When I am working with members who have OCD, there are two words that are often at the forefront of their minds: guilt and shame. Guilt is the feeling you have when you perceive you have done something wrong. Shame is when you internalize that you are a “bad” person. It is important to recognize how these two emotions relate and how they are different. Shame may be focused on who you are as a human being, while guilt may focus more on actions you may or may not have done.
Why it’s difficult for people with OCD to tolerate guilt and shame
When people with OCD experience thoughts, feelings, or urges that they consider taboo, disturbing, or frightening, it often leads to feelings of intense guilt and shame. It has been suggested that people with OCD experience “guilt sensitivity,” meaning they have a higher aversion to feelings of guilt—much like they do with distress and anxiety. They may feel like they cannot tolerate it.
Meanwhile, shame can make them feel like something is wrong with them on a core level. Shame can make them feel alone and cause them to withdraw from others, or cause them to keep their intrusive thoughts bottled up inside.
It’s difficult to know whether OCD causes feelings of excessive guilt and shame or whether these feelings are already present and OCD takes hold of them, making them more troublesome. Either way, these feelings can certainly cause a person to experience increasing symptoms of anxiety and depression.
We know that people without OCD also find feelings such as guilt, shame, anxiety, and distress to be uncomfortable feelings, but those without OCD may have more confidence in their ability to cope with these feelings. If your core beliefs about yourself are rooted in shame and guilt—which is the case for many people with OCD—then it can be very difficult to have confidence in yourself and your ability to manage OCD. That’s one reason that feelings of shame and guilt can interfere with treatment and recovery.
Sharing thoughts out loud can take away their power
Many of the people that I have treated have lived years believing the lie that no one is like them and no one would ever understand what they are experiencing. They believed that they were damaged, or that they were fundamentally bad people. This couldn’t be further from the truth.
One of the first things that I tell my members when I meet them is that nothing they tell me will shock or surprise me, and it certainly won’t cause me to make any negative judgment about them. I truly mean this: therapists who are trained in OCD know that the thoughts, feelings, images, and urges someone has are not indicative of who they are and reveal nothing of their true desires. In fact, it’s often quite the opposite—the nature of their thoughts often goes directly against what they value and cherish most.
I also tell my members that shame thrives in secrecy. We must not keep our shame hidden; if we do, it will fester in the silence. There can be a tremendous benefit to voicing our intrusive and shameful thoughts or feelings. When we say them out loud, we can take away their power.
One of my favorite exposure and response prevention (ERP) that I encourage my members to do involves nothing more than saying the thoughts or feelings that bring them shame or guilt. I ask them to write down an imaginary script of their worst-case scenario or of their most taboo or uncomfortable thoughts (they may just write down triggering words initially). Then I tell them that they’ll be reading and recording their script.
Prior to recording it, I ask them to read what they have written out loud and then tell me what level of anxiety they experienced while reading it, on a scale from 1-10 (10 being the highest level of anxiety they have ever felt). Afterwards, I ask them to listen to it over and over again while resisting the urge to do any compulsions in response, whether physical or mental. They are asked to sit with any discomfort or anxiety they experience while listening to it, in order to allow these feelings to pass on their own. Once they complete the exercise, I ask them to rank their anxiety again.
The first time, most will typically rate at a higher level of anxiety, almost without fail. Members often tell me that there was just something different about hearing their own voice saying the things that cause them such pain and torment. But, within a week of assigning this activity, the majority of people will come back and report substantially less anxiety and discomfort from hearing these thoughts or feelings. They will also say that a side effect of listening to it seems to be that their brain recognizes even more so how illogical the scenarios they fear are.
Overcoming guilt and shame due to OCD
Though the goal of ERP is to allow anxiety to be present in order to learn that we do not need to engage in compulsions, often the impact of the intrusive thoughts themselves reduces as well. Not only does ERP help someone learn to tolerate discomfort, but it also reduces the discomfort that comes from their obsessions. By separating who they are from what they think and feel, they can more readily tolerate the distress caused by these thoughts, recognizing that they are not a reflection of who they are.
ERP can give you the tools you need to sit with uncertainty and tolerate anxiety, instead of living in shame and guilt. If you’re struggling with OCD and want to take the power away from your intrusive thoughts, NOCD can help. The best way to practice ERP and manage intrusive thoughts is to work with a therapist trained in ERP. At NOCD, our therapists specialize in OCD and ERP, and they will provide you with a personalized treatment plan designed to meet your unique needs. Your therapist will teach you the skills needed to begin your OCD recovery journey and will support you every step of the way. They will guide you in taking small steps to reach your goals.
If you’d like to learn more about getting started with treatment, please book a free 15-minute call with the NOCD Care team.