THE OCD TOOLKIT

Part 1: Know Thy Enemy, or Become an Expert on OCD

1.     Know what your body feels like when OCD is there… and why it feels that way

OCD is a neurobehavioral issue, meaning it’s a brain response that affects our actions. Researchers believe OCD stems from a hiccupping brain circuit: the brain’s error detector, our orbitofrontal cortex, sends an unnecessary error/worry/disgust signal, and the gatekeeper, the striatum/caudate nucleus, lets the unnecessary message through to the thalamus, the brain’s command center. The thalamus then tells the body to active the body’s alarm system, our sympathetic nervous system. These are false alarms– like a fire drill, they feel real but do not have meaning.

2.     Tune into your thoughts by asking “what is OCD telling me will happen right now?”

When you get the urge to do a compulsion or habit, check in with your thoughts and the situation to identify the OCD trigger, or what thought/feeling/situation is activating the body’s alarm system

3.     Check how strong the OCD discomfort feels in each situation

Take your “OCD temperature” with a feelings thermometer (fancy name: Subjective Units of Distress Scale or SUDS)– how strong is that uncomfortable feeling, 0–10?  Rate how difficult it would be to resist/ignore OCD.

Part 2: Separate Yourself from your thoughts 

4.     Name the Bully

Naming and/or visualizing OCD and giving it an identity can be helpful in separating from OCD, gaining perspective, and beginning to challenge it when OCD becomes bossy or throws a tantrum.

5.     Catch OCD’s thought tricks

OCD makes thoughts feel real and important… even though they are not. Watch for the following thought tricks:

  • Fusion: believing every thought that you have, a.k.a. “if I think it, it is true”

  • Likelihood Thought-Action Fusion: believing “If I think it, it will happen in real life”

  • Moral Thought-Action Fusion: believing “If I think it, it means something about who I am”

  • Intolerance of Uncertainty: believing you can’t handle not knowing for sure

6.     Label the Thought as OCD

Instead of debating or arguing with OCD about the “truth” of the thought, treat the thought as a random error message by labeling the thought as “OCD” or “junk mail”.

7.     “Let it go, don’t make it go”

You can’t push thoughts or feelings away with success for long (Try this: Do not think about a pink elephant. DON’T… How did that work for you?). Instead of suppressing the thoughts, notice the thought, and let it be there… but don’t hold on to it. Let it float by like a leaf floating on a stream, or a junk mail package on a conveyor belt.

8.     The more you agree, the better you’ll be

Rather than arguing with OCD and trying to be sure (sure that the bad thing won’t happen, sure you’ll feel better, sure you’ll fall asleep), try agreeing with the thought instead. When OCD says “but this might happen!!” opt out of the argument - no reassurance, no rumination - by replying “yeah, maybe”. It will be uncomfortable at first, but OCD will quiet faster when there’s no one to argue with.

Part 3: Face your Fears and “Ride the Wave” of OCD

 

9.     Learn the “big secret about OCD”: doing what OCD says is the fuel that keeps OCD going

Like any bully, the more we let our OCD “boss us around” by doing what it tells us to (like washing to get a feeling of contamination to go away), the bigger/stronger/more bossy that OCD gets.

10.     Boss OCD Back through Exposure with Response Prevention! (a.k.a. “Brave Practice”)

Do the opposite of what OCD says by taking manageable steps toward the situation, event or thing that OCD does not want you doing. Bravery Practice for obsessions about contamination with germs might be playing a rousing game of Uno with “contaminated” cards that have touched a “germy” spot, or a race to see who can touch all the “germy” doorknobs in the house the fastest, and then not washing your hands.

Exposure + No Rituals = Winning!

11.  Work up to the big fears by creating a Bravery Ladder

Rate each Brave Challenge (e.g. exposure) with a temperature (0-10). Put your exposures in order from easiest/least to most difficult. Start toward the bottom of your ladder (a 3-4 out of 10) and work your way up!

12.  If it’s too hard to totally ignore OCD at first, try just “messing with OCD”

If completely resisting/ignoring OCD’s instructions feels too hard, try “messing with OCD” by not following OCD’s instructions perfectly. An example for washing might be to wash hands a different way, wait 5 minutes to wash instead of washing right away, don’t wash for as long as OCD wants you to, or don’t use as much soap as OCD wants you to.

13.  Reward hard work in the fight against OCD

When completing exposures, try to have enjoyable and motivating rewards attached to completion (both small/immediate, and big/delayed “goals”). For example: each challenge = 10 min. screen time,  5 challenges = bake cookies together, 10 challenges = out to lunch, Final challenge = sleepover party!

14.  Refocus on Fun

When tolerating the discomfort of OCD, either during an exposure or during everyday life, focus on things you can do to keep living the life you want! Pleasant activities, accomplishment activities, exercise, or self-care can add positive feelings to the mix. When OCD pops up, practice refocusing your attention on the present moment and the things you are enjoying (playdate! FUN!). If OCD is like a voice on the talk radio of your mind, you can’t turn off the radio, but you can decide how much to focus your attention on it.