by Patrick McGrath, PhD

My newest way to explain OCD to a patient and family.

I love trying to come up with new ways to explain OCD to new patients and families. In my 20 years of treating OCD, I like to think that I have honed in on it pretty well, and thought I would share it with all of you. I would appreciate your feedback and would love to hear if you use it with your patients and how it went.

Here we go.

OCD: Hey, just remember to not think about X anymore, OK? As long as you do not think about it, picture it in your head, or have any urges to do X, then you are I are good.

Me: OK, do not think of X. Oh darn, I just thought of X.

OCD: Hey, I told you not to think of X, and you just did what I told you not to do.

Me: Well, it is pretty hard not to think of something when you are told not to think of it.

OCD: Not my problem. OK, so now that you thought of X, you have to do something so menial and ridiculous, to my standards of course, until I am satisfied that you are not really wanting X to happen. Begin.

Me: I really do hate you OCD.

OCD: Do not really care, but if you anger me, there will be even more menial tasks and ridiculous behaviors that I will make you do until I am satisfied. Believe me, you do not want to experience me unsatisfied. I will really (*9%%&&%) you up if you do not satisfy me.

Me: Sorry OCD, you are right, I will do whatever you say. Please let me know when I have finally satisfied your needs.

OCD: OK, will do……….keep going……….just a little more…….Oh, you were so close, but that last time was just a bit off, so you have to start all over again.

Me: Darn, really?

OCD: DO not piss me off!

Me: Sorry OCD, I will do as you wish.

OCD: OK, keep going, almost there, YES! You did it. Congrats, now, don’t you feel better? I knew that you would. Boy what a relief. Now, just remember, don’t think of X and we are good.

Me: X. Darn , I thought it again……

When I play this out in my funny voices in front of patients, they initially think I am a bit odd, but after a few minutes of this, the family members all start to look at each other and you can see the nods of recognition that, hey, maybe this guy knows a little bit about what OCD is.

That has been my hook recently, and it has worked well. Then I go for the treatment explanation, which I have tried to really simplify as well – here it is.

Dr. PBMc: You have only a few things that you need to do to not pay attention to OCD anymore. Notice, I did not say get rid of it – we have not figured that out yet, but you can get to the point of just not caring about it. Here is what you do. Go with your second thought.

Patient: What does that mean?

Dr. PBMc: Your first thoughts are anxious and OCD thoughts. But, they are just automatic thoughts and there is no need to actually pay attention to them. For example, I can think about punching the wall right now, but it does not make me do it. I could really care less about my initial thoughts to most things, and I want you to get that way about OCD related thoughts, images, or urges.

Patient: Can I do that?

Dr. PBMc: Sure, you do it all the time. I bet you have tons of automatic thoughts that you do not follow through on daily. Heck, I thought about ramming at least three cars on the way to work today, but I still have not done it yet in my 31 years of driving.

Patient: But that is different, you do not have OCD
Dr. PBMc: OK, and find me one news headline that says that a person with OCD actually went and did the thing that they fear.

Patient: I have never seen that.

Dr. PBMc: Good, so the first thoughts do not make things happen, so we can go with our second thoughts.

Patients: How will we do that?

Dr. PBMc: Exposure and Response Prevention
Then you can launch into your favorite ERP rationale and explanations.

About the author: 

Patrick B. McGrath, PhD, is the Assistant Vice President of Residential Services for AMITA Health Behavioral Medicine Institute. He is the Executive Director of the Foglia Family Foundation Residential Treatment Center and the Clinical Director for the Center for Anxiety and OCD and the School Anxiety / School Refusal Programs at AMITA Health Alexian Brothers Behavioral Health Hospital. He is a member of the Scientific Advisory Board and the Conference Planning Committee of the International OCD Foundation, as well as the President of OCD Midwest and Anxiety Centers of Illinois. He is also a Conference Reviewer for the Anxiety and Depression Association of America (ADAA) and a member of the Speakers Bureau and Conference Planning Committee for the Association for Behavioral and Cognitive Therapies. He is the author of a stress management workbook called “Don’t Try Harder, Try Different,” as well as “The OCD Answer Book,” and has been featured on radio and TV stations across the country, including National Public Radio and PBS. He was also featured on the Discovery Health Channel’s Documentary “Anxious,” and on three episodes of “Hoarding: Buried Alive,” for The Learning Channel. Dr. McGrath lectures internationally on the treatment of Anxiety Disorders.