Facing your most challenging obsessions
Many people say, “Oh, I am obsessing about a whole host of things but I don’t feel usually disturbed by it" and they can let the thought pass. Whereas true obsessions are very disturbing. They can be repetitive, persistent, intrusive and more to the point unwanted, they cannot let the thought pass.
These are toughts, images or impulses that occur over and over again and feel out of the person's control. The person does not want to have these ideas, he or she finds them disturbing, unwanted and usually know that they don't make sense. They come with uncomfortable feelings, such as fear, disgust and doubt or a feeling that things have to be done in a way that is, "just right". These feelings can take a lot of time and get in the way of important activities the person values.
The OCD cycle
An OCD cycle often begins with seemingly harmless responses to intrusive and disturbing thoughts or images. Of course it seems intuitive to check the door if you feel you have left it unlocked or to wash your hands if you feel exposed to germs and bacteria. You may know to ask a question more than once just to be certain that you understood the answer. But just imagine having constant thoughts about washing your hands because you think you have been contaminated, or checking the door repeatedly because you are unsure if you’ve locked it.
It probably feels natural to want to get rid of these thoughts and images because they are odd, annoying and they also disturb and frighten. You may use compulsions to alleviate stress brought on by your obsessions (repetitive behaviors or thoughts that you may use to counteract or make their obsessions go away), but over time your behaviour becomes a trap that keeps you from living a fulfilling life.
However, by avoiding the problem and using compulsions to alleviate the anxiety, the OCD cycle and the hold your symptoms have on you will continue to strengthen.
Avoidance is a common compulsive behaviour and this is where a sufferer, in a bid to try and prevent the distress, anguish and the hours of rituals caused by the OCD, will go to great lengths to avoid the objects, places or people that they feel triggers the obsession.
People with OCD may realise this is only a temporary solution, but without a better way to cope, they rely on the compulsion as a temporary escape. Compulsions can also include avoiding situations that trigger obsessions. Compulsions are time consuming and get in the way of important activities the person values.
Exposure and response prevention (ERP)
In a nut shell, ERP means intentionally facing intrusive thoughts, compulsions, images and urges and allowing yourself to feel the discomfort, rather than resorting to compulsions.
Taking the first steps
In your initial treatment session, you will be asked about your symptoms. Together with your therapist, you will make a plan to monitor your obsessions, compulsions and avoidance behaviour and the situations that triggers them. You will develop a plan to tailor your ERP to your particular compulsions, this includes choosing your triggers and compulsions to face. You will work closely with your therapist who will assist you in this process step by step with understanding and compassion. Family members and friends can offer additional support to help you on your journey.
The content of obsessions falls into general categories:
Contamination: Contamination obsessions focus on germs, bodily fluids, diseases and other health threats and hazards. Compulsive handwashing is an example of this.
Order and symmetry: The compulsion to perform a task exactly right in a ritualised fashion. For example, "if I don’t tap my finger three times in a certain way then something awful is going to happen".
Aggressive thoughts: The fear of committing a violent act or harming self or others. For instance, “I could lose control and jump in front of a train".
Sexual thoughts: Obsession can take the form of unwanted sexual thoughts. For example, “What if I am gay just because I like his aftershave”. Most people are aware of their sexual orientation, but those with OCD will fear being misunderstood.
Moral and religious thoughts: Obsessions can manifest in thoughts and doubts about violating religious and moral codes.
Relationships: This may include excessive doubts about your own feelings and about your relationship with your partner. Obsessions can take the form of jealousy and questioning your partner’s fidelity, about their feelings for you, placing a great strain on the relationship.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy is an evidence based treatment that can help you face obsessions and the situations that trigger them without seeking the relief through compulsions or avoidance.
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About Janet Joosten
Janet Joosten is a BACP counsellor, UKCP psychotherapist and CBT therapist. She has a special interest in health related issues and depression.