Self Help -> Anxiety

Obsessive Compulsive Disorder (OCD)

Face your fears

When something makes you feel anxious and upset, common sense tells you to avoid it. In this case, common sense is wrong! If you stay in a situation where you feel anxious, slowly but surely the anxiety will ease off. You will feel better. Your body will get used to what is happening.

This is called exposure. Facing up to a situation helps you to challenge the fears and doubts you have about it. Each time you do this, you will become more sure of yourself. You will learn better ways to cope with the way you feel.

Facing your fears step-by-step

At first, facing up to your fears can seem very hard to do. You will likely feel worse in the short term. But, in the long term you will regain control. The best way to tackle your OCD is to face things one-step at a time. Break down the challenges. This way, it is easier to manage.

It might be helpful to make a list of all the things that worry you. Think about the list you have made and use it to make an 'anxiety pyramid'. Things that only cause you a little anxiety should be at the bottom of the pyramid. Put your worst fears at the top.

Before you start to face each fear, prepare for how you will feel. You can do this by practicing relaxation and thinking of positive things you can say to yourself for e.g. "I can cope with this" and "I feel terrible just now but this will pass, I'm not in danger."

MOST FEARED

8 ______________________

7 _________________________

6 _____________________________

5 ________________________________

4 ___________________________________

3 ______________________________________

2 ________________________________________

1 ___________________________________________

LEAST FEARED

The first step

Now that you have made your pyramid you can start to face your fears. Start with step number 1. Practise doing it until you notice your anxiety lessen. You will likely have to try each step several times. It is a good idea to write down how anxious you feel each time. Rate it from 1 to 10 (with 10 being the most anxious). This will help you to see how your feelings are changing.

Don't be tempted to move on to the next step until you feel able to cope with the first one.

It might help to think about an example.

  • Alison has a fear of contamination. She worries that she will pick up germs and pass them on to her family.
  • The first step on her anxiety pyramid might be touching her front door handle without gloves or a hankie to cover her hands.
  • Alison would practice touching the handle until she no longer felt anxious. She will also fight the urge to wash her hands afterwards.
  • At first, her anxiety will be at level 10 but the longer she keeps her hand on the door handle the better she will feel. The anxiety will ease off.
  • When Alison feels at ease with this step she will move on to the next challenge.

At first, you will find facing up to the things on your list very hard. You will feel very uneasy. This will mean that you will have a strong need to carry out a compulsive act. It is important to break this cycle.

Response prevention

To break the vicious circle of OCD you must fight the urge to carry out your compulsions. This is not easy. At first, you might feel that you need reassurance from friends or family that everything will be ok.

Think about Alison's example - she might feel better if she asks her husband to tell her that everything is ok. But, this will only make her fears stronger in the long run. To feel more confident you must practice coping well by yourself

  • Ask your friends and family to help by not taking part in your compulsions.
  • It is important that no one reassures you.
  • Take your time and try not to be hard on yourself.
  • Make sure that you don't replace old compulsions with new ones. If you usually have to wash your hands make sure you don't replace this with hand rubbing.
  • If you find stopping the compulsions impossible, try to cut them down in small steps. For example, if you must wash your hands after touching another person, try to do it for less time, use less soap, use cold water instead of hot.

Challenging Negative Thinking

As well as changing how you act, it is important to fight the negative thoughts that keep OCD going.

You will likely find that the negative thoughts get worse when you begin to fight your OCD. More often than not, they are criticisms of yourself - "I'm a failure." or "I must be a terrible person for thinking like this." or "Nothing works, I'll never be able to control this."

These thoughts are part of the vicious circle. They lower your mood and make you feel tense. This makes it more difficult to tackle the obsessions.

Here are some things you can try that will to help you to control your thoughts

  • Write the thoughts down in a diary. Write down how they are making you feel. This will help you to see if there is a pattern. It will be easier to control the thoughts if you know what triggers them.
  • You will find that your thoughts are biased. It is important to come to a more balanced conclusion. Think of a 'Big Challenge Thought'. If your thought is - "Nothing works, I'll never be able to control this." - come up with another way of looking at it - "I can learn to deal with this". Find evidence to support your positive thought. Can you think of a time when you have coped well with something else?
  • Look at the evidence on both sides. Don't assume your negative thought or obsessive worry is true. Rate how much you believe in the thought (0-100%). Then, after looking at all of the evidence, re-rate how strong your belief is. Is it a fact or just what you think?
  • Put yourself in someone else's shoes. What advice would you give a friend in your situation? How might someone else see you or your situation? Ask people that you trust what they think. Use what they say to help you to reach a more balanced view.
  • Face your fears! Be prepared to go into difficult situations on your list by relaxing and controlling your breathing. Think positively; think "I am in control." Negative thinking feeds the worry
  • Try not to be too hard on yourself. Think about what you can say to yourself that is more helpful and less worrying.

What if my thoughts are compulsions?

Sometimes obsessive thoughts are followed by thoughts to 'put them right'. Instead of acting out a compulsion you may try to think 'good' thoughts to fight the obsession. An example of this might be thinking "I am a good person, I would never hurt anyone" after thinking about hurting a friend or relative.

  • Accept the thought - don't try to put it right. Don't try to stop thinking about it. If you are told stop thinking about a pink elephant all you can think about is a pink elephant! Let it pass.
  • You are worried about what that thought means. You might think it means you are a bad person. You might think you are going crazy. Challenge this kind of thinking. Weigh up the evidence - Are you really a bad person? What do others think? What else makes you a good person? Thoughts are not the same as actions. We can't always control them.
  • You will have good days and bad days. Don't let bad days set you back. Take things one step at a time. Give yourself credit when you cope well.

Preparing for the challenge - Relaxation

To tackle your OCD you will have to face your fears. You will have to challenge your obsessive thoughts. It is important to think about how you will prepare for this. You will feel very anxious and uncomfortable when you first begin to tackle your OCD.

Learning to control your breathing will help you to cope better. In situations that make you feel very upset and tense your body will be going into overdrive.

Feeling prepared will help you to feel more in control. If you can control your body it will be much easier to tackle the thoughts that worry you.

  • Take a breath in and think "1".
  • Breathe out and think, "relax".
  • Take a breath in and think "2".
  • Breathe out and think, "relax".
  • Repeat up to 10 and then back down to 1.

Concentrate only on breathing and the number and on "relax" in the mind's eye. Use slow normal breathing (10-12 breaths a minute). Breathe in through your nose. Purse your lips and breathe out slowly through your mouth. Practice this breathing technique and use it to help you relax when you feel anxious.

In Summary ...

  • Prepare - practice relaxation, control your breathing.
  • Face what you fear - don't avoid things.
  • Don't rely too much on others - practice coping by yourself.
  • Work hard to stop yourself carrying out compulsive acts when you feel anxious.
  • Challenge any negative or compulsive thoughts.
  • Don't be too hard on yourself - focus on what you can cope well with.
  • Take your time, take things step-by-step - you will have good and bad days.
  • Talk things through with someone you trust.

What if I have other problems because of my OCD?

Living with OCD is very stressful and you may cope by drinking more alcohol or smoking too much. People with OCD can also suffer from other mental health problems like depression, poor sleep, panic attacks or anger problems.

The strain of living with OCD often leads to a breakdown of relationships within your family, work and social life. All of these problems feed into the vicious circle and make it harder to break.

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