Saturday, April 21 , 2018, 7:28 pm | Fair 68º


Jon Lukas: Taking the Wind Out of OCD’s Sails

Healing begins when you learn not to give in to repeated rituals

I like to refer to obsessive-compulsive behavior as “The OCD Monster,” and this monster operates in a very specific way. It relies on a person’s uncertainty that if they don’t engage in the ritualistic behavior then their obsessions will come true, or they engage in the compulsions because they need things to feel just right. That “just right” feeling almost always becomes impossible to obtain because Obsessive-compulsive disorder keeps using your uncertainty to feed itself and thus keep you in its vicious loop. The constant obsessing and compulsive behaviors keep the wind in OCD’s sails.

Jon Lukas
Jon Lukas

When you have a loved one suffering with OCD, it’s imperative to get them to see a trained cognitive behavioral therapist who can help them recognize their “loop” and stop the cycle that can eventually become so debilitating. What many don’t realize is that it’s also just as vital for the loved ones to become educated about The OCD Monster as well, so they can support the sufferer in resisting the urge to ritualize and challenge the “mental noise” of the obsessions. A common mistake many loved ones make is to unconsciously feed into compulsions in an effort to set the person at ease. What they end up doing is actually assisting the sufferer in his or her ritualized behaviors, and reinforcing the compulsions.

When loved ones witness their family or friends in distress, they most often seek to reassure the person that nothing is indeed wrong. But providing constant reassurance to the OCD sufferer actually works against progress. The whole point of exposure and response prevention is to help a person through their anxiety, not around it. This kind of therapy is effective because it consistently puts the client in a position to resist compulsive behaviors. This in turn begins the process of exposing obsessions for what they are: irrational thoughts that feel very real.

ERP aims to take the wind out of OCD’s sails by helping the sufferers realize, through repeated exposure to their anxiety, that they actually can handle the discomfort they feel from resisting a compulsion. When one resists the rituals, obsessions over time lose their potency and become less distressing. This may happen quickly or can be a long process — it depends on the severity of the OCD symptoms, the length of time one has been struggling with OCD, and the client’s own insight into this anxiety disorder. With professional treatment, family and social support, and the client’s hard work, OCD can be managed and, for some, can be turned into only a minor nuisance.

The role of family and friends is so important in the successful treatment of OCD. One of the very common tactics used by The OCD Monster is reassurance-seeking. This comes in the form of questions posed to loved ones such as, “Do I look like I’m getting sick? Do I look skinny to you? Does this food smell/look/taste funny?” It is a way for the OCD sufferer to reduce anxiety by asking questions, researching information on the Internet, or any other way of trying to take the uncertainties out of our minds so we might feel less anxious.

And our loved ones naturally want to help us. Their first instinct is to say, “Of course, you don’t look ill.” Or, “Your food tastes fine to me.” This response is almost always the opposite of what is beneficial. A more effective way to handle reassurance-seeking behavior might be to say, “Well, if I answer that then I am just feeding into the OCD and I don’t want to do that.”

It seems counter-intuitive to cause the person even more anxiety, but it’s an effective way of stopping the loop and reminding the person that it is the OCD talking. This is not to be cruel in any way, but to actually help the sufferer feel the anxiety and sit with it until it inevitably lessens.

The best thing you can do for that loved one who can’t stop asking for reassurance is not to give them any. If you see a loved one engaging in repeated behaviors or struggling with anxiety and seeking reassurance from you, I would encourage you to ask “Are you asking me this question to try and reduce your anxiety?” “How will my answer help or hurt?” Ask them if they will share their thoughts or feelings with you. Ask them if they feel stuck in a loop of obsessions and compulsions. Hopefully, they will open up and ask for help. Then you can start the process of finding help, especially a professional who truly understands exposure and response prevention, educating yourself and planting the seed in their mind that this is an anxiety disorder that is treatable. You are then starting to take the wind out of OCD’s sails.

Humor is also a great tool to use against the OCD’s persistence and trickiness. For example, I had a need to know that the food I was eating was fresh, or I obsessed about getting sick. Going out for dinner at a restaurant really set the OCD sirens off. I actually used to ask people to taste my food before I could eat it. I know it sounds like something an emperor would have done in days past, but for me it was about avoiding any chance of getting food poisoning.

By educating themselves, those around me learned how to responds to the “OCD questions” by saying, “No, I will not taste or smell your food. I think I saw the chef pick up that steak on the side of the road. Eat it anyway. Challenge the OCD.” If you have OCD, you probably have a sneaky way of asking questions that do not sound like OCD questions, so it takes a keen ear and a thorough understanding of what the OCD is trying to do. It is looking for complete and total certainty, and you cannot let down your guard.
It is a tried-and-true rule with OCD in most cases: as a sufferer, stay with the anxiety, don’t do the compulsions and the anxiety will eventually come down. It will take time and a great deal of mental strength to not ask for reassurance or fall back on a compulsion but you will overcome these obsessions if you stop doing these compulsions. This is effective because we are calling out the OCD and identifying that it’s the dysfunctional behaviors that we feel compelled to do that feed The OCD Monster. Don’t feed into it and don’t run from the obsessions. Stand up to them and remember that the anxiety cannot hurt you.

The tricky part about OCD is that it takes some real insight on the part of the sufferer in order to get better. They have to be able to understand that if they resist falling into the OCD loop, then they can manage the disorder. Often with treatment-resistant (severe) OCD, the sufferer goes into a cycle of obsessing, making little or no attempt to resist the urge to ritualize, which reinforces the power and intensity of the Obsession.

Why is this? Often it’s because the obsessions are so terrifying that one would rather not take the chance and face the perceived consequences. Other times there might be a co-occurring disorder adding to the intensity of the OC symptoms. When a person is also battling severe depression, for example, he or she often finds it harder to gather the strength mentally to fight OCD or they find “it’s just too hard to do the work,” so they just give in to the OCD.

Therefore it’s important to not just look at diagnosing OCD but also looking at family history of mental illness, current level of functioning and the client’s own insight into the obsessions and compulsions. I always want to know if the client understands that the obsessions are irrational or how convinced they are that these thoughts will come true if they don’t perform their compulsions.

The bottom line is that sometimes OCD will win the round if the sufferer does not truly believe he or she can beat this disorder. Sometimes it takes several rounds before you begin to fight back. I lost the first few rounds for several years because I couldn’t truly accept that this was OCD that I was fighting. I was at times nearly 100 percent convinced that I had a physiological disease. It took time, high levels of anxiety and perseverance to get to this point in my life. When I stopped giving in by doing repeated rituals, both mental and physical, I was taking the wind out of OCD’s sails and that’s when the healing began.

Jon Lukas MFT is a psychotherapist specializing in cognitive behavioral therapy. He is in private practice and runs The OCD Treatment Center of Santa Barbara, working with adolescents and adults with anxiety disorders. Click here for more information or call 805.453.2347.

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