Dr. Debra Kissen is the Clinical Director of the Light on Anxiety Treatment Center of Chicago.
Dr. Kissen specializes in CBT based treatment to children, adolescents and adults with a focus on anxiety and stress-related disorders, including OCD, PTSD, panic disorder, agoraphobia, social anxiety disorder, generalized anxiety disorder, specific phobias, separation anxiety disorder, compulsive skin picking, trichotillomania and other Body Focused Repetitive Behaviors (BFRBs). Dr. Debra Kissen applies the principles of evidence-based treatments while at the same time treating the whole person, with deep respect for the human spirit and the challenges we all face on our journey through life.
Dr. Kissen is a Clinical Fellow at the Anxiety Depression Association of America (ADAA) and is a Co-Chair of ADAA's Public Education Committee.
Step 1: See Through OCD’s Scare Tactics
OCD is the fear network of the brain sending a signal that something is wrong and needs to be done about it IMMEDIATELY. OCD only reports on feared consequences that are important to a person. For example, if somebody does not fear spilling water on the floor, OCD will not send the intrusive thought, “Oh no you spilled water. You must clean it up IMMEDIATELY”. On the other hand if someone does care about the safety of her family, OCD might say, “Oh no you left the stove on. You must go back and check IMMEDIATELY or the most important people in your life will die and it will be all your fault.” Similarly, if you care deeply about your family's well-being or your students safety, OCD may inject itself into your awareness with the thought “Oh no. What if I lose control and harm my children or students.”
My clients always ask me what it means about them that they could have such “horrible thoughts”. What I tell them is that somewhere within an obsession is the flip side of a core value. If OCD taunts you with images and thoughts about offending god, then religion must be important to you. If OCD reviews all the ways your family could be hurt, then your family is clearly one of your top priorities.
There is checklist of common intrusive thoughts that I find helpful to share with my patients. There are numerous thoughts on this list regarding losing control and acting out violently or sexually. Several research studies found that when this list is shown to a non-clinical sample of people, approximately 90 percent of those surveyed will agree to having experienced some of the intrusive thoughts.
When the non-clinical sample is asked how bothered they are by experiencing these intrusive thoughts, they are most often only mildly bothered by them. In contrast, when this same list is shown to individuals diagnosed with OCD, a similar percentage of the sample will agree to having experienced these intrusive thoughts but the big difference is how much distress these thoughts evoke for the OCD sample. For those meeting criteria for OCD, there will be a much higher level of emotional distress when these same intrusive thoughts surface.
What keeps OCD alive and well is not the experience of intrusive thoughts but actually one’s reaction to them. The more one dislikes experiencing intrusive thoughts and then tries to repress or fight with these thoughts, the greater the frequency of intrusive thoughts one will experience. The very act of trying to “not have” a bothersome thought guarantees its resurfacing. The only way to know if you are having or not having a thought is to think “Am I think about X” or “I better not think about X” which of course causes one to think about X.
So back to the question of why do those meeting criteria for OCD have such disturbing thoughts? Because they are human and to be human means one will experience freaky, odd thoughts. The human mind is constantly spinning around trying to find interesting problems to solve, in order to keep us alive. We don’t have the speed of the jaguar or the strength of a bear but we do have an all too powerful mind that is very good at planning for future challenges but also for tying itself into a knot. Freedom from OCD is not about stopping the mind from offering up strange and occasionally disturbing thoughts but learning how to recognize spam vs. urgent mail.
I must give a disclaimer here that OCD loves taking anything that is reassuring and turning it into a compulsion. So, if you are reading this blog for the hundredth time and desperately trying to figure out if this sounds like you and if your “awful thoughts” are OCD or if in fact you are an awful person, then STOP reading this blog. As I am sure your experience has shown you obtaining short-term anxiety relief through a compulsion comes at a cost in the form of greater overall anxiety. Instead, strive for long-term freedom from OCD by teaching your mind to not take itself so seriously.
Step 2: Exposure and Response Prevention (ERP)
There is no way past OCD except through it. As described in step one, the more one avoids an intrusive thought, the more one will experience the feared, bothersome, super annoying thought. Therefore, we need to flip the equation on its head and practice bringing on the thought while disengaging from any compulsions that have been utilized to obtain short-term anxiety relief. Common compulsions engaged in, when struggling with intrusive thought OCD are reassurance seeking, information seeking/googling to determine if there is something wrong with self, mental reviewing and avoidance. The best way to organize exposure tasks is by creating an exposure hierarchy that outlines baby steps that you can take to slowly but surely prove to OCD who is in charge (hint…YOU).
Step 3: Get Support
“Support” may sound superfluous but without it your Intrusive Thought OCD fighting plan will most likely be a bust. It is near impossible to do this work alone. It is not that you are not smart enough or determined enough or brave enough to beat OCD. The reason you need external support is because there is nothing more powerful in taking the wind out of OCD’s sails than voicing intrusive thoughts out loud, to a compassionate, informed coach. The same intrusive thoughts that feel so real, all powerful and self-defining when swirling around in your head will disintegrate when said out loud. When your intrusive thoughts are released into the world and your supportive coach looks back at you, and still sees the YOU they believe in and hears your intrusive thought as “blah blah blah” and possibly laughable, your brain will be one step closer to understanding that these thoughts are spam mail and nothing more.
In terms of finding a supportive OCD coach, you can contact a therapist that is well trained in CBT for OCD but if this is price prohibitive or if there is not access in your local community to OCD experts, there are other options. You can purchase a CBT for OCD workbook and go chapter by chapter through it with any licensed therapist in your community. You can schedule an appointment with one of ADAA’s OCD specialists who offer tele-mental health services. And it is perfectly acceptable to purchase a CBT for OCD workbook and go through the material together with a friend or family member.
So you now know the three basic steps necessary to kick intrusive thought OCD to the curb. And remember, we are all so much more than our thoughts. Our lives are defined by the actions that we choose to take, not by the electrical storm of thoughts that flicker through our minds.
Dr. Kissen and Dr. Ashley D. Kendall, PhD presented a live webinar on this topic on March 12, 2018 at 1:00 pm ET.
This webinar will share tips and tools to:
- Identify if you may be dealing with harm OCD
- Make sense of why harm OCD picks such painful themes and content
- Take the power away from harm OCD
- Re-engage in your life now that you are giving less of your attention and energy to harm OCD
Q: I was wondering whether or not I could get some ideas or suggestions for hierarchy items-exposure for fear of molesting their child-pedophile OCD. My clients fears are only related to her own children. Any suggestions would be appreciated.
A: Sample exposure hierarchy items for individuals struggling with pedophile OCD.
Sample hierarchy items:
- repeatedly saying out loud and writing “I am a pedophile” or “I am attracted to me child”
- imaginal exposure of sexually molesting her child
- imaginal exposure of sexually molesting child with all details leading to feared consequences (harming child, being ostracized and isolated and alone, not being able to live with guilt, etc) (downward arrow can help identify specific feared consequences for patient)
- looking at pictures of child (or other children) and saying or thinking “I am attracted to child”
- if client engages in compulsion of body scanning to see if showing physical sensations of arousal, combining exposure to images of child with thought “I am feeling sensations of being sexually attracted such as tingling or increased wetness” (whatever clients feared sensations)
- you can go with client to a park and stare at children and practice having the thought “I am a pervert and depraved and attracted to children”
And of course you will need to customize a bit for clients specific feats.