Molly was forever yielding to rituals because she feared something terrible would happen if she didn’t. For example, it felt to Molly as though she had to obey the thoughts in her head as though they were from an inner being, making her choose almost everything she did. It included what to wear, what to eat, which item to select on the shelves in a supermarket, and other things besides.
It happened due to magical thinking associated with obsessive-compulsive disorder (OCD). So, Molly’s anxiety would stay high unless she did the rituals to prevent a catastrophe. Molly sensed she was living in an imaginary world but wondered why it felt real. It was like a monster was inside that world, threatening her with strange ideas that thoughts could come true.
To clarify, suppose you’re thirsty and have thoughts of wanting a glass of water. You know the water won’t just appear. So it’s rational to get that. In other words, having thoughts about something doesn’t make it happen. But when Molly thought about the fearful thing in her head and not doing what it wanted, she couldn’t think of it like the glass of water analogy. Instead, it scared her into believing the thoughts could happen if she didn’t do what it wanted. In this case, she’d lost confidence in her authentic self and relied on rituals to protect her family.
Later, Molly read in a book about OCD that an obsession is like a story that originates from doubt. When she looks back, she can see her obsessional tale unfolding. It includes many mistaken beliefs and inferences. One of her erroneous beliefs was that if she didn’t wear her pink dress (she’d already chosen a blue one), her family would come to harm, and it would be her fault. Then, she heard of someone having a thought that their mother died, and it happened. Of course, it was hearsay, an inference and out of context with her situation. Still, it added credibility to Molly’s obsessional story, making her worry that her story wasn’t OCD.
Before The Doubt
But Molly also read that people don’t have doubts about terrible things happening before an obsession. For example, her fear of something awful happening to her family surfaced after developing OCD. Before that, she didn’t even think of it. So when she realised she didn’t have doubts before OCD, it changed her thinking. Instantly, Molly saw the absurdity of changing from the blue dress into the pink one. She realised it was okay to wear the blue dress because the fear was in her obsessional story, not the here and now. Nevertheless, it wasn’t so easy for Molly to put her new thinking into action just yet.
And so, she responded by changing into the pink dress “just in case”. Such uncertainty explains why Molly feels anxious while knowing simultaneously it’s all in her head. She could see how the inferences made her obsessional story seem more credible but needed to trust it could not make it valid.
Therefore, Molly realised she needed to remove the inferences, leave her imagination and use her senses and common sense in the here and now. For example, hearing of the mother who died gave her the idea that something bad could happen to her family. But she saw she’d developed a fear about it, not a legitimate concern. Therefore, she understood that rituals, like wearing her pink dress instead of the blue one were unnecessary.
Consequently, not checking further reduced what-if questions and eventually helped Molly see that needing certainty her family would stay safe was related to the obsessional fear, not her behaviours. In other words, whether she wore the blue or pink dress, it would make no difference to her family’s safety. She thus continued to systematically resist the compulsions with exposure and response prevention (ERP), an evidence-based treatment for OCD.
In short, severing the association that rituals are the solution to ward off danger and reduce anxiety helped Molly recover through a graduated process of becoming less sensitised to her fear. Simultaneously, removing inferences for sense information in the here and now helped her see that thoughts only come true in the imagination.
Inferences: Clinician’s Handbook for Obsessive Compulsive Disorder” by Kieran O’Connor & Frederick Aardema, 2012.