Can you identify a vicious cycle that applies to your thoughts, feelings and behaviour? Try to draw it out here.
Can OCD be treated?
In the last 20 years the
treatment of OCD has greatly improved and most people do make a good
recovery. The most important treatments are cognitive and behavioural
therapy (which will be described later in this guide) and medication.
Medication
This may be prescribed by your
General Practitioner or you may be offered the opportunity to see a
Psychiatrist who specialises in such disorders. The medicines most
commonly prescribed by doctors for OCD are antidepressant tablets,
which can be very effective in the treatment of OCD even if you have no
symptoms of depression. These tablets are not addictive and have few
side effects. They do take a few weeks to begin to work, so if you are
offered this type of treatment it will be a little time until you begin
to feel the benefit.
It is important to continue with the
treatment in these early weeks and to stay on the treatment as long as
your doctor suggests in order to maintain full benefit.
Cognitive and behavioural therapy
Your GP
may recommend this therapy for you. This approach helps you to tackle
what you think (cognition) and what to do (behaviour). Your doctor may
suggest you try some of the approaches we describe in this guide but if
you require further help you may be referred to a
specialist therapist, usually this will be a Community Nurse, Nurse Therapist or a Clinical Psychologist.
What can I do to help myself?
Research has told us that the most successful way to tackle OCD is by exposure with response prevention. This literally means that you must gradually face or expose yourself to the things or situations you fear, whilst at the same time preventing
yourself from carrying out your usual compulsive behaviour (checking,
cleaning etc). This gradual approach means that with each stage you
become less afraid of what used to trouble you and you learn by
experience that no disaster occurs if you stop your compulsive
behaviour.
Not all the examples in this guide will be exactly like your experience. Use the parts that you think apply to you.
How can I make facing what I fear easier?
Exposure
We know that if we can stay in a
situation where we feel anxious, gradually the anxiety will reduce -
our body becomes used to the situation and we no longer feel fearful.
This is called exposure and it will help us overcome our obsessions.
For the person with OCD however, facing things we fear may seem very difficult if not impossible.
Because
of this it may be helpful to break down into smaller steps the exposure
to situations or thoughts we find difficult. Begin by making a list of
all situations or thoughts you find difficult. Next make an ‘anxiety
ladder' where those situations that you only fear a little are at the
bottom and your worst feared situations are at the top. It may help to
look at this example:
Washing and cleaning
Mary has a fear of being contaminated by germs which she fears she may
pass on to her family. This has resulted in her restricting her
lifestyle and spending many hours washing herself and disinfecting her
home. She has made up the following anxiety ladder.
Most Feared
.....................................8. Going to toilet in public toilets.
................................7. Going to eat outside the home.
...........................6. Touching doors and objects outside home, eg at the supermarket.
......................5. Going to the toilet in friends house.
.................4. Eating at a friends house.
............3. Touching objects at a friends house.
......2. Touching own waste bin without gloves.
1. Touching own waste bin with rubber gloves on.
Least Feared
Mary
will begin her exposure therapy at step 1 (ie by touching her own waste
bin with gloves on) and gradually work towards step 8. She will prevent
herself from frequent hand washing at these times - (see Response
Prevention below). Are you able to list your own anxiety ladder?
Most Feared
............................................................................
....................................................................
............................................................
...................................................
.......................................
............................
..................
........
..
Least Feared
Most
people will at first feel greater anxiety when they begin to face the
things they fear and feel an urge to perform their compulsion or
ritual. The next section may help you deal with this.
How do I stop myself from carrying out the compulsive act?
It
is important to break the cycle of carrying out the compulsive act or
thought following exposure to the thing(s) you fear. This is called
Response Prevention. There are some tips in attempting this.
- Ask your family to help you by not
offering to reassure you by checking for you or by telling you that you
are not contaminated. Reassurance can stop you from confronting what
you really fear.
- Praise yourself for not carrying out the compulsion or neutralising activity. This is an important step forward.
- Keep
a note as you carry out the exposure therapy to show how your anxiety
begins to drop. For example, touching the bin with no gloves on and
without washing hands.
- Don’t substitute new compulsions for old ones. For example substituting rubbing hands continually for hand washing.
- If
stopping all compulsive behaviours at once seems impossible, try to
reduce gradually the time you spend on the behaviour or the number of
times it happens.
If you use this approach then gradually your anxiety will reduce.
How can I tackle negative thinking in OCD?
Sometimes
people get gloomy thoughts when they have OCD especially when they
begin to try and break the cycle of obsessions and compulsions by
response prevention. Typically these thoughts are criticisms of
yourself, for example, “I’m not a caring mother if I don’t check things
fully” or “I’m letting things get out of control I’m a failure”. These
thoughts lead to low mood and you start to feel unhappy. It is
important that you do not just accept these thoughts.
You need to find a more balanced view, try to:
- Identify these thoughts and low mood.
- Jot down the unpleasant thoughts you are having at the time.
- Try
and counter these thoughts by writing down arguments against them.
Imagine what you would say to a friend if they had such negative
thoughts about themselves.
- Concentrate on and remember the good things about yourself and your life, not the bad things.
How can I tackle compulsive checking?
Mark
had difficulty in leaving the house each day. He would check all
appliances at least 15 times. Perhaps you have a similar problem with
checking things all the time. The following example may help you
understand how to tackle this kind of problem:
- Write down all the things you check.
- Decide which is most difficult - make an ‘anxiety ladder‘.
- Starting with step 1 on your ladder (least difficult) decide how many times you will check - try the minimum you can.
- Begin with step 1 one day.
- When your anxiety about that stage is down to a low level move on to step 2.
Mark’s anxiety ladder looked like this:
Most Feared
.........................5. The doors
...................4. The windows
..............3. The gas cooker
........2. The lights
1. The taps
Least Feared
He
began with step 1. He would check the taps only once before he left the
house. At first he felt very anxious about this but gradually his fear
lessened. He then moved on to step 2, the lights ...... and so on.
How can I tackle obsessional thoughts where the compulsion is another thought?
Jean
used to get a picture in her mind of her daughter and the words “your
daughter is dead” would run into her head. She was so disturbed by this
that she would ‘neutralise‘ the thought in her mind by saying “she is
alive and well” and would picture her daughter looking fit and healthy.
She would then feel relief. This began to take up hours of Jean’s time
each day and made her very unhappy. She felt she must be a terrible
person. The picture seemed to get stronger and stronger.
Perhaps you have a similar disturbing thought that you spend time ‘putting right’ with another thought.
The
most important thing when tackling this problem is to break the cycle
of having an obsessional thought and ‘putting it right' with another
thought, ie neutralising. Here are some tips!
- Don’t try and get rid of the obsessional thought, just accept it.
We all have odd thoughts at times. Think to yourself that it’s just an
odd thought, it doesn’t mean anything, it doesn’t mean you are a bad
person.
- Do not neutralise to put the thought right - break that cycle.
- Jean tackled this by telling herself:
- recognise
that this is only a thought, it is only so upsetting if I give it too
much importance. The more frightened of it I am the more it will come
to mind;
- stop trying to put the thought out of my mind - just let it fade - don’t be afraid of it;
- never ‘put the thought right' by ‘neutralising‘ (that is saying in
my head “she’s alive and well”) this will just strengthen the cycle.
- Remember trying not to think a thought will not
help this, and can just have the opposite effect. Test this out - now
try not to think of a blue giraffe! As you can see for yourself this
just brings the thought of a blue giraffe to mind! The same goes for
your intrusive thoughts. Trying not to think of them may well bring
them into your mind.
In summary, how can I help myself overcome OCD?
- Carefully recognise your unwanted thoughts - obsessions, and the actions you take to put them right - compulsions.
-
Gradually face some of the things you fear. Work out an anxiety ladder to help you do this. Begin with the easiest step.
-
Do not carry out any compulsions to reduce or neutralise your anxiety when you are facing the feared situation.
-
Break the obsession compulsion cycle.
-
Challenge any gloomy or critical thoughts you may have about yourself.
Where can I get further help?
We hope you
will use the exercises suggested in this booklet. They may help you
overcome OCD and return to normal life. If you feel you are making
little progress or the problem is getting worse then seek help in
overcoming your problem. Your GP is the best person to talk to first.
Your GP may suggest a talking treatment or tablets or both. He or she
may suggest you see a mental health worker who can offer expert help
with your problems.
If you feel so distressed that you have
thoughts of harming yourself then visit your doctor as soon as possible
and explain to him or her how you are feeling. The following
organisations and help lines may also be useful:
Mind InfoLine Tel: 0845 766 0163
Samaritans Tel: 08457 90 90 90
Confidential support for anyone in a crisis.
Some useful books you may like to buy or borrow from the library:
Isaac Marks (1978). Living with Fear. McGraw Hill.
Judith Rapoport (1990). The boy who wouldn’t stop washing. Fontana.
Padmal De Silva and Stanley Rachman (1992). Obsessive Compulsive Disorder, The Facts. Oxford University Press.
Frank Tallis (1992). Understanding Obsessions and Compulsions. Sheldon Press.
Frederick Toates (1990). Obsessional Thoughts and Behaviours. Thorons.
© EMIS and PiP 2008 Updated: 23 May 2008
