Partner Assisted Rituals

As the work begins towards helping your spouse/partner, family member, or friend fight back against obsessive compulsive disorder (OCD) (or other anxiety disorders where outside individuals become involved in doing rituals for the anxious adult), many partners/friends/etc. start to feel excited that exposure and prevention response (ERP) can help their loved one get their lives back on track. They might even get so excited they decide to try to speed up progress by stopping all the rituals in which they and other family members (or friends or coworkers) previously have been involved. For example, you decide, “That's it, I’m tired of spending so much money on toilet paper, paper towels and soap for my husband. No more Mrs. Nice Guy OCD, I won’t do it anymore!” And you limit the household to 2 rolls a week and 1 bar of soap per month. However, while you’re definitely ready to take this next step, your husband might not be ready. Although one of the goals in managing OCD (and other anxiety disorders where accommodation {see Accommodating Anxiety} exists) is to stop all the rituals in which you are involved, it can be very overwhelming if you do this suddenly, without warning, and completely. Fortunately, anxiety experts have determined 2 methods that can work for many families in this situation: the all-at-once method or the gradual method.

ALL-AT-ONCE:

This method is also known as the “cold turkey” route. This works best for rituals that have not been occurring for long, or only occur in a few small areas. It can help if you imagine your partner/friend’s anxiety is like a bully bossing them and everyone else around, and is growing stronger by making others engage in rituals, day in day out. Everyone is being held hostage by your partner/friend’s anxiety. The best way to reduce anxiety’s power is by eliminating partner-assisted rituals once and for all. Cold turkey. No exceptions. Work with your loved one to set a date when you will start, and on that day remind everyone no more rituals! You can stick post-it notes or send everyone involved a text message to help remind them about this commitment. You might say the following:

“John is tired of his anxiety making us _____ (insert ritual) all of the time. Its going to be hard for him, but he doesn’t want us to feed his anxiety and help it grow, which is what happens when we  _____(insert ritual). So from now on when he asks us to _____ (insert ritual) please do not do it. Thank you!”

GRADUAL:

This method works best for rituals that have been a longstanding problem and occur in more than one area of your loved one’s life, or for people that find the idea of a “cold turkey” approach too hard. You can use the Facing My Fears Exposure format with your loved one to gradually roll back his/her need for partner-assisted rituals in a step-by-step, planned and predictable way. Just like in the “cold turkey” description above, you can remind your loved one his/her anxiety is like a bully bossing everyone around, and that you’re tired of it holding everyone hostage. Work together with your loved one to create a multi-phase plan to get rid of his/her need for partner-assisted rituals. This process might look like this:

Phase 1: Your partner/friend/etc. will agree to seek and receive a set # of rituals per situation or daily. This will be based on how much s/he is typically receiving. For example, if s/he requires 8 “checks” per day, drop it in half, or if there are 4 key situations in which rituals are requested, try for only 2-3 situations.

Phase 2: After approximately 1-2 weeks with success in Phase 1, your partner/friend/etc. will be ready for further reductions. As in phase 1, this will be based on how much reassurance s/he was previously seeking. Trying cutting the amount in half again, or reducing it by some fraction. 

Phase 3: Continuing to use the Facing My Fears model, this phase will move your partner/friend/etc. forward to the ultimate goal of no rituals at all once s/he has been successful for several weeks in Phase 2. While Phase 3 can be hard, it is certainly possible to eliminate all rituals. Review the All-At-Once approach in the above section for more ideas. Although your partner/friend/etc. may become upset at first, remember that s/he has many tools in his/her My Anxiety Plan (MAP) to cope. 

What to expect:  When you begin to reduce partner-assisted rituals your partner/friend/etc. will probably be quite anxious. In fact, s/he might become angry or frustrated, and even say or do things not typical for him her. This is normal. It is important that if you have decided NOT to do a certain ritual, that you stick with it. Anxious adults often get upset or even angry when their loved ones first stop participating in the rituals the way s/he has come to expect. In fact, you might view these outbursts as the OCD getting angry that you and your partner/friend/etc. are no longer behaving in the way OCD has come to expect. Fortunately, if you keep at it, and stick to the plan, your loved one will be able to manage without you engaging in the ritual, and OCD will start to get the message that the family/friends/coworkers will not be bossed about anymore. During this early phase it is important that you give your partner/friend/etc. as much attention and support as possible in other ways. This can help them when they must tolerate your refusal to engage in a ritual when the OCD demands peak. It can also help you to feel more confident about what you are doing if you can recall positive interactions with your partner/friend/etc. earlier in the day, and/or make a plan to do something fun later on that day.

Tips for Success

 To maximize success consider these guidelines:

  • Identify the 4-Ws: What, When, Where, and Who: Be clear with your partner/friend/etc. what OCD partner-assisted ritual you are targeting, when you will target it, where, and with whom. For example, “Jen we have agreed that I will not wash my hands (what) before I cook dinner (when), at home (where), and this includes anyone else who helps me cook such as your sons (who).”
  • Get everyone on board: If you plan to stop partner-assisted rituals, it is important that everyone in the life of your partner/friend/etc. agrees: if s/he can easily get someone else to do it, then this strategy will not work.
  • Make sure your partner/friend/etc. understands and agrees with the plan: When s/he is calm (not experiencing anxiety) explain what the plan is and why you are doing it. Include him/her in designing a My Fear Plan, if you decide to go the gradual method
  • Be consistent: If you give in to the demands for participation in a ritual of your partner/friend/etc. even once, his/her OCD has learned a powerful lesson: “If I persist and ask enough I’ll get what I want.” This will strengthen the OCD. Be strong- stick to the plan.
  • Use rewards: It can be hard for your partner/friend/etc. to tolerate a reduction and eventual elimination of partner-assisted rituals, so providing them with some extra motivation can help. Review the Rewarding Bravery tool for more ideas.