Step 1: Learning about anxiety
- No matter what type of anxiety problem you are struggling with, it is important that you understand the facts about anxiety.
Fact 1: Anxiety is a normal and adaptive system in the body that tells us when we are in danger. Therefore, dealing with your anxiety NEVER involves eliminating it, but rather managing it.
Fact 2: Anxiety becomes a problem when our body tells us that there is danger when there is no real danger.
- As an important first step, you can help yourself a lot by understanding that all of your worries, fears, and physical feelings have a name: Anxiety.
- Once you can identify and name the problem, you can begin dealing with it.
|To learn more details about anxiety, see What Is Anxiety?|
The next important step is recognizing that your anxiety problem is OCD.
Step 2: Learning about OCD
Research shows that people with OCD tend to:
- give unhelpful meanings to obsessions, and
- use unhelpful strategies to control obsessions.
- Everyone has unwanted or unpleasant thoughts sometimes; it’s normal.
- Just thinking about something won’t make it happen. For example, if you think about winning a million-dollar lottery, it won’t necessarily happen.
- Thinking a bad thought does not mean you are a bad person. It also does not mean that you want to do anything bad.
Unhelpful meanings given to obsessions
If everyone has unwanted thoughts from time to time, how come everyone doesn’t have OCD? It is because of the interpretation or meaning that you give to the thought. The meaning you give to an unwanted thought can turn it into an obsession, which happens much more frequently and with greater intensely.
For example, let’s say that you had the following unwanted thought: “What if I pushed someone into traffic?” If you said to yourself, “That’s a terrible thought! But I know that it doesn’t mean anything, and I know I wouldn’t do that”, then you would probably not develop OCD. On the other hand, if you said to yourself, “Why did I think that? Maybe this means that I am a dangerous person!” then you increase your chances of developing OCD: your interpretation of your thought as important, meaningful, and dangerous will make you have more of these unwanted thoughts.
Please see Unhelpful Interpretations of Obsessions sheet for detailed information on some unhelpful meanings commonly given to obsessions.
Unhelpful strategies to control obsessions
When you see your intrusive unwanted thoughts as threatening or dangerous and causing you a lot of anxiety, it is not surprising that you want to get rid of them! However, most of the strategies that you use to control your obsessions can inadvertently push you into traps that will make your OCD worse.
- Trap 1: All the strategies you use (e.g., checking, seeking reassurance, washing, avoidance) don’t work, because your anxiety only goes down for a short time and comes back again. But, because they do work in the short term, you are likely to use them again the next time you have an obsession. By doing so, you never get a chance to learn more effective strategies to manage your obsessions.
- Trap 2: Using these strategies also does not give you a chance to find out whether the meaning or interpretation you gave to the obsessions was really correct.
- Trap 3: These strategies produce the opposite effect you wish to achieve. That is, even though you hoped these strategies would help you to control the obsessions, they actually make you think about the obsessions even more often!
The vicious cycle of OCD
Let’s say you have an unpleasant thought (for example, having a thought of stabbing your spouse) that happens to “pop” into your head. If you attach unhelpful meanings to the thought (for example, “having this thought means I’m an evil person who is capable of murdering a loved one”), you will probably feel very anxious as a result.
Now, because it is uncomfortable to be anxious, you are likely to find ways to lessen that anxiety. For example, you may repeatedly check to make sure the drawer where you store all the sharp objects (e.g., scissors, knives) is locked and say a prayer to yourself every time you have the “bad” thought.
Unfortunately, you find that even though these strategies help you to briefly lessen the anxiety, you need to do them more and more often because your “bad” thought seems to occur even more frequently when you try hard not to have it. You feel trapped because you do not know what else to do but keep using these strategies! The next thing you know, your life is being consumed by the “bad” thought and your constant efforts to control it. This is how the vicious cycle of OCD develops and keeps going!
Step 3: Building your OCD Management Toolbox
The best way to begin managing your OCD is to begin building a toolbox of strategies that will help you to deal with your obsessions in the long run.
Breaking this vicious cycle involves: (1) Learning to gradually eliminate your unhelpful coping strategies (such as compulsions); and (2) Learning to think about your obsessions in a more balanced and helpful way.
Here are some effective tools to help you break the cycle of OCD:
ERP is done by:
- Exposing yourself to situations that bring on obsessions (triggers)
- Not engaging in the unhelpful coping strategies (compulsions or avoidance).
How to Do It
1. Get to know your OCD better
- To face your fears, it is helpful to know what you are thinking (your obsessions) and identify the triggers that bring on your obsessions and compulsions.
- You can do so by keeping track of the triggers on a daily basis for one week by using the Obsessive Fear Monitoring Form.
- Because obsessions can happen frequently, writing down 3 triggers per day (i.e., one in the morning, one in the afternoon, and one in the evening) will be enough to give you a good overview of your obsessions and compulsions.
- In the column labelled “Fear”, rate how intense the fear was in the specific situation. Use a 0 to 10 rating scale, where 0 = no fear and 10 = extreme fear.
- Finally, record all the compulsions/coping strategies you used in response to the obsession. Be sure to include both behavioural and/or mental strategies you used to manage the obsession and fear.
Here's an example to help you out
|Date||Triggers for Obsessions
(specific situations, objects, people, or thoughts that provoke obsessive fears)
|Nov. 30||Used the grocery store pen to sign the credit card receipt.||This pen is covered with germs from strangers. I could contract some terrible disease and pass it on to my children, causing them to be sick.||8||Scrubbed each finger carefully and washed for 3 minutes.|
Try to make an entry as soon as possible after the episode as this will help you to be more precise. You may want to keep a small notebook with you that you can easily carry around.2. Build a fear ladder
- After about one week of tracking your obsessions and compulsions, you are ready to make a list of all the different situations that you fear.
- Build a fear ladder by rank ordering your triggers from least scary to most scary. For example, if you have contamination fears, being at a friend’s apartment may be a situation that is low on the fear ladder because it only evokes a fear of 1/10. But, using the bathroom in a shopping mall may be a situation that is very high on the ladder because it evokes a 9/10 fear. See Examples of Fear Ladders for some ideas about building your fear ladder.
TIP: Build a separate ladder for each of your obsessive fears. For example, you may need a separate hierarchy for all situations related to your fear of contamination. You may also need a separate ladder for all situations related to your fear of causing something terrible to happen.
3. Climbing the fear ladder – Exposure & Response Prevention
- Once you have built a fear ladder, you are now ready to face your fears by putting yourself in situations that bring on your obsessions (exposure) while resisting doing anything to control the obsessions and the anxiety associated with them (response prevention).
TIP: Feeling anxious when you try thes exercises is a sign that you are on the right track!
How to do Exposure (see Facing your Fears: Exposure for more tips)
- Bottom up. Start with the easiest item on the fear ladder first (i.e., fear=2/10) and work your way up.
- Track progress. Track your anxiety level throughout the exposure exercise in order to see the gradual decline in your fear of a particular situation. Use the Facing Fears Form to help you do this.
- Don’t avoid. During exposure, try not to engage in subtle avoidance (e.g., thinking about other things, talking to someone, touching the doorknob only with one finger instead of the whole hand, etc.). Avoidance actually makes it harder to get over your fears in the long run.
- Don’t rush. It is important to try to stay in the situation until your fear drops by at least one-half (e.g., from 6/10 to 3/10). Also, focus on overcoming one fear at a time. It is a good idea to do the exposure repeatedly until the first item on the hierarchy no longer causes much of a problem for you.
TIP: Regardless of its intensity, a fear will peak and then level off. If you do nothing about it, the fear will eventually go away on its own.
How to do Response Prevention
- Resist the urge. In order for exposure to work, it is important that you try to resist, as much as possible, carrying out your compulsions during or after the exposure. The whole point of ERP is to learn to face your fear without having compulsions.
- Modeling. If you have been performing compulsions for some time, it may be difficult to know how to face a feared situation without doing them. In this case, it can be helpful to ask a family member or a close friend who does not have OCD to show you how to, for example, wash hands quickly or leave home without rechecking appliances, and then model their behaviour.
- Delaying and reducing ritualizing as an alternative. You might find it very difficult to completely resist a compulsion, especially the first time you are facing your fears. In that case, you can try to delay acting on the compulsion rather than not doing it at all. For example, after touching the floor (exposure), wait for 5 minutes before washing your hands, and wash for 1 minute instead of 3 minutes. Try to gradually prolong the delay, so that you can eventually resist the compulsion altogether.
- Re-exposure. If you do end up performing a compulsion, try to re-expose yourself to the same feared situation immediately, and repeat the practice until your fear drops by one-half. For example, Practice 1: touch the floor and wait for 5 minutes before washing hands for 1 minute. Practice 2: touch the floor again immediately after washing, and wait for another 5 minutes before washing for 1 minute. Repeat this process until your anxiety drops from, say, 6/10 to 3/10.
Two Keys to ERP: Gradual & Consistent!
- How to move on. Once you experience only a little anxiety when completing an exercise, you can move on to the next one. For example, after several practices, you might feel very little anxiety when you wait 5 minutes to wash your hands after touching the floor. You can then challenge yourself to wait for 8 minutes before washing your hands after touching the floor. Again, repeat this practice until your anxiety drops by one-half.
REMEMBER: It is O.K. to ask for help! Talk to a supportive person when you have the urge to perform a compulsion and are afraid that you can’t resist it. Ask this person to stay with you or to go somewhere with you until the urge decreases to a manageable level.
This technique is a good tool to use in combination with Exposure and Response Prevention to address the upsetting thoughts that are a part of OCD. See How to Effectively Manage Obsessions for more detailed information.
Because it is hard work to manage OCD, your progress will not always be smooth. Also, your OCD can be stronger when you are under stress. Therefore, it is helpful to develop a list of potentially stressful situations (e.g., argument with loved ones, extra responsibilities at work) that might make your OCD worse. Anticipate your stressors so you feel more prepared when they happen. It is also a good idea to actively reduce your stress and lead a healthy lifestyle. Please see Healthy Living and Problem Solving for helpful tips.
Step 4: Building on Bravery
Learning to manage anxiety takes a lot of hard work. If you are noticing improvements, take some time to give yourself some credit: reward yourself!
How do you maintain all the progress you’ve made? Practise! Practise! Practise! The OCD management skills presented here are designed to teach you new and more effective ways of dealing with your obsessions and compulsions. If you practice them often, you will find that your obsessive fears have a weaker and weaker hold over you. Learning to manage anxiety is a lot like exercise – you need to “keep in shape” and practice your skills regularly. Make them a habit, even after you are feeling better and you have reached your goals.
For more information on how to maintain your progress and how to cope with relapses in symptoms, see How to Prevent a Relapse.