I have OCD and always follow up everything I say with “I think”. I’m so indecisive and don’t want to give someone a definitive answer in case I’m wrong. What do I do?

Legitimately, it’s likely you know the answer, yet doubts creep in saying, “Are you sure you’re right?” Saying the words “I think” correlates with the obsessional problem, meaning this is a “just in case” compulsive response.

So what about my indecisiveness, why am I like this?

Any person can be indecisive about what to choose, whether to say something or not, whether to change careers, what to eat, what to wear, whether to say yes or no to someone, and so on. Later, and on reflection, they might worry that they’ve made the wrong choices. This can affect daily functioning or be a distraction to some degree.

But if my problem is obsessional how can this be resolved?

If you can identify that there is a relationship between indecisiveness and worry then this can be problem-solved on a rational level where the worry is handled realistically. Yet, when worry involves threat associated with obsessive compulsive disorder, then errors in thinking would need to be addressed.

Why do you mean by threat exactly?

This relates to magical thinking, which would be on the lines of ‘If I don’t change my mind, or say “I think” after giving advice, I fear something bad will happen’. The thinking errors here would be overimportance of thoughts that shows a relationship with thinking errors such as catastrophising and emotional reasoning.

How are thinking errors addressed?

This would be with cognitive therapy, since thinking errors are often linked to negative interpretations, or strongly held negative beliefs.

Do you have a solution for magical thinking?

One suggestion is to use the theory A and theory B strategy. This covers worry (theory B) and threat (theory A), which is associated with OCD.  By following theory A you might think: “The problem is that I will make the wrong choice, or fail to check all appliances are off, and as a result something bad will happen to my kids and it will be all my fault.” However, by following theory B you would think: “The problem is that I care deeply for my children and I worry about anything bad happening to them.” See how theory B loses the threat element, giving room for rational thought and effective problem-solving. Theory A however keeps you in an obsessive spiral and has you scrambling for solutions on an emotional level, which doesn’t work, because emotional reasoning is irrational.

OCD also affects my memory. First I feel like I have early onset dementia because I forget things so frequently. This is no joke, it’s gotten really bad and then I write excessive lists to make up for the loss of memory.

Obsessions about memory loss occur when important things are difficult to recall, and so it’s often the case that people who have OCD fear they are losing their memory to dementia when it’s more likely a memory hasn’t been mindfully processed. If you look at how memories are stored you can see how certain factors play a role in retrieving a memory. First your brain consciously registers the memory, this is called encoding. Following encoding, short-term memories consolidate to long-term memories. To help with recall, one suggestion is to be more mindful of your environment, and to tune into all of your senses as you take in daily information, taking particular note to anything important you want to commit to mind.

My OCD makes me think I am making things up, like memories, so whenever I have to think of something or recall a thought I always wonder “Did this really happen?” or “Am I elaborating on this memory/story?”

Just the fact of identifying that it is your OCD that makes you think you’re making things up or elaborating clarifies that you’re not. As noted, being mindful of your surroundings, actively listening, chunking reading or being deliberately attentive to something that needs your full attention can all help with encoding and consolidating accurate memories for better recall.

I also really struggle with checking things. I check our radon detector, smoke detector, CO2 detector, check to make sure cupboards are closed and the fridge is closed, check to make sure I didn’t leave something out where my kids or cat can get it. Recently I have started doing elaborate things like throwing my hands in the air and saying “I checked it” out loud in hopes that the obsessive thoughts to check and recheck will go away.

No amount of checking ever takes the grain of doubt away. This is why in therapy a person agrees to resist checking compulsions and other rituals because this is the tried and tested way to starve the obsession – that is, exposure to the obsession and ritual prevention during the exposure. Not yielding to compulsions is done in graduated steps with the purpose that this builds tolerance to distress.

Does ERP help with magical thinking as well as cognitive therapy?

Yes, by not responding to compulsions further proves that the magical element in OCD is an irrational concept. Basically thoughts do not convert to action therefore no “safety” behaviour is required. The additional “I checked it” following a checking compulsion can be tricky because again doubts creep in and compounds the problem – for instance, asking yourself if you said those “safety” words can lead back to re-checking. It’s a vicious circle and so the best way forward is as noted to do cognitive therapy with exposure response prevention and mindfulness plus medication, if required.

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