In dealing with many OCD clients many of the same concerns come up. Most people try to avoid the anxiety or eliminate,when managing it proves more fruitful. Anxiety increases the sense of danger and decreases the person’s belief in their ability to manage it. Anxiety is a problem when the body, usually the amygdala, tells us there is a danger, when there is no real danger, and it stays stuck in the on passion. The strategies used to try to get rid of the anxiety only make it worse, as it goes down for a short time, but comes right back even stronger. Avoidances only short circuit the natural tendency to allow the anxiety to rise until it habituates, and then falls. Doing these avoidances don’t allow your brain to figure out there is no real danger, and produces an opposite effect, making it worse, the more you try to control it. When you use these strategies to get rid of the anxiety and the obsession or intrusive thought, it briefly lessens the anxiety but then there is a need to do it more or the “bad” thoughts just keep occurring more frequently. I work with people to break this cycle by gradually eliminating the rituals in a hierarchy that makes doing this more comfortable, eliminating unhelpful compulsions, and learning to think about them in a better way. ERP is a most effect way to break this cycle, exposing yourself to situations that trigger obsessions, and not engaging in the compulsions or avoidance. Together we build a hierarchy of exposures and response preventions from least anxiety producing to most anger producing. I would have you label the triggers, the rituals, and the level of anxiety. We climb this fear ladder gradually, from the bottom up. It is important during exposures not to engage in more subtle avoidances like thinking of something else, watching television or others behaviors. It’s important to stay with the situation until the anxiety drops by at least half.
I have also dealt with many people with unwanted or unpleasant thoughts that terrorize them. I remind them thinking it doesn’t make it happen, make you a bad person, or mean you will do it. It is the interpretation the OCD person gives the thought that make it so intense and frightening. Many people say maybe I am this or will do this, why else would I think it. A thought-action fusion makes people with OCD interpret their unwanted thoughts as bad, and believe there is an increased likelihood of them occurring. They also exaggerate their responsibility for something happening and believe it will be their fault, or overestimate the threat. Many people have said they should be able to completely control these thoughts or bad things will happen, and they’ll go crazy or run amok. I have worked with people forty years, and I haven’t seen this happen. Many OCD people also believe they need to be completely certain nothing bad will happen to feel safe. Complete certainty about anything these days is highly elusive.
Many times these thoughts come out of the blue, and seem to make no sense in the context of the person’s values. This is exactly why they terrify you, as they are not something you would normally do. Research world-wide has shown 90% of people have these same intrusive thoughts frequently but don’t give them importance. The thoughts mean nothing, but they stick around in the OCD person, making us challenge our notion of ourselves, and continue to make it stick by trying to make sure it doesn’t come back. OCD makes people place too much value on the content of your thoughts. The content of the thought is usually irrelevant and extremely misleading, as this is not something you would do, but it feels awful and repeats. If we actually had something we could do that would lead to a productive outcome, then that is what should be doing. But with intrusive thoughts they just keep returning with no solution, which is why they don’t bear trying to get rid of or avoid. They have no real power until we give it that power in our interpretation.
There are many good resources available from anxietybc.com, anxieties.com, The OCD stories podcasts, intrusivethoughts.org, the International OCD Foundation, and many wonderful workbooks.
If you are interested in working more with your OCD, please contact me at [email protected]. I’d be happy to assist. I take most insurances.
Mark Treegoob, Ph.D.