Managing Obsessions: Helpful Strategies

It is normal to have unwanted or unpleasant thoughts sometimes; everyone has them. Several well-conducted studies have discovered that almost 100% of the general population has these types of thoughts, the same thoughts experienced by people with obsessive compulsive disorder (OCD). The simple difference is that most people without OCD aren’t bothered by the thoughts and can dismiss them. Whereas what happens in the brains of people with OCD is that they give a lot of meaning or interpretation to the thought. People with OCD tend to view an unwanted thought as meaningful, important and dangerous, whereas people without OCD tend not to interpret their unwanted thoughts in these unhelpful ways.

For example, let’s say that you suddenly have a thought, “What if I contract a serious disease from touching this doorknob at the shopping mall?

  • If you do not have OCD, you might say to yourself: “That’s a weird thought! I’m pretty sure that I can’t contract a serious disease just by touching a doorknob at the mall.” As a result, you would probably not feel anxious, and would go on about your day.
  • If you have OCD, you might say to yourself: “It’s possible for me to contract a serious illness from touching this doorknob, then give this disease to my loved ones and cause them to be very sick. What kind of person would I be if I didn’t wash my hands?” This thought would probably make you feel very anxious and engage in a compulsion, and the vicious cycle of OCD would start.

Therefore, an important strategy for managing your obsessions and OCD is to challenge the unhelpful interpretations of the obsession and replace them with more helpful ones. This tool is most effective when used in combination with Exposure and Response Prevention, or ERP (see the Obsessive Compulsive Disorder module for more information on ERP).

Learn to manage obsessions

Identifying your unwanted thoughts

  • In order to challenge some of the unhelpful interpretations you may give to your obsessions, it is helpful to first know what they are. The best way to do this is to start tracking 2 things: (1) your obsessions, and (2) the meanings or interpretations you have given to those obsessions. It is a good idea to do this on a daily basis for 1 week. Recording 3 obsessions per day (i.e. 1 in the morning, 1 in the afternoon, and 1 in the evening) is enough to give you a good overview of your thinking pattern. Use the Obsession Interpretation Form for recording.
  • In the “Situation” column, record the situation that brings on your obsessions.
  • In the “Obsession” column, record the obsessive thoughts you had in the specific situation.
  • In the “Feelings” column, record all the emotions you had when the obsession happened. Rate how intense these feelings were using a 0 to 10 rating scale where 0 = no emotion and 10 = most intense emotion.
  • Finally, in the “Interpretation” column, record your interpretations of obsessions.
To help identify your interpretations of obsessions, ask yourself these questions:
  1. What is so upsetting about this obsession?
  2. What does this obsession say about me (i.e. my personality)?
  3. What kind of person would I be if I didn’t do anything about this
    obsession?
  4. What might happen if I didn’t do anything about this
    obsession?

Here’s an example to help you out:

Date: Nov. 30      
Situation Obsession Feelings
(0-10)
Interpretation
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. Fear 9 Guilt 8 If I don’t wash my hands knowing that I could be passing on some terrible disease to my children, then I would be a terrible and irresponsible parent. Not doing everything in my power to protect my children is as bad as hurting them myself.

For more examples of unhelpful meanings commonly assigned to obsessions, see the Unhelpful Interpretations of Obsessions sheet.

Changing your unwanted thoughts

Once you know what your obsessions are and how you are interpreting them, you can start to manage them. Here are some tools to help you out.

TOOL #1: Know the facts

 

It is normal to have unpleasant or unwanted thoughts. Just because you have a particular thought doesn’t make it true or make you a bad person. These thoughts are annoying but harmless. One good way to manage your obsessions is to remind yourself that this is the case. You might imagine these thoughts like flies- irritating but harmless. If a few flies are buzzing around you, you can still engage in almost anything. So let these unwanted thoughts buzz about while you keep focused on your activity be it cooking, watching a movie, working, etc. Like flies you do not need to interact with them or give them any notice.

TOOL #2: Helpful thinking

 

Adults with OCD, like those with other anxiety disorders, tend to fall into thinking traps, which are unhelpful and negative ways of looking at things. Use the Thinking Traps Form to help you identify the traps into which you might have fallen, and use the Challenging Negative Thinking handout to help you with more realistic thinking (For more information, see Helpful Thinking).

TOOL #3: Challenge Questioning

Here are some questions to help you to come up with a more helpful and balanced way of looking at your obsessions:

  • What is the evidence for and against a particular interpretation?
  • What are the advantages and disadvantages of this type of thinking?
  • Have I confused a thought with a fact?
  • Are my interpretations of the situation accurate or realistic?
  • Am I using black-and-white thinking? For example, does making one small mistake (e.g.  misspelling a word) mean that I am incompetent and a complete failure?
  • Am I 100% sure that ___________will happen?
  • Am I confusing certainties with possibilities?
  • Is my judgment based on the way I feel instead of facts?
  • What would I tell a friend who told me this interpretation?
  • What would a friend say to me?
  • Is there a more rational way of looking at this situation

Here’s how we could challenge the interpretations given in the previous example: If I don’t wash my hands knowing that I could be passing on some terrible disease to my children, then I would be a terrible and irresponsible parent. Not doing everything in my power to protect my children is as bad as hurting them myself.

  • Am I confusing a thought with a fact?
    I am confusing my OCD thoughts with facts. Thinking about contracting and passing on a terrible disease won’t make this come true.
  • Am I 100% sure that I will contract a terrible disease by touching this pen?
    No, not 100% certain.
  • Am I confusing certainties with possibilities?
    I am confusing the possibility of contracting some terrible disease with certainty.
  • Is there a more rational way of looking at this situation?
    Absolutely. The chance of me contracting a terrible disease through using a pen in the grocery store is extremely low.
  • What is the evidence that supports the idea that I’m an irresponsible parent? Once, I was 30 minutes late picking my kids up from school. Another time, I forgot to bake cookies for an event at their school.
  • What is the evidence that does not support the idea that I’m an irresponsible parent?
    I am usually on time to pick them up from school. I check in with their teachers on a regular basis. I attend all the events (e.g. baseball games, dance recitals) that are important to my children. I have good relationships with them and I know what’s going on in their lives.
  • Is my judgment based on the way I feel instead of facts?
    Yes, I am most likely thinking the worst because I feel anxious.
  • What would I say to a friend who had this interpretation?
    It is impossible to protect our children from all harms. That is too much responsibility to take on. Also, not being able to protect them is definitely not as bad as hurting them.

After you have challenged your initial interpretation, you are then better able to give a more balanced meaning to your obsession. Here’s what a helpful interpretation might look like:
This pen might be covered by some germs, but the probability of it containing a terrible disease for me to contract and then pass on to my children is extremely low. I am not an irresponsible parent just because my children get sick, since they might get sick from time to time no matter what I do to protect them from it. There is more evidence indicating that I am a responsible parent than evidence suggesting that I am an irresponsible one.By trying to challenge your initial interpretations and replace them with more realistic and calming ones, you’ll find that you will also feel a lot better as a result. Use the Obsession Challenging Form (example) to help you with challenging and replacing your unhelpful interpretations.

 

REMEMBER: At first, you might find it very difficult to challenge and replace the old interpretations of obsessions. You might also have a hard time believing in the helpful interpretations that you came up with. This is normal and expected. Don’t be discouraged, and keep practicing. Similar to resisting your compulsions, the first time you do it is the hardest; it will get easier with regular practice. Your belief in the new interpretations will grow stronger as you regularly practice resisting your compulsions and challenging your unhelpful interpretations.

TOOL #4: Probability Testing. This method helps you to be more realistic about the likelihood of your worst fear actually happening.

 

How to Do It

a. First predict how likely something you fear will happen.

b. Then determine the steps needed to make your worst fear come true. For example, what events would need to take place for your home to burn to the ground, if you do not check the stove was off before going out.

c. Try to estimate the chance of each event happening. For example, what is the chance of you leaving the stove “on”? What is the chance of something being on/near the stove? What is the chance of the item catching on fire and spreading? Don’t worry about getting the chance numbers exactly “right” (for example, is it a 10% chance? 5% chance?); you only need to come up with what you think the chances are.

d. Calculate the overall chance of your worst fear coming true by multiplying together the chances of each separate event.

e. Compare this overall chance to your original prediction.

For example, you might feel that there is a very high chance (e.g. 99%) of causing your home to burn to the ground if you do not check the stove before going out. But what is the realistic probability of you actually causing your home to burn to the ground after looking at all the steps that would need to happen first?

Event Chance Overall chance
Stove "on" 1% 1%
Something on/near the stove 10% .1%
Item catches on fire and spreads 50% .05%
Smoke alarm fails to go off or takes several minutes to go off 1% .0005%
Fire department is delayed in responding 10% .00005%

After calculating the realistic probability of danger (.00005%), you can see that the likelihood of your worst fear coming true is actually much lower than your initial prediction.

REMEMBER: Just because you think something will happen, doesn’t necessarily make it true. This is why it is important to take a closer look at your thoughts and decide whether your OCD thoughts have been wrong or unhelpful.
Tool #5: Responsibility pie. This method helps you to challenge the excessive sense of responsibility you may have.

How to Do It

a. Write down how responsible you would feel if something you fear happened. For example, you might believe that you are 100% responsible if your child got food poisoning after having lunch at school.

b. Write down all the possible factors that might contribute to this bad event happening. For example, factors related to food poisoning might include the food producer, the packaging and the transport of the food, the store that sold the food, the functioning of the refrigerator it was stored in, the health and cleanliness of the person who prepared food at school, the cleanliness of the utensils, bacteria on your child’s hands at the time of eating, etc.

c. Draw a circle and mark off all the pieces of the pie according to the percentage you believe should be given to each factor.

d. Lastly, draw and mark off the percentage for which you are responsible in this outcome. How does this percentage compare to your original prediction?

Tool #6: Continuum technique. This method helps you to gain a better perspective of how “bad” you really are for having a “bad” thought. For example, you might believe that you are the most terrible, violent person for having thoughts about running over a pedestrian. To challenge this belief, you can list people who may fit on either end of a continuum. For example, “most gentle person ever” vs. “most violent person ever”. Then, try to determine where you may fit on this continuum. At first, you may put yourself at “the most violent person ever” end of the continuum. However, once you begin to think about people who have committed violent acts (as opposed to having violent thoughts), your position on the continuum might change.

Using this technique, you may also find that you are probably much harder on yourself than others. That is, you may believe it is okay for others to have a “bad” thought and not act on the thought, while it is NOT okay for you to ever have a “bad” thought, even though you also do not act on your “bad” thought.

For example:

Tool #7: Survey method. This method can be very helpful in helping you to challenge the need for certainty. For example, you can ask or “survey” your friends and family about how well they remember everything they read, or how well they remember whether a routine task was performed (e.g. locked the car doors, turned off the stove, etc.). Compare the survey results with your initial predictions.

 

Obsession Challenging - Example
Obsession Challenging - Worksheet
Obsessive Fear Monitoring - Worksheet