O.C.D. is the acronym for Opt-out, Consider, Decide. This is my self-applied technique for helping your child face their obsessions and to further assist them in resisting giving into compulsions during their exposures; or in any situation where they might find themselves being triggered.
How does this work?
Well first, when your child is faced with an obsession OPT-OUT provides him with an opportunity to step back and CONSIDER two options. These two options are to help him DECIDE clearly whether to (1) step back in to the irrational moment whereby he gives into the compulsion or (2) whether to stay out and resist doing this negative reinforcing behaviour.
What type of compulsions does O.C.D. help with?
All compulsions whether open, such as handwashing; or hidden ones which might be praying or mental reviewing.
Why is it important for my child to resist giving into compulsions?
It’s important because OCD sends incorrect messages that something is “wrong” or “doesn’t feel right”. This overwhelms your child with exaggerated gut feelings of fear and dread. When she gives into compulsions she finds relief from this type of distress. Yet, this is temporary relief, hence the term negative reinforcing behaviours.
So what is the best way to help my child use O.C.D.?
Prior to exposure, explain to your child that when he decides to OPT-OUT he gets the chance to stand back and see his unwanted thoughts in a way that is not influenced by own feelings or irrational beliefs. Make him aware that opting out gives him a brief moment of awareness in which to think about this. During this brief moment tell him he has two choices to CONSIDER – one, to DECIDE if going back in is the best choice since this will provide him with short-term anxiety relief, since he will be giving into his compulsion; or staying out and building distress tolerance. This means he resists the compulsion whilst agreeing to ride out associated anxiety until it begins to subside naturally, usually within 30-60 minutes, so it’s important your child is aware of this too. Let him know that O.C.D. is a practice goal for reaching his main goal, where the finishing line is recovery or much reduced symptoms overall.
So your O.C.D. strategy offers the chance to act very quickly, and before OCD wins the moment, is that right?
Yes, O.C.D. is a helping tool that supports your child through her EXPOSURE where RESPONSE PREVENTION is the aim, meaning the usual response (compulsion) is resisted for an agreed amount of time. As mentioned before, response prevention helps build distress tolerance, leading ultimately to habituation. Thus, the overall outcome during graduated exposures with ritual prevention can, and does, lead to recovery?
How can doubts and “what-ifs?” be dealt with?
When helping your child face her obsessions and she suffers the dreaded “what-ifs” one helpful thing to do is help her change her self-dialogue to mild exposure scripts. For example, “What if ______ (name fear) happens? to “Maybe ________ will happen, maybe it won’t, and I will live with that uncertainty.” Or, “I might have caused an accident; but nothing is certain, so I will ride out my anxiety until it comes down naturally.” Or, “Perhaps I left the stove on; on the other hand perhaps not, and if I did the house could set on fire, but I will live with the uncertainty of that whilst allowing my anxiety to subside.” Exposure scripts initially increase anxiety but with practice this does get better and the what-ifs and doubts start to become noticeably less.
What about magical thinking, any tips on this?
Remind your child that magical thinking gives her a sensation that makes her believe something could happen, but that a sensation isn’t evidence of this. Continue to remind her that intrusive thoughts do not convert to action. This tells her that there is actually no need to give into compulsions to “prevent” perceived danger or to “feel right”. One thing worthwhile thinking about when your child is faced with O.C.D. is that if she steps back in and does the compulsion, nothing bad will happen; and if she stays out and doesn’t do the compulsion, nothing bad will happen either. Basically, everyday occurrences happen, but not because your child had an unwanted thought about it.
So what if my child steps back in and gives in to the compulsion, what then?
It’s simple. Let him try again next time. There are no failures when your child faces his fears, just doing that alone is an achievement, and so with your encouragement he has a better chance of getting through his fears and reaching his recovery goals.
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