OCD

Four Core Ideas For Getting Out From Under OCD

Here are a few ideas for better understanding and fighting OCD.

Posted Jul 16, 2018

Here are some helpful ideas to better understand and start to get out from under OCD.

1.  People with OCD take actual precautions for imaginary dangers.  For example, people with germaphobic OCD who touch something that they fear might be “contaminated” (i.e., with germs, toxins or other potentially harmful substances) will experience an intense jolt of anxiety.  Naturally, the anxiety is a false alarm because no actual contamination has occurred.  Still, people with OCD will feel like they have been contaminated and will therefore engage in a variety of decontamination rituals until they have regained their sense of safety, security or comfort. Thus they take actual measures to protect themselves (and others) from purely imaginary risks, threats or dangers.  The solution for this feature of OCD is, of course, experiencing the triggered anxiety and discomfort rather than escaping from it, cognitively labeling for what it is - a false alarm (or as I often call it, “an emotional mirage”), and waiting as long as it takes for the distress to resolve naturally.  A proven method called “exposure and response or ritual prevention,” or ERP.

2.  A related OCD idea is the fact that people with germaphobic OCD wash far beyond the point of factual cleanliness until they feel clean.  Therefore, even when there is a valid reason to take safety measures or rational precautions (e.g., washing after a bowel movement or after touching something objectively unclean), people with OCD will engage in the safety seeking behavior much longer than necessary.  Or they will perform the action an excessive number of times (i.e., washing 4, 6, or 8 times). This is because when OCD sufferers do a ritual, they seek a certain physical sensation that signals to them the behavior has been performed satisfactorily.  Indeed, say after taking out the trash, factual cleanliness can usually be achieved within 30 seconds of washing.  But it’s typical for germaphobic OCD sufferers to wash for several minutes and extend the area being washed up their wrists, and even up to their elbows.  And as previously mentioned, many do this several times until they feel the sensations they’re seeking of safety, security or comfort.  Hence, in general, people with OCD ritualize to regain a sense of safety, security or comfort either completely unnecessarily, or to a point of extreme excess. 

3.  Another, crucial, OCD idea states that the anxiety you experience if you don't do a ritual - or during ERP -  is how it feels when your brain is trying to normalize it's balance and function.  Indeed, convincing research has shown that people with OCD have an overactive brain region (the supraorbital-cingulate-thalmic circuit or “SOCT”) that acts as a launching pad for irrational worry and anxiety.  Activation of this circuit often drives high anxiety that people try to neutralize with a ritual.  Unfortunately, doing rituals to cope with anxiety never works in the long-run and only makes the OCD and the anxiety it produces worse (because of a process called negative reinforcement, not to be confused with punishment.). This is why ERP is the sine qua non (i.e., the most important ingredient) for treating OCD.  As I tell my patients, “The anxiety you feel is your brain trying to heal” (a saying coined by my wife, Donna Astor-Lazarus, LCSW).  And the research noted above does indeed show that when people’s OCD symptoms decrease the activity in their SOCT circuit also decreases.

4.  The last idea for this post is to consider that it's unwise to do for your body or your brain what it's supposed to automatically do for you. Specifically, with respect to OCD, reduce or neutralize irrational anxiety. While it has not been identified as precisely as the OCD-driving SOCT circuit, there are almost certainly other brain regions that automatically neutralize irrational worry and anxiety.  Now our bodies and brains are very adaptable and prefer not to expend metabolic energy needlessly.  For example, for some inexplicable reason, if a person stops using one of his or her arms, it will weaken and wither.  Its neuromuscular pathways need to be stimulated and its muscle fibers recruited to remain fully functional. Similarly, if a person decides to (or has to) ingest predigested food, his or her digestive system will stop producing digestive enzymes.  Hence, if someone with OCD wants his or her brain to automatically reduce, neutralize and prevent irrational anxiety, he or she must stop trying to neutralize it “manually” with rituals.

Obviously, there are plenty of  instances when people need outside or “manual” help to manage certain conditions or illnesses.  But in many cases, even with these situations, the external or “manual” help is best kept to a minimum.  So, if someone is an insulin dependent diabetic of course he or she will need insulin!  But it is possible for even insulin dependent diabetics to reduce their reliance on insulin by increasing their insulin sensitivity with weight control, proper eating, exercise, and other healthy lifestyle habits. Similarly, even people with debilitating depression who do CBT (and/or it’s derivatives like ACT, mindfulness, DBT, etc.) can often successfully reduce and sometimes stop their medication.  Again, the point is don’t for your body or brain what you’d like it to reliably do for you.

To sum it up simply (if you have OCD):

Don’t take real safety measures or precautions for imaginary dangers.

Do necessary safety seeking actions only to the point of factual safety instead of to the point of feeling okay (i.e., until the OCD signals it’s okay to stop).

No pain, no gain.  The distress of doing ERP is how it feels when your brain is working to normalize its activity.

Use it or lose it.  By doing ERP, and not “manually” trying to neutralize anxiety, you’re probably recruiting and strengthening vital neural structures that evolved to manage irrational worry.  Not pressing them into action will only make them weaker.

The interested reader might be want to peruse these two other posts of mine on OCD:

Understanding OCD

https://www.psychologytoday.com/us/blog/think-well/201511/understanding-ocd

How to Beat OCD Without Drugs (It’s Simple But Not Easy!)

https://www.psychologytoday.com/us/blog/think-well/201406/how-beat-ocd-w...
 

Remember:  Think well, Act well, Feel well, Be well!

Copyright Clifford N. Lazarus, Ph.D. This post is for informational purposes only. It is not intended to be a substitute for professional assistance or personal mental health treatment by a qualified clinician.

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