A smart young boy entered in my office. After some initial greetings he started sharing his purpose to visit me.Conversationwas started with this line, “I am facing some stupid, insane and weird but very serious issue. I am having some difficulty which I guess nobody has ever experienced nor I have heard. It’s really odd; I don’t know how to put it in words”. After my assurance that I will try to understand it to my level best he started saying, “I don’t know what’s wrong with me. I see negative images of people in my mind, especially my family. If an image pops up in my mind about a family member having a car crash or an accident, I try to avert this to a happy image quickly.
I feel if I don’t do this; the negative images might happen in real life. I am afraid that I will harm somebody, so I have to avoid every harmful object such as knife, gun etc. I have to check just about everything. Was my computer turned off? Did I turn off all the lights? Did I shut the door properly? Did I forget the television on? By the time I am done checking the last thing, I am not sure I checked the first thing. Is n’t it creepy and strange?”
Do you know what Ali’s problem is? It is not something stupid, insane, weird or rare. It is a mental health condition where a person has obsessive thoughts and compulsive behavior, called Obsessive Compulsive Disorder (OCD). According to statisticsit’s not a rare condition. It is estimated that up to 2.5 percent of the population is affected by obsessive-compulsive disorder. Its onset age is between 19-35 years. Although OCD affects individuals differently, most people with the condition fall into a set pattern of thought and behavior. This pattern is in the form of a vicious cycle:
It means that your mind gets overwhelmed by a constant obsessive fear or concern, such as the fear your house will be robbed. This obsession provokes a feeling of intense anxiety and distress. One has to adopt a pattern of compulsive behavior to reduceanxiety and distress, such as checking all windows and doors are locked various times before leaving the house. This compulsive behavior brings temporary relief from anxiety, but the obsession and anxiety soon return, causing the cycle to begin again. This produces a constant mental noise and endless worry, but also often includes a cognitive process known as thought-action-fusion. It is an irrational assumption that just because a “bad” thought presents itself to your mind, then it is undeniably followed or accompanied by a specific “bad” action. In other words, thinking something makes it so. For some, this fusion is so strong that they believe that their thoughts actually cause actions to occur.
Clients who suffer from thought-action fusion often report intense fear because of their belief that their thoughts will come true. For example, a teenage girl may worry that if she has a thought of a stabbing her family, then murder will undoubtedly occur. In an attempt to prevent harm to themselves or loved ones, those with thought-action fusion often take on the weight of the world and compulsively attempt to be prepared for impending doom. The girl who fears the home invasion avoids spending the night out with her friends, and repeatedly does compulsive rituals in an effort to protect her family from attack. She begs her family begs her to lock her in from the outside so that there is no risk that she will get out and harm someone.
The simple fact of the matter is that life is a risk. We cannot be prepared 100% of the time to prevent and protect ourselves and others from tragedy. For clients with OCD and anxiety, a primary goal of treatment is to change the paradigm towards these compulsive thoughts. If such thoughts are left untreated, it will result into shame, guilt, and feelings of hopelessness. The treatment offers education, insight, and tools to move towards overcoming the fear tied into this type of thinking, and provide a new found sense of peace of mind.
Handling OCD and Thought-Action Fusion
For those with OCD complicated by thought-action fusion, treatment proceeds through a structured series of steps in order to gain the insight. We train people in “cognitive restructuring”; clients learn to spot their irrational thoughts, and to challenge the “bully” in their brains. They learn to respond to an irrational thought (i.e., “I may hurt someone”) with a more rational and evidence-based thought (i.e., “I have had this thought many times, and never once hurt someone”).
Mindfulness for OCD
When clients can begin to effectively distinguish their distorted thinking therapy proceeds to what is known as Mindfulness. A simple way of describing mindfulness for OCD is that it is learning the skill of non-judgmental awareness and acceptance of one’s thoughts and feelings. Using mindfulness, one learns to focus not on changing or eliminating unwanted thoughts and feelings, but rather on fully accepting their existence. After all, the thoughts and feelings are there, whether we like it or not!
Exposure and Response Prevention
When clients begin to develop the ability to truly accept their unwanted thoughts, and to recognize that these thoughts do not automatically have meaning, treatment turns to the “Exposure and Response Prevention” (ERP). The goal of ERP is straightforward – to expose one’s self to the feared thought or situation, without doing any compulsive or avoidant response
When the student is ready the teacher will appear. You are now the student and it’s time to seek out the proper teachers. Teachers you can trust. I know how hard it is to see therapists and support groups when you’re feeling like staying in bed all day or the OCD symptoms are keeping you stuck at the bathroom sink, washing your hands for hours or checking the locks one more time or trying not thinking certain thoughts for fear it may harm your family. But, it’s time. It’s time to heal. It’s time to become willing to do whatever it takes to get well. It’s time to learn a new way of thinking,a new way of being and new way of trusting. It’s time to let in the awesome paradox of: when you let go of control, you can gain control and when you stop acting, the inaction will weaken the obsessions.
Laura Yocum BOYLE MACHLAN