It is not uncommon during my first encounter with a member to have them state that if they could just get rid of their distressing thoughts they would be fine. As a therapist who also has experienced obsessive-compulsive disorder (OCD) for many years, I agree with them, that it would be nice to not have intrusive thoughts anymore. However, I then tell them something that usually leaves them stunned. I tell them that OCD is actually not a “thought problem.” Some back and forth about this almost always ensues until I explain that it is actually a “feeling problem.”
Seeing OCD as a ‘feeling problem’
When you really think about it, what does an individual with OCD spend most of their time and energy on? They spend it desperately trying to get rid of the feelings of discomfort and anxiety that arise from their intrusive thoughts. The emotional distress around their unwanted thoughts is what drives their compulsions.
Most people have many, many thoughts during any given day, but they don’t feel the need to respond to all of them. They fly under the radar and don’t even really reach consciousness, or are easily weeded out as unimportant. But when someone has OCD, it often feels like their ability to decide which thoughts are meaningful and which aren’t is somehow impaired.
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Consider Remi. Remi describes feeling like there is an accusing voice in her head daily. Everything she does or says just feels “wrong.” She describes that when she is in a crowded room she feels like she is the oddball. She feels awkward and describes this sense of inferiority. She never feels good enough. Remi thinks she is an imposter. She is a well-educated doctor and a renowned scholar, yet all she can ever think about is her flaws. She could be given a series of compliments and one area of constructive criticism and that one area that needs improvement would lay on her mind for days and sometimes even weeks.
On several occasions, these feelings have left her asking for reassurance from colleagues. She has also found herself turning down speaking engagements because she doesn’t feel qualified. It is heavily impacting her ability to perform her job and has recently begun to impact her relationships with her co-workers.
Regardless of how irrational those feelings are, they just won’t go away. I like to use the idea of an email system gone awry. Think about the way in which your email is set up to discard spam messages. Spam messages aren’t important or worth paying attention to. This saves you time and energy, since you don’t have to read through each and every one and formulate a response. You probably never even see these emails in the first place, as the process is seamless and automatic. In the brain of someone with OCD, they often don’t have a spam monitoring system, so when a thought appears, they believe that they need to respond.
Since individuals with OCD often attach a great deal of meaning to their thoughts and feelings, they assume that because they felt something it must mean something. They experience “thought-action fusion” or the idea that just thinking about something is the same as actually doing something. Additionally, many of these thoughts are ridden with guilt and shame and trigger a strong emotional response, making it difficult to dismiss them as meaningless.
People with OCD also have a high distress intolerance. In other words, they feel as though they cannot possibly handle feelings of distress or discomfort. Although I have never had anyone tell me that they enjoy feeling uncomfortable or anxious, most people recognize that should it happen, they can deal with it effectively and that it will pass. When someone has OCD, however, they feel that they can’t tolerate that experience and that the impact of that would be detrimental to their well-being. They overestimate the threat and underestimate their ability to handle it.
Compulsions as a threat response
Individuals with OCD will often respond with a fight, flight, or freeze response. They react as if their thoughts mean something, and are immediately compelled to explain why they had them in the first place, in an attempt to reason or solve those thoughts away. Typically these individuals have a great deal of insight. They are well aware that the thoughts are unreasonable and illogical. They can name all of the ways in which the thoughts are unlikely to be true. However, that nagging feeling lingers. The person seeks certainty. They continue to look for reassurance and relief from that sinking feeling in their stomachs, leaving them constantly at war with themselves. Their danger instincts kick into full-blown action, and this is where compulsions are born, in an attempt to prevent or ward off that emotional turmoil.
Take George, for example. George recently began struggling with uncomfortable physical sensations. It started one day while he was at the gym with his friend. He was working out and suddenly he felt aroused. He actually explains it as first just a thought, “What if I was to get aroused” and then almost immediately after this, he felt a tingling sensation in his groin area.
George has been happily married for several years. He has never questioned his relationship. A sense of guilt and shame encompassed him. Just the thought of him finding other people, outside of his marriage, attractive bothered him. While he knows deep down that this is a normal part of the human experience, he somehow feels that he should not feel that way about other people. He sets himself to a higher standard. George would never want to do anything that could harm his partner. He feels that cheating is the ultimate betrayal.
Struggling with OCD most of his life he was easily able to recognize the familiar pattern that was taking place. Even still, the feelings felt so real. He just couldn’t seem to convince himself that they meant nothing. The risk just felt too great. He felt a responsibility to tell his partner what had happened, even though part of him knew that this would only bring about a temporary sense of relief until the next time a similar experience occurred.
This is a common problem that OCD specialists see daily. A person with OCD can identify certain characteristics of the disorder and logically see that the thoughts don’t make sense. When feelings appear, however, it can cause immense confusion. The idea that feelings of false attraction can occur in OCD is actually very common, yet few know this. The more those suffering from OCD can see that feelings, even physical feelings, can also be intrusive, the more they can learn ways to combat the shame and guilt often associated with these feelings.
Learning to tolerate anxiety and distress is an important part of OCD treatment. Members are often asked to ‘lean into’ their feelings. This is to help them to see that although they don’t enjoy the feelings that the thoughts may bring, they are not inherently dangerous. They are just feelings. Feelings are not to be avoided but to be experienced. The more we try to avoid a feeling, the more likely it is to keep reappearing.
ERP can treat uncomfortable feelings in OCD
Are you struggling with intrusive thoughts and feelings and ready to stop giving them so much importance? If you’re ready to start your own recovery journey, we can help. Our licensed therapists at NOCD deeply understand OCD and are specialty-trained in treating OCD with ERP therapy.
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We work side-by-side with the OCD experts and researchers who designed some of the world’s top OCD treatment programs—and that means the best care for our members. You can book a free 15-minute call with our team to get matched with one and get started with OCD treatment.