Fact: If one wants to function reasonably well in this world, one needs to dismiss relatively quickly doubts or queries that prevent rational action. To be convinced of it, one needs to watch the Monty Python sketch called “Philosophers' Football Match” (keeping one’s sense of humour helps OCD management).
Problem: Whether we like or not, doubts regularly arise in our minds. Maybe I didn’t turn off the faucet properly. Maybe if I dismiss too quickly the possibility of harming someone else, I’ll regret it later. May be if I start my household chores and stop cogitating, I’ll miss a mind-appeasing answer. Maybe if I don’t go to the hospital right away, I’ll die of a heart attack, etc. A judicious way to deal with those concerns is to examine them, address those we judge sensible based on evidence and common sense, and disregard those we judge dismissible. However, it’s not easy if you have a conscientious mind, and uncertainties cover a domain you value. My experience is that if I have good reasons to dismiss a worry and I don’t hesitate too long before disregarding it, my ability to focus on normal activities is preserved.
However, if I hesitate too long to set aside a baseless concern in a domain that I value, what happens? In my case, I tell myself: “If I’m not ready to dismiss a concern that’s asking me to delay a sensible course of action, maybe that concern has more meaning that I think”. That leads me to examine it with increased scrutiny, and the overthinking loop starts. I can’t stop addressing all the questions that successively present themselves because I don’t know how else to return to a more reasonable life.
Exposure and response prevention is advising us to count on the passing of time instead of engaging in compulsions in order to diminish irrational anxiety. Could the time factor (delaying compulsions, but engaging relatively PROMPTLY in a reasonable course of action) also play a role in enabling us to overcome excessive scruples?
I suspect that ERP purists would balk at the idea of using action (viewed as a form of distraction) to control an OCD urge, but several OCD experts prone that idea. I’m thinking about Jeffrey Schwartz's Four-Step Method that involves refocusing attention away from the urge or thought and onto any other reasonable task or activity. Reid Wilson’s 6-Moment Game also invites us to turn our back on the intrusive question, keep moving forward, and sit with the discomfort. For them, to act according to our better judgment without too much delay and in spite of nagging doubts is part of the exposure.
Personally, I think a debate in our community about how promptly to use action in order to overcome excessive scruples about making reasonable choices would be healthy. For instance, people with hit and run OCD who drive over a small bump and keep on driving (like an OCD-free person would) are using action in order to overcome their scruples that push them to retrace their route and see whether by chance they drove over a pedestrian. So, action could be our ally in setting aside qualms that prevent functional living. What do you think?
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Based on my own experience, I don't see much value in experiencing maximum anxiety just for the sake of experiencing it. The most helpful factor to me is treating an irrational thought as irrelevant, giving it as little time and attention as possible. After all, that is what non-OCD people do with their irrational thoughts, without even trying. If "moving on" from an irrational thought and not engaging with it causes anxiety, then so be it, but I think it's perfectly fair to use action to show my brain that an irrational thought is not worth my attention.
Your hit-and-run example actually applies to my case. Hit-and-run OCD has never been a major problem for me, but I have had it occasionally, and in weaker moments I have in fact turned around to check for accidents. But usually I can remind myself I have OCD and that my predetermined course of action when I have these doubts is to keep driving and stop thinking about it. I don't attempt thought-suppression (which is generally accepted to be a bad approach), but when my brain screams that I may have just hit someone and I need to either turn around or ruminate about what exactly happened, I try hard not to do so. I think about whatever I'd be thinking about otherwise, or I let my mind wander in a different direction, and within a few minutes the urge to check and ruminate passes.
Applying this approach to all forms of OCD, including ruminations about morals and scruples, has helped me more than anything else.
I fully concur with what you said. I find that if I delay reasonable action my mood starts to degrade and the worst-case scenario gains momentum. Indeed to keep on driving after hitting a small bump and let one's mind freely and unconsciously drift in another direction, or invest time and efforts in OCD-free projects is a powerful tool in overcoming OCD and a sure sign of recovery.
I have noticed that when I am successful in overcoming just one compulsion, I feel like it will be so much easier to overcome the next, that I will be able to use that previous success as the method I will use from then on. That it is doable. If it can happen once, it'll be okay/"safe" to do again. But the OCD wins almost every time. I'm scared to let my thoughts only be thought without a compulsion. It would be so unnatural for me to let them go. I honestly wouldn't know what to do with myself if that were to happen. There are also so many bad things that "could happen" from my thoughts, and to just let them go, I don't feel is an option. It's not really with specific issues, so I'm not able to hold off doing a compulsion. My OCD is a lot of magical thinking, which causes me to have to immediately cancel a thought or do a mental compulsion in some way. It's so natural for me to do that, hence, not knowing how I would act without doing them. They're part of me and I have no idea how I would use ERP, etc., to stop this since it's not caused from a specific obsession. I am at a total loss.
Should I maybe just try to let the thoughts go on my own, not necessarily with ERP/other behavioral therapy? I am seeing a therapist regularly, for other concerns.
Nobody can be 100% sure they’ll never lose self-control. What we need is to maintain a reasonable degree of self-control over time, so we can have reasonable faith in the future. If we can trust ourselves to some extent, it becomes easier to face the future because whatever it holds, we know we can handle it. If I understand correctly, it’s what you said when you wrote: “when I am successful in overcoming just one compulsion, I feel like it will be so much easier to overcome the next”. In other words, we need success in order to believe we can overcome OCD. We also need success for our OCD thoughts to leave us alone because if we fail to resist compulsions, we can’t help finding a way to regain some control by any means, even if it means sinking deeper into our OCD thoughts. We do it because we lost any other hope to get back on our feet again. Despair is driving us to sink deeper in our OCD thoughts, not our normal judgment. What we need to get better is hope.
In time of stress/doubt/great temptation to engage in mental or physical compulsions, we need to ask ourselves what would an OCD-free person would do in the same circumstances, and try to do it in spite of the difficulties. It’s what I did and “tyrannical thoughts” left me alone. It happened a long time ago. As you know, thoughts are tricky to control. Behavior is easier to control, and if you change your behavior, a change of thoughts will naturally ensue. Temptations will never disappear though. I still feel bad and uncomfortable about certain imperfections/incompletions/uncertainties/losses more than the average person (at least, it’s my impression; I could be wrong). I’m tempted to dwell on them and let them ruin my day or my life depending on their severity. That’s okay. There is a time to be unsure/unsettled and a time to be decisive. Despite hardships here and there I’m determined to make the best choices possible given the circumstances I’m facing and the information available at the time. Results are not perfect, but my self-esteem is better and so far, OCD leaves me alone. I wish you experience some success in overcoming OCD even if ever so slightly. Every little bit counts.
Prompt action is helpful in preventing the obsessive thinking from growing. Response prevention is key but how that is done can be varied. Sometimes it’s too challenging to not do the compulsion at first. Sometimes people need to start smaller by delaying the compulsions or mixing up the steps in them. This throws the OCD off its game.
Anything done to reduce or get rid of the distress directly from OCD ends up reinforcing the OCD cycle instead. It tells the brain that there is an imminent threat and that the compulsion is the way to relieve the distress. It can work in the very short-term but not the long-term. Using logic, reassurance, avoidance, distraction to relieve the distress backfires because there will always be another “what if”. Using logic to talk one’s way out of OCD is self-reassurance. Even though something may be highly improbable to occur, it may occur, and OCD uses that. That doesn’t mean we have to accept a worst case scenario. Long-term recovery comes with accepting uncertainty AND realizing that we can make it through distressing situations.
Distraction can be helpful when it is not used to reduce or get rid of the distress from OCD. A person can acknowledge the intrusive thought, realize it’s possible that it could happen, accept the uncertainty, and move on with their day. They have accepted the uncertainty and aren’t engaging with the OCD at that point.
I fully agree with what you said. What I meant to say is this. Let’s say I’m under pressure to carry out some home renovations because of the risk of further damage if I don’t do it, and I don’t feel currently ready to carry out those renovations because I’m overrun by the need to ruminate. Would refraining from rumination and feeling the anxiety decrease (ERP) be enough to dispose me to do the work? If not, further delaying the work, feeling bad about it, and being conscientious may restart my need to ruminate. So, in order for ERP results to last, they need to be paired with timely action.
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