Molly was forever yielding to compulsions 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 and let them choose almost everything she did. That would be like what to wear, what to eat, which item to select on the shelves in a supermarket, and other things besides. It felt like the thoughts pushed her to double-check that she locked the doors and turned off the gas stove, and the taps, among other things.
It happened due to obsessive-compulsive disorder (OCD), which was severely active at the time. So unless Molly did the rituals, her anxiety would stay high.
Molly was living in an imaginary world that felt real. It was like another being was inside that world, threatening her with strange ideas that thoughts could come true. For instance, when she was thirsty and had thoughts of wanting a glass of water, she knew the water wouldn’t just appear. It’s rational to get that. But when Molly thought about the fearful thing in her head and then not doing what it wanted, well, she couldn’t think of it like the glass of water analogy. Instead, it scared her into believing its thoughts could transform and do the terrible things it threatened if she didn’t obey it.
Later, Molly read that an obsession is like a story that originates from doubt. When she looks back, she can see her obsessional narrative unfolding. It included many mistaken beliefs and inferences.*
One of her erroneous beliefs about a harm obsession was thinking, ‘I’m having thoughts of harm coming to my family. The thoughts say if I don’t wear my pink dress (she’d already chosen a blue one), my family will come to harm, and it will be my fault.’ And an inference was overhearing someone saying that thoughts come true if you think hard enough about them. Of course, it was hearsay, the inference. But it added credibility to Molly’s obsessional story. It had her imagining all kinds of frightening scenarios that made her doubt if thinking of being thirsty, water would appear, after all.
Before The Doubt
But Molly also read that people don’t have doubts before an obsession.* For example, her fears of something terrible happened 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 wearing the pink dress. She realised it was okay to wear the blue dress because the fear was in her imagination only. Nevertheless, it wasn’t so easy for Molly to put her new thinking into action.
But in any case, it had her see why she had fallen deeper into losing sight of the present as it dragged her into a hypothetical future. It’s where she feared the consequence of what would happen for wearing the pink dress. And so, without realising it, she responded by changing into the blue dress. It was a ritual to reduce anxiety and ward off danger. It’s a primitive thing. In other words, the brain’s amygdala hasn’t evolved from the time it alerted our ancestors to fight, flight or freeze. That being so, it doesn’t know whether an OCD fear is real or imagined, so it fires up, alerting us to prepare for danger. It explains why we feel anxious and uncertain while knowing it’s all in our heads.
Either way, it’s still scary because you daren’t trust that it’s not real. And so, you still fear the envisioned outcome. Admittedly, Molly tried to prevent possible consequences by continuing to do rituals. But she can see now that doing such actions is all in vain. The more she did them, the more she became lost in the obsession.
Molly realised she needed to remove the inferences, such as hearsay, and swap them for sense-information statements instead. For example, ‘Hearing of thoughts coming true gave me the idea that it could happen to me. But I developed a fear, not a legitimate concern. Therefore, I do not need to check further.’
Not checking further reduced what-if questions and eventually helped Molly see that needing certainty was related to the fear, not her. At the same time, she challenged yielding to compulsions by systematically resisting them. She did this with exposure and response prevention (ERP), the 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 made it so she could accept that she wasn’t uncertain about thoughts coming true before the obsession.
Inferences: Clinician’s Handbook for Obsessive Compulsive Disorder” by Kieran O’Connor & Frederick Aardema, 2012.