Obsessive-Compulsive Disorder (OCD) is an anxiety disorder wherein a person has obsessive, worrisome thoughts that are persistent and highly distressing. The OCD sufferer deals with these thoughts by engaging in some compulsive behaviour or thinking ritual, which temporarily reduces the anxiety. The problem with this strategy is that the individual develops the strong belief that her compulsive behaviour is actually helping prevent some unwanted future catastrophe and thus, leads the person to develop a strong link between the obsessive thought and the behavioural compulsion.
For example, a person may develop a fear of contamination and may come to believe that touching certain objects, such as door handles or other people, can transfer germs which could lead to a serious illness. To manage this obsessive, anxiety provoking thought, the individual washes her hands repeatedly, thereby reducing the person's anxiety because she believes she has lessened the likelihood of becoming ill.
There are several strategies one can use to reduce OCD thoughts and behaviours:
Exposure and response prevention is key. ERP is the gold-standard method for treating OCD. It is based on the same principal used to treat all anxiety disorders, namely, if you expose yourself to your anxiety provoking stimulus, your body cannot continue to produce high doses of adrenaline indefinitely and eventually, your anxiety will reduce, even though you are still being exposed to your feared object. Eventually, over time, the person begins to pair the idea that they are in front of their feared stimuli but it is not producing the same effect, thereby diminishing its power to create anxiety.
Exposure and response prevention is exactly what it sounds like. You and your therapist could put together a list of feared objects, such as touching door knobs, shaking hands, and touching a garbage can. They would rank these in order of least to most distressing, and then slowly work through the list.
For someone with a fear of germs, they could start with a low anxiety provoking item, such as touching a new Kleenex from the box. They would be required to rub it on their clothes and face and tell themselves that they are being contaminated. They would also be required to not wash their hands or clothes. During this task, the person can be breathing slowly and deeply and adopting an attitude of "bring it on!" to the anxiety. This reduces the person's fear. If the person repeats this task, their anxiety will diminish over time. At this point, they would move on to the next item on the list.
Change the obsession into something else less threatening. If the person fears germs, they could sing that out loud, "I am covered in germs, la, la, la". They could say the fear in a robotic voice or say, "Hey, there is that OCD thought again". They could also draw their fear in a silly way or dance whenever they have the obsessive thought. All of these actions distance oneself from the fear and reduces the anxiety because you are taking power away from the fear.
Worry time works. Whenever you have an obsessive thought, say to yourself "I will wait until worry time". Then, schedule 15 minutes a day where you sit comfortably somewhere, start with some deep breathing for a few minutes, and then let yourself worry as much as you want. Finish with a few more minutes of deep breathing. Delaying is a good strategy to tackle worrisome thoughts.
Lean into the worry. What most people do when they are scared is try to do something to distract themselves, which only alleviates their worry for a short time. It is important to adopt the mindset of a fearless person and if you are having an obsessive, scary thought, say out loud, "Come on fear, do your best to scare me!" This type of statement will make you feel stronger and more empowered.
Here is a book I recommend to all my OCD suffering clients:
