Obsessive-compulsive Behaviour - Psychological Strategies

Obsessive-compulsive disorders (OCD), like other anxiety disorders, are triggered off when stress rises too high to cope with, leaving significant needs unmet. But even if a need becomes met (you get over a relationship break-up and meet someone new; you find a new job or get promotion), the habit may remain because, just like any other addictive activity, it is hard to break without conscious effort. It is as if the behaviour has a life of its own and you still have to deconstruct it bit by bit. So you must actively target it, as well as working to get your lifestyle balance right. Here's how.

Treat OCD as a bully

Because that is what it is. Bullies say, "Do this or I'll hurt you". So you do whatever it is. But then they threaten again, another time, and again. They never let you go free. Well, OCD is bullying you into washing your hands 100 times a day or reciting psalms in a set order or counting how many cars go past before you get to the end of the street, as the price for preventing a feared event. And then it does it again. And again. It doesn 't keep you safe or stop the worry of terrible things happening. All it does is blackmail you, raising the stakes, extending the punishment and still not letting you go free.

So recognise that OCD is nothing more than a parasitical bully and resolve to take back control.

Separate yourself from the OCD thought

This is powerful. When the fearful thought flashes into your mind ("My children might die if I don't go back home and check that the smoke alarm is still functioning"; "I will get a terrible disease if I don't wash my hands after touching the newspaper/ coins/ doorknob"), recognise it as an OCD thought. Actually say to yourself, "That is an OCD thought. It is not a genuine thought" and push it out of your mind. If you stand back from it in this way and don't engage with it, it loses its power. Then, if you don't give it any further attention, the associated anxiety will stay mild and quickly disappear.

Refocus your attention

Immediately focus your attention on something else, so that the OCD can't get house room in your brain. Have activities or responses prepared in advance that you can do immediately the thought comes into mind. It should be something pleasurable or satisfying. Perhaps put on some music and do exercises to it or dance to it in your front room or bedroom. Sing a song out loud that you know a lot of the words to. Call a friend. At work, phone a colleague or make a round of tea. Do 7/11 breathing, subvocalising the numbers as you go; jump up and down on the spot; run up and downstairs. But be careful that you vary the activity. You do not want to create a new compulsive ritual.

Call its bluff

As you stop doing the rituals, you will discover that nothing bad actually happens. (You knew it wouldn't, of course, but it's only when you are not in the grip of the OCD thought that you can see that. If you let it take you over, however, you won't have access to your thinking brain at all, which is why someone can possibly entertain the ludicrous idea that, for instance, touching their left ear and then their right 50 times without a break will stop a plane from crashing.) The important thing is that, when you are emotionally aroused and you still don't do the ritual, the amygdala will then also realise that the ritual is not what alleviates the anxiety. The more you avoid performing the ritual- not by getting tense and resisting but by dismissing the thought and concentrating on something else instead - the more the connection between the thought and the ritual will fade. And, as nothing life-threatening is happening as a result, the amygdala soon stops getting alarmed by the thought, and the thought fades too.

Make sure that you can calm yourself very quickly with 7/11 breathing and then try it out. And, trust yourself. Trust that you can beat this bully.

Avoid seeking reassurance

Because not performing an obsessive ritual can be so highly anxiety-arousing, people sometimes desperately try other means of getting for themselves the same, albeit illusory, 'peace of mind'. So, try not to resort to ploys such as saying to someone else, "It won't really matter if I have left the back door unlocked, will it?" "I won't really get ill if I don't wash my hands after touching that newspaper, will I?" "The window is locked, isn't it?" "No car crash was reported on the radio this afternoon, was it?" Your intention must be not to assuage the irrational anxiety but to experience it at a low levet cope with it by preventing it from escalating, and realise you can let it go.

Lee and the spare parts

Lee's OCD started when he reached 40. His father had died of a heart attack at the age of 40 and Lee was secretly terrified that this would happen to him too. He worried about how his wife and young family would cope and the financial problems he also had. So the day came when he had his first panic attack and assumed it was a heart attack. His doctor reassured him that his heart was fine and that he was fit and healthy. But his amygdala was by now hyper-aroused and he started to look for different reasons to explain the constant background of fear.

Lee worked in a garage, where he was in charge of the spare parts division, and the OCD almost cost him his job. When customers were leaving the garage after work had been done on their cars, the thought would suddenly occur to him that he might have supplied the wrong part to be fitted. He would imagine their car skidding on a road or catching fire and burning its occupants to death. The anxiety induced was so extreme that he would feel impelled to run after customers and ask them to return, while he checked the new part against the stock, to ensure it was the right one. This regular occurrence became extremely annoying, both to customers and the garage owners.

Then, while driving home from work, the thought would occur to him that he might have knocked someone down without realising it. The thought of someone lying, bleeding or unconscious on the lonely country road, was so horrific that he felt compelled to drive slowly back almost all the 30 miles to the garage, to ensure that no one was lying injured on the road. Not surprisingly, this was causing him to arrive home late every night. In their first therapy session, his psychologist taught Lee how to relax and gave him a tape of the session, with the instruction that he must drive straight home without deviation and listen to the tape at once. While Lee was still relaxed in the therapy room, his psychologist encouraged him to imagine himself successfully doing this, instead of turning back to retrace his route. Because the instruction tapped into Lee's tendency towards obsessive behaviour, he was able to do this and, after a couple of weeks, during which time there were no stories in the local newspaper of fatalities caused by hit-and-run drivers, that particular obsessive thought faded away.

Dealing with the spare parts ritual was more complex as Lee became so emotionally aroused when the thought of supplying the wrong part occurred to him that he couldn't bear not to check his work. The psychologist therefore suggested that they should break the problem down into chunks and deal with each one in turn. The first step was not to try to stop the ritual but to dilute it. Lee agreed to keep a notepad with him and note down the number of each spare part when he handed it out. Then, instead of running after customers and alarming and annoying them, when the anxiety came upon him, he would go to the stock room and check the number in his notepad against the stock. This wasn't as satisfying but it settled his anxiety and, after a few weeks of this, that obsessive thought and the need for the ritual had disappeared too.

Lee had other more minor rituals too and, all in all, it took 12 sessions of therapy to deal with the whole constellation. During that time, his psychologist used the rewind technique, helped him to visualise success and helped him to find ways to focus outwards and distract himself from irrational, fearful thoughts. However, Lee's last obsessive activity was listening to his psychologist's relaxation tape! So, to help him with this, the psychologist suggested he start listening to it on alternate nights, then once a week and then only when he felt anxious and gradually the need for it stopped.

OCD, in any other form

Remember, OCD is a reaction to stress and unmet needs and it can come back in another form at another time, if these rise to a higher level than you can cope with.

For instance, another psychologist once worked with a conscientious young builder called Chris, who had developed the need to check repeatedly that he had properly locked up the windows and doors of the properties where he was working. This tendency was always particularly bad when he was stressed because of the uncertainties of his business. And as he tended to work on several jobs at once, he often spent hours every day and evening in a trance, locking and unlocking and locking again, "just to make sure".

His psychologist quickly helped Chris to cope with the symptoms by teaching him the skills we've described above and getting him to address his stressful circumstances in a practical way. The OCD faded away. Some years later, Chris called his psychologist again. The OCD was back. He had developed another compulsion but this time based around asbestos. He couldn't get over the thought that, whenever he was demolishing parts of buildings, there might be asbestos present. He had been affected by the many health scare stories concerning asbestos but had not registered that most forms of asbestos are quite harmless. So now he was changing clothes and showering several times a day after the merest hint that he might possibly have been anywhere near asbestos.

During therapy it emerged that everything had been going well till a few months ago, when his wife had had their first baby and, at the same time, a firm for which he was working as a sub-contractor went bankrupt, owing him over £21,000. The sleepless nights and responsibilities of being a new dad, plus the financial stress of his business (which made him feel he should put in very long hours to make up the deficit at just the time when he also felt he should be at home supporting his new wife and baby) took their toll. His stress levels were at maximum.

Once again, the psychologist was able to help Chris take control of his symptoms and insisted he take a break from work, so that he could stand back, take a bigger perspective on his situation and decide how he could best manage to reduce his stress. At first Chris resisted this strongly, saying he certainly couldn't afford to take a break and that he needed to take as many jobs as possible at knock-down prices "just to get myself out of a hole" (but in fact digging himself further into it). But, in the end, he agreed. He took a well-earned holiday. In this essential 'time-out' period, he realised that working in this way only perpetuated his problems, as he never got ahead.

He decided that he wasn't suited to the life of a self-employed builder and joined a local firm as a foreman. He also learned to recognise if OCD was starting to creep up on him again in some new disguised form and to take stock of his circumstances at once. (He now gives talks to OCD sufferers to show them that it is possible to overcome the condition.)

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