By Carol Edwards and Sunil Punjabi
AS HUMAN BEINGS, we are complicated thinkers and can be affected by specific influences depending on the situation. We want to be sure that we’re okay, that our families are safe, even when that comes with some uncertainty. For most of us, this is fine, because naturally, we know certainty cannot be guaranteed. We live our lives accepting probability, and we take appropriate care to minimise risk (e.g., locking doors once before going out in the morning and at night before getting into bed).
When OCD interferes
However, when OCD interferes, emotion and conflict tend to get in the way of rational thought. One loses sight of reasonable mind and relies on feelings and guesses instead of facts. For instance, I remember having intrusive thoughts about something terrible happening to my family if I didn’t double-check all the doors and windows were locked. No matter how many times I checked, my anxiety would resurface and often reached uncomfortable limits. My uncomfortableness, to me, was evidence that risk was high, so I did the compulsion again to minimise the chance of harm occurring, and to feel safe. Without OCD, the thoughts might have puzzled me, briefly, but not where I couldn’t let them go. Instead, the thoughts stuck, and I found myself caught in the OCD trap. It felt like there was no way out of the spiral.
How insight plays a role
When we have good insight, it allows for a better understanding of different perspectives. For instance, if we believe our feelings are not evidence of facts, then our thinking style will be less judgmental. Rationally thinking about what might or might not happen and then influencing what we do next helps with sound decision making. For example, Mr X locks the door once before going to work; therefore, insight tells him that the chance of a burglar breaking in is minimal. He trusts that while he’s doing his job, the likelihood is that everything will be fine. Consequently, he accepts uncertainty based on the low-probability that something terrible could happen.
When OCD comes into play, however, it clouds insight, meaning the “feelings-versus-facts perspective” is hard to grasp. For instance, and in contrast to Mr X, I remember catastrophising, irrationally thinking that the likelihood of something bad happening was high. Subsequently, this not only made my anxiety worse, but it also had me believing there was an underlying “threat”. I was on constant alert, repeatedly checking the doors were locked to ward off perceived danger. I could not tolerate uncertainty because of my emotional judgement about what might or might not happen.
It can be helpful to identify that stress could be making things worse. An extra workload, moving home, problems in a relationship, new baby, and so on, can all add to everyday stressors. Acute stress or burnout can then cause strange sensations (such as depersonalisation) and erroneously have us think that our OCD thoughts and feelings are inconsistent with the regular OCD cycle. Even still, we’re left with the choice to stand back and put in some rational perspective or continue to make things worse with what-ifs and doubts about our state of mind.
Cognitive behavioural therapy helps to change thinking errors based on emotional reasoning and gives us the confidence to live with doubts and uncertainty. It sets the foundation for engaging in the systematic resisting of harmful compulsions. Exposure-response prevention (ERP) is the gold standard evidence-based treatment for this and leads to remission or much-reduced symptoms. One of my exposures was leaving the door unlocked and living with risk. It helped me see how my anxiety and emotional evaluation had been influencing my decisions. In my subsequent remission, I can lock the doors once now, and then walk away while accepting that certainty can never be guaranteed. Also, to see that should something terrible happen away from OCD, that mostly I would cope.
Medication (SSRIs or tricyclic antidepressants) can be helpful as an adjunct to ERP, especially when symptoms are moderate-severe. Medication alters brain chemistry to reduce symptoms, usually by up to 60%. ERP, on the other hand, actively alters brain chemistry (neuroplasticity).
Generally, we are complicated thinkers, but rationally, we manage risk in terms of probability. For those of us on the OCD spectrum, however, the symptoms interfere by introducing doubts and what-ifs; as a consequence, an emotional evaluation interferes with our rational perspective. Insight helps us clarify the difference between feelings versus facts; yet, extra stress can cause us to feel confused about what our thoughts and sensations mean. Cognitive therapy helps to change unhelpful thoughts, feelings and behaviours, and ERP is the active therapy that can lead to remission or much-reduced symptoms. Finally, medication is a helpful adjunct alongside active therapy.
unshackle is not about jargon or loudspeak. unshackle is not about lofty, unachievable dreams. unshackle is about you. Be it something as intimidating as a mental wellness issue, or something as simple as uncluttering your mind, unshackle is about you, dear reader.
Visit Sunil Punjabi at www.unshackle.in and quote CTE for your FREE counselling consultation!
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