OCD is a shape-shifter. Its content often changes, especially with primarily internal obsessions and compulsions (involving thoughts about harm, sexual orientation, and relationships). For many with the disorder, addressing the ever changing obtrusive thoughts is like playing Whack-a-Mole.
The internet is full of articles about “hOCD,”(OCD about sexual orientation), “rOCD,” (OCD about the “rightness” of a relationship) and “Pure O” (obsessions in the absence of compulsions) OCD. Although these designations can be appealing if you’re trying to make sense of distressing thoughts, I find this alphabet-soup approach to OCD problematic for several reasons.
Addressing the form OCD takes is important only in designing a treatment plan for ERP (Exposure/Response Prevention). To keep the OCD from becoming a pattern in which one obsession dissipates only to have another pop up, focus on accepting uncertainty.
Here’s how to begin the process of response-prevention:
1) Refrain from checking and analyzing.
2)Acknowledge that OCD is causing you to doubt yourself and that no amount of research will help you arrive at an answer you’ll believe.
3)Don’t try to categorize your OCD.
4)Give up trying to figure out if your fears are justified.
5)Stop seeking advice from internet forums.
Taking these steps will start you on the path to recovery and keep the moles from lying in wait to ambush you.
My newly rescued terrier Dewey is, in almost all ways, an excellent dog. He’s energetic, inquisitive, friendly, and affectionate. But when we’re out walking and he spies another dog, he turns into a whirling, barking Tasmanian Devil. Luckily he weighs only eighteen pounds—any bigger and he’d knock me off my feet. Still, the prospect of a surprise canine encounter made me dread our daily outings.
So I signed up for a Distracted Dog class. I already had been working on undoing some of the bad habits Dewey had acquired over the seven years of his life before coming to us. He’s learning how to wait for his food, lie down instead of jumping up and begging, and walk on a leash without pulling. The challenge now is to keep his attention on me in more stressful situations.
Before the first day of class, our instructor asked us to send her a hierarchy of our dog’s top five distractions, much like the hierarchy of anxiety triggers used in CBT for exposure and response prevention. At the top of Dewey’s list was “seeing another dog approach while on a walk.”
In treating anxiety, I help people stop avoiding and start approaching what they most fear. I needed to apply the same mindset to changing my dog’s (and my own) reactions to the stimuli that send him into a frenzied display of doggie frustration.
So, instead of anxiously scanning the environment for other dogs in order to do an about face before Dewey spots them, I’ve started looking for ways to practice building his self-control. As a result, I’ve observed a dramatic change in my own (if not yet Dewey’s) emotional reaction. I’m excited instead of tense when I see neighbors out walking their dogs. I now interpret a potential trigger not as a threat to steer clear of but as an opportunity to seek out.
If I were drawing only from my personal experience, my method wouldn’t carry much weight. But the results of several research studies support my anecdotal evidence. Saying, “I feel excited” instead of attributing physical arousal to anxiety—a technique called “anxious reappraisal”—can improve singing, test-taking, and public speaking performance by putting people in an “opportunity mindset” even though the physiological markers of anxiety such as increased heart rate and cortisol levels remain elevated.
In fact, you don’t even need to tell yourself you’re excited; just believing that anxiety can improve rather than impair performance helped test takers score higher on the GRE. It’s a trick actors often use to cope with stage fright. Those who are successful don’t necessarily feel less nervous. But they’re able to view the fluttering of their hearts and rumbling of their stomachs as feelings that give energy to their performance.
Confronting anxiety is hard. You can’t make progress unless you’re willing to face the situations you fear. But changing the way you think about arousal might make it a little easier to rise to the challenge.
OCD is a tyrant. It will control you with threats of the most horrific consequences if you don’t follow its commands.
“Don’t touch that or you’ll get sick and die.”
“Go back and check the stove five…no, ten…no, fifteen times or the apartment building will burn down and it will be your fault.”
“Don’t hug your niece. If you put your hand in the wrong place, she’ll be scarred for life.”
“That bump you felt while you were driving was a body. The police will arrest you for a hit-and-run and you’ll go to jail for the rest of your life.”
“You had a bad thought while you were in church. If you don’t repeat the prayer the right way, you’ll go to hell for eternity.”
Who wouldn’t be terrified by such thoughts? They may seem preposterous to people who don’t suffer from OCD, but to those who do, they’re grimly familiar.
To break free from OCD, you have to refuse to follow its orders. Its demands are unreasonable. You may think you can appease it to arrive at an uneasy truce. But unless you say no to the rituals, OCD will keep escalating its requirements and make you its prisoner.
So you have to stand firm. Push back. Do the opposite.
Terrifying? Yes! But it’s a tactic—called “response prevention”—that works.
In his book, Stopping the Noise in Your Head: the New Way to Overcome Anxiety and Worry, psychologist Reid Wilson outlines specific steps you can take to break free from the tyranny of anxiety. One of the messages he drives home is that OCD worries are NOT ABOUT THE CONTENT despite what OCD is brainwashing you into believing.
So if you’re doing rituals to protect yourself from contamination, repugnant or blasphemous thoughts, or the risk of being responsible for harming others, you can shift your perspective instead of blindly following OCD’s orders. Don’t try to convince yourself you’re protecting yourself from the content of your fears; instead, remind yourself you’re doing compulsive behaviors to eliminate doubt about something that feels threatening.
Practice moving towards those feelings of uncertainty, and you’ll be on your way to freeing yourself from the stranglehold of OCD.
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.