Wearable devices have risen in popularity over the past few years, with a range of options—from medical devices that can only be prescribed by a physician to consumer products that can be bought by anyone online or in a store. These devices can help researchers capture essential patient data in their home environment, broadening participation in clinical trials, and empowering consumers with information about their health, according to Harvard Medical School specialists.
Wearables have also become a hot topic in my work as a clinician treating people with OCD and anxiety. A cursory search of Reddit will show a host of folks worrying about their health due to information and alerts from their wearables: Why am I in ‘high stress’? Does that mean I’m sick? Does it mean my hormones are fluctuating? Or could this be something more serious, like cancer?
In addition to triggering health anxiety, I have seen wearables impact self-esteem and confidence. Imagine that, as you’re going on about your day, you have a wearable alerting you that your body is stressed. This happens day after day. It seems your body is reacting negatively to the tasks you have to complete on a regular basis. You might start to wonder if you’re capable of handling your responsibilities.
If wearables are both useful and a risk for exacerbating health anxiety and OCD, where does that leave us?
Understanding your health and the OCD cycle
Let’s start with some basics: OCD is often called “the doubting disorder.” OCD symptoms are a cycle. It starts with an intrusive thought, a doubt, an urge, a sensation, or an image. These intrusive thoughts can come out of absolutely nowhere, or they can be triggered by something external. Wearables can become one of these triggers, bringing up excessive worries about health and kicking off a cycle of compulsions.
In response to intrusive thoughts, people with OCD perform compulsions—behaviors meant to stave off feelings of anxiety or distress. Compulsions may even feel like an attempt to keep yourself safe. But the relief is only temporary, and compulsions are no guarantee of safety. One of the most common compulsions in OCD is checking, and excessive checking can show up in many different ways. You might check repeatedly that the refrigerator door is closed. You might turn around on your way to work to check that you blew out that candle. In the case of health anxiety and wearables, you might repeatedly check your device for your heart rate, or look at your wearable app to ensure your stress levels are ‘normal.’ Intrusive thoughts about health triggered by alerts or information from wearables can even drive folks to repeatedly visit the doctor to check that nothing is wrong, even if they feel physically okay.
In fact, a recent article published in the academic journal Psychology Research and Behavior Management estimates that as many as 80% of OCD sufferers engage in checking behavior, so it’s not surprising that wearables can, even accidentally, become a source of checking compulsions in response to health anxiety triggers.
How compulsive checking increases health fears
OCD promises that our compulsions will keep us safe. It’s a comforting thought that if we can just monitor our health enough, we will be able to avoid serious illness or catastrophe. Unfortunately, that just isn’t the case. Wearables can be a very helpful tool and can even help uncover health problems—but they are no guarantee, and it’s important to consult a physician to help you interpret the data. Remember, OCD is known as “the doubting disorder.” Even the most comprehensive review of your health is only a snapshot in time, and OCD will always find a way to doubt the results.
When wearable checking becomes compulsive or excessive, it’s possible that anxiety might increase. A 2015 randomized control trial conducted at Utrecht University in the Netherlands showed that checking behavior increases the severity of OCD symptoms. Specifically, study participants who were asked to increase checking behavior had increased threat perception.
In other words, engaging in a checking compulsion makes anxious thoughts increase and makes the compulsion feel important—even though it isn’t actually helping. Taken together in the context of health anxiety, checking might make you think more about or become more fearful of the thing you’re monitoring (your heart rate, for example). And checking will make it feel more important to monitor your health closely. The more you check, the more you’re fearful, which makes you check more, which makes you more fearful. It’s a cycle!
Managing wearables when you have OCD
So, should you throw out your wearable? The answer is a bit more complicated—and response prevention is the key. Life is full of triggers. We cannot avoid them, and trying to do so often exacerbates OCD and anxiety. A consumer-based wearable can be easily taken off or discarded, but that does not mean we won’t someday have to interact with a wearable prescribed by a doctor, like a Holter monitor, which is a medical device to monitor heart rhythms.
Instead of total avoidance—which can itself become a compulsion—it is crucial to practice response prevention. Response prevention is a skill learned as a part of exposure and response prevention therapy (ERP), the most effective form of treatment for OCD. Response prevention teaches people with OCD to respond differently to triggers, intrusive thoughts, and worries. Response prevention helps us to accept uncertainty and refrain from behaviors, like compulsions, that reinforce our fears. This ultimately breaks the OCD cycle. So, if you are using a wearable and experiencing increased health anxiety, I strongly recommend speaking to a clinician trained in ERP.
Each person is different, with different core fears, compulsions, and thoughts that are unique to them. That is why it is important to seek professional help that is tailored to your needs.
To help you understand what exposure and response prevention therapy might look like, below are a few examples of response prevention that you might practice with a trained therapist:
- Agree to a monitoring regimen with your doctor. Some folks need to monitor their health due to chronic conditions. Others prefer to have data when they go to the doctor. That’s okay! To keep the wearable use from becoming excessive, ask your doctor what they recommend. When is it appropriate to monitor your blood oxygen level? How often should you check your blood pressure or heart rate? What about temperature? The answer will vary widely depending on the person, their medical conditions and their health goals. Stick to what the doctor says and try your best not to check more than what they recommend. Remember that you are always entitled to a second opinion, but beware that OCD can sometimes lead us to seek excessive reassurance from doctors. This is where an ERP-trained therapist can help you navigate the complexities of your personal situation.
- Experiment with turning off unnecessary alerts. If you want to use a wearable but you’re also interested in reducing checking compulsions, try limiting the alerts or notifications it is allowed to send you. The wearable can still collect data for a doctor to interpret if necessary- but you don’t have to be reminded of it quite so often. Smartphones can also help you set time limits on certain apps. If you’re spending a lot of time checking your health stats on a particular app, you could try setting a time limit to help you reduce the checking behavior. Delaying or limiting a compulsion is often a helpful first step toward eliminating it entirely.
- Practice accepting uncertainty. Getting comfortable with uncertainty is critical to overcoming OCD. We all live with an incredible amount of uncertainty every single day. That’s true whether you have OCD or not, but OCD really hates uncertainty. OCD compels us to search for certainty, for a final answer to every question, but no answer will ever be good enough for OCD. So, whether your wearable has ‘good’ news or ‘bad’ news, we must gleefully accept that we can’t know anything for sure. Did your watch tell you that you had excellent heart rate variability today? Great! Maybe it’s wrong. Did your watch say you were under high stress? Fabulous. That could mean you have a frightening medical condition, or it could mean nothing at all.
The truth is, recovery from OCD is a process that requires professional help. With an ERP therapist, you will build a treatment plan that addresses your specific fears. The tips above may be a useful starting point, but I find that folks are most successful in overcoming their OCD when they have an arsenal of response prevention tools that they have practiced in therapy, rather than just a few general tips. ERP gives people a structured, evidence-based way to stop organizing their lives around anxiety. With proper care and the right support, meaningful recovery is possible.
If you’d like to learn more about starting ERP therapy, schedule a free call with NOCD to find out how this type of treatment can help you. All of our therapists specialize in OCD and receive extensive training in treating OCD with ERP.
