By Patrick McGrath, PhD, Head of Clinical Services at NOCD
The first three months of 2020 have brought much of the expected news: politics, sports, the awards season for music and movies. But now it’s hard to even remember all of that, given the global outbreak of a new coronavirus called COVID-19. Since January, the illness has spread from Wuhan, China across the globe.
Any outbreak of a new and potentially fatal virus will cause anxiety in just about everyone—and, in fact, changing our behavior is a responsible way to decrease the chances that we get sick or become another link in the virus’ spread to our friends, family, and neighbors. When SARS, a similar and sometimes fatal illness, spread across the world in 2003, effective quarantining and social distancing in the affected countries were the major factors in its quick containment. It’s reasonable and ethically responsible to take COVID-19 seriously and be more careful in our daily habits.
But if this sounds like an easy recipe for the worsening of many people’s obsessive-compulsive disorder (OCD), that’s because the overestimation of risk and responsibility that characterize this psychiatric disorder find an easy match in this sort of situation. Not everyone with OCD will notice a difference, but at the very least people with two of the most common subtypes—contamination and harm—are already reporting a noticeable spike in their distress. Those in the former group worry that they will get sick or infect someone else; they may respond by ramping up their hand-washing or cleaning efforts to the point of exhaustion and bodily harm. And those with a fixation on harm are concerned with the possibility that they somehow won’t do enough and will end up infecting (and even killing) someone else.
Surely, these are only two prominent examples of the many ways people with a wide variety of obsessions and compulsions could find their symptoms intensifying during the COVID-19 outbreak. Based on current information and a look back at historical outbreaks, we have no way to estimate how long this might go on. So, what can we all do in the meantime to deal with OCD and heightened anxiety during the times of COVID-19?
Enough really can be enough
During their most difficult periods, people with OCD can be trapped all day long in cycles of obsessing (“What if I get sick and then get my kid sick and they die!”) and performing compulsions (hand-washing every ten minutes). Whether it’s about illness, a relationship, or anything else, this OCD cycle is driven by a feeling that one still hasn’t done enough. One is never certain enough.
But, as with many of life’s big challenges, we simply can’t know what really is enough when it comes to an illness outbreak. The constant pursuit of perfection will only wear us out (and maybe make us ill in another way). The very best we can all do is take the advice of official sources; their information might be imperfect, but it’s the best we’ve got. Resources like the CDC have clear guidelines for the appropriate steps. To stay as healthy as possible while making sure OCD and anxiety don't take over, I would recommend that people stick to these guidelines without going above or beyond them.
Distance without avoidance
With the rapidly spreading recommendations that we distance ourselves from other people and stay home from social gatherings, it’s tempting to follow this path to complete avoidance: maybe I really should just cut myself off and avoid any risk. When it seems like everyone else is avoiding social contact, this can feel enabling for people with OCD and anxiety disorders.
For right now, the public-health imperative to avoid contributing to COVID-19’s spread might win out. Especially if you are at higher risk of getting this coronavirus (primarily older adults and people with chronic medical conditions), avoiding any big gatherings or crowded public spaces may the best choice until we get other information or the virus has been controlled.
Whatever your situation, keep in mind that social isolation tends to worsen all types of OCD and any accompanying mood issues. Choosing to spend more time at home doesn’t mean you can’t stay in touch by calling friends, Skyping with loved ones, or making open-ended plans for whenever the outbreak has been curbed. As for bars and restaurants, public transit, small gatherings, and so on, limit the obsessive-compulsive cycle and all that anxious guesswork by sticking with the experts for now.
Watch out when you watch the news
Constantly checking the news or a social media feed for coronavirus updates might just be a new anxious behavior for someone who doesn’t usually struggle with any psychiatric disorder… or it might be a compulsion. Just like Googling, reading every new article and Tweet gives us the illusion that we can get rid of uncertainty and stay one step ahead of the risks involved in this outbreak.
Remember that news outlets want your readership and are financially motivated to constantly throw new information at you. If you typically read the news in the morning or at night, it may be best to limit your coronavirus news intake to that one period every day. And, as mentioned above, try to stick with primary, official sources like the CDC: our news sources often try to move a little faster than the facts.
Plus, these are primarily bits of information we can’t do anything about. How does it help to wake up and find out there are more new cases in another country? It’s great to feel empathy for other people around the world, and some have specific reasons to keep an eye out (like family members on another continent). But otherwise we might just be amplifying our anxiety without good reason—unless you’re actually working on an exposure with a licensed OCD therapist. Speaking of which...
A situation like this is the perfect storm for anxious minds. The official information is constantly changing, and recommendations shift each day. News and social media outlets throw alarmist headlines at us; the scarier the better, because more clicks means more money. Nobody can keep up, and with every school closure and government action we just feel worse.
Friends and loved ones can be helpful, but they may not know how to listen without bringing in their own fears. They might also inadvertently encourage any compulsive behaviors that they now see as reasonable responses simply because nearly everyone is being highly conscientious. With these complications in mind, we could all benefit from professional guidance during these times of heightened anxiety.
Even people who have already been in therapy are finding themselves unable to go in for appointments. As efforts to contain the coronavirus continue to ramp up, many therapists are shifting from in-person to video appointments. This is a great option for plenty of people, but most insurance plans actually don't cover teletherapy (treatment delivered via live online video). This sudden lack of access to therapy is making daily life much harder for countless people with OCD, anxiety, and other psychiatric disorders.
Going without therapy, for any reason, is a major source of unnecessary suffering; those with OCD may be bearing the brunt of this reality. The good news is that the most effective therapy for OCD—exposure and response prevention (ERP)—is just as effective when conducted via online video appointments. When done with a licensed OCD therapist, ERP is the most reliable way to significantly decrease the amount of distress caused by OCD.
Trying to "fight" our thoughts directly is a losing battle, so ERP works by helping people recognize and resist their mental compulsions (like replaying painful memories until they feel "resolved"). This, in turn, gradually teaches us that we can tolerate even our most distressing thoughts: we don't need to do anything about them after all.
Although this might sound simple, it involves careful planning and constant adjustment; so ERP is most effective when practiced with a therapist who has received specialized training. An OCD-trained therapist knows how to spot mental compulsions and tease them apart from obsessions. Is this a reasonable fear about coronavirus or another manifestation of my old contamination obsessions?
These observations are the building blocks of the personalized treatment program you will follow under their guidance. Their expertise is in teaching you how to manage your OCD and make positive changes in all areas of your life, redirecting all the energy you might otherwise have spent on OCD.
This is the same training all of our NOCD Therapists receive. The goal of NOCD is to reduce your OCD symptoms within just a few weeks of live one-on-one video therapy. You'll be welcomed into our supportive peer community, with 24/7 access to personalized self-management tools built by people who have been through severe OCD and successfully recovered using ERP.
Schedule a phone call with a member of the NOCD team to learn more about how a licensed OCD therapist can offer you live video sessions and help you get better. This consultation is free and doesn't take very long—and it could be one of the most important calls you ever make.
Please note that this post is an exploration of a common topic. It is not intended to diagnose.