I hide sharp objects. I avoid tucking my child into bed. I pray. I seek reassurance. Nothing will make my thoughts go away and I’m terrified that my thoughts will come true. What can I do?

First, the behaviours you are doing are known as compulsions. The purpose in doing compulsions is to gain temporary anxiety relief caused by your harm obsession and to “ward off danger”; however, doing compulsions is what keeps this process cyclic.

Why can’t I just stop the thoughts?

This is another compulsion. One way to look at this is to recognise that fighting to stop OCD thoughts is like trying to stop rain pouring down just by thinking about it. It doesn’t work. Intrusive thoughts are biologically driven into your consciousness without your will. These are not your fault.

It’s hard for me to believe this. I’ve tried analysing my intrusive thoughts; yet they still persist. Why is this?

Basically, OCD cannot be reasoned with on an emotional level or by analysis.  This is because intrusive thoughts are not based on valid content. You simply become further entrenched into the confines of the disorder the more you try to interpret the thoughts.

Yeah, I’m getting the picture, but how can I do this?

Well, we’ve discovered that you cannot defeat OCD by analysis or by giving into compulsions. However, what you can do is defeat OCD with cognitive behavioural therapy (CBT). This is because CBT is concerned with identifying and reframing thinking errors linked to certain belief domains. In a harming example, the cognitive error is viewed as catastrophisng since the probability of harm is exaggerated. Catastrophising in this sense links with the belief domains overimportance of thoughts and responsibility. Once these are corrected and your emotions are more regulated, then altering your behaviours in response to intrusive thoughts are put in place.

How?

This would be with exposure response prevention (ERP), the crucial part to CBT. A new response following cognitive restructuring of thoughts would be to resist all compulsions that correspond with your obsession and bearing with the anxiety until it reduces naturally.

What’s the main purpose for doing ERP?

The main purpose is to gradually delink your obsessional fear from your associated anxious response. As an example, when you take your child to bed and the intrusive harming thoughts enter your mind, you would acknowledge they are there, accept them, and allow them to pass all the while you continue to put your child to bed. This is your new response. By doing this regularly your brain learns to dismiss the irrational fear. As a result, alert signals stop or become much weaker. By breaking the connection between your obsession and your fear-related response you grasp that there was never any need for “safety” behaviours (compulsions) in the first place.

To summarise, harm OCD has two essential characteristics – obsessions to harm and compulsions to “prevent” harm. The way out of this spiral is to engage in CBT with ERP (also medication and mindfulness). The cognitive side of therapy helps to correct thinking errors linked to faulty beliefs; and by facing your obsessions (exposure) and resisting compulsions (response prevention) your longterm gain is remission; or at least reduced symptoms.

 

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