‘Dater Analysis’ is a CBT therapist who works with people with anxiety and depression in the UK. She has been working with OCD for 8 years. On her blog, she writes about her experiences of dating and relationships, from a Psychological perspective.
A CBT Therapist’s Perspective on OCD
Have you every stood on a train platform and had an image of jumping in front of the train?
Or been driving your car and had a sudden urge to swerve into oncoming traffic?
Or been talking to a friend and suddenly imagined stabbing them?
If so, you are NOT alone.
Thoughts like the above, that just pop into your head out of nowhere, that are unpleasant, that you know you will never act on are known as ‘intrusive thoughts’. And most people experience intrusive thoughts – 90% of the population to be exact.
The first time I personally had an intrusive thought, I was about 12. I was talking to my best friend at school when an image suddenly came into my head of me strangling her. I was horrified. What did this mean? Why had this happened? Luckily, I soon learnt the answers to my questions.
I grew up in the 90’s when what was known as Teletext existed which could be accessed through the TV. It was on Teletext I used to read a problem page where, one day, the topic of intrusive thoughts appeared. The agony aunt on there said it was completely normal and that it didn’t mean there was anything wrong with you at all. I was so relieved and stopped worrying about my own intrusive thought.
However, some people who experience intrusive thoughts can become really distressed by them, and try and stop the thoughts or cancel them out. This is known as OCD.
Types of OCD
Some people with the anxiety disorder can experience intrusive thoughts which they might try to cancel out with ‘good thoughts’ (otherwise known as neutralising) or by trying to avoid thinking about them. Unfortunately, the more you try to avoid intrusive thoughts, the more they come. It’s a bit like if you try not to think of a pink polar bear – it’s suddenly all you can think about! The more you try to block out the thought, the more you have it.
For other people with OCD, it’s not so much intrusive thoughts. The obsessions might be doubts or urges to do compulsions like checking or cleaning or repeating behaviours. I think everyone with OCD has different and unique symptoms, but there are some common themes.
From an evolutionary perspective, it seems like intrusive thoughts are your brain’s way of pointing out danger. If you’re on a bridge and you have an image of jumping off, it’s your brain’s way of saying “you’re up really high, be careful.” If you are holding a new born baby and you have a thought about physically hurting it, it’s your brain’s way of saying “you’ve got a new baby you need to look after, make sure you’re careful”.
Some of our intrusive thoughts are of socially dangerous things, rather than practically dangerous. For example, if I’m at the theatre watching a play, and it’s a quiet, serious scene, sometimes I get an urge to run on stage and do a cartwheel!
These socially dangerous thoughts still have an evolutionary basis, like the thoughts of practical danger. This is because we’ve evolved from animals that need to stay in packs to survive, to share shelter, food, resources and reduce the risk of being eaten by a predator. This means we have an evolutionary desire to make sure our peers accept us – if we did anything that caused our pack to reject us when we were apes we would increase our risk of dying.
How I help with OCD
I’m a CBT therapist, and one of the problems I work with is OCD.
When we work with someone with OCD, one of the first things we do is map out the problem. We call this a formulation. It can help us understand what’s happening and how to help. The idea in CBT is that a mental health problem is caused by vicious circles between your thoughts, behaviour and feelings.
We would also do ‘psychoeducation’, which is explaining the psychology behind intrusive thoughts including how normal they are.
Then, a lot of the treatment would be ‘behavioural experiments’ – doing things to test out the beliefs about the triggers. We might also do ‘exposure response prevention’ (ERP). This means exposing yourself to the trigger, and preventing yourself from doing your usual compulsions. ERP might involve facing various triggers and not doing the compulsions.
For example, some people with OCD can have an obsession with contamination which causes them to engage in excessive hand-washing. We would start out with the easiest trigger, such as touching something that feels quite clean anyway like a new book. We would gradually build up to more difficult triggers, like touching the floor. Facing the trigger head on by not washing their hands after this might be really tough at first but over time it has a huge impact on overcoming OCD.
Usually, not doing the compulsion initially causes the person’s distress to go right up. Then, after a while, their distress comes down by itself, even without doing the compulsion. Over time, this breaks the association between the trigger and their compulsion.
With practice, these CBT techniques can chip away at the whole, big, vicious circle. They are less distressed by the triggers, and the triggers also happen less. Their mood becomes less anxious and distressed, and they can stop avoiding things.
We might do other things I haven’t described here, ways of lifting their mood, exploring and challenging their anxious thoughts. These techniques can include drawing pie charts, talking about probability and discussing past experiences.
OCD is a terrible illness. I have focused more on the technical side of it because I think some of the other guest posts on this blog have already done such a great job at describing what it feels like.
CBT is the main Psychological therapy recommended by NICE for OCD. We find it works really well and helps lots of people. However, it takes so much courage for people to even ask for help, and then even more courage to engage with CBT and face the challenges it brings up.
I’m really proud to do a job where I get to help such inspiring and brave people to get out of the grip of OCD, and get control of their lives back.
You can find Dater Analysis over at her blog: https://dateranalysisblog.wordpress.com/