Obsessive compulsive disorder - OCD treatment and therapy from NOCD

First Steps Toward OCD Recovery: What’s Going On With These Thoughts?

Dec 20, 201710 minute read

When I was in junior high school, one of my best friends lived across the street. He always had the latest video games, his parents were more easygoing than the other adults I knew, and he had younger siblings to boss around– something that fascinated me, because I was the youngest in my extended family.

We’d flop down on their massive couch and watch a bunch of TV while his little brothers and sister came over and smacked us with various objects. Their house was so different from mine, and when I’d had enough of the chaos I could cross the street and go home to be the youngest again.

One night nobody else was around and we were watching reruns of Man vs.Wild, wondering why Bear Grylls would sleep inside dead animals if he didn’t really have to. When the episode ended, another show started right up. I don’t remember what the show was, but it was about someone caught in the wilderness who ended up cutting herself with a knife. I had no idea why anyone would do that, and the show was making me really uncomfortable. Not wanting to say anything to my friend and reveal my fear, I got up to grab some water from the kitchen.

I started to look around while I waited for the glass to slowly fill. Next to the fridge was a counter, and on the counter was a big block of kitchen knives– I had never noticed those before. But now they were the only full-color objects in a room that had gone black and white. I thought: I should grab one of those knives and use it to hurt myself. I was suddenly in more immediate danger than ever before; this wasn’t the half-tolerable fear that I’d felt while walking through haunted houses or playing drums in front of a crowd, but something more like complete fear, because now I knew that one of the things I feared most was bound to happen soon.

Heading back to the living room to avoid being asked what was wrong, I sat down and pretended to watch the show while a bunch of terrible thoughts and feelings filled me up. Everything mixed together: I tried to convince myself mentally that I would never grab a knife and do something like that, but then another thought about self-harm emerged and I felt even more ashamed, and the shame led me to thoughts like I’m so pathetic I might as well hurt myself like that. As long as I was having thoughts about self-harm I was convinced I might actually do it; and as long as I was convinced of this possibility I knew I needed to find a way to protect myself from myself.

When all of this only made me feel worse, I tried to insult myself away from the thoughts: What kind of sick person thinks like that? Don’t be so weird. This didn’t work, so I tried the old guilty thoughts: Imagine how disappointed my family would be if I did something like that. Any momentary replacement of this intense anxiety with slower, more familiar feelings like guilt and sadness was a welcome reassurance.

Eventually none of this worked and I ran away, across the street to my own house where everyone was asleep and there was also a knife block on the counter. Seeing that one didn’t help, of course, and by the time I’d run upstairs to my bed I felt like I had the flu. I hoped for morning to come, because it would mean I’d made it through the night without letting the thoughts take over; but I also couldn’t imagine facing my family in the morning, with this new knowledge that I might be the type of person who would harm myself with a kitchen knife.

What was happening?

At the time I didn’t know I had stumbled– thanks to a nice pairing of bad television and well-placed kitchen knives– across another manifestation of the the way my brain vastly overestimates the significance of thoughts I don’t like and gets stuck on them. I had no reason to suspect these thoughts of self-harm were anything but idiosyncratic: something that was wrong with me, and only me. Without any context, it was extremely difficult to place any limits on my thoughts, and so they took over.

If you’re feeling the way I felt then– no matter what the bothersome thoughts are about, and whether or not you have been diagnosed with OCD or are even interested in a diagnosis– knowing a few first steps toward feeling better can be really helpful. So, enough of my story; on to yours.

Notice what’s been going on

As soon as you’re able to take a step back and shift from engaging with your thoughts to noticing your thoughts, you’ve made one of the most important moves. Here’s the key: OCD recovery is never about getting rid of certain thoughts. It’s about changing your relationship with those thoughts. It’s hard to accept at first, but you will always experience thoughts like the ones that bother you now. What’s yours to change is the way you react to them– and, ultimately, whether or not they bother you much at all.

First you’ll need to identify patterns in your thought and behavior. You might notice that you’re always fine until a certain thing happens, or that every time someone says this specific thing you find yourself behaving differently from those around you. It’s not always great to use comparison with others as a primary method of gauging yourself, but in OCD recovery it can be helpful at times. When you’re the only one doing something and it’s making your life more difficult, it’s probably one of the things you could work on.

You’re looking for a few things: what sets you off, what thoughts and feelings arise when you’re set off, and how you respond to it. Don’t worry about how you’re going to fix things yet. Just observe, track, examine, notice, etc. If it helps to write things down, do that too.

Learn to recognize what’s what

Contrary to popular depictions, people with OCD aren’t bothered by everything. They might also be generally anxious, or especially sensitive, but obsessive-compulsive disorder is not a generalized tendency to be uptight about things. That’s why people can have OCD and still use a public restroom without washing their hands after, or constantly forget to clean up after themselves.

Only you know what really bothers you– and with untreated OCD we’re not talking about being kind of bothered by something. Usually the obsessions will revolve around one or a few themes: every time you’re near train tracks, or each time you’re with kids, or whenever you’re with your significant other and you walk past another couple, and so on.

Think of these as your triggers. What do they trigger? Usually an intrusive thought: I could jump on the train tracks, I could hurt these kids, Isn’t that couple more attractive than us? This intrusive thought, together with the ones that follow, form the obsession. Am I the type to hurt kids? I might be the type to hurt kids. Am I similar to other people who hurt kids? I heard a story about this person in my town who hurt some kids and we have some things in common.

The easiest way to tell obsessions from compulsions is that obsessions increase the amount of anxiety you feel. Compulsions are an attempt to decrease the amount of anxiety you feel. Although compulsions do backfire sometimes, if you’re doing something to get rid of anxiety caused by an obsession it’s probably a compulsion.

Compulsions come in many varieties: repeated actions like counting or touching things in the same order, checking, reassurance-seeking behaviors like asking other people or using Google, mental behaviors like thinking through things or reassuring yourself, and avoiding situations altogether.

Often people with OCD already know that their compulsions are strange or don’t make any sense but don’t know how to stop. But they don’t know that they can let down their guard and stop with the compulsions because they haven’t seen their obsessions for what they are: thoughts that don’t require any more attention than all those other thoughts we get throughout each day.

Behave differently to make the thoughts less scary

As you’ve probably noticed, arguing with your thoughts isn’t going to make them go away. In fact, this type of self-argument often becomes a compulsion in itself. This stuff doesn’t work because in most cases obsessions latch onto things that are fundamentally uncertain. Your brain is looking to be certain you won’t get sick, but you’ll never have that certainty. In fact, nobody ever lives a single day sure that they won’t catch a deadly illness. So you’ve got to stop trying to achieve a certainty that’s in fact impossible to reach.

This applies to all those other obsessions too: could you one day lose control of your own mind and jump on the train tracks, hurt some kids, or use a kitchen knife to hurt yourself? Is it possible that you might leave the stove on accidentally and cause injury to others? Yes, of course, because life is vulnerable and uncertain, and your brain can never change that. You’ll end up exhausted, frustrated, even panicked, and everything will still be uncertain.

So what can you do? Change your behavior in response to these thoughts and you’ll find that they begin to shrink. They won’t control you any longer, and eventually you’ll look at them every time they appear with only a vague memory of how much they used to bother you.

But it will get harder first. If you change your behavior and eliminate compulsions, you’ll still have the thoughts and all the bad feelings they cause in you. You’ll really want to use one of your compulsions to tap out and just be done with the pain, but in order to get to a point where the thoughts are just thoughts you’ll have to stick with it, finding different ways to keep yourself from using a compulsion. And only by making it through this pain without using a compulsion will your mind and body learn that they can tolerate uncertainty. Your brain can only be in distress for so long before it starts to habituate and realize that it’s alright. The tough part is that you’ve got to “sit through” this distress and let the habituation happen.

I’ll be writing more soon on specific strategies for staying away from compulsions, but these first steps are a good start. The main takeaway: OCD recovery is not about getting rid of thoughts, but about giving yourself a chance to learn how to tolerate them. If you or someone you know is struggling with OCD, you can schedule a free call with the NOCD clinical team to learn more about how a licensed therapist can help. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. At NOCD, all therapists specialize in OCD and receive ERP-specific training.

Important note on self-harm and suicide

This story talks about thoughts of self-harm. Even though uncertainty is a key part of self-harm obsessions, if you suspect your thoughts might cross over into actual self-harm please contact a professional (like a therapist or your doctor) so they can assess your symptoms and help you make a plan.

If you’re already engaging in self-harm, get in touch with a professional immediately. And if you’re ever considering suicide, please call 1–800–273–8255, or your local suicide hotline if you live outside the US.

If you or someone you know is struggling with OCD, you can schedule a free call today with the NOCD clinical team to learn more about how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

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