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Obsessive Compulsive Disorder - OCD


OCD is a mental health difficulty that can affect people in all walks of life; it is a condition where a person can become caught in a loop, or cycle, of obsessions and compulsions. You could consider that the loop starts with an obsessive or intrusive thought, feeling or urge and that in order to feel better about that obsessive or intrusive thought or feeling the person feels a need to carry out a compulsive behaviour.

The problem with carrying out the compulsive behaviour is that this then 'feeds' the obsessive or intrusive thought, and so the process can begin again - obsessive/intrusive thought leading to a need to feel better by acting out the compulsive behaviour.

OCD loop diagram

Most people experience a degree of obsessive or intrusive thoughts at some point in their lives; usually when an unwanted thought comes along we may not even notice it, or we may think 'that's odd' and ignore it and move on. The point being that usually such thoughts are given no weight or 'power' and can be forgotten. For a person with OCD these thoughts gain power and are not easily ignored or forgotten; they affect the person's life, consuming their time and concentration.

Obsessive thoughts can present themselves in various different ways; Contamination, Harm, Control, Precision and Perfection, Unwanted sexual thoughts, Religiousness or Illness.

Usually the obsessive thoughts are understood by the person as being irrational, unwanted and disturbing. Having such thoughts lead the person to feel fear, disgust or other negative thoughts about themselves. 

In response, a person with OCD will want to try and do something to feel better about these thoughts, this compulsive behaviour is intended to relieve themselves of the fear, disgust or negative thoughts.

The specific 'ritual' or compulsion will depend on the obsession, for example an obsession about contamination may lead to compulsive washing, obsessive ideas of harm may lead to compulsive checking. Typical compulsions include washing and cleaning, checking, repeating, arranging, counting or confessing.

How I work with clients who experience OCD:

I use a form of Cognitive Behavioural Therapy called Exposure and Response Prevention (ERP).

'Exposure' refers to the way that we will carefully expose you to situations that can trigger unwanted thoughts and that can make you feel anxious. This can be done 'in-vivo' (actual exposure) or by using visualisation. Both methods require care to provide sufficient stimulus without causing serious anxiety.

By carefully experiencing these situations, it can be possible to learn a new way of responding when the compulsive behaviour is not done. Learning a new way of responding over a period of time is called 'habituation'. As you learn the new response more and more, so the associated anxiety or distress will gradually reduce; there his no 'cold turkey' or 'flooding' of the experience but rather a gradual change in response. 

Another approach that I use if ERP isn't working or if ERP isn't appropriate is Acceptance and Commitment Therapy (ACT). ACT works quite differently with OCD and focusses on helping you to notice the thoughts and feelings but not to give them any 'power' - "Oh that thought again, now what was i doing...". Central to this approach is the concept that thoughts don't make things happen on their own, so thinking about making a stone levitate is not sufficient for it to move - it would require a whole further mental process for you to decide you want to move the stone, to go over, pick it up, and then physically move it. Having a bad thought doesnt mean that something will happen. Accepting the thoughts and learning to not fight them takes their 'power' away.

With practice it can be possible to be aware of obsessive or intrusive thoughts but to accept them as being only that, and to get on with what you were doing. With time, the thoughts will lose their 'power' and become even less noticeable.

One difficulty that can occur is that when you learn to accept the thoughts, or learn to not respond to them, a different form of discomfort can occur - it may seem uncomfortable or 'wrong' to not fight the unwanted thoughts, or to not respond to them - this is not the same as saying the thoughts are ok, it's just that you are no longer fighting them.

The above information is just a brief introduction to ERP and ACT and there is plenty more depth to the two approaches.

Get in touch:

If you are experiencing intrusive thoughts, or if you are aware of experiencing obsessions and compulsions then please do contact me to arrange an initial discussion about how I can help you and what approach we might use.

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