Externalizing OCD

Obsessive-Compulsive Disorder

You’re fine one moment, and the next moment, panic sets in. You must go back and check that you locked the door, even though you checked several times before.  Or you have a growing sensation that eventually dominates your consciousness, a fear that you’ll blurt out something inappropriate at a work meeting. Or you’re absolutely sure that if you don’t count to a certain number, perhaps on repeat, someone you love will be harmed.

These are classic symptoms of OCD, Obsessive-Compulsive Disorder, a mental illness that affects millions of individuals, approximately 2.5 % of the adult population in the U.S.

Living with OCD can pose serious challenges and create significant distress. At it’s worst, it can be disabling. Most people who struggle with OCD symptoms are incredibly uncomfortable that they engage in obsessive thinking and/or compulsive thoughts/behavior. On top of that, they often feel shame around their symptoms.

Externalizing OCD

One key intervention for OCD involves identifying the the thoughts and urges as symptomatic of the disorder. While this might seem obvious at first, when in the grips of an episode, many lose site of the illnesses’s hold and experience the triggers as real threats to their safety or well-being. To challenge this, it can be helpful to engage in the following self-talk (either aloud or internally): “I’m having OCD symptoms. My OCD is telling me to think/act in a certain way. I don’t need to do this, but my OCD is trying to convince me that I do.”

This is exactly what Dr. Jeffrey Schwartz encourages readers who struggle with OCD to do in his book, Brain Lock. Schwartz describes a four-pronged approach to addressing OCD: 1) Relabel 2) Reattribute 3) Refocus and 4)Revalue.

In step 1: Relabel, you call the intrusive thought or urge to do a troublesome compulsive behavior      exactly what is is: an obsessive thought or compulsive urge. In this step, you are learning to clearly    recognize the reality of the situation and not be tricked by the unpleasant feelings OCD symptoms      cause. You develop the ability to clearly see the difference between OCD and what’s reality.

Expanding upon this, externalizing OCD, as something separate from yourself, is a related intervention that some might find useful. Note that in the self-talk above, OCD is referred to as something separate/distinct from you. It’s not you, and that’s an important clarification. Picture your brain as it typically functions and then imagine that a foreign entity, OCD, has temporarily hijacked this organ. It thrives on you engaging in repetitive thoughts and behaviors. It convinces you that these are necessary for your survival. The fact is, they aren’t; they’re necessary for OCD’s survival. The more you engage in OCD symptoms, the more the disorder gains strength. It’s as if the disorder wants you to suffer in order for it to survive.

But you have a say in this process.

Therapy for OCD

That’s why it’s so important to challenge urges to engage in compulsive thoughts and rituals, a practice honed using Exposure and Response Prevention (ERP) therapy, a cognitive-behavioral (CBT) intervention.

With ERP, you challenge yourself to sit with obsessive thoughts or urges to engage in compulsions without taking action. In beginning ERP, your subjective experience of distress might increase. After all, who wants to sit with uncomfortable thoughts without doing something about them, namely, something you know will cause them to subside (albeit temporarily). But with time, ERP works to rewire brain pathways, to train your brain to know that compulsion need not follow obsession and that anxiety will naturally dissipate over time – and in a more sustained way than if you continue to act on compulsive urges. This is how recovery from Obsessive-Compulsive Disorder occurs.

If you need help coping with symptoms of OCD, Gatewell offers CBT/ERP treatment, borrowing additional concepts and interventions from Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT).