Learning to manage the thoughts of the Purely Obsessional Form of OCD means learning to do the exact opposite of what your emotions are pushing you to do. What follows is an excerpt from my book which gives examples of how I learned to apply Exposure and Response Prevention/ERP to the intrusive/unwanted thoughts of my Pure O – OCD.
NO MORE GHOST BUSTING: LEARNING TO TOLERATE THE PRESENCE OF INTRUSIVE THOUGHTS
My favorite ghost story is also a true one. (Just here, you might want to shut off the lights and fire up a few candles for effect and then brace yourself!)
One night many years ago I was awakened by the most eerie sound I’d ever heard. As first I thought I was dreaming as I became aware of a strange high pitched moaning that seemed to undulate in pitch in an almost melodic way. Within a few moments I was fully awake and made the rather unsettling discovery that the sound was actually real and also seemed to be quite near. Mere seconds later I was relieved to discover that the sound was actually coming from the other side of the bed and more specifically from my husband, Dennis, who was lying on his side curled up into a tight ball. I sat up, leaned over to watch him for a couple moments of entertainment, but then becoming more and more aware of the cartoon like quality of the sound coming out of him, I started cracking up. He sounded just like a ghost from a Scooby Doo episode. My laughter woke him up and as he turned over he too began to laugh hysterically.
It took some time before we were able to compose ourselves enough to talk about it. Finally, I was able to ask him what he’d been dreaming that prompted him to make those strange noises. He told me that he’d been dreaming that a ghost was floating above the bed and howling at him. But when he woke up he realized that he was the one making the sound effects in his own dream, which was hilarious to him. Basically, he’d spooked himself. We had a really hard time getting back to sleep afterward because just as one of us would gain some measure of composure and finally quit laughing the other one would start up again. We even woke up the kids who wanted to know the following morning; “just what the heck was so funny last night?”
Years later when thinking about my OCD I came to view my unwanted obsessions in a similar way. They seemed like ghosts or phantoms of my own making which, just like my husband’s dream, had been created by my own brain. The difference was that there was nothing funny about them and rather than being able to laugh about them I had cowered in fear and viewed each and every one of them as serious concerns. As I learned more and more about ERP it dawned on me that I needed to treat them in the same way we’d treated my husband’s “ghost” all those years ago.
The difficulty in doing this with OCD obsessions is that they feel horribly scary and threatening. Never the less I had to learn to treat them as if they weren’t, even while I was in the midst of experiencing intense anxiety. From then on when an intrusive thought would begin to plague me, I started to practice treating it like a silly cartoon ghost. Instead of hiding from it through avoidance or employing ghost busting techniques through rumination, I would instead visualize allowing the thought/ghost into my brain and offering it a seat while doing my level best to ignore it. I could imagine my intrusive thought as an actual ghost sitting there and doing everything imaginable to try and get me to freak out. There might be all sorts of howling threats, each one creepier than the last. But no matter how much it tried to spook me I would refuse to flinch or give it any attention what so ever. If its main goal was to scare me then I wouldn’t give it any satisfaction. No matter what tactics it employed I’d just smile at it and say; “Whatever!…….. I really don’t have time for your shenanigans right now.”
THE FORMULA FOR THE GHOST ANALOGY
- The Obsession = The appearance of the ghost. (Uncontrolled event)
- The Anxiety = The fear response to the haunting nature of the obsession. (Uncontrolled event)
ERP: Applying the brakes = “No more ghost busting”; so that I don’t engage in:
- The Compulsion = Applying any ghost busting tactics through mental rumination, argumentation, avoidance, problem solving, checking my emotional response or any kind of reassurance seeking behaviors or rituals.
So in order to apply this analogy we have to learn that when our OCD ghosts say “Boo” we must stand firm and refuse to flinch and make room for them in our consciousness even though to do so feels horribly wrong.
WELCOMING THE GHOST – TAKING IT UP A NOTCH WITH IMAGINAL EXPOSURE
Learning to tolerate the presence of intrusive thoughts by ignoring them is a very effective form of exposure, but in order to really habituate my brain to the thoughts so that it stops over reacting to them I found that I had to learn to do a form of imaginal exposure which meant taking ERP up a notch.
With imaginal exposure instead of just ignoring the “ghost” of my OCD obsession I’d have to invite it in and even encourage all its spooky howls and threats. I pictured this imaginative scenario in my mind about a university named; “Caspers Academy of Studies in the Art of Spectral Haunting”. I imagined that as part of the general requirements at this college, each “student” would have to pass a final test by being assigned to a human. In order to pass the test they’d have to illicit an obvious terror response from their human victim that would be outwardly observable by the human either screaming in terror, hiding or attempting to drive the ghost away through “ghost busting” tactics. For my analogy purposes the ghost assigned to me would be represented by my Pure O intrusive obsession. But in applying ERP I was determined to not only cause my ghost to fail the test, I was also going to humiliate IT, (as in intrusive thought), in the process.
Here is how I applied this analogy to one of my obsessions:
- Obsession – “What if I stay clinically depressed for the rest of my life?” I’d been fighting against this thought for months to the point where even just hearing the word “depression” would cause an intense fear response. If I saw a TV commercial about depression I’d feel like I was going to pass out.
- Anxiety Response – “OK… I’m aware that my brain has just latched onto this right now because of the excess adrenaline in my system. I know this is due to the chemical imbalance in my brain and therefore my brain needs something to be upset about in order to expend all that excess energy on. That’s the reason this thought is making me feel so uncomfortable.”
Note: Just being mindful of why the anxiety is there does not make it go away, it just helps to acknowledge its presence as part and parcel of the disorder. Expect and accept it.
- ERP/ imaginal exposure: Welcoming the “ghost” in and mocking its haunting efforts:
So in floats my OCD ghost with horrid howls and threats of how I might have to spend the rest of my life in a state of hopeless despair and depression. Every time it howls out the word, “DEPRESSION!” it feels like a knife to my gut. But I’m determined not to let it know that I find it even the slightest bit frightening. As it rises up and spreads itself out over the top of me, baring it’s ugly decayed teeth, I take a step toward it. Then I take a step to the side and gesture for it to come on in and have a seat in the house of my mind. Then I pull up a chair right next to it, pat it on the shoulder and say, (with a condescending tone): “Really is that the best you can do? Why it’s such a shame that you obviously haven’t gained much expertise in the art of haunting, even with all that college behind you. You poor, pitiful excuse of a ghost! Please allow me to offer up some suggestions. You might have tried spooking me in the following ways; “Mitzi……..(using my cartoon ghost voice in my head), this depression is going to become so unbearable that you’ll start to feel an overwhelming and uncontrollable urge to kill yourself! But – you will fail in your attempt. Then you’ll have to be committed to a mental institution in order to keep you from harming yourself. While you’re there you’ll be required to undergo intensive psychotherapy, none of which will bring relief. Nothing and I mean nothing; will make the depression go away, not even electroshock therapy. Every drug in the arsenal against depression will be tried but none of them will work. You’ll have to live in a padded cell for your own safety. So there you’ll sit in misery day after day for years on end with no relief in sight. Isn’t that the most horrific thing you can imagine?”
What’s the point of being a ghost if you can’t scare anybody or as in this analogy, as it applies to my Pure O: How can my obsession continue to terrorize me if I’m willing to voluntarily contemplate and sit with the very worst outcomes and threats that it poses? In practicing this type of ERP I’m howling even louder that the ghost of my obsession. I drown it out and in doing so I eventually rob it of its ability to terrorize me.
It’s important to remember that the goal of ERP for Pure O isn’t to get rid of the thoughts. The goal is to change the way my brain reacts to the thoughts and I’ve found these techniques to be very effective so I wanted to share them.
To read more about my experience of living with Pure O check out my story at: