Imagine you’re going about your day, a bit frazzled—because let’s face it, you’ve always been anxiety sensitive—when you suddenly fear that you’ll contaminate your family with an incurable disease if you touch them.
Or you’re driving to work and out of the blue you have a panic attack on the freeway. You hastily pull to the shoulder of the road until your breathing becomes less labored, the tightening in your chest releases its unforgiving grip, and your heart rate slows. As you reach for your mobile to alert work that you’re running late, your mind tells you to count to 1,013 before starting the car. You try and push the ridiculous thought out of your head, but it’s relentless. “Count, count, count, or you’ll crash your car.”
If you haven’t guessed, OCD (obsessive-compulsive disorder) wins the award for the anxiety category most of us would relegate solely to the violent criminals of this world.
Unless of course, you suffer from OCD, and then you’d likely fear that wishing that may result in becoming a violent victimizer yourself.
The struggle is real, y’all.
The good news is knowing the common pitfalls to treatment speeds up recovery substantially, whether you’re trying to go it alone, or you’re a practicing mental health professional.
Public enemy #1: focusing too much attention on the fear-based obsessive thoughts. For example, “I must wash my hands of all germs so I don’t infect my family with an incurable disease,” and the elimination of their subsequent rituals (compulsive hand washing, avoiding public places) when this is not of primary clinical importance.
I know. The first time I heard this I had the same reaction. Read on for more common pitfalls of treating OCD.
What is Obsessive-Compulsive Disorder (OCD)?
Obsessive-compulsive disorder (OCD) is defined by recurrent intrusive thoughts or images (obsessions) that create significant distress and compel people to perform repetitive behaviors or mental rituals (compulsions) in an attempt to reduce the anxiety.
OCD causes substantial disability due to its severe and chronic course. As with most complex neuropsychiatric disorders, the causes and procedures underlying OCD are not well understood, although genetic contribution is estimated in the range of 40% to 50%.
In the U.S., approximately 3.3 million people have OCD, or roughly 2.3% of the population between the ages of 18-54, and 1 in 100 children.
Studies of OCD have found the cause to be damage to a specific part of the brain called the basal ganglia. Medications such as clomipramine, or other SSRIs are often prescribed, with 40-60% of patients responding to pharmacological treatment, according to research reported by Stanford University.
Cognitive-behavioral therapy (CBT), including exposure response prevention (ERP), have also shown to be effective.
Essentials for Treating OCD
Anxiety is a biologically based indicator of danger, an emotion that signals something is wrong and immediate attention is warranted to avert a problem or catastrophe. With OCD, the brain fires false danger signals, but reacts as if a true danger was imminent. For this reason, focusing on the process of OCD, and not the content, is key to recovery. Common misconceptions about overcoming OCD include the following areas of focus:
- Over-attention to the content of the thoughts, and under-attention to the process of anxiety
- Seeking reassurance that things will be okay, including fact checking and statics
- Dismissing the importance of completing daily homework assignments
The following strategies can help:
1. Forget the ‘why?’ behind the bizarre, irrational obsessive thoughts, for they are not necessarily indicative of pathology, reality or childhood trauma. When Steve suddenly develops an obsession that he will become a child molester if permitted to be in wp themes the same room as a child, the impulse is usually not the root of the problem. In fact, the fear may not be based on any transgression or subconscious desire, at all. This non-linear causal connection makes understanding the brain of an individual with OCD all the more vexing. As humans, we naturally want to know why something happens, but curiosity can derail action.
Everybody experiences bizarre, unwanted thoughts, but people with OCD attribute meaning to these thoughts and their subsequent anxious reactions. Complicating matters are the physical signs that accompany anxiety when the amygdala (area of the brain responsible for the fear response) floods the brain with danger signals to prepare for fight or flight. Symptoms include rapid heart rate, shallow breathing, tightening of the chest, and blurred vision, etc. As scary as this experience is, remembering that feelings and thoughts are constructs of the human mind, and not facts can be helpful.
2. Expect to worry. Life is rife with problems, and no amount of wishful thinking, seeking a loved one’s reassurance, or trying to control the environment will ease anxieties. In fact, these tactics may exacerbate symptoms. Accepting that discomfort is a part of life enables sufferers to be more tolerant of stressful events, including the discomfort associated with not performing certain rituals.
3. Take a social supports inventory. Well-intentioned family or friends often re-arrange social gatherings, vacations, and daily activities to appease the person with OCD. While it’s hard seeing a loved one suffer, individuals who go out of their way to reassure or control environmental conditions for perceived danger, inadvertently reinforce the very behavior they are trying to help eliminate. For example, let’s say Denise is afraid of dogs to the point that she won’t go shopping. If her partner John combs Whole Foods for canines until the coast is clear, John is enabling Denise’s avoidance by providing proof that dogs are dangerous and should be vetted before going out in public.
4. Complete daily homework. Anxiety loathes problem-solving and stepping outside its comfort zone. However, combating intrusive, exhausting, and debilitating thoughts and rituals entails executing a plan of action. Every. Single. Day.
Putting nervous energy toward a detailed plan, including ERP: exposure and response prevention (which entails facing fears and then refraining from ritualizing), means less procrastination and rumination. Anxiety loves drama, and rigid, inflexible and concrete thought patterns. The antidote is a calm, flexible and open mind regarding change. Remember, with anxiety, it’s the reaction that is the problem, not the thought itself. This free relaxation Mp3 provides step-by-step guides to deep-breathing, relaxation and mindfulness. While this article offers in-depth details about Cognitive-Behavioral Therapy.
The bottom line about OCD (or any other anxiety-related disorder), is at its core, anxiety is over-reacting to worries, and under-reacting to problem-solving. The good news is anxiety is highly treatable, and help is available.
If you’re interested in gaining more insight into your anxious mind, and discovering the tools I use with my therapy clients to become more calm and in control, click here for access to the Team Happy Course: Calming Your Anxious Mind.
Yours in overcoming OCD + other anxiety disorders,