The Four Challenges of Recovery From OCD
What's it going to take to get better? There are four challenges that lie in front of you as you begin to face your obsessions and compulsions:
Challenge 1: Be determined to conquer this problem. This is a tough problem to overcome. You really need to spend some time making sure that you're ready and willing to go through short-term suffering for long-term gain. You need determination because you have to take the risk to experiment with behaviors that are totally opposite of what you would tend to do in these situations. You're going to have short-term doubts, and you have to be willing to overcome those short-term doubts and have a kind of faith in this approach.
The second challenge as you begin is to gain the perspective that your worries are excessive, or irrational. The symptoms that your worries produce are so powerful and so disturbing that you get distracted by them and believe they represent true concerns. I am asking you to begin to practice a new belief, and it is this: when these obsessions occur, the content of the obsessions is irrelevant. It is meaningless, it is purposeless. Your obsessions represent an anxiety problem. The topic of your anxiety is not the issue, even though your anxiety leads you to believe that it is.
This is not an easy task to accomplish when you are dreading that you might pass on deadly germs, kill your own child or cause a terrible accident. Nonetheless, I am asking you to step away from those thoughts, to get perspective on them, and say, "Wait a minute, I have an anxiety disorder. What is an anxiety disorder all about? It's about anxiety, not about this content."
Try not to get into a battle of logic in your head. If you try to convince yourself of how illogical your worries are, you may become very frustrated, because you'll have a hard time being certain about anything. You'll always find a thread of doubt you can follow. So don't get caught in this trap of logic. Instead, keep stepping back mentally and saying, "I need to be addressing my anxiety, not this specific topic".
Your OCD is going to encourage you to do just the opposite. It's going to push you to think this is all about whether you really locked the door. Or it will get you to try to reassure yourself that you did actually make the appropriate decision. Or that you have not contaminated something. You'll work hard to get the right reassurance. And it's totally the wrong thing to be doing... You are falling right into the clutches of OCD. So this is a very important challenge to meet: address your symptoms of anxiety, not your fearful thoughts. Don't be fooled!
The third challenge as you begin: consider that ritualizing is not the only way to reduce your anxiety. Most people with this problem believe that if they don't ritualize, they will remain distressed forever. If you share this belief, you must be willing to challenge it in order to discover that there are other ways to reduce your distress. It will be extremely difficult to give up your compulsions unless you are willing to experiment with new behaviors. You need to be willing to explore options to ritualizing.
Do you remember the old joke of the guy who every morning gets up at 6:00 and stomps around the outside of his house. His neighbor finally comes out and says, "What in the world are you doing? Every morning, I look out my window when I'm fixing my breakfast, and there you are in your bathrobe stomping around the house." The guy says, "Oh, well, I'm keeping the elephants away."
"Elephants? There are no elephants in this neighborhood."
And the first man says, "See how well it works!"
So, he never challenges his belief. That's what people do. They say: "The ritual was the only way I could possibly have shaken loose of my terrible distress, and I need to keep using it."
To resist your compulsion is really a courageous thing to do. Because you are having to resist this powerful belief that something terrible is going to happen if you do.
The fourth and last challenge is: decide to accept your obsessions instead of resist them. This is the toughest of all four, and it is the most important. This one is the basis of all the self-help interventions we'll talk about. Because the more you resist your obsessions, the stronger they become. It's as though your solution to the problem actually increases the problem. You resist the symptom, and it persists.
So you need a new inner voice that says, "It's OK that I'm obsessing right now." This is not saying, "it's OK in the next 20 minutes to do it"; it's not saying, "I'm going to continue to do it." But I am asking you to say, "It's OK that I just had that thought." I know that sounds like a crazy thing to say. You are trying desperately to rid yourself of these terrible thoughts, and I instructing you to accept them! Accepting the obsession generally looks like a bad idea to people.
But what's the other choice? The other choice is to say, "It's terrible that I had that thought." And what's the reaction that you're going to have physiologically when you make that statement? That statement's going to produce more anxiety.
I agree, of course, that the end result is to get rid of that obsession. That's everyone's objective. But the technique that you use and the end result are different. That's why it's called paradox, which means opposite of logic. And that's why you have to have faith. First, you're going to accept this obsession, and then you're going to manipulate it. Why are you going to do it in that order? Because that's how it works best. So there's a big, big leap of faith here when you accept your obsession. But if you will really dedicate yourself to experimenting with this approach for several weeks, I think you will discover its benefits.
Let's review these four challenges again, first with how people generally think about this problem, and then with how I am encouraging you to think as you begin your self-help program.
The first challenge: People say, "I'll always be controlled by this problem." You want to shift it over to, "I'm now determined to conquer this problem."
The second position is: "I believe my obsessional concerns are accurate." I want to shift that one over to: "My obsessions are exaggerated and unrealistic." The third one: "Rituals are the only way to reduce my distress." Shift that to, "there are other options to reduce my distress." The fourth one: "I must stop these obsessions" is the problem stance. Shift this to, "I accept these obsessions."
How would you apply this fourth challenge? When you begin obsessing and worrying, you typically react emotionally to those thoughts and images, by becoming anxious and afraid. That compels you to ritualize. The first place to start practicing is anytime you begin to obsess. Take that opportunity to focus on the idea of permitting the obsession to exist in that moment. Work on not being afraid of the obsession and not being mad at yourself that you just had the thought. Wouldn't that be great, to not get distressed at those momentary worries, to not think that they mean anything.
Let me tell you a story. When my children were infants, I would carry them in my arms as I walked around the deck of our home. Every once in a while, I'd stand at the railing, looking at the beautiful scenery out in the woods, and then I'd have this flash: I'd see myself accidentally dropping my child two stories down from the deck, and there she'd lie on the ground, dead. And then I'd see myself jump over the edge to kill myself out of my shame that I'd just killed my child. But I'd break my neck instead, and end up being humiliated and shamed for what I just did to my son or daughter.
And then I'd step away from the edge of the deck.
It was the same with my kids as toddlers. I'd be reading in the living room while one of my kids was playing in another room. Then I'd notice that all was quiet. On a number of occasions I would then think, "Oh, my God, he's swallowed a penny and he can't breathe, and he's passed out..." And I'd get up and quickly move to the other room to check on my child. There he'd be, quietly and safely drawing on the wall with crayons. Now, I'm sure I've have had those kinds of fantasies over 40 times. Each one took about two or three seconds, with slight variations.
What is the difference between what I experienced and what someone with OCD experiences? There are many similarities. The difference is not about the thoughts that we have but in how we interpret those thoughts and images. I would say, "I know what that's about, and that's no big deal." I'd say, "That's because I'm a new parent. It's my mind's way of reminding me that I need to protect these fragile children. I know I'm not really about to accidentally drop my kid."
People with OCD might say, "Oh, my God, I had the thought of killing my daughter? Why did I think that? I'm not sure I can trust myself. I might accidentally do that." They decide to doubt their ability to stay in control.
So this is where you begin in your self-help program. Confront your interpretation that the content of your obsessive thought means something terrible about you. I want you to downgrade each obsession to a kind of momentary glitch in your thinking. The thought doesn't mean anything. You had a fearful thought, and you got scared by it. That's all. When I saw in my mind the image of my child lying on the floor not breathing, I became momentarily scared, and my heart raced. That's an expected reaction. It's like sticking your finger in the wall socket and getting shocked. That's all it is. And that perspective is what you should work toward.
When you notice your obsessions, choose to have them. As soon as you choose to have your obsessions, they're no longer involuntary. Remember that the definition of an obsession includes that it is involuntary. So as you begin to accept your obsession, as soon as you choose to have it then that involuntary thought is now voluntary. And you've begun to change the nature of the problem.
This is the direction I am going to take in this self-help program. I am not asking you to stop obsessing right now, or to stop ritualizing. I am asking you to change some smaller components of the pattern. You're going to disrupt the pattern by various means. You're going to modify your obsession in little ways. You're going to add things to your ritual. In this way you can gradually learn about your ability to control your symptoms
Last Updated: 01 July 2016
Reviewed by Harry Croft, MD