appeasing, or getting into a fight with it won’t work. You’ll lose.
If you suffer from repugnant mental intrusions, you may believe your thoughts are the problem. You’ve probably spent hours, days, or, quite possibly, years trying to reason with them or push them away. One obsession may resolve only to have another one surface. It’s exhausting and demoralizing.
Surprising as it may seem, your thoughts are not the problem. Everyone has thoughts, even bad ones. In a seminal 1978 experiment, psychologists Stanley Rachman and Padmal de Silva found that nearly 90% of the “ordinary” people (that is, a non-clinical population) they sampled admitted to having had occasional thoughts about committing violent crimes, engaging in taboo sexual acts (with children, family members, or animals), blurting out obscenities or racial slurs in public, harming themselves or loved ones, or doing something inappropriate (such as laughing at a funeral). The main differences between these so-called “non-clinical” obsessions and the “clinical” ones of someone with OCD are the frequency of the thoughts, the distress they cause, and the efforts expended (ie, the compulsions) to get rid of them.
British writer David Adam has recently published an excellent memoir, interspersed with fascinating historical accounts of the disorder, about his struggles with OCD, The Man Who Couldn’t Stop: OCD and the True Story of a Life Lost in Thought.
Here is some cutting-edge advice in Adam’s book on how to cope with obsessional thoughts:
“Grit your teeth in the face of your thoughts and for God’s sake be more obstinate, head strong and wilful [sic] than the most stubborn peasant or shrew. Indeed, be harder than an anvil . . .If necessary speak coarsely and disrespectfully like this: Dear devil, if you can’t do better than that, kiss my toe.”
The statement embodies all we’ve learned from evidence-based treatment. It’s exactly the type of approach psychologist Reid Wilson advocates when he talks about “chasing the bogeyman” (I attended a workshop he gave on this treatment method just a few weeks ago).
An up-to-the-minute strategy for dealing with intrusive thoughts. From the 16th century, courtesy of the theologian–and OCD sufferer–Martin Luther.
Much of the advice I dispense daily in my clinical practice involves guiding people beset by negative thoughts and feelings to respond to emotional discomfort in counterintuitive ways. Anxious? Approach your fears. Depressed? Get moving. Impulsive? Ride out your urges.
It all sounds rather simplistic. Yet changing behaviors in this fashion can improve your mood relatively quickly. Even more important, moving towards what feels scary or hard can help you build a protective core of confidence, making it easier to cope with the difficult times you’ll inevitably have to face in the future.
I won’t ask my patients to do anything I wouldn’t agree to do myself. Some of the “approach behaviors” I work on with them—touching a public toilet seat, say, or limiting themselves to only one glass of wine—don’t present personal challenges. But I certainly generate enough of my own worries to give me ample opportunity to practice what I preach.
Here’s an example: I just signed up for an eight-week course on Mindfulness-Based Stress Reduction (MBSR).
Silly that a program designed to reduce stress should significantly increase mine, right? But just thinking about it makes my mouth dry up and my heart beat faster.
I’d been looking for an opportunity to deepen my meditation practice for some time now. Periodically I’d google “Mindfulness Meditation in DC.” The Insight Meditation Community of Washington (IMCW) always came up. I’d pore over the course offerings and then reject them because the timing wasn’t right or the center’s Buddhist orientation made me uncomfortable.
I had many of the same automatic thoughts and a few new ones yesterday when I found the listing for an MBSR course given through the Insight Meditation Community starting in just two weeks. “Maybe everyone will be a Buddhist. I hope they don’t expect me to practice Buddhism.” “I won’t know what to do.” “Will there be chairs or cushions? Should I bring my own cushion?” “Seven to nine-thirty on a Thursday night . . . I’ll be so tired after work, I won’t feel like going.” “I won’t have time to eat dinner and I’ll be starving.” “I won’t get home until after 10 and I’ll be so wound up I won’t be able to sleep.” “It might be lame, like that last mindfulness course I took.” “I might not be able to find parking.” “I won’t be able to walk the dogs or exercise on Thursdays.” “I don’t know what to wear. Should I wear yoga pants?” “I’’ll have to bring a change of clothes to work.” And even, embarrassing though it is to admit, “We’ll have to take off our shoes. I hope we can wear socks because I won’t have time to get a pedicure in the next two weeks.”
In the end, I recognized my reservations for what they were—excuses designed to avoid an unfamiliar situation causing me trepidation. I don’t like being a newbie, and this class raises all those old first-day-of-school insecurities (probably dating back to the start of kindergarten, when I wet my pants because I was too shy to ask my scary new teacher where the bathroom was and, humiliated, ran to hide in the coatroom when she asked the class who was responsible for the puddle on the floor).
So I did what I’d tell anyone else to do. I signed up.
To be continued . . .
My last post described the many ways the compulsion of seeking reassurance can interfere with decision-making and overall wellbeing. The differences between compulsively looking for validation and carefully weighing your options are easy to spot if you ask yourself the following questions.
This isn’t a scientific survey. But if you answered “yes” to many of these questions, you’re probably prone to seeking reassurance. A careful, deliberate person might do research and even ask for other’s opinions before making a decision but anxiety wouldn’t be the dominant emotion. And doubt wouldn’t typically accompany a choice as it often does with chronic reassurance-seekers.
After having read this, you may be tempted to ask the people close to you if they think you use them to provide reassurance. If so, don’t bother to pose the question. You already know the answer.
This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.