Cheat Sheet

Managing OCD with CBT For Dummies Cheat Sheet

Obsessive-compulsive disorder (OCD) can be a highly distressing and disabling psychiatric problem. It’s characterised by unwanted recurrent, intrusive thoughts, impulses or images that cause marked distress. OCD is also characterised by compulsions — (often repeated) behaviours and/or mental acts in response to obsessions aimed at reducing distress or doubt or preventing harm to self or others. People with OCD often may also avoid triggers for their OCD or fears to avoid the distress of obsessions and the distress and time consumed by compulsions. Cognitive behaviour therapy (CBT) is the evidence based psychological treatment of choice for OCD.

Building a Profile of Your OCD

Just like any other problem, solving your OCD is far more productive if you define the problem well. Here are some of the key elements of OCD to look for and then target for change:

  • Your main fears, intrusive thoughts, images, impulses or doubts

  • Situations, people, objects or activities that you avoid because of your fears or obsessions

  • Compulsions that you carry out in your mind or in your behaviour in response to your obsessions

  • Ways in which you and/or others may have adjusted to or accommodated your OCD so you can try to get by in the short term

  • Ways in which you may practise perfectionism, black-and-white thinking or the need for things to be just so or feel right

  • Ways in which you tend to take significantly more responsibility than average for causing or preventing harm

  • Ways in which you may be intolerant of uncertainty

  • The meaning you attach to the unwanted thoughts and images that enter your mind

  • The importance you place on responding ‘appropriately’ to an unwanted thought, image, doubt or impulse rather than simply dismissing it

  • Ways in which you attempt to control or get rid of the unwanted thoughts or images that enter your mind

When you’ve defined the problem a bit more clearly, you can start to think about how you can turn things on their head and start to chip away at the mechanisms that are maintain your OCD.

Managing OCD with CBT: Putting ‘Pulling Yourself Together’ into Perspective

Before you can begin to manage your OCD with CBT, you first need to understand a few things about OCD. Research indicates that OCD is a problem connected to a number of different aspects your psychology:

  • Your emotional system, including fear, guilt, shame, disgust and depression.

  • Your memories.

  • Your habit system; all too soon, avoidance and compulsions become second nature.

  • Your mind’s natural tendency to err on the safe side to protect you from harm.

  • Your natural instinct to protect the people you care about or see as vulnerable.

  • Your natural human tendency to seek relief from discomfort. When your behaviour produces a reduction in discomfort, even if only in the short-term, that action is reinforced (and therefore more likely to be repeated).

This psychological mooring is why you can’t simply ‘pull yourself together’. Your mind has a nasty problem you need to help it recover from. So be kind, appropriately firm and persistent as you help rehabilitate your mind and get it fit and flexible again.

Acquiring Anti-OCD Attitudes and Action

OCD’s maintenance mechanisms have deep roots in your mind, which is why OCD tends to be a long-lasting problem unless you make a considerable effort to break free. It’s like asserting yourself against a bully; you have to be forceful and deliberate. That’s why you need to devise a plan that is actively anti-OCD to free yourself from OCD’s grip. Here are some tips:

  • Reduce and (most importantly) stop yourself from using the compulsions that you carry out physically and in your mind (called response prevention).

  • Deliberately face your fears and/or the triggers for your unwanted mental events — thoughts, images, impulses and doubts. Doing so helps you overcome your fears as you become more used to them and also gives you an opportunity to practise responding differently.

  • Understand that literally no one has control over the thoughts that pop into his or her head and that thoughts and images can just as easily reflect something that you don’t want to do as something that you do want to do.

  • Reinterpret your unwanted mental events as normal. Yes, even yours. Even that one.

  • Recognise that if a thought of disaster has occurred to you, you don’t have to take responsibility for preventing it from happening. Letting thoughts of catastrophe pass without checking or taking precautions is normal, not irresponsible.

  • Know that the thoughts that pass through your mind mean about as much about you as a cloud passing in the sky does. Some are nice, some nasty and some in between. Judging yourself on the basis of your thoughts is like judging the planet Earth on the basis of a cloud that you’re looking at. Yes, the cloud is a product (is part of) the planet, but it hardly gives you a good understanding of the nature of the place.

  • Allow any unwanted mental events, emotions or bodily sensations to pass of their own accord without engaging with them (for example, trying to stop, change, replace or get rid of them).

  • Restore confidence in your mind. Put trust back into the aspects of your mind that you may have come to mistrust: your morality, your memory, your judgment and so on.

  • Reclaim your lost hobbies, interests, activities, and relationships and fill the void left behind as your OCD reduces.

These steps have helped countless people with OCD before you. Stick with them, and they can work for you too.