Are you struggling with intrusive thoughts associated with obsessive-compulsive disorder (OCD)? Do you want to know how to make exposure and response prevention (ERP) work for you? Then, transform your mindset in 90 minutes when you commit to reading this book and welcoming uncertainty.
Philosophy: It’s okay for me to live with risk.
THIS BOOK IS INTENDED for people who struggle with obsessions and compulsive behaviours and are uncomfortable with uncertainty and taking risks. Taking risks means people fear taking a chance on the imagined consequences if they do not do compulsions. For example, they worry something terrible will happen if they do not obey the thoughts inside their head.
In short, it is for anyone who struggles with building a tolerance for uncertainty. It is for people who cannot cope with ERP but want to find a way to make it work and get out of the obsessive-compulsive loop. Therapists might also find it useful to use with clients reluctant to engage in ERP.
OCD DESCRIPTIONS AND THEMES
Before going any further with what this book promises, let me give you a description of OCD from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). First, it describes OCD as the presence of obsessions, compulsions, or both. Obsessions are defined by (1) recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress and (2) The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralise them with some other thought or action (i.e., by performing a compulsion).
Appropriately, ERP involves two procedures: exposure and response prevention. Exposure means confronting fears or situations that prompt distress, which increases the urge to do compulsions. By purposely becoming anxious yet resisting the urge to do compulsions, individuals learn that the urge eventually decreases, helping to reduce the symptoms of OCD overall. In short, ERP leads to fear habituation. I write in detail about ERP in my other book, 3 Effective Ways to Treat OCD and Reclaim Your Life.
Various themes are involved in OCD, and this book addresses some of them. But if this book does not address your theme, don’t worry because all variations are OCD. Instead, the themes described are to build a picture of OCD and how this book can help you. So, let’s look at what some of these themes are.
There are different ways people fear contamination. For example, you might fear toilets, bins, illness germs, etc., and will wash repeatedly. I can relate to what you’re going through. I can also relate if you are someone who has an aversion to touching others, such as shaking hands, then fearing you’ll catch a disease and spread it. These refer to contact contamination and differ from non-contact contamination fears. The latter is where human interaction takes place without touching and the consequences of such fears. For example, fearing someone will infect you with a life-threatening disease if they breathe near you. It also occurs with objects without touching them and worrying about the transference of eerie traits.
You might be a righteous person who struggles with disturbing thoughts, images and urges to do ungodly things. In this case, I understand the torment you are going through. Yet, some of you may have reason to think you want to act on those “ungodly” things. It sucks, and I identify with how horrible that is. But, of course, the uncertainty of whether God will reject or forgive you keeps you stuck in the obsessive-compulsive spiral. And that’s despite logically knowing such ideas are against your moral values.
You may have violent-intrusive thoughts about harming yourself or others and animals. These thoughts scare you and make you wonder why it’s happening. Similarly, you may worry about harm coming to your family and friends, for example, feeling hypervigilant about your spouse driving to work and crashing their car. It feels real, and you take measures to prevent harm by doing rituals. For instance, you may phone your partner repeatedly to check their safety.
Or you might have unsettling ideas floating around in your head, making you have an obscure awareness of saying or doing something you regret. For example, suppose you’re in a happy relationship but have a false memory of telling someone else you’ve fallen for them. Afterwards, you compulsively rack your brains for days, weeks, months, or even years to locate the “memory” despite that it’s in vain. In other words, it becomes a relentless need-to-know obsession. I understand how such intrusions can make you feel so awful. Yet, some keep it secret, especially when they inwardly think they did the thing they are afraid of. Or if they fear terrible consequences for their perceived wrongdoing associated with their particular “memory”.
Additionally, this book is for people who fear liking the thoughts. For instance, you might be a father, mother, teacher, or paediatrician. So in your parent or professional role, I empathise that you may face children daily with paedophile-intrusive thoughts and feel sickened yet confused. You might say to yourself, ‘So what makes me think I like the thoughts?’ You might then say, ‘Does it mean I don’t have OCD but another sinister disorder?’ Of course, objectively, you know that’s not the case, but OCD controls the doubt, urging you to avoid tasks involving children “just in case”.
Perhaps this is how it is for you. Maybe you struggle with the uncertainty of not knowing if the thoughts mean something terrible about you and will do rituals to counter those thoughts. So, if the above descriptions resonate with you in one or more ways, then this book is intended for you.
In sum, this book is for those who escape and avoid the obsessions that disgust and terrify them. It is for people who want a breakthrough to solve the problem they’ve searched for through ritualising but are afraid to stop due to tormenting doubt. Finally, it is for people who feel uncomfortable with bracing uncertainty and worry about engaging with evidence-based treatment, exposure and response prevention (ERP).
If you are one of these people, this book can help change your life.
IS ASSURANCE WHAT THIS BOOK IS ABOUT?
If you think this book is about assurance, I can vouch that you are correct. However, you can rest assured that I do not write about reassurance as a compulsion but instead as conviction in what I’m about to share with you. So what I write about can help you defeat OCD and embrace risk.
For example, many people who ask for help are not looking for reassurance per se. Still, some mental health professionals may inadvertently stop people from asking questions, assuming that certainty and momentary relief are what they seek.
So let’s suppose a client has harm-intrusive thoughts and asks their therapist why they think they might act on them. Now imagine the therapist saying, ‘I cannot engage with you on that question because I’ll collude in giving reassurance that will feed the problem.’ The therapist might add, ‘You need to live with uncertainty.’ Then, of course, they might discuss with their client how rituals reinforce the obsession. However, they don’t usually explain the deeper reasoning for living with uncertainty or what it means exactly. In that case, the client continues to look for answers.
I assure you that I will answer the above and similar questions clearly. In addition, I will give helpful information to improve your understanding of why you have an aversion to intrusive thoughts. And I will explain simultaneously why false desire intrudes. I will also throw light on why false memory happens. On top of that, I will reveal how to manage uncertainty and live comfortably with risk. Finally, I explain why risk isn’t exactly what you might think it is.
CHANGING YOUR THINKING STYLE
This book is not an instruction manual that will take you through various methods to make your OCD disappear. The truth is, no matter how many how-to guides you read, it might surprise you to learn (as it most certainly surprised me) that most authors don’t provide the inside information for the people this book is intended for.
We have a steady flow of OCD information right in front of us. So much so that such information alone is not enough, no matter how reliable it might be. It’s not enough to help you understand uncertainty from the competing titles in the busy bookstores. But more specifically, imagine searching the book shops and not finding the book you’re looking for. A book that will help you get a grasp on uncertainty and recover. The book you’re reading now isn’t available in the bookstores, which is why it’s valued.
WHY ELSE IS THIS BOOK VALUED?
While there are some excellent books on OCD, here’s what I’ve found (and will explain in the following pages). Rather than taking in all the information you read about ERP and engaging with it, this book will demonstrate how you can focus on changing the way you THINK about it. So, let’s suppose your approach to your problem is a fear of battling with ERP because of overwhelming uncertainty. Now imagine you’re reading a top title on putting ERP into practice. You might quickly put the book down despite at first thinking you will engage with it.
In contrast, I want my book to help you look at how ERP works objectively through a three-step process. In that case, you will begin to see it as not something to be afraid of doing but to help you see your obsessive-compulsive problem neutrally. That being so, you will discover that you can apply the techniques impartially, not emotionally.
The benefits of this are that you will have the following:
- You genuinely helped yourself.
- You became a reliable authority in your mind because you actually helped yourself.
- You placed yourself as the person you will call and invest in when looking for support in resolving the problem. In other words, you will learn how to self-advocate and use this ERP guide objectively.
So the aim of Obsessive Compulsive Disorder: Three Powerful Steps to Help You See ERP Differently is not to teach you HOW to get rid of intrusive thoughts because I don’t believe that’s your main challenge. You know enough to see that intrusive thoughts are absurd. You’re smart enough to see they are at odds with your rational thoughts. That means you have the right idea that OCD happens to you, you don’t make it happen, and it does not represent something terrible about you. You can understand that intrusive thoughts come and go because everyone gets them.
But not everyone commits to doubt following an intrusive thought or triggering situation.
It’s the doubt that starts an obsession. And yes, plenty of online information teaches you how to use ERP to weaken the obsession when you become involved in doubt. But, for the people this book is intended for, such treatment can only work when their core problem is fully understood. Mindset change comes to mind in that respect.
CHANGING YOUR MINDSET
So Obsessive Compulsive Disorder: Three Powerful Steps to Help You See ERP Differently that I refer to in the title is the mindset you’re bringing to this entire process. This attitude transforms educating yourself from how-to books to something that’s totally self-supporting. That is to say, self-help books and other guides can help you when you help yourself.
My sole job is to shift how you fundamentally think about your intrusive thoughts and uncertainty forever. It’s so that the self-help books will work for you or that you will make them work. Doing so will encourage you to let go of some beliefs about what you currently think your approach should be, which keeps you stuck. Then, when you reach this book’s last page, the objective is to have you think, ‘I get it now. It stands to reason for me not to keep avoiding or analysing but to do the opposite.’
I will show you how you can be a reliable authority to help yourself. Because NOW is the best time to turn what you already know into an objective focus. I want to reveal how you can use self-advocacy to help you stay motivated. I’m dying to show you how people buy into uncertainty. By that, I mean rather than going head first into ERP treatment and opting out at the first exposure hurdle, they work with it instead. And so, I’m eager to teach you how to refine what you already know into one clear message to yourself. For example, my clear message to myself is that it’s okay for me to live with risk. There’s a reason for this, which will unfold as you read through this book.
Your message to yourself will help raise your confidence to get the results you deserve. Therefore, I will show you how you can start seeing the right way forward. It will help drive you towards your goal, to do the work you need to do to put OCD into remission. I will show you how my approach will be more straightforward, more inspired, and more effective than any short book you’ve ever thought of reading or already read on the market for OCD. I mean a book demonstrating that ERP does not need to be feared yet embraced.
Accordingly, this book promises that I’m going to show you the three steps to help you see your obsessive problem neutrally. These three steps will take you through a process and show you how to manage OCD and view uncertainty nonchalantly. To be clear, I’m not going to show you how to do ERP — that comes later (with your chosen OCD workbook or therapist and becomes much easier AFTER you go through these three steps). Finally, I will cover why this is the best thing you can do for yourself, your family and your livelihood.
DOES THIS SOUND LIKE YOU?
So, does this sound like you when it comes to living with uncertainty?
Do you feel worried about starting or continuing with exposure and response prevention with a self-help book or therapist?
Have you started talking with a therapist but then lost focus and direction, putting appointments off and then starting again?
Do you know the frustration of working with a fear hierarchy but never actually finishing it because you’re apprehensive about what it will be like living without OCD? For example, do you worry about how you’ll fill in the void where compulsive behaviours demand your complete attention?
Do you see other people reaching their recovery goals with an OCD workbook or therapist and, either way, embracing uncertainty?
Do you feel discouraged and think, ‘I know I can do that, too,’ and then think, ‘but something’s holding me back?’
Did you have a bad experience with an unqualified therapist claiming to cure you or a qualified therapist who didn’t understand OCD? Did that hold you back?
To add to what’s holding you back, do you feel the pressure and the fear of knowing that you’re missing out on opportunities? For example, how would recovery improve work, study, social life, family and more?
Do you feel ready to claim uncertainty but at the same time feel the vulnerability of whether you know you can?
Do you know that there’s indifference towards OCD within you? But does the whole process of being indifferent towards this condition put you into a fog of overwhelming doubt? For example, do you worry that you cannot bear something terrible happening if you don’t do a compulsion to eliminate risk? And if something did happen, you’ll think it’s associated with OCD, that OCD is substantiated, and therefore, all your fault? That being so, has it put you off ERP?
THE REAL PROBLEM
If you relate to one (or several) of these questions, know that none of those things is the real problem. That isn’t to say some of those things haven’t been tough. But at the end of the day, they’re all symptoms holding you back.
The real problem is that you haven’t decided that all of this ends today. You haven’t quite made up your mind that you’re ready to put the bad experiences to rest and commit and focus on starting or continuing treatment. And, of course, accept the mental freedom you deserve.
I’m about to show you how all of this sits on one single decision — your decision to take risks by welcoming uncertainty.
THE GOOD NEWS
No matter where you are right now, the good news is that once you go through the three steps that I’m about to share with you, you’ll see that embracing uncertainty is achievable. It’s more reachable than you’ve been thinking.
After you go through the three steps, you’ll have a clear message you might want to share one day. You’ll wake up with a sense of clarity, a sense of focus, and a simple plan that’s all driven by your one message. For example, ‘I want old ways out and new ways in’.
You will establish yourself as the authority on your mental wellness. You will become an advocate for yourself and help others with your message.
You’ll start thinking, talking or writing about uncertainty and why ERP is worth doing. Then, like others who’ve recovered, you’ll recommend the process. It gives you freedom and can provide others with a readiness to dive into therapy.
If you follow what I share here, you can create a life of freedom. It will be a life of freedom where you can profoundly impact and serve the OCD community if you wish. It can be where you can support others, even deciding to study and work as a therapist or peer support. Recovery can deliver incredible results and offer life-changing opportunities for you and your family, whatever they are.
WHO IS CAROL?
This book isn’t about me, but it’s worth spending a few minutes telling you who I am and how I got here. I’m a mother of three children and a carer of two cats and a puppy. I like to play chess and read historical fiction and books on OCD to stay updated. I also enjoy playing pool, watching snooker, psychological thrillers and history programmes.
I’ve authored two other books and plan to write more. My first book is 3 Effective Ways to Treat OCD and Reclaim Your Life: Evidence-Based Treatments for Obsessive-Compulsive Disorder. The second is Address Staring OCD: How to Manage Visual Tics and Obsessions. Both books are on Amazon if you want to check them out. My goal is to help people understand the genetics, biology and environmental issues of OCD.
My background is as a cognitive-behavioural therapist specialising in OCD. However, I became a full-time carer due to a change in circumstances. And so, I left my therapy days, focused on my writing, and started an author page on Amazon. I have some of my articles at thriveglobal.com and my website at ocdwriter.com. I also see myself as an adviser for OCD and help clients where I can.
I write focused articles and books to express aspects of OCD to people struggling with intrusive thoughts or anyone wanting to understand it. For example, I explain why people experience certain phenomena they cannot grasp, such as why they obsessively stare at people’s private regions and peripherally. So much of this is through my lens. So as an adviser, I allow my clients to talk with me openly, make headway and resolve their problems with the best available support.
I answer specific questions my clients have asked their therapists but haven’t received the right solution. I understand this frustration because I was once a therapist’s client struggling to understand something beyond the scope of knowledge, or so it seemed. I wanted that extra knowledge, not reassurance. But there was usually a closed door, making it look like I was trying to convince myself it wasn’t reassurance.
And so, while my work has had its ups and downs over the years, I’ll admit to feeling quite proud of my continuance in this fascinating profession. That is, particularly considering that the drop-out rate for ERP patients is 20-30%. But, of course, the whole process of ERP is challenging and time-consuming. It’s why I want to share the three steps with you so that your perception will change, and you’ll want to be one of the 70-80% who completes an entire course of ERP.
As a former CBT therapist, I’ve worked with clients who’ve successfully completed a course in ERP. But I’ve also worked with the ones who dropped out. I tried every possible path to encourage them to face their fears and resist the compulsions that reinforced their obsessions. I know of other therapists who’ve done the same.
But pushing clients when they’re not ready doesn’t work. And so, something needed to change.
It’s why I’ve blogged for years and recently did some interviews to discuss intrusive phenomena. It’s also why I plan to start a you-tube channel. That way, I get the opportunity to write and talk about unfamiliar topics or unusual problems relating to OCD.
For instance, some people worry that ERP will reveal something sinister about them. After all, they worry they never had OCD but something more terrible and real.
Many insist they do not have genuine OCD because they feel aroused, stirred, or angry when triggered by their sexual, religious, or aggressive obsessions. Others recoil in disgust when faced with their feared stimuli associated with contamination.
Understandably, they will be terrified of the possibility of learning they are sexually deviant, evil, or criminally insane. Or if their fear is contamination, they live in horror that they, others and their surroundings are riddled with germs or stained with an infectious disease. Their fear is the possibility of coming into contact with the dreaded contaminant.
What’s worse is when they feel urged to act on the thoughts, sometimes testing them to prove they won’t. I explain in my other book, 3 Effective Ways to Treat OCD and Reclaim Your Life, that it is not acting on obsessional thoughts per se. Instead, it is a compulsion on a more extreme level to prove that their integrity outside of OCD is the norm. But, of course, there’s more to it than that, which I describe in the abovementioned book. It’s why change is needed for the ERP process to work.
And this is the reason I believe investigating unfamiliar topics is my forte. I bring a speciality to my writing and advice service to help those who get stuck in the OCD trap, as I once did.
For this to happen, I gathered a more scientific approach to see that whatever atypical problem my clients are facing, I would help investigate it. I can then explain how, for example, why testing one’s obsession interrupts the ERP process. Or when a legitimate problem goes unrecognised and confuses the OCD picture, explore it and find a resolution. Further, suppose someone has a memory issue that has no legitimate foundation. Then it will always come back to the source: obsessional doubt.
OKAY, LET’S GET TO THE POINT
My point in sharing the above is to demonstrate that I am very familiar with how subtle or explosive OCD can be. If there’s something you want to figure out, I’ve likely faced that problem before. Even though I’ve tripped into several potholes along the way, I found a solution for myself and my clients most of the time.
Let me illustrate one of those elusive problems with you. Consider Tilly, who complains of anxiety when she has intrusive memories of harming her younger brother sexually. Her therapist doesn’t think of it as anything to worry about. It’s an obsession, and that’s it. But Tilly believes she has a legitimate memory of incestuous paedophilia. It’s because the supposed memory occurred at an actual event (a party at home) in which she recalls putting her little brother to bed afterwards.
And so Tilly contacted me for advice, saying her therapist could not see there could be another problem to explain the upsetting event. That’s even though it was hindering the ERP process. Instead, her therapist regarded it as Tilly seeking reassurance, a compulsion. So she refused to collude with it since it would reinforce the obsession as compulsions go. While that is correct regarding OCD, Tilly nonetheless continued to worry that she had a genuine concern.
Aside from what appears to be a legitimate memory, Tilly knows that OCD is something that happens to people (including her) but still worries that the content of her thoughts could be about her authentic self and that she made it happen. Since Tilly struggles with memory obsessions, she does rituals, such as analysing past events, particularly the ones about her brother. These repetitive behaviours act as a temporary solution to make sense of the thoughts about the past, make them go away and reduce anxiety.
But at the same time, Tilly doesn’t want to make the thoughts disappear. She says it’s the only thing she has to cling to and make certain of what happened. Therefore, Tilly checks her mind over and over again. She will also get close to her brother to check for arousal, which is testing. So on that basis, she needs to recognise that before the obsession, she did not suffer from doubt. In other words, since she worries she could have harmed her brother, Tilly can remind herself that the “memory” she experiences is the source of doubt. It is the doubt that birthed the obsession. In that case, it has nothing to do with sexual harm in the here and now.
It means Tilly does not need to do rituals, such as avoiding situations that bring on unwanted thoughts and intrusive memories. It means she doesn’t need to test it. But, as anticipated, an intolerance to uncertainty, as we’ve seen, makes this difficult for her.
So far, I’ve said nothing different to what her therapist has already discussed with her at this stage. However, there is something more explicit to explain. For instance, how the brain’s amygdala confuses anxiety-related problems with arousal.
For example, while Tilly thinks she remembers doing something that would get her into trouble, she cannot seem to get a concrete version of the event. In that case, she experiences conflict. Tilly questions whether she even has OCD or if it is an excuse to explain away the persistent flashes of doing something terrible to her brother. Worse, did she feel aroused when she spent time with him? Erm, yes. But was it true arousal? Erm, not sure. See how uncertainty of what’s real and imagined interferes here?
FALSE ENCODED MEMORIES
To cut a long story short, I discovered, through my research, that some people struggle with false encoded memories. So, for example, when aroused or scared by intrusive thoughts, images and urges, the amygdala takes it on as genuine feelings. It is then passed to the brain’s hippocampus, the gateway to memory storage. In other words, since the amygdala is the anxious part of the brain, it scans for danger. Therefore, once it sees something as real, it makes an emotional memory of it with the help of the hippocampus. It can then warn you when it thinks you need to protect yourself and others.
For example, think of a snake and a twig. Imagine you came across a twig in the woods some time ago and recoiled in fear, thinking the twig was a snake. The amygdala will warn you of danger when you approach a twig, thinking it’s a snake again. It wants to protect you but gets it wrong. Thus, it confuses reality with imagination.
So, back to Tilly. Her amygdala fires up when she has a false memory in which she believes she sexually harmed her brother. But again, this brain region thinks the memory is real when it isn’t.
For Clarity, Tilly had watched a documentary on child abuse the week before and thought how devasted she’d feel if she molested her little brother. She imagined it without wanting to and made herself feel anxious and upset.
So when Tilly put her brother to bed a week later at the party, she connected her brother’s bedtime and the TV programme subconsciously. After that, she became confused. It was a trigger that brought on the doubt, ‘did I just molest my little brother?’ It then erupted into a false memory obsession. How? Because Tilly was immediately guided by the doubt. In other words, the doubt infers that there is a possibility that what Tilly imagines could be real. Hence, she does rituals to check, not able to tolerate the uncertainty.
Can you see how the amygdala alerted Tilly through error when putting her brother to bed? It took what she imagined when watching the documentary and her subsequent emotions as real. Of course, other brain regions are involved too to make the error, but I’ll talk more about this later in the book.
For now, Tilly struggles with the error, and thus inferential confusion, the fusing of reality and imagination noted above.
In short, the amygdala is designed to produce anxious feelings to prepare you to make a move to settle your mind and find safety, as in Tilly’s case.
But it’s not the false memory that is the problem, but the obsession with the false memory.
For example, suppose Tilly had false memory intrusive thoughts but waved them away as ridiculous. Then, in this case, there would be no obsession. Without the obsession, there would be no doubt (Aardema & O’Connor, 2012). Additionally, with no doubt and obsession, there is no risk.
Here’s something from human-memory.net on false encoding and false memories.
False encoding is the processing of information in such a way that leads to the formation of false memories. The processes that lead to the formation of false memories may include self-referential encoding and the construction of a gist trace. Perception and storage processes are also included in creating false memories during encoding.
False memories can also be created at the consolidation state. This usually happens due to post-event information and sleep. During sleep, reorganisation and linking of memories with pre-existing representation takes place. This leads to the changing of memory representation that was originally encoded. Post-event information creates false memories due to memory updating process.
False information is retrieved due to the activity of the hippocampus. Hippocampus equally retrieves true and false information. The hippocampus leads to the creation of false memories due to incorrect recombination.
Later, Tilly identifies that false memory isn’t the issue. Instead, it is her obsession with it noted already. She also discovers the difference between memory and remembering. In other words, she understands that people remember and forget because a retrieved memory is accessed and stored away again. But, of course, we can retrieve, access and store the memory many times. This relates to legitimate memory. Therefore, Tilly realises that remembering the party event is accurate. But molesting her brother is due to a falsely encoded memory. Again, it was the memory associated with the party (bedtime) prompted by an earlier association (the TV documentary and imagining the horrors of molesting her brother).
Soon after, Tilly objectively identifies the obsessive-compulsive cycle. She sees the problem with analysing which memories could be genuine and false. In other words, Tilly realises that obsessively needing to know for sure only makes the false memory obsession worse.
Therefore, she feels more confident about treating the disorder with ERP instead of feeding the obsession with rituals to find solid proof where there is none. Thus, gradually, her amygdala doesn’t fire up so much when intrusive thoughts about it try to grab her attention. In other words, the obsession weakens without the rituals. Or better put, the doubt loses its power; the doubt is the source of OCD.
YOU CAN’T LEGITIMISE AN OBSESSION
So here you can see that in my endeavours to help solve OCD problems, I do not help analyse an obsession because that’s not the goal. It’s not possible because you cannot legitimise an obsession. So instead, I will research concerns about the obsession, e.g., to learn how false memories appear as real encoded memories when the amygdala scans for danger and gets it wrong. In that case, it can help a client see more about the biology of OCD, not reassurance. Consequently, they engage with ERP more readily. Of course, I research only if I think it needs it. I will also be honest and tell my clients that their problem comes back to the source (DOUBT) regardless of the explanation from my research.
BACK TO THE SOURCE
Tilly’s complaints of having a memory of doing something terrible to her brother felt real to her. But to help her see its falsity, she needed more than to identify how it played into the OCD cycle. Therefore, explaining false encoded memories and how obsessional doubt interferes revealed to Tilly that she could manage uncertainty from a new perspective. That being so, we had something concrete to go on, and a resolution was reached.
The main point is that finding a solution for Tilly meant she could identify intrusive memories as invalid and get back into treatment for OCD. That is with exposure and response prevention. And this is the goal, to keep sight of treatment and recovery.
But it is hard for some people to accept that that’s the case. And that’s because they feel convinced something else is lurking. And so, learning to be indifferent to intrusive thoughts instead of analysing them is one of the critical shifts this book will discuss. It means getting to grips with obsessional doubt.
In such instances, educating my clients on OCD is of utmost importance. And so, I think it’s beneficial to understand genetics, biology, and lived experiences (environment) in OCD. These factors are where the three steps in this book can help you see the treatment process for obsessive-compulsive disorder more accurately.
Of all the things I’ve done, nothing has been more powerful, more consistent, and more worthwhile than writing this little book. To help find a resolution to a problem similar to Tilly’s is amazing. Remember, it’s not unhelpful reassurance I provide; it’s an explanation that shifts perspective.
It thus opens up a great discussion on the biology and experience of OCD. It takes the attention away from analysing the obsession to correcting the fault in the brain that maintains it. As noted before, it means facing an earlier adverse situation and experiencing it differently. It doesn’t matter what the theme is and trying to make sense of its nonsense thoughts; it is to help clients get back on track with the ERP process.
In fact, knowing what I know now (after exploring every other approach over the past decade), suppose I were starting my writing and advice service today. I’m confident that the absolute BEST thing I could do for that service would be to decide to write a book on OCD and recovery.
Once again, I felt destined to investigate a client’s uncertainties that some therapists might explain away. Usually, it’s along the lines of ‘whatever you give your attention to is what you get.’
So, for example, when Tilly and people like her search for a missing memory they cannot locate, they maintain doubt.
Consequently, they cannot bear the uncertainty that they did something they don’t remember.
They don’t fully grasp the concept of ‘whatever you give your attention to is what you get.’ It’s not spelt out enough for someone with OCD. Being someone who struggled with active OCD for years, I can empathise with that.
Even still, their therapists are right about where their client’s attention is and its consequence. And, of course, most people have the insight to see that they must stop checking and avoidance. They know they must pay attention to response prevention, not compulsive activity.
However, fearing hypothetical consequences over trusting long-term health through ERP gets in the way of the 20%-30% who drop out of therapy. Whatever they give their attention to spirals out of control. These individuals get lost in a maze and don’t know which exit to take. So they struggle on another level, becoming enmeshed in the obsession.
Therefore, this book intends to help people return to the ERP process and accept this is the way to recovery. In other words, it is to help them move away from continuing to live in an uneasy state of mind over imagined possibilities associated with their obsession.
THE OLD WAY
Before writing my books, I was doing things the old way. I was waiting for the penny to drop. In other words, I was doing what the other therapists were doing. For example, taking my clients through the ERP methods with a hierarchy of fears and wondering why some of them remain stuck. Seeing them in a never-ending circle of obsession, feared consequences, anxiety and compulsions puzzled me. It puzzled me more that they did not figure out that habituation to their fears was in their hands.
So what was missing? Why didn’t the “ah, now I understand” ring clear for them? I wanted to find what it was. I wanted a new approach to help them see the gateway to freedom. I wanted to give them hope and allow them and me to do things differently while keeping their focus on the ERP method.
Eventually, after realising that while people on the OCD spectrum ride the same obsessive-compulsive cycle, each one of those people is unique and sees ERP differently. In other words, how they take to therapy and get off the obsessive-compulsive wheel is personal. So similarly, while ERP does not change, I realised I could help them break the cycle from their perspective.
And so, the one major thing I did was permit my clients to tell me everything they wanted about their problems. I made them feel easy about opening up about how they thought they had another problem, not OCD. I allowed them to discuss their fears of acting on their thoughts through testing. In short, I let them get everything off their chests without interruption. Then, as they talked, I gathered the information that unfolded like a story filled with inferences, paradoxes, absorption, uncertainties, obsessive analysis and more. Their stories revealed things that would help me help them solve their problem.
For clarity, consider Harry, who was so terrified of opening up for fear of irresponsibility and labelled reckless that he nearly didn’t. That is until I told him a few stories of my own, and then he got it.
So this guy, Harry, told me he thought he had an urge to self-harm and that testing it would prove whether he could keep everything safe. But, unfortunately, it had gotten so out of hand that he was regularly scratching himself with sharp implements, such as the pulls on Pepsi cans.
In other words, Harry had become so absorbed in the obsession that testing was becoming a risky experiment. As a result, he came to me unhappy by the unexpected anxious rush that made him think he was a genuine self-harmer.
But it turned out that Harry was worried because his father and stepmother had recently had a baby, a sister. Shortly afterwards, he began struggling with intrusive thoughts of harm coming to the baby.
However, an earlier therapist told him he was a self-harmer and treated him for it. But, unfortunately, she didn’t realise he was carrying out a compulsion to protect his baby sister. And so, the therapist didn’t understand why it was getting worse, not better. It made Harry feel so terrible that he fell into a deep depression. Even worse, he thought he’d let his family down because he had to put his studies on hold.
But back to the point. Again, I investigated the problem with Harry. This time, he felt utter relief that harming himself came right back to obsessional doubt. Of course, I knew it would, but Harry needed time to believe that testing was a deeply involved compulsion or experiment, not acting on his thoughts per se. Had I straight away told him to quit the compulsion and that it would reduce the obsession, it wouldn’t have been enough.
In other words, while Harry needed to resist the harming compulsion, he first needed to understand the difference between self-harm (non-suicidal self-injury, NSSI for short) and a self-harm obsession. (I discuss the difference in my book noted earlier) After that, Harry would see the whole obsessive-compulsive scene objectively, and he did.
He suddenly realised how experimenting (scratching himself with the pulls on Pepsi cans) had fed and maintained the obsession. Specifically, standing back and seeing himself as a character in a scene where the problem was happening to him helped change his perspective. So, he saw the dissimilarity between NSSI and self-harm OCD rather than thinking as he did before, for example, that he must be into NSSI if the urges won’t go away. Therefore, we talked about the difference.
First, I asked him what he thought the outcome would be if he didn’t scratch himself. He said he had intrusive thoughts telling him to harm himself to keep his baby sister safe. So in this respect, the event of being presented with a baby sister had paired with a negative conception. Subsequently, it reinforced to Harry that the solution was to give in to the magical thinking, ‘if you don’t hurt yourself, your sister will come to harm.’
However, had he surrendered to NSSI, he would have been scratching himself due to a life’s stressor, for example, peer pressure. In other words, cutting would get him emotional relief to cope and regulate his feelings. It’s similar to someone who seeks out alcohol, drugs, gambling, and anything else that will help them manage life’s worries. But, contrary to that, Harry’s scratching himself was a compulsion to ward off danger (the hypothetical threat of harm coming to his baby sister) and reduce his anxiety.
After our chat, Harry realised his mind had been clouded; he could not see that compulsions were the problem before. He could not know that they were dragging him more and more into the obsession to where he was becoming consumed with it.
As a result of realising, he became more accepting of uncertainty. Subsequently, he followed through to the end of his ERP course after his new diagnosis of OCD. And so his motto at the end of therapy was as follows. ‘My baby sister may come to harm because anything’s possible in the here and now, not because I had intrusive thoughts that played out in my mind like an imaginary story.’
Such a statement shows that the remaining doubt is already handled, hence accepting uncertainty; therefore, Harry did not need to double-check. In other words, certainty is a state of mind in which you are free of doubt. But Harry realised that nothing could take away that grain of doubt once the obsession was there. Therefore, to recover, he knew he had to live with it and manage it with common sense. So again, accepting uncertainty shifts perspective and is crucial to successful ERP implementation.
OLD WAYS OUT
The point is that most people with obsessive fears have good insight and manage their treatment goals successfully, but others struggle. Those who drop out are concerned that ERP isn’t working for them. Some don’t understand why they should put themselves through heightened anxiety. They don’t grasp the habituation process or do but don’t see how it can work for them. So again, I set the idea of explaining that they could choose to see it from a different angle. In that way, instead of worrying and waiting for a problem to disappear, I ask them to let me help them see their situation and ERP from a fresh standpoint.
Again, it means helping them look at their person as a character and how OCD happens to them, like seeing yourself on TV. Next, it means objectively observing your thoughts, feelings, and actions instead of being involved. So, it would be like a TV script; you are viewing yourself in the programme, reading the lines. And then it’s about seeing how the thoughts got there or got stuck (biology), why they are there (genetics) and what triggered them (environmental).
But it’s not just about that. It’s also about reining yourself from a hypothetical scenario to the here and now. It’s about helping you see how assumptions can make an obsession seem valid when your brain already got it wrong. Finally, it’s learning to spot those assumptions confidently, which is another shift that helps you change your mindset and find freedom from OCD.
It jolts you into seeing that this is not about me but a disorder I can defeat. More about this later. But here’s the thing — several people have joined me in the three steps leading to the gateway to freedom. And this is what this book is intended to do for you, too.
ARE YOU BUYING IT?
Even though this short book is not the usual book you see in the marketplace, it is written and published to help people struggling with doubt and not be guided by it. Thus, it can help them get on with ERP and recover. Or, how to manage leftover doubt following a course of ERP and accept uncertainty. My job is to get you to be alongside me, to see an opportunity to help yourself out of the OCD trap.
So many authors have outstanding books on OCD and how to apply ERP (I’ve read many to know this). So, to say I wished my first, less-than-usual book Desire-Intrusive Thoughts could be a great seller and help people worldwide would be an understatement. You could say I felt crushed at the missed opportunity there. I wanted to get a meaningful message to the OCD community and beyond. But I was down to thinking I had no interest in my topic anymore. Something wasn’t working, so I don’t know how I made it through that time.
However, push came to shove, and I had the decision to make. Either I’d figure out how to get my writing back on track and support people through my advice service or let it all go and get a different job to make ends meet.
I didn’t want a different job.
So then, when a fellow writer advised me to ditch the publisher platform and become an infopreneur, I asked him to tell me more. That’s when he said I could write and self-publish on Amazon myself, that I didn’t need to pay hundreds of dollars to a publisher, and it changed everything. And so after that, my enthusiasm came back, and I couldn’t wait to jot down my thoughts and share my knowledge through my books.
The first thing I did was ditch the publisher that put me in debt. Then, I revised and republished Desire-Intrusive Thoughts as a second edition and gave it a brand-new title, 3 Effective Ways to Treat OCD and Reclaim Your Life.
My plan was now happening. So I decided it was worth investing in online writing tools like Designrr. In short, my helpmate’s approach challenged me to write more about my topic, OCD.
Naturally, my writing tools didn’t help me write my book’s content, the one you’re reading now (and the others). However, it helped me understand that simple was better. For example, I could now create an e-book for Kindle and upload it to Amazon. I was happy knowing I had a platform to share my insights.
But then, my fellow writer asked me a smart question that few authors think about. The question was, what did I want my readers to do the moment they finished my book?
After some thought, I realised I wanted my readers to absorb everything they’d read from this book. And then invest their time in overcoming OCD.
I can’t thank my helpmate enough for showing me that investing in yourself, deciding once and for all to get it done, and then making your investment pay off is amazing. It is the best thing I ever did for my writing career.
But what was more important to me was that I could now support people struggling with OCD to do the same. That is to see purpose in recovery, recognise the benefits of being well, and then invest their time and energy to recover.
So the next step was producing a three-step plan and bringing onboard readers ready to dive into it. Therefore, what I’m sharing with you from now on is what I learned through my knowledge—also personal experience of living and recovering from OCD.
These are the three steps I’ve been telling you about. These three steps can help you change your feelings about ERP and ultimately find freedom from OCD.
Let’s look at what they are.
I remember waiting for uncertainty to feel easy. It NEVER did. So instead, I had to decide to accept that I could be comfortable with being uncomfortable. But first, I had to have conviction in that belief and then work on it.
It’s unlikely that anyone who has agreed to accept uncertainty has been easy going about it, at least to begin with. If anyone has, then we’d want to know their secret. In any case, uncertainty doesn’t work that way. You have to learn it and then claim it for yourself. It’s your responsibility to own it and use it. I can’t say enough that this has never been truer than right now. That is, especially when you consider that it can make you one of the 70-80% who later follow through with the exposure and response prevention (ERP) process.
This therapy is at your fingertips to take advantage of and recover.
But first, let’s look at what you need to do to start, which, as we’ve seen, is to change your perception on uncertainty. Then, afterwards, you can take the ERP tools by yourself and be confident that you can be self-reliant and responsible for your recovery.
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