Treatment for Obsessive-Compulsive Disorder (OCD) involves facing fears head-on through exposures while resisting the urge to perform compulsions, which can be difficult enough as it is. It’s even more difficult when errors in thinking impact your willingness to move forward in treatment, as well as when OCD sinks its teeth in and pulls you into traps that keep you stuck in your symptoms.
Below are five common traps to look out for and how to cope.
Trap 1: The belief that you cannot move forward with life unless you are 100% certain about your obsessions
How many times have you thought the following: I must know if I will harm someone, if I am a pedophile, my true sexual orientation, if this event actually happened or is a false memory, if I am living in a dream, (or insert any other obsession here) to move forward with life? How many times have you acted as if this were a fact? How many times has that “fact” interfered with your daily living and progress in treatment? This train of thought is common for people living with OCD who have difficulty tolerating uncertainty.
The reality is that uncertainty exists for all of us, whether we have OCD or not. We all live life daily in the face of massive uncertainty. We get in the car and drive to work without knowing whether we will get in an accident and die. We go on a date with our partner without knowing with certainty that the relationship will last. We go away to university without knowing whether or not it is the right school for us.
Uncertainty is a price we pay in life. Living with OCD is no different. It just feels different because of the hyperactive fear center of the OCD brain. It feels different because of the sense of urgency that people with OCD feel to figure things out now, or else.
So how does someone with OCD move forward in life without certainty?
You’re already doing it and you’ve made it this far. Keep moving toward your values and tolerating inevitable uncertainty. None of us have crystal balls or the ability to predict our future but we are capable of making values-based choices in the face of uncertainty. If we want to live meaningfully, we have no other choice.
Trap 2: The belief that you must perform compulsions to prove that you do not like your intrusive thoughts
In the all-or-nothing, rigid world that people with OCD often live in, compulsions feel like definitive proof that you do not align with your obsessions. The grey area doesn’t exist. You either must perform compulsions to prove your disdain for obsessions or resist compulsions and agree with them.
In reality, a compulsion is not an indicator of agreement or disagreement. You can disagree with or dislike intrusive thoughts and not perform compulsions. You can also disagree with or dislike intrusive thoughts and accept their presence. It might feel very irresponsible, as it does when we do nothing in the face of blaring false alarms the brain sends out. The work is to tolerate the feeling of irresponsibility and do nothing about it.
Trying to prove to yourself that you don’t like your obsessions is also inherently compulsive. It is paying far too much attention to the obsessions, which is ultimately what keeps people stuck in the OCD cycle.
Trap 3: You’re no longer as anxious about obsessions and start to worry that this lack of anxiety means that you must like your intrusive thoughts.
This is what Dr. Steven Phillipson, a pioneer in the treatment of OCD, coined The Backdoor Spike. While it often makes people anxious when OCD throws them for a loop in this way, Dr. Philippson views the Backdoor Spike as progress in treatment.
This makes sense given that Exposure and Response Prevention (ERP) can facilitate habituation to a stimulus. The more we expose ourselves to a stimulus, the less anxiety-provoking it can become over time.
Think about sitting in a room with a bee. If you’re like me, you’d be very uncomfortable at first because bees sting. However, sitting in the room with the bee would likely feel different on day four than it did on day one. You’d likely have acclimated to the bee’s presence.
Habituation can happen for people with OCD during ERP treatment. For people with harm obsessions, holding a knife throughout treatment might make using knives less anxiety-provoking. For those with sexually intrusive thoughts, purposely saying triggering words and phrases out loud might make those very intrusive thoughts less anxiety-provoking over time. This is when OCD can flip you on your head and utilize the absence of anxiety against you. When you recognize an improvement in symptoms over time, you might start to fear that the lack of anxiety signifies your approval of obsessions. This is a trap to avoid falling into.
We treat the Backdoor Spike like any other obsession: mindfully and with response prevention. It can feel compelling to try to prove to yourself that you disagree with your obsessions, but that is compulsive. The work is to notice that thought and move forward without engaging with it.
See the following example:
Intrusive thought: “You’re not anxious about this anymore. You agree with it!”
Mindfulness + Response Prevention: “That’s a thought! I don’t need to know.”
Trap 4: The belief that intrusive thoughts make you a bad, undeserving person
This is a painful, albeit distorted, belief that many people with OCD hold. It has a lot to do with the content of obsessions. That content could be violent intrusive thoughts about harming your kids, sexually intrusive thoughts about family members, blasphemous thoughts that attack a religious figure you believe in, intrusive thoughts about the “rightness” of your relationship, etc.
Those with OCD often think that there must be something terribly wrong with their character to be experiencing such thoughts. They might also falsely interpret their having thoughts as the same thing as carrying the thoughts out. The psychological term for this is thought-action fusion.
So how do you cope with this? The first step is to recognize the many errors in thinking at play here. The feelings of guilt and shame are valid but not rational. They’re valid because the feelings exist and irrational because thoughts do not carry any intrinsic value. They are not good or bad. They are thoughts.
Also, we are not in control of the thoughts that our brain produces most of the time. If you had a choice, you wouldn’t want to be thinking about these things. That goes for anyone and everyone. Remember, every human being has had an unwanted intrusive thought at some point. It’s how the brain works. Yours is just wired differently with OCD and the thoughts stick. Lastly, it’s important to recognize that thoughts are not actions. I could think about winning the lottery all day long and it doesn’t mean that I will now have a million dollars.
The next step is to act as if you are deserving and move toward your values. This can feel irresponsible and difficult at first, especially when your worth is so tied up in the content of your obsessions. It’s also very possible. We must change our behavior for our thoughts and feelings to change. In other words, you likely won’t all of a sudden feel deserving without making any changes. When you change your behavior by offering yourself compassion and cultivating a meaningful life for yourself in the face of anxiety and fear, you might start to feel as if you do deserve it.
Trap 5: Why would I stop performing compulsions when they make me feel better temporarily? I’d rather have that than the discomfort of not performing compulsions.
It’s true. Performing compulsions might offer you temporary relief. It might alleviate anxiety in the short term, but I can almost guarantee that it exacerbates your anxiety in the long run. That’s because compulsions keep OCD alive.
Compulsions are the problem, not the solution, as they reinforce to the brain that obsessions are valid, dangerous, and must be paid attention to. What does the brain do? It sends out more of those very obsessions you are trying to neutralize or get rid of. Performing compulsions also leads you to falsely believe that the only way to be okay is to do the physical or mental ritual. It reinforces to your brain that compulsions are necessary to survive, which is not the case.
With Exposure and Response Prevention (ERP), the gold standard treatment for OCD, the goal is to face fears head-on and learn to tolerate anxiety and discomfort without performing compulsions. When we cut out compulsions, inhibitory learning can take place: we learn that the feared outcome is not as likely as our brain makes us believe and that compulsions do not keep us safe. This can be uncomfortable in the short term, especially when you have reinforced again and again that compulsions are the answer.
Choosing to perform compulsions for possible (it’s not guaranteed) short-term gain is choosing long-term pain. If you’re willing to tolerate the short-term pain of resisting compulsions, you will reap the reward of the long-term gain: a reduction in symptoms and less time spent performing unnecessary rituals. The choice involves discomfort either way. The question is: would you rather experience discomfort in the short-term or live with it long-term?
How To Stop Getting Stuck In These OCD Traps
If you’ve experienced any of these traps, you’re not alone. Most people with OCD commonly experience them, but there’s help available. The key to freeing yourself from the traps that are keeping you stuck and treating OCD effectively is by seeing a licensed therapist who specializes in OCD and is specialty-trained in ERP.
It’s important to see a specialist who truly understands OCD and its treatment because they’ll be able to recognize the sneaky ways OCD rears its head and will help you tolerate uncertainty in the face of your OCD fears. They’ll also give you the tools and knowledge needed to learn how to implement acceptance into your daily life and provide you with the response prevention strategies you need to prevent compulsions.
NOCD has licensed therapists that are specialty-trained in treating OCD with ERP. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment and get started with OCD treatment at NOCD. Their consultation is free and doesn’t take very long—and it could be one of the most important calls you ever make.
About Alegra Kastens:
Alegra Kastens is a Licensed Marriage & Family Therapist and received her master’s degree in clinical psychology from Pepperdine University. She specializes in the treatment of obsessive-compulsive disorder (OCD), anxiety disorders, eating disorders, body-focused repetitive behaviors (BFRBs), and body dysmorphic disorder (BDD). Her passion for OCD treatment, education, and advocacy comes from her own personal experience with the disorder. She understands firsthand the relentlessness of OCD and how painfully it holds one’s life captive. She also understands that relief and recovery are real with a large dose of evidence-based treatment and an equally large dose of willingness.