Conquering Distressing Abhorrent OCD Thoughts - Free Self-Help

By Diana Holbourn

Article Summary

Welcome

This article explains why some obsessional thought patterns can develop and what can keep them going. It explains how a lot of things that are obsessively worried about aren't likely to happen at all, and reasons why people can mistakenly believe they will happen. It goes on to talk about ways of getting over obsessive thinking.

Lastly, it talks about ways of making sure symptoms of OCD stay away, and then how various situations that can cause stress can be handled to reduce the stress they cause.

Skip past the following quotes if you'd like to get straight down to reading the self-help article.


Things People Have Said That Relate to OCD and Anxiety

Nothing fixes a thing so intensely in the memory as the wish to forget it.
- - Montaigne

Refuse to act on an obsession, and it will die of inaction.
--Recovery Inc.

Everybody knows if you are too careful you are so occupied in being careful that you are sure to stumble over something.
--Gertrude Stein

If you just set people in motion they'll heal themselves.
--Gabrielle Roth

When you attempt to eliminate risk from your life, you eliminate along with it, your ability to function.
--Fred Penzel

Habit is overcome by habit.
--Thomas Kempis, (c. 1420)

The Main Contents

Background Information About This Article

The Self-Help Information in the Article

  1. Some Reasons Why Obsessions Develop and Keep Going
  2. The Characteristics of Obsessions
  3. The Reasons Obsessive Thoughts Don't Need to be Worried About So Much, and Mistaken Beliefs that Keep them Going
  4. Mistaken Beliefs Specific to Religious Obsessions
  5. Working Out What Beliefs Make Our Thoughts More Distressing If We're Not Sure What the Beliefs Behind Our Obsessions Are
  6. Compulsions and Other Methods of Coping With Obsessions
  7. Things That Can Get in the Way of Treatment
  8. The Problems with Trying to Control Thoughts and Other Coping Strategies
  9. Proving to Ourselves that Obsessive Thoughts Aren't Dangerous
  10. Making Sure Symptoms Stay Away

Part One
Some Reasons Why Obsessions Develop and Keep Going


He who fears something gives it power over him.
--Moorish Proverb

Natalie thinks:

Thinking

It's interesting what Liz said about how quite a lot of people actually have thoughts of harming people sometimes, but most just ignore them. She said a few psychologists have done research that's found that a lot of people they spoke to without OCD have unwanted thoughts of doing something violent or otherwise unacceptable to people from time to time. She said that part of what makes disturbing thoughts turn into obsessions for some people is that we think they have more significance than other people think they have, and so we worry about them much more.

Horrified

She gave an example of how worry can make unwanted thoughts turn into obsessions, saying that one person might have a horrible impulse to tip boiling water over a baby, for example, and think, "What a horrible thought! I wouldn't really want to do that at all!" And then they might more-or-less forget all about it.
But another person might have the same thought, and get really worried about what kind of person they must be if they can have thoughts like that. They might be scared that they might have the thought again, and that one day, they might act on it before they can stop themselves. They might be horrified with themselves and think they must be a really bad person if they can have thoughts like that, and that it's extremely important that they never have them again. They might worry about whether they're a monster at heart if they can think thoughts like that, and think through all their memories to try to find evidence as to whether they are a bad person. They might lose all their confidence that they're fit to look after babies. If possible, they might start avoiding them. Or they might start thinking a good thought every time they worry that they might think the bad thought again, to make it go away. Because the horrible thought's on their mind a lot because of all the worrying they're doing about it, they're more likely to have it again than they would be if they just thought, "What a horrible thought!" and then forgot about it.
And the more they have it when they're around babies, the more anxious they become about having the thought.
The more they're worried about it, the more it'll be on their minds when they're around babies, and so the more likely they are to think it.
The more they think it, the more worried they become about thinking it.
The more worried they are, the more it'll be on their minds.
The more it's on their minds, the more likely they are to think it.
And things can spiral upwards like that, on and on, getting worse and worse.

So maybe interrupting the spiral would be a good thing to do.

Anxious

Liz said that the reason we can have distressing thoughts about harming people more the more we worry about them is that if we know what usually triggers them off, for instance, if the time we had thoughts of harming a baby before was when they cried, then the next time we hear a baby cry, the thought will come into our head again, because it'll be as if we're expecting it, or we'll think it again because we've been reminded of it and we'll be worried we'll have it again because that was when we had it last time. After that, we'll start worrying all over again about whether the horrible thought means we're not safe to be around babies, so it'll be on our minds more. If we develop strategies to distract ourselves from the thought, using those can make us have it more as well, since anything that reminds us of what we use to distract ourselves from the thought will begin to remind us of the thought as well, so we'll have it more often. And if we can still have the thought despite our best efforts not to, that can upset us even more.

Relief

But we might not be so upset if we can realise that just having the thought in itself doesn't mean it's more likely that we'll act on it.

So just dismissing a disturbing thought and letting it fade away would be more effective at getting rid of it than worrying about it and trying to develop strategies to stop ourselves having it any more.

Liz said that someone who just dismisses a nasty thought, assuming it's just a one-off horrible thing that intruded into their thinking for a little while but can be quickly dismissed, is more likely to be right about the thought than someone who gets more and more anxious about whether the thought has deep significance and means they're likely to harm people. So we can worry far, far more than we need to.

She gave another example, of a man who had to do a lot of air travel for his work as a salesman. One day at the airport, he had an urge to blurt out the word "bomb" when he was just about to pass through security. He started having the urge every time. He knew that blurting out the word "bomb" would probably get him in trouble and cause a lot of hassle for the security people, so he became really worried about wanting to do it. Eventually, he couldn't get the word "bomb" out of his mind at the airport. He got so anxious about it that he started refusing to fly. Because he couldn't seem to control the thought - he couldn't seem to do anything about it coming into his head, he was worried that it would make him blurt out the word "bomb" and he wouldn't be able to stop it. He was worried he was beginning to go insane. He wondered what would happen next if he was, and whether he would start acting on his thoughts because he couldn't stop himself. He was a considerate, law-abiding person, so he was upset at the idea of all the trouble it would cause the security people if he did shout out the word "bomb". He also wondered if the fact the thought was so strong meant it could be a prophetic sign that he really was going to blurt out the word "bomb", or whether he had a hidden self-destructive side and some part of him wanted to get him into trouble. He was scared it might win.

Liz said that it was his preoccupation with worrying about the thought that caused most of the problems, because his anxiety wouldn't have got anywhere near that point if when he'd first got the thought, he'd just thought something like, "Ugh! I wouldn't want to do that!" and then forgot about it.

The Promise of Being Able to Reverse the Process

But she said that if people have got to the point in their thinking where they're very anxious, there are things they can do to reverse the process. She said that if we work out what obsessions we have, we can work out how to treat them differently in the future to make them die down. She said she'd give me some suggestions as to how this could be done.

I have tried strategies though. I'm worried that the only reason I haven't done something nasty as a result of what my thoughts tell me to do is that I always make sure I think a good thought after I've had a horrible one to get my mind off it, and try to avoid the people I worry about harming as much as possible.

But Liz said there are other things that are more effective in making obsessive thoughts die down, and that we might not need to do things like the ones we usually resort to after all, because we might not be anywhere near as likely to act on our OCD thoughts as we might think.

She said that people with OCD where they have disturbing obsessional thoughts can recover significantly when they come to believe that having nasty thoughts doesn't in itself mean they're bad people who might really harm others.

She said that people with OCD are typically very concerned about harming people, so we'll want to eliminate the risk altogether, even if it's only very tiny. So someone who had a thought about tripping an old lady up or something and just thought "Ugh, what a horrible thought!" and then didn't think anything more about it, might think there was a tiny possibility that they might act on the thought at some point in the future, but they might know there's only a tiny risk and so they don't have much to worry about. But someone with OCD might want to make sure there's absolutely no possibility at all of it happening.


Part Two
The Characteristics of Obsessions

Working Out What Obsessions We Have

Liz said that one good thing to do to begin the recovery process can be to write down a list of troubling thoughts we have so we can work out which of them is an obsession, so we'll know which ones to work on. She said the types of thoughts we ought to write down are ones that intrude into our minds time and time again, that upset us a lot, and that we find very difficult to stop. She said it doesn't matter if they're real obsessions or other types of thoughts; we can work out whether they are obsessions after we've written them down.

OK, I'll write mine down.

What Distinguishes Thoughts as Obsessions

The thoughts just won't go away for long no matter what I do.

Liz said distressing thoughts like this can be classified as obsessions if the intrusions into our minds and thoughts about them take up more than an hour of our time a day, and if the things we do to try to stop them take up more than an hour.

Well, I wouldn't be surprised if mine did!

Liz said there are several differences between obsessions and other unwanted thoughts.
I'm glad I wrote them down.
She said:

Liz said we can get a good idea of whether our thoughts are obsessions by going through all those characteristics of obsessive thoughts and thinking of how much our thoughts match those characteristics.

I think the thoughts I've been concerned about are obsessional thoughts, because they match all those characteristics very well.

Liz said that other people do have thoughts just like OCD thoughts, but the difference is that people with OCD have many more of them and they're more intense, upsetting and hard to control. But she said a worrying obsession can grow out of the occasional worrying intrusive thought if it's dwelled on in certain ways too much. But she said people can reverse the process and turn obsessions back into occasional intrusive thoughts again.

Some Characteristics of Religious Obsessions

If you like, skip past this part if you don't get religious obsessions

I told Liz about my religious obsessions. I'm sure some of my responses to them are over-the-top really, like repeating little parts of prayers till I get the wording exact, and washing myself till I'm sure I'm thoroughly clean before reading the Bible. I know other people don't do things like that. But I get so anxious about not being perfect that I feel I need to do things like that. My anxiety makes me think I must be anxious for a good reason so I must have done something wrong. So I'm always questioning myself to see if I can remember what, like asking myself if I can have had a lustful thought when I looked at the man next to me, or whether I was fully concentrating on devoting myself to God during a church service or deliberately allowing my mind to wander, or whether I consider God's will enough when I make decisions, or whether he's forgiven me for all the things I've done wrong today. Not knowing that makes me really anxious. And I worry about what I've done wrong.

Liz said we can determine whether our religious practices are caused by OCD and not just devotion to God by asking ourselves questions like:

Liz said that the more of those things we answered yes to, and the more we can identify with those characteristics, the more likely we are to have diagnosable OCD.

Well, I've got most of them.

Liz said that religious belief doesn't have to be like this. She said that normally, it brings people happiness rather than distress and severe guilt, and it helps them in their relations with others, rather than hinders them.

Liz said that often, someone with religious obsessions will focus on one or two areas of morality to the exclusion of others, maybe more important things. For instance, they may be seriously concerned about whether they've had a sexual thought, while forgetting the religion's commands for people to be charitable, and so they might sometimes be quite nasty to people, not thinking there's anything wrong with that.

Thinking about it, perhaps I do do that sometimes.

Liz said people with religious OCD will often avoid what triggers off their distress, even if most religious people in their group take delight in it. For instance, they might avoid going to church because it triggers off fears of sin and God's punishment, while other people love going to church because it uplifts them.

Well, I know it triggers off fears of God's punishment with me, especially if I worry that I haven't been concentrating or might have done something else God disapproves of. So I don't go to church so much now.


Part Three
The Reasons Obsessive Thoughts Don't Need to be Worried About So Much, and Mistaken Beliefs that Keep them Going


It is no measure of health to be well adjusted to a profoundly sick society.
--Krishnamurti

Thoughts of Sexually Abusing Children or Harming People in Other Ways

Tearful

One thing that scares me is that I might really do the things I get urges to do, like stab someone.

But it's nice that Liz was reassuring and said that it would be unusual for someone with OCD to do that, because several things have to happen for thoughts to turn into actions. She said that someone who studied sex offenders for years found that even if they didn't want to be paedophiles or rapists, they found their aggressive sexual thoughts pleasurable at some level. One way that could work is if they felt guilty about what they did afterwards for a little while, but when the feeling died down, the feelings of pleasure at the idea of doing it again became far stronger than the guilt. But she said people with OCD don't take pleasure in their sexual thoughts at all, so they've got no incentive to carry them out. She also said that if it was common for people with OCD to snap and carry out their obsessions, prisons would be full of people with OCD; but in fact, there may be lower levels of criminality among people with OCD than there are among the general population.

But sometimes I wonder if my urges have a self-destructive quality, as if the OCD's making me want to do something that'll get me in a lot of trouble and severely punished. I was worried about that after I went in that shop doorway and a child came out at the same time and brushed past me. I've been scared ever since that I abused it, even though I'm disgusted at the thought of abusing children, and I'm fairly sure I didn't really. I told Liz I was worried about having abused the child, and I'm glad she reassured me. She said that if I had, there would surely have been an outcry. The child would have started crying; some people would probably have seen what happened, and they would probably have expressed disapproval, and I might even have been arrested. None of that happened. She asked me how much damage I thought I could have done the child anyway within the couple of seconds we took to pass each other. And I know it was really only a couple of seconds. She asked me what I thought the worst thing I could have done in that time was without causing a serious disruption, and supposing I had done something, how long I thought the child was likely to remember it for, and whether it was really likely to have caused any emotional damage. Well, I don't suppose I could have done much at all really, thinking about it. She asked whether, even if I had an urge to abuse a child out of a self-destructive impulse, I thought I was the kind of person who'd consider my urges to be more important than a child's well-being, even for a second. Well, I don't think I would really.

Liz said that for people with OCD to act out our obsessive thoughts, we would have to think of our urges as being more important than the well-being of others, or convince ourselves that we weren't really doing others any harm by acting on them. But she said that people with OCD don't spend their time wondering how to talk themselves into believing they're not going to be doing a child any harm by molesting them or anything like that. Instead, they tend to be concerned with the exact opposite, being preoccupied with how to preserve the safety and well-being of others. So she said that for someone with OCD to abuse a child or commit another crime, it would mean that high principles of concern for the safety of others and well-established personality traits would have to be overridden, which takes some time and wouldn't happen just in a moment.

Taking More Responsibility For Tragedies and Possible Harm Than We Need To

Scared

Liz said that one mistaken belief that can keep our OCD going is when we think we'll be far more to blame if something goes wrong than we really will be. She said when things go badly wrong, there are usually several different things that contribute to them going wrong, perhaps a whole series of little mistakes or oversights made by several different people. But some people can think they're entirely to blame for something, because they think that if they can foresee that something bad just might happen, they're responsible for doing whatever they can to stop it, even when there isn't all that much likelihood of it happening. She gave an example, saying one man noticed that when the wind blew in a certain direction, the branches of a tree occasionally obscured the view of a stop sign on the corner near his house. He phoned the council and reported it. But they didn't come and cut them down. There was an accident there a bit later, and he felt very bad about it and blamed himself, thinking it was criminal of him not to have made more of a fuss about the branches, or cut them down himself. He even felt as bad as if he'd taken the stop sign away. But really, while in hindsight he could have done more, it was the council's job, so he couldn't really be blamed for expecting them to do it.

She gave another example, of someone who ate some peanut butter cookies in a library, and about an hour after she'd gone, she suddenly thought that she might have dropped some crumbs, and that someone with a peanut allergy might touch them and have a bad reaction and die. She felt as guilty and distressed about leaving crumbs there as she would if she'd actually attempted to murder someone, even though the chances of someone suffering because she'd left crumbs there weren't very high at all, and she hadn't done it with intent to harm anyone.

Liz said there was a woman who was very worried that she'd burn the local park down by not putting her cigarette out properly before she dropped it, and that if it did burn down, it would be all her fault for not checking properly that the cigarette was put out. So she felt compelled to go and check many many times that it was out. In fact, she estimated the chance of her burning the park down accidentally as being 60%, which would be 3 in 5. But her therapist helped her calculate that it was much, much lower than that. This is how he did it:

When he asked her what she thought the probability was of her dropping her cigarette without putting it out, she estimated that it was 1 in 10. So that was already far below 60%. He said that lots of other things would also have to go wrong before things got to the stage where the park burned down:

  1. A spark from it would have to fall on something flammable, like dry leaves;
  2. The leaves would have to catch fire;
  3. she'd have to fail to notice that they'd started burning;
  4. The fire would have to get bigger and yet she still didn't notice it;
  5. It would have to go unnoticed by everyone else in the park as well;
  6. When she finally did notice the fire, it would have to be too big for anyone to control, or she would have to not be able to do anything about it, like not being able to get help.

She estimated the odds of all those things happening, one after another, and then she estimated that actually, the probability of all those things happening in sequence was about 1 in a million.

Liz suggested we do the same thing with our obsessions, thinking through what sequence of little things would have to happen between us forgetting to do something properly and something disastrous happening, and calculating how many little things there would have to be. We can estimate the odds of each one of those happening on its own, and then the odds of every one of those things happening in a sequence. We might well discover that the odds are much lower than we thought.

Over-Estimating the Consequences of Thoughts

Scared

Liz said another thing people with OCD can do is to over-estimate the harmful consequences of their thoughts. For instance, someone who always had impulses to swear in church when she prayed was convinced she must be demon-possessed, and that she'd be damned to hell if she didn't stop. She was scared of being damned to hell, even though from the Bible, it seems that Jesus never automatically blamed people who were demon-possessed for what they did under the influence, and so even in the unlikely event that she was demon-possessed, it would be unlikely that she'd be sent to hell for something that wasn't her fault. And being sent to hell just for swearing would be rather an extreme punishment anyway. That would be especially so if she was horrified by her impulses to swear rather than wanting to, since the Bible says God judges people's motives, not just their thoughts.

Liz gave another example, of a lawyer who had impulses to say something very inappropriate in court, and though he'd never done anything impulsive at all in court before, and was known for being very calm and controlled, he was still fairly sure he'd lose control of himself and say what kept flashing into his mind. He thought it was more likely to happen than not, even though he'd never done anything like that before.

The Belief That Thinking About Tragedies is More Likely to Make Them Happen

Shocked

Liz said another mistaken belief people can have is that having thoughts about disasters is more likely to make them happen. She gave an example of someone who got an image in her mind of the space shuttle Challenger exploding about a week before it was launched, and she tried her hardest to keep it out of her mind, because she was scared that thinking about it would make it happen. When it did explode, she blamed herself, and still felt guilty years later. But really, the space shuttle explosion was caused by a piece of equipment not working in the cold weather, and it was found out later that engineers from the company that had made it had been warning and warning their management that it could function inefficiently in the cold for months before the launch of the space shuttle, ever since one of them had inspected the ones that had been used on a previous flight that had launched in the cold and discovered they were worryingly damaged; but the management didn't feel they had enough resources to look into the matter. And there was a long conversation the day before the explosion happened with Nasa where the engineers were expressing concerns and urging them to delay the launch till the weather warmed up, but the company management overruled them and gave the go-ahead, because they didn't want the company to look bad by having to admit that part of the equipment they'd sold Nasa didn't work as efficiently in low temperatures.

So people can worry that their thoughts might cause problems, when really, if the people do have problems, the problems would probably have been going to happen anyway, they might have been brought about by several different people's mistakes or bad decisions over time, and they might be to do with things that were causing problems and should have been put right months before.

Liz said there was someone else who was convinced that her thoughts could kill. Disturbing images of destruction kept coming into her mind, and she felt she'd be responsible for any consequences. She was given the task by a therapist of testing out whether her thoughts really could kill.

She was asked to think about one of her house plants dying as hard as possible to see if she could kill it with her thoughts. She agreed that all the while, she would make sure she didn't use the strategy she usually used to undo the worrying thoughts which was touching a religious pendant. The plant didn't die.

Then she was asked to try and kill her goldfish with her thoughts. That didn't die either.

Then she was asked to try and make the neighbour's noisy dog die by thinking about it dying as hard as possible. She couldn't make that die either.

Then she was asked to try to make a person she knew die with her thoughts. But they didn't die either.

After that, she became more convinced that her thoughts wouldn't be able to do anyone damage by themselves.

Someone else was asked to think as hard as they could about winning the lottery the following week to see if their thoughts made that happen, but they didn't win any money.

The Belief That thinking a thought is as bad as actually committing the Equivalent action

Feeling hopeless

Liz said that some people with OCD think their thoughts make them as immoral as they would be if they'd really done the actions. But for one thing, there's a big difference between some thoughts and others. Some thoughts can be as immoral as actions, or nearly as bad, because though under normal circumstances, a person having them might not act on them so they might not seem as bad, under temptation or provocation, the thoughts might be just what triggers the immoral actions. So the thoughts can be said to be just as bad, or nearly as immoral. But these will be thoughts where immoral actions are thought about with pleasure, or as things that are desirable things to do. Unwanted distressing thoughts of doing immoral things will be on a completely different level, because the person doesn't think about them deliberately and nurture them, and because they're much less likely to lead to actions.

She said people with OCD can get their thoughts in perspective if they think about the most moral person they know or have heard of, and then consider whether they'd change their view of them if they discovered they had a similar OCD problem to themselves. If they wouldn't consider them any less moral than they did before, then they're being unfair to themselves by judging themselves by a different standard. Also, if the person's actions were very moral, it would mean their morality couldn't be judged by their thoughts alone, but also by their actions. So that would also be the case with the person with OCD.

She suggested an exercise that anyone who feels sure they're an immoral person because of their thoughts can do. She suggested we first write down in a notebook the name of the most virtuous person we can think of, either a person we know or someone we know about because they're famous.
Then, we should write down the name of the most immoral person we've ever heard of.
Then, we can think for a few moments about the bad things we've heard on the news recently.
Then, we can think of the worst criminal we've ever heard of in history.
Then, she suggested we list several of our best friends and closest family members.

She said the idea is that we draw a line on a page in our notebook, and put the name of the most virtuous person we know or know of at the top, and the name of the person we think of as most immoral at the bottom. Then, we should put the names of everyone else we've just thought of in between, depending on how moral we assume they are. We should put our own name on the line somewhere. If it's nearer the top than the bottom, we'll realise we can't be that bad.

Feeling bad

Liz gave an example of someone who thought thoughts were as bad as actions, saying there was a man who had thoughts of having sex with a woman who wasn't his wife, and who he wasn't even attracted to. He thought that mentally doing that was as bad as doing it for real. So he thought that in effect, he'd been unfaithful to his wife and must be an immoral person. But really, there's a big difference between having a sexual thought come into your mind that you don't want there, and having one that you cherish and enjoy so you like being mentally unfaithful. So she said he didn't really need to feel bad about it. He'd only need to feel bad about it if he welcomed the idea of being unfaithful to his wife. That would be the only thing that could tempt him to act on the thought.

Worrying that Thoughts Are as Bad as Actions For Religious Reasons

If you like, skip past this part if you don't get religious obsessions

Praying

Liz said that if the reason he felt so bad was because he thought God would disapprove of him, he didn't need to worry, because God doesn't judge unwanted upsetting thoughts in the same way as thoughts that are cherished. She said it's true that Jesus said that people had been told they shouldn't commit adultery but whoever looked at a woman lustfully had already committed adultery with her in his heart. But from other things he said, it's clear that he did make distinctions between one person doing something and another doing it, depending on their motives and attitudes.

For instance, he told a parable of a tax collector who was really sorry for what he'd done, in the days when tax collectors would commonly defraud people of money, and a Pharisee, who would have been one of the Jewish leadership considered as highly moral by most people, who wanted people to think he'd done everything perfectly. The Pharisee stood up and prayed in public, proclaiming to God how thankful he was that he wasn't immoral like other people, and particularly like that tax collector. But the tax collector was fully prepared to admit he'd done wrong. He was ashamed of what he'd done and begged God to be merciful to him. Jesus said it was the tax collector who came away in the right with God, rather than the man who believed he was so good, because the tax collector was prepared to admit his sin and was sorry for it, whereas the Pharisee wanted people to believe he didn't have any sins.

Jesus said on another occasion that although everyone might think the Pharisees were very moral people, in their thoughts, and in the behaviour that really mattered like being merciful to people, they were very corrupt. When he said that anyone who looked at a woman lustfully had already committed adultery with her in his heart, it was after he'd said that anyone whose righteousness didn't exceed that of the Pharisees wouldn't make it to heaven. When he said that the people had heard they shouldn't commit adultery, he was giving them an example of something the Pharisees would probably have taught them because it was in the old Law of Moses they taught. So when he said that anyone who looked at a woman lustfully had already committed adultery with her in his heart, implying that it was just as bad, he was giving an example of how people's righteousness could go beyond that overtly demanded by the Law of Moses and exceed that of the Pharisees. So the Pharisees might have often had lustful thoughts about women, and really enjoyed them, and thought to do that was perfectly allright, as long as they didn't actually commit adultery physically. So they may have been thinking lustful thoughts, all the while boasting about how moral they were. But they would be unacceptable to God, whereas a tax collector, who'd done much worse things and yet was sorry and upset about what he'd done and was worried that he'd offended God and wanted to change, would be acceptable to God, and God would be merciful to him and forgive him.

So if God will look kindly on someone who's had a lifestyle of defrauding people when they're sorry and want to change, he surely isn't going to be harsh with people who merely have thoughts that they don't even like to have.

The Belief That Thoughts Need to be Controlled, Otherwise They'll Lead to Actions

Liz said another mistaken belief is that people have to get full control over unwanted thoughts if they're not going to turn into actions. But really, thoughts only lead to actions if there are other things going on, like temptation to do the thing because it seems pleasurable, or because of anger and the desire to hurt someone.

Scared

She said some people think that if they're having intrusive thoughts about harming people, it might only be a matter of time before they snap and act on those thoughts. For instance, there was someone who was training to be a nurse who had thoughts of tripping people up, especially elderly people or people carrying babies, and she was extremely concerned about the thoughts because she worried she'd act on them one day, and wondered if she should give up nursing training. But her friends knew her as a gentle, caring person. She thought the impulses to do violent things might mean there was another side of her nature she didn't know about. But she wouldn't have just snapped and done something violent if she found the idea abhorrent. Liz said that although actions will always be proceeded by thoughts of doing the actions, thoughts won't always lead to actions. There are several steps that have to take place before a thought turns into an action.

She said people can prove to themselves that their thoughts don't always lead to actions by thinking over the past few days to see if they can remember times when they thought about doing something but didn't, like buying a chocolate bar from a vending machine, perhaps, or renting out a video, or having an urge to tell their boss what they thought of him. People might be able to think of several examples. There might be several different reasons why they didn't do those things. Urges to do things can come up in people's heads suddenly. But so can thoughts about whether or not to act on the urges. Anyone who suddenly gets a craving for a chocolate bar might very quickly decide not to have one because it'll be fattening. Someone who suddenly fancied renting a video might just as suddenly decide that it would be nice to spend time in their garden that evening instead. Someone who had an urge to tell his boss what he thought of him might just as suddenly decide it wouldn't be worth it because it might put his job in jeopardy. So changes of mind can happen very quickly.

So we can reassure ourselves that thoughts aren't as likely to lead to actions as we might think, by thinking through everything like that we can remember from the past few days, or trying to notice whenever things like that happen again.

Liz said it certainly is possible to act on impulse, doing violent things on the spur of the moment that are regretted later. But people who do such things enjoy what they're doing at the time, or they really want to do them, even if they regret it later because of consequences they didn't think about at the time. Someone who finds their obsessions repugnant right from the second they get them won't act on them. To do so, they'd have to do something they really didn't enjoy, as well as going against their moral values and character. Liz said that some people worry that they might one day start to find their obsessional urges enjoyable, but it's very unlikely that that would happen, since by the time people are adults, their personalities are usually quite stable. It would take quite a change in personality to make someone who found the idea of committing violence against vulnerable people or other acts of abuse abhorrent start enjoying them.

Liz said that some people worry about losing control of their behaviour because they feel sure they can think of times when they have lost control of it. But really, people only "lose control" of their behaviour to the point where they allow themselves to. For example, if a mother who hated the thought of smacking children lost her temper and shouted at them, she might have thought she lost control of her behaviour, and yet she didn't smack them. A motorist who is usually considerate might lose their temper with a careless or irresponsible driver and show their irritation by making a hand gesture they later regret having made, and they might think that was a loss of control, and yet they didn't get out of their car to beat the inconsiderate driver up. So their behaviour hasn't really deviated very far from their moral values and character.

But then, I did once hear an expert in crime or something once say on the television that murderers are often moral people who wouldn't usually do things like that. Then again, I've read somewhere else that things can become desirable under provocation or temptation that a person would normally not want to do. But they have to start thinking of it as a good thing to do before they do it. I know someone who punched his father once, thankfully not very hard, so it didn't hurt much, but he said that normally, he'd never want to do anything like that. But he said that a few hours earlier, he'd been thinking over what he'd do if his father became a bit aggressive about something he'd done, since his father disapproved of it so much. He was thinking of making a quick getaway, maybe pushing his father out of the way but doing no more than that. But he was fantasizing about his father being a bit aggressive and then him reacting very quickly to get away. Later, his father came up behind him and thumped him on the back. He might have been being fairly friendly, but the person said it was as if the son lost control, and he whizzed around and whacked his father before he thought about what he was doing. But he'd really been cuing his brain to react quickly and aggressively to provocation by fantasising about what he'd do if his father showed signs of aggression before. So it was as if he'd been rehearsing reacting quickly, so his brain was all geared up to do something. That would be very different to what would have happened if he'd had a thought of punching his father but at the same time he'd become distressed by the thought. If he had, the distress would have been reinforcing the message in his brain that that would be a horrible thing to do, not programming it to do it, as going through the scene in his imagination thinking about how much he'd like to do it would be.

So when it seems that someone's done something on the spur of the moment, it may well be that they've been fantasising about doing something similar and finding the fantasy desirable in some way for some time beforehand. That would be different from someone with OCD who always finds their thoughts of violence or sexual deviance distressing.

Proving to Ourselves That Thoughts Don't Necessarily Lead to Actions

Embarrassed

Liz said that one way we can prove to ourselves how difficult we find it to lose control of our behaviour when we really don't want to do the thing we're thinking about is first to think of several things we really wouldn't want to do because they'd embarrass us, but they wouldn't harm anyone. So we couldn't choose one of our obsessions. But they can be things like shouting something out loud in a supermarket, bursting into song at a bus stop, jumping up and down while waiting in a queue when it isn't cold so there's no good excuse, or talking to our watch as if it's a pet in a crowded area. They ought to be actions we don't think of doing very often, things we really wouldn't want to do, and ones where the only person who could suffer anything as a result of them is us.

She said the idea is that we note down any action we've chosen in our notebook, writing down the details of how we'd go about doing it, and rate how likely we are to engage in it. Then, for the next week, we should try to think about it as hard as we can as often as we remember, to try to see if thinking about it makes us do it. We should think in detail about how and where we'd go about doing it. We should read what we wrote in our notebook about it, several times a day if we can. We can do something to remind ourselves we should be thinking about it, like wearing our watch on our other wrist or something.

Then, at the end of the week, we should write down how many times we lost control and did the behaviour, and rate again how likely we think we are to engage in it in the future.

She said it's probable that no matter how hard we thought about doing it, we'll find we didn't do it once; so we'll rate our likelihood of doing it to be much much less.

Interpreting OCD Impulses as a Sign from God or a Premonition

Scared

Liz said that sometimes, people wonder if the impulses to harm people that the OCD gives them are signs from God, warning them that they'll start doing those things. She said that someone who got distressing impulses to kick crutches away from disabled people and to trip old people and mothers carrying babies up was training to be a nurse, and she wondered whether the impulses were signs from God telling her she'd put people in danger if she carried on with her nurse's training. So she thought about giving it up. She was a gentle, caring person who'd never done anything aggressive to anyone, but she was worried that the thoughts were warning her that she might change.

But Liz said that just supposing the urges were signs from God, they would be unlikely to mean God wanted her to give up nursing training, especially since she'd never done anything aggressive before. The New Testament's full of commands that indicate that Christians should live lives that help others. So God clearly wouldn't want her to go against commands like that. She might think she could help others in ways that meant she didn't have to have personal contact with them though. But another thing is that a sign from God would be unlikely to be saying, "You're going to become a menace to vulnerable people in the future, and when you do, I don't want you to go near them". Someone who was a menace to vulnerable people, even in their thoughts, would not be acceptable to God, no two ways about it; so if the sign was warning someone they were going to become a menace in the future, it wouldn't mean that when they did, they had to avoid people, because God wouldn't want them to be a menace to other people at all. So it would be saying, "I don't want you to become a menace, so you have to make sure this doesn't happen. If you stop finding your impulses distressing and start enjoying them, you have to start living closer to my commands". But then, since it's actually very unlikely that a person who finds the idea of harming vulnerable people distressing could ever begin to find it pleasurable, the sign would actually be unlikely to be saying that. If it's highly unlikely that someone who hates the idea of harming vulnerable people would one day start taking pleasure in it, if the impulses that upset them were anything to do with a sign at all, which is actually unlikely, maybe the most likely meaning of the sign would be that they had OCD and they needed to stick to a good recovery programme.

Liz said that sometimes, people don't necessarily think that their distressing impulses are signs from God, but they think they might be premonitions that they'll do something harmful. So they again wonder if they ought to isolate themselves from society to protect other people. But she said that premonitions might not happen nearly as much as people think. She said that people probably often think they've had premonitions of things that went on to happen when what they've really experienced are coincidences. She said many people can speak of dreams they once had about meeting someone they hadn't met for a while, for example, and then they met them in person. But they forget all the dreams they had where they dreamed of meeting someone they didn't meet again for real. Or it can happen that someone mentions something that gets pushed to the back of their mind or they catch a glimpse of someone they forget about having seen in the town, but their brain recalls it in a dream, and they remember the dream but not what happened before. so when they meet the person who's been around the town, or the thing they dream about happens, they think their dream must have been prophetic.

She says people usually only think they've had a few prophetic dreams in their lifetime, and yet people have several dreams a night. So that leaves lots of room for coincidence. She said that research has found that believers in the paranormal often tend to underestimate the odds of any type of coincidences happening.

But again, she said that even if someone's impulses to do harm were premonitions, they might not mean that something was going to happen for definite, but simply that they needed to make sure it didn't by learning the best ways of making their obsessions subside.

The person who wondered if she should give up nursing training because she worried that her thoughts were signs or premonitions was persuaded to carry on with it by a therapist who convinced her to rely on information she could be sure of to make her judgments, not on an information source as unreliable as obsessions, that probably just kept happening because she was so worried about them. She had a history of being a caring person, and she knew she could be good at the job. So those things were better indicators of whether she was fit to be a nurse than the obsessions.

Insecurity About Uncertainty

Biting fingernails

Liz said another belief that can keep OCD going is that a person has to be absolutely certain that a bad thing won't happen or hasn't happened before they can make a decision or carry on with daily activities. She gave an example of someone who thought she might be sexually aroused by violence, so she spent hours looking at profiles of the personality types of rapists to see if hers matched, because she thought that if it did, she'd isolate herself from society so she didn't harm anyone, but she needed to know whether she should do that. But really, people don't do things like attacking people unless they want to. Someone who got really anxious at the thought wouldn't be able to do it. Rapists usually work up to committing the act by fantasizing about it a great deal first, enjoying the fantasies, so she would have plenty of warning that she might harm someone like that if she really was likely to, although since she would have wanted to, she wouldn't have wanted to take notice of any warnings. So the fact that she did want to take notice of them was a good indicator that she didn't need to.

So it would have helped her if she'd become more aware of all the things that made it unlikely that she would do a thing like the one she worried about.

Liz said another person spent ages each day thinking back over what she'd done to see if anything was sinful, because she was always worried that she might have sinned, and even committed the unforgivable sin. But again, there would have to be intent behind a thing for it to really be sinful. The Bible says Jesus was tempted in every way like humans but didn't sin, but because he was tempted, he can sympathise with our weaknesses. So any sin done in a moment of weakness would probably not be looked on by God as harshly as something that was premeditated by someone who knew the probable consequences beforehand.

As for the unforgivable sin, it's commonly held that that's to do with people rejecting the Holy Spirit and so refusing to allow him to draw them to God through Jesus to receive his forgiveness, not just saying a word against the Holy Spirit in a moment of misjudgement. So anyone who wants Jesus to forgive them can't possibly have committed the unpardonable sin, because they obviously haven't rejected his forgiveness.

But as for people wanting to make sure there's absolutely no risk that they'll harm anyone, Liz said there's no way that anyone can do that. It's very, very unlikely that obsessions could lead to the harm that someone with OCD obsesses about. But she said the possibility that harm could come to someone despite our best intentions is just a risk that everyone in the world has to live with.

Crying

She said she heard someone say he was giving a psychology lecture not long before on a therapy that's thought by some people to help people a lot, and he just happened to mention that he'd been tidying his desk, and that it had been so messy it took him quite a while. And just saying that made someone burst into tears! Afterwards, the person said it had reminded her of how much work she was going to have to do to clean up her home after burglars had made a mess of it. So if even saying you've been tidying your desk can upset people, we probably haven't got a hope of going through life not doing anyone any kind of harm! People just have to take what they hope will be acceptable risks.

Perfectionism

Liz said that another belief that can cause problems is the belief that everything has to be done perfectly before it will be acceptable, and that there's only one correct way of doing things. She gave the example of someone who thought that even if she had the slightest trace of an impure thought while she was saying her prayers, she'd have ruined them so she'd have to say them again.

Liz said that if the person's worries about saying prayers perfectly had been to do with Jesus' command that people must be "perfect just as God the Father is perfect", again, she didn't have to worry about it so much. Liz said that although Jesus was saying that people should have high moral standards, the word translated as perfect actually has a slightly different meaning. It doesn't mean flawless in every tiny thing, but more like mature or complete or full-grown, or impartial. So in the passage where it was being used, it would mean mature and fair and considerate in outlook. She said that we can get an even clearer idea of what Jesus meant by looking at the passages just before that verse and seeing how it fits in with them. Jesus is talking about interacting with other people, saying people shouldn't show a double standard by treating some people well and others badly, depending on how much they like them, but they should treat everyone well as far as possible, even people they don't like. He goes on to say that God treats people impartially like that when he doesn't deprive the wicked of sunshine while it shines on the good, or make it rain on them more. Then Jesus said that people should behave towards each other in the same way. So being perfect in that context would mean not doing someone wrong or ignoring them just because you don't like them, but treating people decently whether you do or not. In Paul's Letter to the Romans, it says that to love someone in the way it means when we're commanded to love people in the Bible means never to do them wrong.

But the Bible does say that everyone will have sinned, and even that if someone says they have no sin, they're deceiving themselves. So God obviously knows that it's unrealistic to expect absolute perfection from people. So we don't need to worry when we sin accidentally.

Shaking head

But Liz said another reason people get the feeling that things haven't been done perfectly is because of a chemical imbalance in the brain that's perhaps been caused by the way we've been worrying or something. But she said we can put it right ourselves by doing things differently. She said the chemical imbalance means the brain gets stuck on something rather than moving smoothly from one thing to another, so it gives us the impression that things haven't been done properly; but we can shift it to the next thing by ignoring the signals it's sending us that tell us things haven't been done right and moving on to doing something else. And if we do that often enough, it'll change the brain chemistry so the brain gets better at moving us from one thing to another without us consciously having to tell it to. So if we concentrate hard on doing things right the first time, such as washing or praying as much as we genuinely feel we have to, perhaps doing it slowly and reminding ourselves we've done it, then if we get an urge to do the same thing again, we can just remind ourselves that it's our brain chemistry imbalance that's making us want to do that, and that we can alter it in time by doing something different instead so we don't reinforce the wrong messages. If we know it's only our brain giving us faulty messages because its chemistry is temporarily out of balance, and that we can put it right ourselves over time if we train it not to give us those signals by doing things differently, then we hopefully won't have to worry about what it's telling us.

Over-Estimation of the Threat of Thoughts

Liz said that the reason people find OCD thoughts so distressing is because they hold one or more beliefs like the ones she described about them and so think they're much more of a threat than they really are.


Part Four
Mistaken Beliefs Specific to Religious Obsessions

If you like, skip past this part if you don't get religious obsessions

Fear of God's Wrath and Punishment

Worried

Liz said there was someone who had a life-threatening illness in middle age, and she'd always been a Christian, but she started thinking more seriously about the after-life then, and afterwards, she became fearful about whether she'd committed a sin and would be damned to hell for it, and whether she was making the right decisions in life that were pleasing God. She began to repeat prayers of confession and praise to God to win his favour, and to look for reassurance in sermons or Christian songs that she was pleasing God. She searched the Bible all the time for verses that would relieve her doubts, and asked other people if they thought she might be displeasing God. She was never happy with their reassurances for long, because she would always start thinking of other reasons she might have displeased him. By the time she went for treatment for OCD, her whole day was spent in fear over sin and punishment, and she was even finding it difficult to make basic decisions about personal hygiene for fear of displeasing God.

Liz said it seems as if some people assume that their salvation's just hanging by a thread, and that God's like an ogre who'll cut the thread at the merest slip of behaviour. But God isn't like that at all. God doesn't expect people to be perfect, and as long as people repent of any wilful sin they've committed, he won't hold anything against them, because it's been paid for by the punishment Jesus took on our behalf. She said people can only lose their salvation if they throw it away themselves, by showing contempt for God's commands by wilfully and persistently disobeying them all their lives. People have to be living a lifestyle of deliberate disobedience. A few unwanted thoughts or spur of the moment impatient words won't do it. God loves us, and his commands are all meant for our protection and well-being and the protection and well-being of those around us. If he cares so much about our protection and well-being that he's prepared to give us several commands to guide us so we'll be less likely to harm others or get ourselves into trouble, it would be against his nature to condemn people for things they didn't do deliberately or did in the heat of the moment and sincerely regretted later, because that would be making people feel less safe and secure instead of more. She illustrated that God's commands are meant for people's protection and well-being, by quoting a Bible passage giving examples of them:

Colossians chapter 3 (GWT)

5 Therefore, put to death whatever is worldly in you: your sexual sin, perversion, lust, and greed (which is the same thing as worshiping wealth). 6 It is because of these sins that God's anger comes on those who refuse to obey him. 7 You used to live that kind of sinful life.

8 Also get rid of your anger, hot tempers, hatred, cursing, obscene language, and all similar sins. 9 Don't lie to each other. You've gotten rid of the person you used to be and the life you used to live, 10 and you've become a new person. This new person is continually renewed in knowledge to be like its Creator.

Liz quoted another Bible passage:

2 Corinthians chapter 3 (NIV)

17 Now the Lord is the Spirit, and where the Spirit of the Lord is, there is freedom. 18 And we, who all reflect the Lord's glory, are being transformed into his likeness with ever-increasing glory, which comes from the Lord, who is the Spirit.

She discussed a few of those things:

Sexual Sin

Tearful

Liz said we can tell that God's commands about sexual sin were meant to protect us. Many teenagers end up frightened and miserable because they've had sex before marriage and ended up with an unwanted pregnancy. Many married people are deeply emotionally hurt when their spouses are unfaithful. Those are just two examples of the consequences of people knowingly or unknowingly violating God's commands. There are several more. God's commands for us are wise, and meant for our benefit. That includes what Jesus said about how whoever looks at a woman lustfully has sinned because they've already committed adultery with her in their heart. Like any rule, it's bound to have exceptions, like people who have unwanted sexual thoughts. But some people cherish lustful fantasies, and it makes them far more easily tempted to do the real thing. That's the main reason why their thoughts are sinful.

The Bible says that on the judgment day, everyone's secret thoughts are going to be made known and their hidden motives are going to be judged. But people will hardly be damned if their motives for having the thoughts they have aren't bad, but they only had the thoughts because they intruded into their mind without them being able to control them. Anyone who believes God knows all their thoughts must surely believe that he must know why they're thinking them, because it will most likely have been some process of the mind that caused them to think them, so there won't really be much difference between that process and their conscious thoughts. So he'll know they're thinking them not because they want to, but because the thoughts have just intruded into their consciousness like unwanted guests gatecrashing a party. And God would also be bound to know how they were reacting to each thought. He'll surely know if people are upset by it. So he'll be more merciful towards people who have unintentional distressing thoughts than he will towards people who cherish fantasies of infidelity, especially if they're doing that while not caring how their wives would feel if they knew what they were thinking.

Even the harsh commands in the Old Testament were meant not because God was just a strict God, but for the protection of the community. Sometimes, it can help to look into the historical and cultural background to understand more why they were considered necessary. But it's interesting to do that and find out why.

For instance, if a young woman wasn't a virgin when she married, it could actually be a capital offence. That sounds incredibly harsh, but actually, it was meant as a severe deterrent to protect any offspring women had and their future families, since if a relative of a family could cast doubt on the virginity of a man's mother when she had married, he could attempt to rob him of his inheritance by arguing that it might not have been rightfully his, since he might not have been a legitimate member of the family. If the relative was successful, the man, along with any family he'd built up, would be made homeless. Deprived of the land on which they would have grown crops to support themselves, before the days of social security, the family could starve. So the capital offence was in keeping with the "life for life" principle.

Lust

Lust doesn't just mean sexual desire, but sexual desire with an element of selfishness that makes the person having the lust want to put their own desires first before the well-being of the person they're lusting after and others. So it would make someone want to have an affair with someone without stopping to think about how it might affect their wife, for example. So lustful thoughts are actually very different from the sexual thoughts a person with OCD might have that distress them because they don't want to have them.

Greed

Someone stuffing their face

Again, commands against greed don't mean that God will smite a person for the slightest greedy thought, simply because he's strict. The commands against greed are actually the equivalent of the many commands in the Bible to be caring in the way we use wealth and to help those less fortunate than us. The commands aren't to make us wary of every little thought and action we have, but about our general lifestyle. Someone who spends all their money on their own pleasures won't be pleasing God, especially if they're well aware of people in need around them whose lives could be improved if they put some of their money towards helping them but they don't care. On the other hand, people who think they have a responsibility to use their wealth to help people in need as well as to use it to make their own lives better, and they live their lives with that general attitude, will be pleasing God. God isn't going to condemn people for making the wrong decision every now and then, spending money on something for themselves when he'd prefer them to be spending it selflessly. And he isn't going to begrudge people spending some of their money on their pleasures. It's when people live a lifestyle where they consistently disregard the needs of others and think of their own pleasure as more important that God will be displeased with them. After all, Jesus himself enjoyed good meals. He didn't condemn people for giving him nice things to eat, saying the money should have been spent on others. But he certainly showed in his general lifestyle that other people's needs were his number one priority, rather than his own desire for pleasure. The Bible says that sometimes, he couldn't get any rest because of the crowds that came to him, but he still compassionately ministered to people's needs, even though he was tired and had gone without food.

The Bible says that Jesus has the very nature of God. A Jesus who cared enough to do things like that doesn't sound like a God who would deprive people of salvation for every minor infringement of his will even when it was unintentional. The commands against greed, like the others, were given because God cares about us.

Another problem with greed is that people can be easily defrauded when they're greedy. For example, if someone writes them a letter saying they've won a lot of money in a prize draw, but they have to give them their bank account details to get it transferred to their account, anyone carried along by greed might not stop to think that it sounds too good to be true. They might give their details away, only to discover they've given them to criminals who take all their money. On the other hand, people following God's commands won't be carried away by greed, so they might stop to think longer, which will give them time to decide it sounds too good to be true and disregard the letter. So that's another way that following God's commands protects us.

Anger

Angry

This isn't a blanket condemnation of anger. In another part of the New Testament it says people should be slow to anger, and in another part it says that if people do become angry, they should ideally get the matter resolved before the day's out. Liz said that there are three words translated as anger in the Bible: indignation, rage and resentment. The word translated as anger in that verse could mean rage or resentment, since indignation is a good form of anger which people should feel when they witness someone being hurt or something. Not having fits of rage or harbouring resentment though will obviously protect others, as well as being good for our health, since a build-up of angry feelings is bad for the heart. So the commands against anger are another way we know that God cares about us and people around us.

Obscene Language

Swearing angrily

Liz said the command against obscene language is also for the protection and well-being of ourselves and those around us. One reason is that people can find obscene language threatening, or they can lose respect for the one using it, so they don't treat them with so much courtesy. But also, what's really important is the attitude of the person using it, the reasons why they're using it. God isn't waiting to trample on someone because they've slipped up and said a rude word. He just isn't like that. Again, it's a lifestyle issue. If a person's regularly using obscenity, what does that say about their feelings towards the people they're talking about? They're not being respectful. They're being hateful or scornful, unkind, abusive or potentially upsetting. Obscene language is often used to intimidate or belittle people. It doesn't ever help the person who hears it. It can ruin the atmosphere of a place. It's a person's attitude that's important to God, and if the obscene words they speak indicate an attitude where they're being disrespectful, inconsiderate, hateful, or anything like that, then they need to change.

Dishonesty

Again, Liz said this is an attitude and lifestyle thing. If someone disrespects others so much that they're not considerate enough to tell them the truth, or if they're lying to them because they're selfishly putting their own desires before a concern for other people, then they need to change. Again, God isn't going to damn someone for telling a lie by accident or to get themselves out of a corner on the spur of the moment or something, although ideally, they should do something more creative instead. But again, this command is meant to protect people. It doesn't mean people are sinning if they tell less than "the whole truth and nothing but the truth", but that people shouldn't intentionally mislead people, because that could cause them harm.

Even lies told with the best of intentions can sometimes harm people. Liz said she heard of someone who didn't like something her boyfriend cooked, but didn't want to hurt his feelings, so she told him it was "great". She could have got out of hurting his feelings by simply saying she preferred other things he cooked. But she actually pretended to be enthusiastic about something she didn't like. So he cooked it more often. One day, in a fit of anger, in an argument that was started about something else, she blurted out that she hated it, and that was especially hurtful to him since she'd told him she liked it before. So finding a tactful way of saying she wasn't keen on it in the first place would have been a better thing for her to have done. So not telling the truth, even when you think you're lying for a good reason, can be a bad idea.

Baby

But Liz said there are examples in the Bible of people who lied to save lives, and they were praised and blessed by God, not for lying, but for the attitude that made them do it, their wish to save lives. For instance, when Pharaoh told the midwives looking after the Israelites to kill male babies when they were born, they didn't do it, and when Pharaoh called them before him to ask them why, they said the Israelite women weren't like the Egyptians, in that they gave birth so quickly that it was all over by the time the midwives got there. This was unlikely to have been entirely true, and yet God blessed them and made them prosperous, not because they'd lied, but because of their wish to save lives and not become killers. Their lies didn't stand in the way of them being blessed, because the attitude of their hearts was well-intentioned, and that was the most important thing.

Then Rahab the prostitute lied, when the two Israelite spies came to Canaan and it was discovered that they were there and the authorities came to her house to ask if she'd seen them, and she said she hadn't, whereas really, she was hiding them in her house. She was also blessed by God, not for lying, but for wishing to save the spies. The more minor sin was overlooked, while the attitude of her heart was what mattered most and brought her God's blessings.

This must surely mean that the sins of anyone who is genuinely trying to do things for the best, who cares about people's well-being and who isn't sinning with the intent to do evil, will not be looked on with anywhere near the harshness that the sins of those who are deliberately out to cause harm or don't care about what effect their actions have on others will be.

Doing God's Will

Liz said that if God overlooks even sinful things if they're done with the best of intentions by caring people, then he isn't going to condemn people for every little deviation from his will. Again, what matters is people's general lifestyle and attitude. People can get a very clear idea of the general attitude God wants us to have and the general type of lifestyle he wants us to lead by reading his commands. From the New Testament, it's clear that the general attitude a Christian should have and the general lifestyle they should lead is one where they behave in a caring way towards other people, doing their best not to do them any harm. But God usually leaves us to work out the details of how we'll do that in our everyday lives, since there are quite a lot of different things people can do with their lives while living a caring life. So he doesn't demand that people obey his will in every minute decision they make.

God's Patience

Liz said that if God demanded that his followers had to be absolutely perfect if he was going to forego damning them to hell, sending Jesus to take the punishment for sin so people could be saved would be an absolute waste of time, because everybody probably displeases God even a hundred times a day sometimes. For instance, resentful thoughts might spring up; people can say things to others in a flash of impatience ... lots of different things can happen. The ideal is that we be as sinless as possible, but God doesn't expect spotless purity from people this side of heaven, much as he'd like it. The Bible says that if anyone says they don't have any sin, they're deceiving themselves. People should treat the sin in their lives as an undesirable thing to be eliminated if possible, but people shouldn't get distressed because they're not perfect. The Holy Spirit is given to people to help us become better. That's what the Bible says. God knows people can't get to be perfect on their own. So he gives us help. The Holy Spirit is our special helper from God, to help us come closer to doing what God doesn't expect anyone to do on their own.

Part of what Liz quoted from one of those Bible passages she quoted me said:

Colossians chapter 3 (GWT)

9 ... You've gotten rid of the person you used to be and the life you used to live, 10 and you've become a new person. This new person is continually renewed in knowledge to be like its Creator.

17 Now the Lord is the Spirit, and where the Spirit of the Lord is, there is freedom. 18 And we, who all reflect the Lord's glory, are being transformed into his likeness with ever-increasing glory, which comes from the Lord, who is the Spirit.

Liz said that those verses, and several others in the New Testament, mean that God doesn't expect people to become spotlessly pure all at once, but he knows the transformation may be gradual, a continual process. So he's sent the Holy Spirit to help us. He understands we need help to get there.

She said God loves his followers. He must love them a lot to have sent so precious a being as his son to die for our sins. It wouldn't make sense for someone who loved us that much to be damning people to hell left right and centre for minor violations of his moral code that they didn't even do on purpose. In fact, she said that people have done much worse things and yet not lost their salvation.

Not wanting to see something scary

She gave a few examples, like King David in the Bible, who had an affair with someone he liked the look of, and when she got pregnant, he had her husband, who'd been away at the time, killed, so he wouldn't discover it. Those were the days when adultery was punishable by death, so the woman could have been in danger if the affair had been discovered, (as David could have been, technically, although it's questionable as to whether anyone would dare challenge a king). But that meant it was even more inconsiderate of him to have started the affair with her in the first place. and having the man killed when he could have tried to pay him to drop the matter or something was still very callous and a severe crime. David was severely punished by God for it. Yet God didn't say he was no longer one of his people and would go to hell for it. David became very ashamed of himself, and was forgiven. And God blessed him afterwards.

Peter denied he knew Jesus three times on the night of Jesus' arrest, but beforehand, Jesus said he knew Peter was going to do it. He didn't say, "For this violation of my trust in you, you'll go to hell". He understood the strain that would be on Peter and told him that when his faith was renewed, he should strengthen the other disciples.

One day, not long before Jesus was arrested, he and his disciples were going through a village in Samaria. The people of Samaria and the Jews were traditionally antagonistic towards each other. Jesus and his disciples were trying to find a place to stay for the night, but no one would give them a room, because they were going to Jerusalem. James and John, perhaps in a flash of temper, asked Jesus if they should call down fire from heaven to consume the villagers. Jesus rebuked them for it, but he didn't say, "If you haven't remembered everything I said in the sermon on the mount about doing good to those who hate you, and all the other things like that that I've said, you're clearly not fit to be my disciples or to go to heaven!" He didn't threaten to reject them. They were still his closest disciples after that, along with Peter.

Since the Bible says Jesus had the character of God, we can tell God won't reject people for making mistakes, or for sometimes displaying bad attitudes, or for violating one of his commands under pressure. The Bible says God wants everyone to be saved.

It's true that God did inflict some very severe punishments on communities in Old Testament times. But these were usually people who were persistently doing very evil things that were harming others, like sacrificing children to Pagan gods and other crimes of violence, often people who'd been warned over and over again beforehand that they'd be punished if they didn't change, and yet they wilfully chose evil over good over time.

Heaven

Liz said she wondered why anyone who thought God was the kind of God who'd damn people immediately for trivial things unless they did something to change his mind and who'd become offended extremely easily by the smallest of things would ever want to be with him in heaven, since it might be nearly as scary to be near him as it would being in hell. She said anyone who thinks God would damn them for the slightest thing, even things they didn't do deliberately, has misunderstood God's motives for keeping people out of heaven. She said God wants heaven to be a place of peace and harmony, where everyone enjoys it and is considerate to each other. So it would be different from what the world's like. But in order for it to be a place like that, it has to mean that everyone who goes there is willing to give up inconsiderate or harmful behaviour. If God let people who weren't willing to do that into heaven, it would mean it got just as bad as the earth. Since God doesn't want that to happen, he can't let people who deliberately persist in inconsiderate or evil behaviour and don't want to change their ways into heaven. So anyone who hates the fact that they sin and wants to be purified shouldn't have any trouble getting into heaven.

But she did say that everyone will have times when they don't feel like being considerate and they want to do selfish or bad things, so people shouldn't feel guilty when they do and wonder whether God's rejected them, because it's just natural. It's a person's overall attitude that matters, not how they feel from second to second. The Bible says:

Galatians chapter 5 (NLT)

17 The old sinful nature loves to do evil, which is just opposite from what the Holy Spirit wants. And the Spirit gives us desires that are opposite from what the sinful nature desires. These two forces are constantly fighting each other, and your choices are never free from this conflict.

And:

1 Peter chapter 2 (TEV)

11 I appeal to you, my friends, as strangers and refugees in this world! Do not give in to bodily passions, which are always at war against the soul.

These verses mean that we'll always be tempted to do sinful things, and God understands that. Everyone, or most people, will have moments when they'd prefer to do sinful things than to be purified. But the Holy Spirit is here to help us overcome the temptations.

And the important thing is not to feel guilty, worrying about whether we've failed God, but to focus on the future, doing what we can to get close to God, whether that be reminding ourselves of his commands regularly, since it's easy to forget them sometimes in everyday life; spending time with people who make us more enthusiastic about being Christians; reading favourite Bible passages or encouraging stories of people who became Christians; asking God regularly to renew us in the Holy Spirit, or whatever helps us. But we should only be doing that kind of thing if we want to, not because we feel pressured to. The Bible says God is Love, and he wants us to love him, not to be afraid of him.

The Unpardonable Sin

Liz said that because there are so many Bible passages that show us that God's merciful to anyone who sincerely wants to follow him, and that he cares about people, it's unlikely that blaspheming the Holy Spirit means doing something that might be seriously regretted and that isn't that bad in comparison to other things, like just saying something horrible about him. She said some people can be tormented with worries that they've blasphemed the Holy Spirit of God, but if they're worried about it, it'll mean they're very unlikely to have done it. She said the background to Jesus' words that anyone who blasphemed the Spirit of God could never be forgiven was that the Pharisees had been saying that Jesus was working by the power of an evil spirit, rather than the Spirit of God. Since the way people are drawn to God by him is through the Holy Spirit, anyone who thinks the Holy Spirit's an evil spirit won't allow him to draw them to God so they can receive forgiveness through Jesus. God can't forgive anyone who doesn't want to receive forgiveness.

She said that's why anyone who's worried about having committed the unpardonable sin is very unlikely to have done it, because they'll be upset at the idea that they might not be forgiven, craving to be forgiven.

Hell

Fiery

Liz said that some people might be afraid of God because they've heard terrible descriptions of hell. But some people think it will be worse than the Bible says it is. Some people might think that hell is a place where people will be tortured for eternity. But for one thing, Jesus said people will "cry and gnash their teeth" in hell. If they were being tortured, they would be screaming, not just weeping.

Some people think the descriptions of fire are symbolic. The image of fire is sometimes used in the Bible to symbolise purification. Some people believe that what will be burned up and destroyed is all impurities in people, and that once they've been purified, they will be allowed into heaven. They say the word translated everlasting can also mean age-long. So they believe hell will only last for a time.

The word translated as hell that Jesus often used was the word Gehenna, which was literally a rubbish dump outside Jerusalem where fires often burned, but was widely used in those days as a metaphor for hell, although it was thought to be a place of punishment where people only went temporarily.

Some Jews of Jesus' day thought punishment would last different lengths for different people, depending on how evil they'd been, and there would be different places of punishment, Gehenna being the first stage; and then, some would be allowed into heaven, and some would be annihilated, while some went off for further punishment. There were differences of opinion, since the Bible doesn't make it clear.

Some people think hell will be a place of eternal shame rather than pain.

Jesus gave hints that punishment in the after-life would be more severe for some people than others. For example, he criticized religious leaders who robbed widows of their homes and then made a show of saying long prayers, saying their punishment would be "all the worse" because they'd behaved like people who were sincerely committed to God after having done such horrible things. And after telling a parable warning about how people ought to behave well so they don't suffer on Judgment Day, he indicated that those who'd done wrong but had done it in ignorance of what God really wanted would be punished more lightly than those who had known full well what God wanted and yet had still done wrong.

Jesus didn't say what would happen to people who knew what God wanted but accidentally sinned. But we can tell his attitude from other things he said, like what he said to Peter before Peter denied he knew him, about how he knew he was going to do it but still regarded him highly, even though Peter's sin wasn't accidental but something he did deliberately to protect himself from possible danger. And the Bible does reassure Christians about little sins they might unintentionally lapse into on an everyday basis or do in a moment of weakness and then regret:

1 John chapter 1 (NLT)

5 This is the message he has given us to announce to you: God is light and there is no darkness in him at all. 6 So we are lying if we say we have fellowship with God but go on living in spiritual darkness. We are not living in the truth. 7 But if we are living in the light of God's presence, just as Christ is, then we have fellowship with each other, and the blood of Jesus, his Son, cleanses us from every sin.

8 If we say we have no sin, we are only fooling ourselves and refusing to accept the truth. 9 But if we confess our sins to him, he is faithful and just to forgive us and to cleanse us from every wrong. 10 If we claim we have not sinned, we are calling God a liar and showing that his word has no place in our hearts.

1 John chapter 2 (NIV)

1 My dear children, I write this to you so that you will not sin. But if anybody does sin, we have one who speaks to the Father in our defense--Jesus Christ, the Righteous One. 2 He is the atoning sacrifice for our sins, and not only for ours but also for the sins of the whole world.

Handing Worries Over to God

Anxious

Liz said there was someone who was a devout Catholic, who became distressed because she started having thoughts she found disgusting and upsetting about Jesus and Mary having sex. She became extremely anxious if she didn't try to banish them from her mind right away. She even thought they might lead to a nervous breakdown. But when she asked other people if they had blasphemous thoughts like hers, she was surprised to discover that they did occasionally have thoughts that were a bit naughty and that they found distressing, though not as bad as hers. But they didn't believe that terrible things would happen if they didn't put all their efforts into controlling them. Instead, they said they dealt with them by thinking of them as a stranger's thoughts and not their own, and then saying a little prayer and handing them over to God to take care of. So they didn't actively try to suppress the thoughts, but just let them float away from their minds, as if they were now God's concerns and not their own. They said they didn't believe the thoughts were sinful or a threat to their faith, since they were unwanted. The Bible does urge people to cast their anxieties on God, saying God cares about people, so that would include anxiety about distressing thoughts.

Liz said that obsessional thoughts do tend to just fade away after a while when people stop worrying about them but just leave them to drift out of the mind.

Experimenting with Not Controlling Thoughts

Liz said the person who had the distressing blasphemous images of Jesus and Mary having sex did an experiment where one day she tried to just let the thoughts float out of her mind rather than actively trying to control them. She discovered that when she did nothing to try to control the thoughts, they did just leave her mind, and she started to have them less and less than she did when she actively tried to control them. She kept on just leaving them to go away on their own after that, and eventually, she hardly ever had thoughts like that any more. When she did, she still found them disgusting, but she didn't try to control them, and they just went away on their own. So she didn't have to spend any time at all doing what had used to take up time, trying to control her thoughts.

Liz recommended that we experiment in the same way, by some days leaving thoughts to just leave the mind of their own accord, and on other days actively trying to control them, and seeing which strategy is the most effective. We can write down what happened in a notebook, to remind ourselves which strategy is the most effective, and to remind ourselves that even if not trying to control the thoughts seems distressing at first, our distress levels will go down, and the amount we have the thoughts will go down.

She recommended that fairly soon after we start experimenting, we move on to having more and more days where we experiment with not doing anything to control our thoughts or to relieve our distress, but where we just leave our thoughts to go away on their own.


Part Five
Working Out What Beliefs Make Our Thoughts More Distressing If We're Not Sure What the Beliefs Behind Our Obsessions Are

Liz said that people with OCD, like other people, are likely to have thoughts that intrude into our minds every day that we don't think are important, as well as the ones we do. She said it can be good to write down examples of which ones are important to us, and then write down examples of thoughts we have that we dismiss as unimportant. That way, we can work out the reasons we think some thoughts are more important than others, and the reasons why will be equivalent to the beliefs behind the thoughts.

She said we can write those two categories of thoughts in two separate columns on a page if we like. She suggested we write down five to ten examples of each type of thought - five or so important ones and five or so unimportant ones.

She said when we've done that, we should try to work out why some of the thoughts are more disturbing to us than the other thoughts, since it might be that we have beliefs about them that make them more distressing, but we take them so much for granted and we've had the beliefs for so long that we don't really realise we've got them and that they're influencing our thoughts so much. But if we think of our obsessive thoughts and try to work out why they make us more distressed than other intrusive thoughts we have that come into our minds without us wanting them to, it could help us realise what beliefs we have that we weren't really aware of but that might be standing in the way of our progress towards recovery.

Then we can work out or find out if the beliefs are really true, because if they're not and we stop believing those things, then we won't have any reason to think the thoughts are important anymore, so we'll stop worrying about having them and letting them upset us, so they'll stop bothering us.

An Example of Someone Who Had Disturbing Religious Thoughts

If you like, skip past this part if you don't get religious obsessions

Scared

Liz told me a story about someone who thought through which of her intrusive thoughts she considered important enough to worry about, and which ones didn't bother her. The thoughts she wrote down that she thought were disturbing and important were impulses to swear during religious services, worries that she might have committed the unforgivable sin, and worries that she'd contaminated a prayer she'd said by having an impure thought in the middle of it.

She wrote that the intrusive thoughts she had that she didn't think of as important were an impulse to pull a fire alarm cord, a worry that she hadn't paid a cheque, and a worry that she'd left a surface dirty in her house. She said those things didn't seem important, because she was confident she had the self-control not to pull the fire alarm; she was confident that her memory of paying the cheque was accurate and felt sure she wouldn't have been forgetful enough not to; and she didn't think the worry about the work surface not being cleaned was important, because she was confident she had a strong enough immune system to fight off any germs that might be there. So she was different from some people with OCD whose beliefs about the way things are might be different and so they'd think those thoughts were a lot more important than that.

But Liz said the person had incorrect beliefs that made her think the other thoughts she had were important. She was very disturbed by her impulse to swear during church services because she believed that thinking about doing that was just as bad as doing it. If she could have become convinced that thinking about it wasn't as bad as doing it, the thought would lose its importance.

She thought her worry about committing the unforgivable sin was important because she thought she'd be condemned to hell if she had. If she had researched into what people really have to do to commit the unforgivable sin and found out that many people believe it's something far worse than anything she was likely to have done, and not just saying blasphemous words against the Holy Spirit or having a feeling of antagonism towards him for a moment or something, then that thought might have stopped worrying her because she'd have been reassured she hadn't committed it, so the thought wouldn't have distressed her any more.

Upset

She was worried that thinking an impure thought in the middle of a prayer would mean she'd have to say the prayer all over again. If she could have been convinced that God's merciful and understanding; and if she had come to feel confident that he'd know that if she had thought an impure thought in the middle of a prayer, it wouldn't have been her fault given her dedication and the fact that she didn't want to think it; and if she'd come to believe that people's general attitudes are far more important to God than that they do every single part of a religious observance perfectly, then she might have stopped worrying about that thought, so it might have become one of the unimportant ones as well.

But Liz said the person thought that having all those thoughts might mean that at heart she wasn't a true believer in God, and that was another reason she found them so upsetting. But if she'd been reassured by someone telling her that some of the most saintly people had been plagued by intrusive thoughts of impurity when they tried to read the Bible and pray, and yet they achieved great things for God, and if she'd been persuaded that the intrusive thoughts had been put into her head by the OCD and so if they weren't wanted, they could have been dismissed as just unwelcome OCD thoughts, not disobedience, then she might have been reassured and stopped thinking those thoughts had the significance they did, so they'd have stopped bothering her even more.

Liz said the person had thought that she couldn't just ignore her worries as to whether she'd committed the unforgivable sin or had an impure thought while she was praying, because she thought that would be sinning. But if she could have become convinced that God loves people so much that he doesn't want them to torment themselves with doubts, so it wouldn't be sinful not to, and also that it's the intentions people have that are important to God, not just thoughts on their own, then she might have been relieved and stopped worrying about the thoughts. For instance, if she had come to believe that there was a world of difference between having an impure thought that she had absolutely no desire to go out and act on, and having one that she found pleasurable that made her want to go out and act on it, and it was having thoughts like the latter and enjoying indulging them that God objected to, not merely having the thoughts on their own when they just came into the mind by themselves, she might have realised that God wasn't going to disapprove of her because a thought had come into her mind that she hadn't wanted there, and so she would have been reassured that she didn't have to worry about those thoughts any more, so they might have gone away.

One Reason Why People Get Obsessive Thoughts

Running away

Liz said the reasons people get the obsessions they do and the reason some thoughts might turn into obsessions while others won't is because of concerns the people having them are currently having, or because they have worrying thoughts that conflict so much with their values and sense of identity. She gave an example, saying that a woman who prided herself on her gentle, considerate nature might be upset by having an impulse to spit on a friend she was talking to, whereas someone who wasn't that bothered about being considerate wouldn't, so they might just forget the thought and not worry about it. She said she heard about someone who had thoughts of pushing people in front of trains, and the thoughts didn't bother her until she wanted to work in a caring profession, and then she started to worry about whether the thoughts meant she had a violent side she didn't know about and might harm someone. So then they turned into OCD.

Liz said that what can turn nasty thoughts into OCD is catastrophic interpretations of them, where people think they mean much more than they do. For instance, if someone has a thought of exposing himself in public, he might think he's really in danger of doing it, because he thinks thoughts lead to actions, whereas really, thoughts will only lead to actions if the person who has the thought wants to do what they're thinking about. Or a woman might be horrified about an impulse to drop her baby and think she's really in danger of doing it because she must have some unconscious resentment towards it, when in reality, she's never done anything but loving things towards it, she cares deeply about it, and her self-control is so strong that she'd never do anything to harm it.

Questioning Beliefs About Obsessions

Questioning

Liz said it's a good thing for people with OCD to question the beliefs we hold about our obsessions, to think through whether what we've been assuming about them for all these years is really true. She said people can take their beliefs so much for granted that it never occurs to them to question them. But when they do, they can work out the errors in them.

She said it can help if we ask ourselves questions like:

  • What do I believe this obsession means about my personality?
  • What do I worry this obsession means might happen in my future?
  • What bothers me most about having this obsession?

She said someone who was worried about impulses to molest her child asked herself those questions, and reflected that she believed that having the obsession might make her lose control and act on it. So she found information about how there has to be more than just a thought about molesting a child to make someone act on it, for instance the thought has to be pleasurable.


Part Six
Compulsions and Other Methods of Coping With Obsessions

Liz said it's common for people with OCD to perform rituals to try to make our anxiety go down when we get disturbing intrusive thoughts, or to try to atone for obsessive thoughts or undo them. For instance, she said it's common for people who have images intruding into their minds about hurting people to replace them immediately with images where the people are healthy. That would be called a neutralising act. Or they might perform a ritual like counting to a certain number or repeating an action a specific number of times, or always doing it in the same way. She said these are typically things people feel they have no choice but to do, because the alternative is feeling really anxious.

Liz said that checking is a very common thing to do in response to OCD obsessions, like checking the newspapers to see if anyone's been hurt recently in the way the person with OCD fears they may have hurt someone, making sure all the knives are where they're supposed to be to try to reassure themselves they haven't used one, or asking for reassurance from others that no harm has occurred, like asking a child every few minutes if they're allright if they're worried they might have sexually abused them.

Actually, I've done things like that.

Liz said that with religious obsessions, people can do things they hope will atone for them, like thinking a good thought every time they have a blasphemous one.

Characteristics of Compulsions or Neutralising Acts

Liz said we can tell if we've got compulsions or we do neutralising acts if what we do has certain characteristics:

  1. Unlike the urges or images that come into our minds, what we do to try to stop them is intentional. And it's repetitive, and excessive. She said the rituals or neutralising acts may become automatic over time, but they will still be done deliberately. And they will be done repeatedly, like asking for reassurance or praying several times a day.
  2. We can feel a very strong urge to do them. She said it's quite common for people with OCD to try to resist the pressure from within to do the compulsion rituals at first, but the pressure gets stronger and stronger so it's too difficult not to give into, and in time, people often don't try to resist it any more because of that. Every time a person with OCD completes one of their rituals, the pressure to continue doing it goes down for the time being and we can feel a lot of relief. But when the obsession comes back into our minds, we'll feel under pressure to do the compulsion again. Or we can start to feel the pressure again if we start doubting whether we did the ritual properly.
  3. People with OCD feel as if the compulsion rituals are taking control of their lives, as if they're enslaved to them against their will. Liz said that some people with OCD can spend most of their waking hours performing them, having to give up important activities to do them.
  4. Compulsions are done to make feelings of distress subside, and neutralising acts are done to stop worries that bad things will happen if the person doesn't do them, or to make up for having a harmful or sinful thought. Doing them calms anxiety and can bring relief, but even when it doesn't, people can still feel compelled to do them, because they feel the anxiety will be worse if they don't.

Liz said we can work out if the things we have are compulsions or neutralising acts by writing down the things we do in response to obsessions and thinking about how closely they match those characteristics.

Ways of Trying to Control Our Obsessive Thoughts

Liz said that people with OCD typically use other strategies besides compulsive rituals to control our obsessive thoughts, trying to do them before we feel the need to do the compulsion, in the hope we won't have to. But some are more effective than others. She said the techniques people use can include:

  • Avoiding situations that often spark off the obsessive thoughts, or avoiding what will make the distress people feel about having the thoughts worse. For instance, people who worry about harming children might avoid being around children, or they might avoid being with them alone.
  • Trying to convince ourselves that our obsessions are unimportant and don't have the significance we really think they do.
  • Thought-Stopping, where people say "Stop!" firmly in their heads or out loud, to try to stop their thoughts in their tracks.
  • Making critical or disparaging remarks to ourselves about having the disgusting obsessions.
  • Trying to distract ourselves from an obsession by doing or thinking something else.
  • Attempting to replace the obsessional thoughts with other, nicer thoughts.

She said some of those strategies work better than others, and that the strategies people with OCD tend to use are often the least effective ones, like avoidance, using compulsions, and self-criticism.

She said the efforts to control the obsessions tend to be exhausting and make it difficult for a person with OCD to focus on doing other tasks.

She said it will help us work out how to recover if we first consider what thought control strategies we use, and how often we use each one.

The Problems With Compulsion Rituals And Other Thought Control Strategies

Miserable

Liz said it's understandable that people with OCD will do things like compulsion rituals to reduce the threat we think we're facing if we believe one or more mistaken things about our thoughts, because we're bound to want to reduce the stress those thoughts are causing us. So it's no wonder that people with OCD might keep seeking reassurance from others or checking that no harm's been done or could be done or whatever else we're worried about. She said that the trouble is that when people do those things, we never get to learn that our thoughts aren't a threat after all, because the strategy makes us feel better for a while, so we rely on using it, and in fact since we know it'll make us feel better for a while, it'll be more and more difficult to resist using it.

I suppose that must be how some addictions work as well.

Liz said something just as bad as that can happen when we try to escape from an obsession by replacing a horrible thought in our minds with a nice one, because every time we see something that reminds us of the nice thing we've replaced it with, we'll think of the obsession as well, because the nice thought reminds us of it. So it'll make the obsession worse.

Scared

She said someone had horrible worrying thoughts of stabbing his grandchildren, and he always used to replace them in his mind with nice thoughts about them having grown up to be healthy adults. He made the thoughts quite detailed, imagining what the children were wearing, like graduation gowns, to symbolise that they'd made it to the end of university. The trouble was that whenever he saw clothes like that after that, they reminded him of the thoughts he made himself have about his grandchildren being healthy, and because of that, they reminded him of the horrible ones, so the horrible thoughts came into his mind again. So really, thinking the nice thoughts made it more likely that the horrible ones would come into his mind again, because whenever he saw nice things that reminded him of the nice thoughts, they'd remind him of the horrible thoughts, so he'd have them again. So he got them more often.

Liz said we can gain a lot by thinking through what our OCD makes us do and what we believe about our thoughts, because then we'll know what we have to deal with when working towards recovery. She said that sometimes, strategies to deal with the OCD will have become such habits that we might have forgotten they're to do with the OCD. She says the person who had those nasty thoughts about him stabbing his grandchildren would avoid the colour red because it reminded him of blood and that reminded him of the obsession. It meant he avoided driving his son's red car, eating in restaurants decorated in red, wearing red clothes, and other things. But he got so used to doing those things that he forgot they were part of his OCD and thought they were just a colour preference.

Working Out What Thought Control Strategies We Use

Liz said we can work out what we do as part of our OCD if we spend a week monitoring ourselves, to work out when we have obsessions and when we use strategies to get rid of the OCD symptoms. She reminded me of exactly what to look out for besides the intrusive thoughts:

  • Compulsions and neutralising, which are any mental or physical things we do to stop ourselves feeling so distressed about an obsessive thought we've just had.
  • Thought control, which is any attempt to get rid of a thought we've just had.
  • Avoidance, which means avoiding any place, person, situation, object or action that we worry might trigger off the obsession or make us feel worse afterwards.

She recommended that a good way to go about monitoring them is to make six columns on a page in a notebook, or six headings in a document on the computer, for things we need to fill in. She said the columns or headings can be labelled:

  • Day
  • Obsession
  • Feelings about it
    (these would be feelings like fear or disgust or whatever)
  • Compulsions/neutralizing
  • Thought control
  • Feelings after the use of compulsions/neutralizing

She said we only have to document three obsessions a day, since there will be so many otherwise. So over the week, we'll end up with 21.

So when we have the first obsession we decide to write down in any given day, the idea is that we write what day it is in the first column, and then in the obsession column, we write a short note of what it was. In the feelings about it column, we list what they were. She said it's good if we put a number by each feeling we mention on a scale from 0 to 100, depending on how strong it is, with 100 being the strongest we think it could possibly be, and 0 being insignificant.
Then, in the next columns, we should list what compulsion we used to make our anxiety go down, or how we tried to neutralise the thought, or how else we tried to control it.
In the last column, or under the last heading, we should write a number on the 0-100 scale signifying how much we were relieved by doing the strategy, with 100 being really really really relieved, and 0 being not at all.

Liz said it's important to try to write those things as soon as possible after we get any obsession we're planning on writing about and we do the strategy to try to get rid of it or whatever. Otherwise, we might forget things.

She said we can write down on separate pages all the incidents where we avoid people or things, whether that be complete avoidance of them, or partial avoidance, for instance being with them while others are there but not wanting to risk being alone with them.

She said that doing that will give us a clearer idea of exactly what behaviour is linked to our OCD, so we'll have a better idea of what to work on in our recovery.

Challenging Obsessive Thoughts Some More

Liz suggested that people with OCD write down in a notebook all the reasons we find our disturbing thoughts so upsetting or disgusting, so we can challenge them, if we haven't already. Writing these things down is just a memory aid, so we won't forget all the things we think of that we can use as evidence against our obsessive thoughts being true. Liz suggested certain techniques, but they're probably not any better or worse than other techniques.

Anyway, I'll try what she said for now.

She said that working out what significance we believe obsessions have will help us understand why we have such bad anxiety responses to them, so at least understanding that will be a bit of a relief.

Thinking

She suggested we do another page in a notebook with columns, this time four, the one on the left for the day, then one for the obsession, then one for our feelings about it, like fear or whatever, and then one for our beliefs about what it means, like whether it means we're worried that we might be a psychopath at heart or not fit to be around people or whatever.

It might be helpful and give us a clearer picture if we keep up those records for a week as well.

She said understanding why we get so anxious about the thoughts we have will help us understand why we keep feeling the need to do things that reduce the distress we feel about them. She said the things we do after we've had obsessions might have become such habits that we don't even see ourselves as doing them to relieve distress now.

She said people who want to stop doing compulsions can find it difficult because of the relief from distress they bring. She said we can work that out for ourselves by thinking about how much better we feel after we've done a compulsion than we did before, or how much worse we think we'd have felt if we didn't do it.

She suggested we think about one of the intrusive thoughts we have that we don't worry about, and think about what we'd need to do to turn it into an obsession, to help us work out how our obsessions got going. So if someone had an impulse to pull an emergency cord on a train for no good reason, for example, but they were sure they'd never do it, they'd have to start worrying that they might do it to turn it into an obsession. And then if they developed a ritual to take their minds off it or something so their anxiety went down, it might start to be difficult to stop doing the ritual whenever they were on trains in the future, because they might worry that if they did, the thought of pulling the emergency cord might make them really anxious, or it might make them do it. But in the beginning, before they started worrying about it, the thought didn't bother them.

Making Deliberate Efforts Throughout the Day to Recognise OCD Symptoms for What they Are

Liz said that instead of actively trying to control our obsessions or worrying about them, it can help if we start to try to think of them in the way a detached observer would. The technique's called mindfulness or mindful awareness. So when we have an obsession, instead of trying to control it or getting anxious about it, we just think, "Oh, I'm having an obsession", and let it pass by. And if we get an urge to do a compulsion, instead of thinking we need to do it, it's good if we think, "Oh, I'm having an urge to do a compulsion now". This will help us recognise that these aren't part of the way our personality functions but are part of the OCD illness. So perhaps if we have an urge to trip an old lady up in the street, instead of worrying about the thought we've just had, we should recognise it for what it is and label it as such in our minds, by thinking something like, "Oh, I've just had an OCD obsession that's put it into my head to trip someone up". And then the idea is that we just let it go. Or if we have a compulsion to wash our hands, we should make a deliberate effort to recognise it for what it is and make a mental note, not thinking that we feel as if our hands are dirty and need washing, but giving the feeling the name it deserves so we recognise it more fully as part of the OCD. So we'd think, "Oh, I'm having an OCD compulsion to wash my hands now".

Liz said It can help if we do those things whenever we notice we're having an obsession or an urge to do a compulsion or another thought control strategy.

It can also help if we keep reminding ourselves, "It's not me; it's my OCD".

That can help us realise that the thoughts don't have the significance we've been thinking they do. They're really just the brain malfunctioning a bit; but it might well stop if we get our brain out of the habit of thinking it's necessary to do what it does. And when we start to view the thoughts as just OCD thoughts, rather than anything that's really telling us something important, we'll have more confidence about fighting it.


Part Seven
Things That Can Get in the Way of Treatment


What would life be if we had no courage to attempt anything?
--Vincent van Gogh

An unfortunate thing about this world is that good habits are much easier to give up than the bad ones.
--W. Somerset Maugham

Liz said that one thing that can hinder recovery is if we're absolutely certain of what we believe about the consequences of an obsession, like that it means we must be a bad person or it'll make us act on it if we don't stop it, or that we'll be punished by God for it. She recommended we do some more investigation into whether such beliefs could really be true if we think those things.

She recommends we treat our beliefs about our obsessions as guesses, not as truths. She suggested we look back at what we wrote in our notebook about what thoughts we had that made us so anxious about our obsessions and reword them as guesses. So if someone wrote something like, "I must be a pervert at heart if I could have such thoughts", they could change the word "must" to "might".

Liz said another hindrance to recovery can be that some people are concerned that recovering from OCD will have disadvantages.

  • She said some people worry that if they try to recover but don't despite their best efforts, it'll mean they'll have to start thinking of themselves as a hopeless case; far better not to have tried, so they could still be optimistic they might succeed if they did.
    But really, if they don't recover, it might just mean they ought to try another form of treatment instead, or that they've got too much to cope with at the moment. For instance, if they're depressed as well as having OCD, it can take longer to recover, and they might need help with their depression first sometimes. Or medication might help correct a chemical imbalance in their brain that was causing some of the symptoms.
  • She said some people worry that they'll have to relive past horrible experiences as part of their recovery.
    But they shouldn't have to do that.
  • She said that some people are afraid that treatment will make their symptoms worse.
    But once they know about the reasons why symptoms get worse, it'll be easier to work out what kind of things are likely to make them worse and what kind of things might make them better.
  • She said some people worry that if they get better, their family won't like their new confidence.
    But families can be reassured if the OCD sufferer reminds them of all the advantages they'll get from their recovery, and other issues can be worked out.
  • She said some people worry that their families will be angry with them for not recovering sooner, wondering why they couldn't recover earlier if they can do it now.
    But people need the right help to recover, so if they didn't find it before, or didn't know decent help even existed, that'll be why they couldn't recover before.
  • She said some people worry they'll lose face if they've been insisting they really need to do their compulsions for years even though they've inconvenienced others, but then they don't need to do them anymore.
    But really, the compulsions will have been the best coping strategy people knew how to use at the time, so they were important then. But after people have recovered, they can cope without them at last.
  • She said that some people worry they'll lose the emotional support and attention they had when they had OCD.
    But once they're well on the way to recover, they can start living a new life where they won't be so dependent on it, and work on improving family relationships so they're just as satisfying if necessary.
  • And she said that some people would rather stay as they are because they fear the unknown.
    But imagining how good the future could be without OCD could help. And also, if they know the reasons for doing everything they've been asked to do in their recovery, they hopefully won't feel so bad about it.

Liz suggested we write down all our misgivings about recovery, so we can work on reassuring ourselves or thinking through creative ways of stopping our concerns becoming problems.

She said that people often have good grounds for their fears, but they still worry far more about them than they need to, or worry that things will be worse than they really will be. For instance, some family members might say angry words to a person who had OCD but recovered, because they might think they can't really have had as much of a problem as they let them think before, or wonder why they didn't recover before if it was so easy to get over it, and be annoyed that they allowed themselves to be inconvenienced for so long. But once they start realising the advantages of their lives free from OCD and enjoying them, and they notice how much better the person who used to have OCD feels, their anger will go away. After all, presumably they'll care about the person. If their anger doesn't go away, there will probably be deeper relationship issues that didn't have anything to do with the OCD that need resolving. And people can do that better if they don't have the stress of OCD to cope with as well.

Or sometimes, people worry that others will expect too much of them once they've recovered, asking them to take on responsibilities that they're not sure they can handle. But while people probably will be asked to take on more responsibilities, not having the stress of OCD any more and knowing they're well on the way to recovery will make them more confident and feel more competent to take them on. So they shouldn't be too much. And since recovery will probably be gradual, people will probably take on new responsibilities bit by bit anyway, so they won't be expected to do too much at once, and will feel more and more capable as time goes on.

The Personal Costs of OCD

Liz said people can become more motivated to recover if they think about all the ways OCD impairs their functioning in all aspects of their lives. So that would include:

  • Work: That would include the quality of life at work, ability to concentrate, relationships with others, promotion prospects, finding a better job, and so on.
  • Relationship with a marriage partner for those who have them: So that would include how the OCD affects the partner's happiness, whether it affects the sufferer's ability to be supportive to the partner, whether it interferes with the things they like to enjoy together, and so on.
  • Relationship with children, for those who have them: So that would include whether the OCD sufferer's behaviour sets their children a good example, whether they're able to be supportive of them, whether they can enjoy quality time together, and so on.
  • Relationships with friends: So that would include similar things, like whether we can enjoy time with them without the OCD interfering, and whether we can be supportive towards them as much as we'd like.
  • Personal fulfilment: So that would include whether we can pursue hobbies and interests as much as we'd like, and how much we can do voluntary work to help others, unhindered.

Liz said it can help if we think about how our life could improve in all those ways if we didn't have OCD, and then ask ourselves whether we're still so worried about the possible consequences of recovery that we think improving our lives won't be worth the risk. We should bear in mind that hopefully, any costs of recovery will only be temporary, while the costs of continuing to have the OCD are more likely to be permanent if we don't get rid of it.


Part Eight
The Problems with Trying to Control Thoughts and Other Coping Strategies

The Reasons Why Trying to Suppress Thoughts Doesn't Work

Liz said that the more people try to control their thoughts, the more problems they can have with them, because if we're always aware that we shouldn't be thinking about them, they'll always be on our minds at some level, so they'll rise to the surface of our consciousness much more quickly than they would if we weren't bothered by them so we didn't try to control them.

Ice-cream

She said we can test that one out for ourselves if we sit down for two minutes, with a notebook and a watch with a timer function that'll beep at the end of two minutes so we'll know our time's up and won't be distracted by the need to keep looking at the watch. Then we can try to think of ice-cream with gravy on it or something else like that for the whole time. We can try as hard as possible, but whenever our thoughts stray from it, we should make a mark in the notebook. After that, we can relax for a little while and then spend another two minutes trying to keep the thought of ice-cream with gravy on it out of our minds to see how often it comes into our minds despite our best efforts. If we make a mark in the notebook whenever it does intrude into our minds, and discover there are lots of marks, we'll know that trying to just block thoughts from the mind is very difficult. And that'll be especially so when they're far more important to us than just thoughts of ice-cream with gravy on it or something.

Liz said some research has found that the harder people try to suppress obsessive thoughts, the more difficult it is to do, because the thoughts either won't go away, or they come back worse after the person's efforts to control them have eased off.

She said a psychologist did that experiment on university students where he asked them to think about white bears for two minutes, and then to make efforts to keep the idea out of their minds for that long. He spoke to the students some time afterwards and discovered that the thought of white bears still preoccupied them quite a lot. He thought it must be because thoughts come back worse after someone's tried to suppress them, because the efforts needed to suppress them make the mind more conscious of the thoughts. He said he thought that happened for two reasons: One was that in making a deliberate effort to suppress a thought, the mind will be monitoring itself for signs that the thought is about to appear so it can suppress it, which will mean the thought is really always on the mind somewhere. And also, when a thought is suppressed, it will have to be replaced with another thought to keep it away, so the task of thinking about what to use as a distraction from the thought will also mean that the thought stays on the mind, because the mind has to think about it in the process of thinking about what to replace it with. Also, the things the mind uses to replace it will become reminders of the thought it's trying to suppress, so soon, thinking about the thoughts used as a distraction from the thought the mind's trying to suppress will bring it to mind.

The psychologist said that distraction can be a successful means of suppressing obsessive thoughts for a while, but only if a person's able to concentrate on it fully. It becomes more difficult if something stressful happens so concentration becomes poorer, or if a person's in an anxious or depressed mood so anything they think of to distract themselves might be just as bad as the original thought. Or it can be difficult over a period of time, when people are bound not to be able to put the same effort into it all the time. And then if people are distressed because they've failed to control the thought, it will be on their mind more so it'll be worse.

So since people with OCD will be trying to cope with stressful things at the same time as controlling thoughts, it's no wonder that we don't succeed that well by such methods.

Liz said that people with OCD use a number of different strategies to control thoughts, and some are more successful than others. But the ones that tend not to work are criticizing ourselves for having the obsession by telling ourselves we're being silly to get so upset about it or something; saying "Stop!" to try to get rid of it; worrying about having the obsession; or using a compulsive ritual to try to relieve distress, or a neutralising strategy to try to undo the thought.

How to Deal with Thoughts Better

Liz said it might sound daunting or contrary to common sense, but since trying to control thoughts can make them worse, the best way to deal with them is not to control them. She said people can do this by coming to understand that obsessions in themselves won't lead to anyone being harmed. She says there are ways we can convince ourselves of this.

She recommended we look back in our notebook to where we wrote down the thoughts we had about what our obsessions must mean, and then think through whether our beliefs about them are really true, if we haven't already.

The Problems with Doing Excessive Things to Make Sure Harm Doesn't Come to People

Crying

Liz said that some people go to such great lengths to make sure harm doesn't come to people as a result of the thoughts their obsessions are putting into their heads that it really interferes with their day, because they believe that if harm does come to someone, and their carelessness could have played even a tiny part in it, they would feel as bad as if they'd deliberately caused it, and that not to do something to prevent harm when there's even the most minute chance of it happening is as immoral as causing it.

Liz told the story of someone who felt her car drive over something one day and looked back and saw she'd driven over a little pot hole. Some time afterwards, she wondered if she could have run someone over. After that, she got more and more worried about the idea that she might run someone over, till even though she knew it was improbable that she could do that without knowing, she would retrace her route looking for people in the road or by the side of it that she might have run over. She thought that not to do so so she could help anyone she found was as bad as murdering people.

Liz told another story about someone who found preparing meals for the family very stressful, especially after an elderly relative moved in, because she was scared she'd accidentally poison her family by not preparing food hygienically. So before opening a tin, she would check the sell-by date and make sure the can didn't have any dents. She would sterilise the tin opener and the lid of the tin before opening it. She knew it was very unlikely that her family would be more likely to get food poisoning if she didn't, but she felt that as long as there was a slight risk, even a tiny one, the responsible thing to do was to take extreme precautions. She thought that not to do so would be as bad as poisoning her family herself.

But Liz said it's questionable as to whether less harm really does come to people in households where someone has OCD. Most conscientious people do manage to prevent harm coming to those around them the vast majority of the time by taking ordinary everyday precautions, like washing their hands after they've been to the toilet and before they prepare or handle food, and cooking things thoroughly.

And attempts to prevent harm can backfire, such as if the house gets so clean that there aren't any bacteria around to give a child's immune system practice at fighting things off, and because it hasn't got anything to do, it turns against the body and causes allergic reactions to things or something, or the cleaning fluids used cause people skin irritation or give them eczema or something.

Liz said that no one can make absolutely sure they won't cause harm to anyone. Harm can accidentally be done by the most caring people. But harm won't necessarily be an unmitigated tragedy. Sometimes, something that seems like a disaster can lead to good things in the end. For instance, if someone did accidentally give their family food poisoning and they had to go to hospital but they all recovered, maybe one of them would report the food that caused it to an organisation like Trading Standards, and if they investigated other tins of the same thing and found that they were contaminated as well, the manufacturers might recall the product from supermarket shelves and ask families who'd bought it not to eat it, and many families might be spared from food poisoning who might have got it if the original family hadn't got sick with it. It's impossible for us to know the ultimate consequences of a thing.

Naturally that wouldn't be an excuse not to take normal precautions to prevent harm. But extreme precautions might not be worth it. Liz said the person training to be a nurse who was worried about whether she should change careers because she had urges to trip people up on the street had been advised to take careful hygiene precautions to guard the health of the patients, but went way beyond what she was advised to do, so she was spending so much time guarding against them being contaminated that she didn't have so much time to spend caring for their other needs, so their overall quality of care deteriorated. Liz said that people with OCD can spend so much time trying to guard against harm to their families in one area of life that the family's overall quality of life suffers, because the OCD sufferer doesn't have the time to do things at work or with their family that would make life easier and more pleasurable for them all. On the other hand, doing what's commonly held as necessary to guard against risks will protect people the vast majority of the time, and while that's happening, the family will probably enjoy a better quality of life.

Liz suggested we look back at all the things we wrote down about what having OCD costs us, in terms of how it affects our relationships with work colleagues and family, and our life chances, and we ask ourselves whether guarding against something that only has a tiny tiny risk of happening is worth doing in the face of all the costs. It's impossible to know the answer to that one really, because if something really bad did happen, it would outweigh all those costs. But then since the possibility of something bad happening is only very small, it probably isn't worth risking the distress of divorce or whatever, or the on-going upset the rest of the family might suffer at seeing us in distress or having our lives so restricted.

Actually, whenever I hear about food poisoning outbreaks, they always say they suspect the chefs didn't wash their hands after they went to the toilet, or the butcher's shop fell below legal safety standards, or the food was left out for hours where there were flies, or it wasn't cooked thoroughly enough or something. They never say that all the usual precautions were taken and yet people still got food poisoning.

Liz said that if everyone in the world took the precautions to ensure safety that people with OCD take, then it's possible that the world might be a bit safer in a few respects, but in others, it might become much less safe, since people would have much less time for doing things like growing crops to feed the world's population, and running public services like healthcare. And besides, all kinds of unexpected harm can occur, so it's just impossible to guard against everything. For instance, someone who took hours a day ensuring their home was faultlessly hygienic might suggest to someone else in the most well-meaning possible way that they do more exercise, since exercise can help people beat depression. The person might go out to do some exercise, and fall over and sprain their ankle. And yet the person who suggested it might have suggested exercise to several other people before who benefited by it a lot. It's impossible for a person to ensure they never accidentally harm anyone else. People can't be expected to live the whole of their lives not doing anyone any harm at all. People obviously ought to do the best they can within normal limits, but it's impossible for anyone to guarantee that they won't inadvertently cause anyone harm, and in trying, they might fail to do a lot of good that they could otherwise have done. For instance, if the person who suggested exercise to the person who sprained their ankle stopped suggesting exercise to anyone in case that happened again, several people who might have been really helped by it might not be.

Convincing Ourselves We're Not Immoral If We Don't Do Everything We Possibly Can to Try and Prevent Harm Coming to Anyone

Liz said a good thing to do, for anyone who feels sure that failing to prevent harm even when there's only a tiny chance of it happening is as bad as actually causing harm, is first to write down all the ways we try to prevent harm coming to others as a consequence of our obsessive thoughts. So what we write down can include compulsive rituals, neutralising strategies and avoiding things.
Then the idea is that we draw a line down a page in the notebook. We first put the worst possible action we can think of anyone doing at the bottom of the line, and then put the best possible action we can think of anyone doing at the top. Then, we can imagine how bad failing to do each of our avoidance, compulsions or neutralising strategies would be, in comparison to the worst possible act we can think of anyone doing.
Then we can make a note naming each one of our coping strategies on the line, wherever we estimate that failing to do it would be, in comparison to the worst possible action we can think of.
We can make several lines if we do a lot of things to try to prevent harm coming to ourselves or others so making notes to signify not doing them would take up a lot of space.

Liz said that while we're doing that exercise, we should try to keep in mind a realistic perspective on how bad the risk of harm coming from us not doing our compulsions and the other things really is, so we don't exaggerate the risk.

The exercise is meant to illustrate to us that we're not really that immoral after all if we don't try our very very best to make sure there's absolutely no risk of harm coming to people whatsoever. Our notes might all be a lot nearer the top of the line or lines than the bottom.

Another Exercise About Thought Control

Uncomfortable

Liz said that if we think we need more proof that using strategies to control thoughts doesn't work, there's another exercise we can try to test it out. She said the most common reasons obsessions can get worse rather than go away when we try to control them are because if we're always thinking about making sure we don't have them, they'll be on our minds somewhere; and we might have spent a lot of time thinking about them because we were trying to understand them, so they'll be coming to mind a lot like an important news story might; and because we'll have been on the lookout for warning signs that they might be coming to mind, anything that reminds us of them will make us think of them again. So things like that could be sights, sounds, situations, colours, people, and even feelings, like anxiety, anger or other things.

Funny image

Liz said we can convince ourselves that this kind of thing happens, if we do an exercise where we think of something harmless for a while and then deliberately try to keep it out of our minds. She suggested we sit down and time ourselves using a watch with a second hand if possible, and for a minute, we should imagine a puppy wearing a red bow and a frilly blue dress with yellow flowers on it. We should imagine the image for another minute after that if we like. Then, for the next two days, we should try to keep the image out of our minds, and then think about how successful we were, or if we weren't successful, we should think about what triggered off thoughts of the image, whether it was the same colours that were in the image, flowers, dogs, or what. We should think about whether more and more things triggered off the image as time went on. For instance, first it might have only been flowers on a dress, and then real flowers, or first it might have only been puppies, and then all dogs. Or whatever. Then we'll have a better understanding of how more and more things trigger off our obsessions because they remind us of them, so we have them more often even though we try to stop having them.

An Exercise to Help Calm Worries About Obsessive Thoughts

Nervous

Liz said that people with OCD can often accept that our obsessions aren't harmful when we're feeling calm, but when we have the obsession again and get anxious about it, it might be hard to remember we don't need to worry about it. So she suggested an exercise that might help us remember they're harmless, saying that three times a day for the next week, we can write down what one of our obsessions was, write down how we felt about it straight after we had it, and what thoughts we had about how harmful it was likely to be. Then, when we're a bit calmer, we can write down any new understanding of the thought we have, that means we recognise that we don't have to worry about it so much. Then we can write down how our feelings about it have changed as we've considered the reasons we don't need to worry about it so much. Liz said we can put the information in columns in a notebook again if we like.


Part Nine
Proving to Ourselves that Obsessive Thoughts Aren't Dangerous

Skip past this if you think you're already well on the road to recovery now


If you want to reach a goal, you must "see the reaching" in your own mind before you actually arrive at your goal.
--Zig Ziglar

If we wait for the moment when everything, absolutely everything is ready, we shall never begin.
--Ivan Turgenev

Perhaps the most valuable result of all education is the ability to make yourself do the thing you have to do, when it ought to be done, whether you like it or not.
--Walter Bagheot

Liz said that if we haven't got rid of our OCD by understanding it better, we can prove to ourselves that our obsessive thoughts are very unlikely to be dangerous or helpful, by just letting ourselves experience them without doing anything about it. That will also mean they're left to go away on their own, since they get worse when we use strategies to control them. She said that people can experience some distress at first when they don't do anything about their thoughts, but their level of distress will probably go down fairly soon. She said when people use strategies to try to relieve the distress or cope with the thought, they never learn that the distress will go away on its own, so they think they need to keep doing them, so it keeps the OCD going. But really, the distress will likely go down by itself after a while. So if a person's willing to tolerate it for a little while, they probably won't have to put up with it for that long.

Hopefully not.

She said that doing neutralising strategies because we think they'll ward off disaster means we'll keep on doing them, because we'll never learn that they don't make a difference to whether disasters happen. Experimenting with stopping doing them can help us prove to ourselves that they don't make a difference.

She said that also, compulsions and neutralisation strategies are like false friends; they make us feel better in the short-term, but they keep our OCD alive by never letting us learn we don't need to do them. If we're more confident we don't need to do them because of what we've realised about them and about our obsessions, then not doing them shouldn't be so distressing as it would be if we were trying it without having thought them through first. But if we do find them distressing at first, we should bear in mind that everything seems more of a crisis when people are anxious. That's how it is for everyone. But once we've calmed down, we'll be able to see things in their true perspective again, so we'll be better at reminding ourselves that the thoughts don't have the significance we've been thinking they do. And the more often we allow ourselves to experience our obsessions without using our coping strategies, the more our distress will go down while we're having them, the less of them we'll have, and the more we'll be able to interpret them in a non-threatening way, because we'll be calmer.

Deliberately Experiencing Our Obsessions Without Using Coping Strategies

Scared

Liz recommended that we people with OCD deliberately put ourselves in a position where we'll experience our obsessive thoughts, and don't use coping strategies, starting with deliberately putting ourselves in a position where we're likely to experience the obsessions we find least distressing, and working up to experiencing the obsessions we find most distressing. Or we can first experience them at a time and place where we'll be least distressed by them, and then work up to experiencing them in a situation where we'll find them more distressing, or would have done if we hadn't thought them through before.

So she said that what we ought to do is to work out a list of situations where we could experience our obsessions, to help us prove to ourselves that they aren't harmful after all, starting with a situation we'll find only a bit distressing, and working up over time to a situation we think we'll find quite distressing now, but which we might not find very distressing by the time we've got used to doing the others and realise we don't need to worry about them after all.

Anxious

When we're doing each task on our list, she said we have to remain in the situation until our anxiety about it goes down. Then we have to do the same thing several times over the next few days or however long it takes till we can do the task without feeling much distress about it at all.

Then we can move on to the next slightly more difficult one.

So, for example, the idea would be that someone who hates violence but nevertheless has upsetting impulses to push people in front of trains or to swerve into another lane on a busy road into oncoming traffic should stand on a station platform or drive on a busy road where they might get their obsession, and not use any of their coping strategies to relieve their distress about it, so they can prove to themselves that the thought will just go away if they ignore it, and that it won't make them act on it.

Horrified

Liz said people who'd hate to harm their loved ones and yet have distressing images of doing them harm can focus and concentrate on their images mentally, or by writing down descriptions of them in detail, or by putting themselves in a situation or searching out an object that's likely to prompt thoughts of each of the images that come to their minds about harming people. That'll prove to them over time that they have the self-control and moral values not to act on those thoughts, without having to try to control the thoughts.

Miserable

She recommended that for people whose obsessional thoughts are doubts, like worries over whether they could be a paedophile, they sit down and focus their thoughts on the doubt without trying to find information either for or against it, such as reassurance, or monitoring their body for signs that it might be true, like whether they feel sexually aroused when thinking about children. They should just try to concentrate their mind fully on the thought .

Liz said that someone who kept having doubts about whether certain thoughts or feelings she had might be the unforgivable sin mentioned in the Bible and who'd given up church activities because they triggered off the upsetting thoughts and they made her anxious sat down for three half hour periods a day and just focused her mind on the question of whether she'd committed the unforgivable sin, without seeking information that would give her any clues either way. She found it distressing at first, but eventually, her anxiety went down, she found it more and more difficult to keep her mind on the thought, she stopped feeling it was so necessary to seek reassurance, and she found the thought stopped plaguing her and she started going about the church activities she enjoyed again much more happily without worrying about it any more.

Worries About Feeling Distress While Doing Nothing to Control the Obsession

Anxious

Liz said people can feel distress when they begin to do these things. But it won't have any long-term health consequences, like prolonged stress can. Any anxiety shouldn't last more than half an hour or so.

That sounds bad enough!

But at least Liz said the anxiety will probably go down over time. She said that if we're worried that if we don't do a compulsion ritual we'll worry about the fact that we haven't done one all day and won't be able to settle to anything, we probably won't worry about it for that long. Our worries will probably fade over the day. She said that people's anxiety can be very high at first when they expose themselves to an obsession without doing any of their coping strategies, but after a few times, the distress should go up less high and come down more quickly, and eventually, people experience very little distress when they get the obsession, so they don't really feel the need to use a coping strategy.

If I do this, I'll buy something before each session that I can eat afterwards as a reward, or I'll arrange to go somewhere nice. It'll be easier to discipline myself to do this if I know I've got something to look forward to.

And Liz said we should also praise and encourage ourselves with every little achievement.

And since I know it hopefully won't be long till I get over my OCD now, I'm going to start day-dreaming about all the things I'd like to do when I have. That'll give me an incentive to carry on.

Writing a List of Exposure Tasks

Scared

Liz recommended we think of ten situations where we might have our obsessions, ranging from the one we feel would distress us most to one that would distress us a bit but not that much. We can put them in a list from most to least distressing, and then do them in reverse order, starting with the one that would distress us least, and working up to the one wee feel would distress us most. So someone who had a horrible image of tripping elderly people up could maybe first go out somewhere where there were unlikely to be many, and work up to going out somewhere where there were a lot more. Or someone who had violent images of stabbing his grandchildren could start off by wearing a colour that reminded him of the images, and work his way up to looking at a picture of his grandchildren, and then to being with them, and then to being with them while chopping vegetables with a sharp knife.

Liz said the first stage of putting our lists together should be thinking through what obsessions we have. She said that if we have ones on very separate themes, like one on harming people and another on offending God, for example, we can make separate lists.

Writing

She said that one way of writing our lists is to make two columns in our notebook, one called exercise and the other called distress level. We can write the numbers 1 to 10 down the left-hand-side to represent the beginnings of ten rows. We can think about which of our obsessions we would find the most distressing to have without using any of our compulsions, neutralising strategies or other coping methods. It might help us to do that if we think of what it is about the obsessions that makes them distressing, like whether we feel worse about them in certain situations if we can't do our compulsions or anything. Then we can write the most distressing of our obsessions that we can think of at the top in the first row in the left-hand column, and a number representing how distressing we think it would be for us in the right-hand column, between 1 and 100, with 100 being the most distressing we can imagine it being. Then we could write an obsession that wouldn't be too bad on the bottom row, about 30 to 40 on the distress scale. Then we can write one that would be about halfway between the two somewhere in the middle, and then fill the rest of the rows in with others.

She said it doesn't matter if we think we've estimated the distress levels a bit wrong later, because we can always put things in a different order afterwards.

A Few Things to Remember About the Exposure Tasks

She said that when we do the exercises where we deliberately experience our obsessions, we should put ourselves in a situation where we'll experience the least worrying one on our list at first and then think about it for a while till it stops distressing us. Then we should do that several more times as soon as we can so we don't even get distressed by it much when we first get it. Then we should move on to the next one on the list and do the same with that, and so on.

Nervous

Liz said there are three things we ought to remember when doing this: We can't use coping strategies, either while we're thinking of our obsession or afterwards; we're supposed to stay in the situation till our distress goes down noticeably; and we're supposed to repeat the exposure exercise as soon as possible after the first time so we get really used to it.

Making Successful Progress Easier

Liz said we ought to do the exposure tasks often so we get used to them. She said we should plan beforehand where to do them, and how to go about it. She said doing one exposure task per day for ten days is better than doing one a week for ten weeks, since when we start to notice it working, we'll have less time to work ourselves into being scared or unenthusiastic about it if we can do the tasks often. And though our distress levels might be high when we first start, the more often we do the tasks, the more quickly they'll go down. She said it's common to feel discouraged at first because it's difficult; but if we stick at it, we should soon start to notice the benefits as it gets easier.

Anxious

She said that although feeling the anxiety while we wait to get used to having the obsessions without using coping strategies will be unpleasant, it will at least be teaching us that we can have them without anything more drastic happening. Anxiety's bad enough on its own, but if we think of the anxiety as just something our body's learned to give us because it thinks it needs to, rather than something that's telling us something's really wrong, we might well be able to cope with it better. It's just a habit the body's got into because it thinks something dangerous is happening when it isn't really. It's really just putting us into fight or flight mode. The brain has two parts, the emotional part and the thinking part, and it's the emotional part that makes us think something dangerous is happening, so it starts the anxiety symptoms. But if we can just recognise them as the emotional part of our brain doing something it's learned to think it needs to do but that it doesn't really, and it'll learn it doesn't if the thinking part of our brain can stay in control and just let the emotional part do its thing till it realises it doesn't have to, then it should get the message in time.

She said we should judge how successful the exercises were by what we managed to do in them, not by how we felt during them.

Not Using the Coping Strategies we Usually Use to Stop Our Scary Thoughts Bothering Us So Much

She said that if we get the obsession at other times as well as in our exposure therapy sessions, we should let it happen without using coping strategies as well. But then, if it's more difficult to handle than the ones we've been practising handling in our exposure sessions, we can use coping strategies with it till we get to the stage in our exposure sessions where we're handling obsessions like it.

Discouraged

But she said that if we do give in and use a coping strategy with an obsession like the one we're working on, we should expose ourselves to it again without using any coping strategies as soon as possible afterwards, to get into the habit of not using them again. She said that using coping strategies with obsessions sometimes and not others would teach us that we feel a lot better when we use them, so we'll find it more difficult not to use them next time when we're supposed to be allowing ourselves to feel a bit of distress to teach our brain that nothing bad will happen so it can stop feeling it.

She said that if we do give in to the urge to use coping strategies while we're doing an exposure exercise, we don't need to be annoyed with ourselves; we should just do the exposure exercise again without using them as soon as possible, even though it'll mean we have to discipline ourselves to, because we'll know we won't enjoy it.

Liz said that not only should we not be trying to ease our distress by using coping strategies during our exposure sessions, we shouldn't use them afterwards either, because that'll mean we undo the work of teaching the emotional part of our brain that we don't need to use them to start feeling better.

Not Putting Ourselves Through Any More Distress Than the Exposure Tasks Call For

She said it's important that we're the ones who decide what pace we want to take the exposure exercises at. We need to be the ones to decide how much distress we're able to put ourselves through at any one time. So we shouldn't allow anyone to push us into doing anything we don't want to do.

Biting fingernails

She said it could take a few days for our distress over a situation to go down, or maybe a week. If it takes longer than that, it might mean we've been a bit too ambitious and tried to do something we found too anxiety-provoking too soon. So then we should try something easier instead, like experiencing the obsession somewhere where we don't feel so threatened by it. She said that sometimes, people do think situations will be more distressing or less distressing than they turn out to be. But if we do that, we don't need to worry. We can just move them to a different place on our list and try something else.

She said that when we move to doing the more challenging things on our exposure list, it's best if we still continue to do all the other things we did before that we've stopped feeling much distress about, to make sure we don't start feeling anxious about them again. Otherwise, we might, because we've only just begun to teach the emotional side of our brain that they're not harmful really, and it's used to thinking they are, so it could quickly fall back into old habits if we don't train it not to. Also, the more often we can experience an obsession without feeling distress about it, the more confident we'll feel about having it without feeling anxious about it.

Scheduling the Exposure Sessions

A clock

Liz said we might find it easier to make time in our day to do the exposure exercises if we set aside a time beforehand and write it in a notebook or on a calendar or something. She said some people might even feel they need to take time off work to do the exercises. She said that if we've planned beforehand what time of day we'll do the exposure exercises, we're more likely to do them than if we just think we'll do them when we get around to them.

She said it might help us if we write down in a notebook our plans for how, when and where we're going to do our first exposure exercise, and then the others.

She said that before we do an exposure session, at least for the first few times, we should remind ourselves what to expect, like that it might be distressing at first but that the distress will probably go down soon.

She recommended we do at least four exposure sessions a week, maybe cutting down on things we do in the home for a while to make time for them.

She said we'll probably find them tiring, and might be irritable for the first week or two. But that shouldn't last.

Relaxation Exercises

Confused

Hmmm! I don't like the tone Liz's advice has taken over the past couple of weeks. I'm not really sure why she's saying we're not allowed to use any techniques to bring our distress down while we're doing the exposure tasks.

She taught me some relaxation techniques when I first spoke to her, that she said were good for people with anxiety disorders in general. Things like breathing in a slow, steady, controlled way, through the nose with the mouth shut to slow the breathing down for a few minutes, while we count slowly to a number like four every time we breathe in and out.

She recommended I do that several times a day. I'm not sure why she's recommending we do the exposure tasks without using anything like that. Maybe she thinks relaxation exercises might become a substitute compulsion that we'll end up thinking we have to do if the obsessions aren't going to make us anxious, so we never get to find out we can handle them with no problems. Or maybe it's so we'll end up feeling sure we can handle them if they happen when we're out and haven't got the time to do a relaxation technique. Maybe it would be allright to use the breathing technique for the first few days though and then try doing the exposure tasks without it.

Relaxing

Another relaxation technique she suggested that sounds as if it would be good to do once or more a day is to sit somewhere comfortable, focus on one particular spot on the wall, or on a plant pot or something, and then spend about fifteen or more minutes trying to focus on that and nothing else at all. She said we're very unlikely to manage to focus on it the whole time, but whenever our thoughts drift off it, no matter what we start thinking about, we should pull our thoughts back to what we're focusing on. We shouldn't get annoyed with ourselves if our thoughts drift off it, because everyone's thoughts do, but every time they do, we should make sure we don't get involved in the thoughts. So even if we have our worst obsession, we shouldn't think about it, but we should gently pull our thoughts away from it to what we're focusing on again. We should try to be like a detached observer of our thoughts, treating them as if they have no significance.

So if we have a thought of harming someone, for example, we should think something like, "Oh, I've just had an obsession about harming someone". Then we should gently pull our thoughts immediately back to what we're focusing on, as if the thought was just a passing car we noticed for a moment but then forgot about as it faded quickly away into the distance. Even if we think, "I'm bored doing this", we should treat that thought like any other thought, just letting it pass by as if it was a car that we saw pass that we noticed and then didn't think there was any reason to pay particular attention to. Then if we have another of our worst obsessions, we can just notice that and then gently pull our attention back to what we're focusing on, as if the obsession's something we've just noticed pass by like a car going past or someone we don't know walking by. That'll get us into the habit of not taking so much notice of our obsessions.

How to Go About Doing the Exposure Exercises

Anyway, back to the advice Liz is giving me nowadays:

She recommended that before each exposure session we do, we write the date and time in a notebook, along with the situation we're putting ourselves in, and our distress level, on a scale from 1 to 100, with 1 being hardly any distress and 100 being the worst it could get. Our distress when we do the exposure tasks shouldn't be that high, because we're only supposed to take on things that aren't that distressing, at least to begin with.

She said that during our exposure sessions, we should keep our mind focused on the obsession and not try to distract ourselves from it at all in any way. But we can say soothing things to ourselves like encouraging ourselves that we can handle it, or telling ourselves that though it's difficult, we'll manage, or that it'll be worth it in the end, or that the distress is unpleasant but not dangerous. It's just our body behaving in the way it would if we were in danger, because it hasn't learned the difference yet between real danger and obsessions, but it will learn to behave more how we want it to behave when we've taught it the difference by showing it that we can expose ourselves to our obsessions without anything bad happening.

It's funny, but this advice seems to contradict the thing about trying to think of ourselves as detached observers so when an OCD thought comes into our heads, we just think, "Oh, that's just an OCD thought", or something like that, not thinking of it as if it has any more significance than that, and then dismissing it, just as we would forget a car we'd just seen going past. And then we do the same if we get urges to do compulsions or other coping strategies, dismissing them as just our brain's chemistry not having quite got back into balance yet, although we're working on it. Maybe it would be worth experimenting with both approaches to see which one works best for us.

Hiding under a chair

Liz said we should keep our thoughts focused on the present, and not allow them to start thinking up all kinds of awful possibilities as to what could happen if the worst cane to the worst.

She said that if we give in to the urge to use our coping strategies, we should do the exposure exercise without them soon afterwards; and if we give in again, we should modify what we're doing so it's easier first before trying the task like that again. We can always remind ourselves of the reasons obsessions shouldn't be harmful again.

She recommends we write down roughly how long our distress took to come down each time, and what it was like when we started, so we can be encouraged if it falls faster and faster, and if it doesn't get so high when we start each exposure session.

She said we can move on to another more difficult exposure task when our distress levels typically start out at about 20-25 on the 1-100 distress scale over a few sessions, so not all that high. We should tackle each new task on our list in the same way.

She said that some obsessions, such as doubts, can be almost constant. But she recommends we still deal with them in the same way, thinking about them without using any coping strategies like checking or seeking reassurance. And after a while, our distress about them will probably go down. Liz said it can take a couple of weeks, but after that, doubts can become much less frequent and much less intense.

She said that if we have more than one list of exposure tasks because we have more than one type of obsession, we can do tasks of similar difficulty from each list at around the same time.

If Our Coping Strategies are Things we Really Do Need to Do

Liz said that sometimes, coping strategies can be things we really do need to do in ordinary life, just done much more often than we need to do them, like washing our hands. She said in situations where we're not sure how extreme our precautions need to be to prevent genuine harm, we can ask an authority on the matter just once, and then stick to doing what they suggest. For instance, she said someone had a son with a peanut allergy, and he was so concerned that he almost kept him in the house. But he was advised to seek the advice of an allergist so he'd know what precautions were reasonable.

She said sometimes, we might have to use our own judgment about what's best, rather than knowing for sure. But if we feel as if it's the OCD making us want to do something rather than that it's something we genuinely need to do for safety, then it very probably is the OCD making us want to do it, and we should stand up to it.

If We Find the Exposure Tasks Problematic

Liz said some people worry that they're not doing the exposure exercises properly because they're not experiencing the distress they've been led to believe they will. She said sometimes when that happens, it'll be because they thought a particular situation would frighten them far more than it does. Sometimes people can do the opposite, and think something will frighten them a lot less than it turns out to. So she said if we're not experiencing much anxiety with exposure to an obsession, we can simply move on to the next task on our list. And if something's bothering us more than we feel we can cope with at any one time, especially without using a coping strategy, we can move back a step, or modify it so it isn't so difficult.

Scared

But sometimes when distress is lower than we expected it to be, it can be because we've been using coping strategies without really thinking about it. So we ought to think back over our exposure exercise to see if we can remember what we might have done to make the distress less. Liz said that the person who avoided driving his son's car because it was red and it reminded him of his obsession about stabbing his grandchildren started driving it again, but at first when he did, he played loud music to distract himself so he wouldn't get the obsession, and so he didn't feel any distress. So he didn't learn that the obsession would just stop bothering him after a wile if he didn't do anything about it. The woman training to be a nurse who had impulses to trip old ladies up on the street stopped herself from feeling so much distress while she was walking down the street to expose herself to her obsession by reassuring herself that she didn't have far to go, and then she could use her compulsion.

Or Liz said we might not have experienced as much anxiety as we expected because we were using one of our compulsions without really thinking about it, and a sign that we did would be if we felt really anxious at first but then our anxiety dropped really quickly. She said we'll get better results in the long-term if we discipline ourselves not to use anything like that.

Some people find their distress doesn't go down at all though, even after they've focused on their obsession for a session lasting quite some time. Liz said that if that happens, it might be that they need to move back to doing something easier. Or it could mean that they're using some kind of neutralising act or compulsion that really makes them feel worse, like trying to convince themselves that what they fear won't happen, while part of them tells themselves that it will.

She said another reason it can happen is that they're not focusing on the obsession itself but something they use as a substitute for it so they can avoid the obsession itself, like focusing on the words "trip an old lady up" instead of focusing on the impulse to do it. That'll mean that their anxiety response to the obsession doesn't have a chance to diminish.

She said it's important not to become preoccupied with catastrophic thoughts about what might happen if we focus on our obsession. That's bound to make our distress worse, and what we're worrying about probably won't happen. So we should just focus on the obsession itself, not what might happen if we don't use our coping strategies.

She said that some people might be troubled because after their exposure sessions, they think about their obsession more often throughout the day than they would have done otherwise. But she said people still shouldn't use coping strategies, and she reassured us that the distress level at the obsession will probably go down over time.

She said some people don't want to do exposure tasks on days when they're feeling a bit fragile; but doing them and succeeding might give their mood a boost. And if they do, then exposure on good days won't seem so bad by comparison. And some people don't want to do them when they're in a particularly good mood because they'll spoil their day. But if they're feeling positive, it might mean they achieve more, and that'll be really encouraging.

What to Do When the Anxiety Just Seems Too Much

Too much anxiety

Liz said some people find their anxiety intolerable. But she said it can sometimes have physical symptoms that can make people think something really bad's happening, when what's actually happening is all to do with the body's natural coping mechanism for danger. If the emotional part of the brain thinks it's in danger, it can put the body into "fight or flight" mode, where it triggers off physical symptoms. She said when someone had his obsession of harming children, his heart would race, and he'd feel sick and dizzy and short of breath. The symptoms would make him scared he was having a heart attack. So he didn't feel he could face doing exposure tasks.

Liz said there are several things to do if our anxiety feels too much for us.

She said that one is to consider that our body's making a mistake. It mistakenly thinks we're in danger so we'll need to perform at our best to get away from something. That response would have been very useful hundreds of years ago when wolves might have been after us, but it's needed a lot less now. What causes the physical anxiety sensations is that blood is redirected from places that shouldn't need it in a hurry to our big muscles, and the heart beats faster to help it get there. Tingling sensations in the hands and feet can be caused by the blood leaving them to go to the big muscles. The muscles can perform better when they've got more oxygen, so the blood carries oxygen to them so they can do that. That's one reason the heart pumps more blood there. It's also the reason people breathe more quickly, to get more oxygen into the system. But breathing too shallowly can cause dizziness, and sensations like a feeling of suffocation.

The brain does eventually stop the behaviour.

Some people find it helpful to deliberately practice causing the sensations so they can get used to them, starting with the least worrying one and working up to ones that bother them more. For instance, they spin themselves round and round till they're dizzy a few times so they get used to it, and run up and downstairs a few times to get used to their heart beating faster.

Family Members

Grandpa

Liz said it's important for family members to encourage any progress and not criticize setbacks, or the person will become discouraged. She said family members can become upset sometimes at watching the sufferer's anxiety levels rise during their exposure exercises, but they should remember that although relieving the distress might work in the short-term, in the long term it will just mean the sufferer takes longer to get over the problem.

She said that family members can make an agreement with a sufferer not to help them during their exposure sessions. Then, in the midst of anxiety, sufferers might ask family members for help, but the family members should resist the temptation, perhaps by saying things like, "We agreed that I wouldn't help you, because it'll mean you take longer to get over it".

Angry

She said sufferers might get angry with family members who refuse them help when they're distressed, but since the sufferer will know really that it's for the best that they don't use their coping strategies, they should resist the temptation to say anything nasty.

She said that sufferers should acknowledge the family member's refusal to help as a wish to do what's best in the long term, because after all, it would be easier for the family member to help, because they won't like seeing another family member in distress.

She said family members can help most by reminding the sufferer of the gains they've made so far and praising them. Mocking them or making light of their fears won't help. Encouraging them that they'll improve further if they carry on trying will be a good thing to do.

She said some people manage to stop their compulsions and other coping strategies all at once instead of gradually phasing them out. She said people on some of the most successful recovery programmes have done that. She said if we try that, it can help if we write down all our coping strategies beforehand so we'll know what to make sure we don't do. She was kind of reassuring that although our distress might be high at first, it won't be dangerous, and it will probably go down.

She said we'll be able to tell how much we've recovered by our responses to our obsessions. When we think they're harmless but unpleasant thoughts rather than distressing ones, we'll have recovered well.


Part Ten
Making Sure Symptoms Stay Away


Getting well is 50 percent of the job, staying well is the other 50 percent.
--Fred Penzel

Still Using the Exposure Techniques From Time to Time

Liz recommended that even after people have recovered from OCD, we still expose ourselves to our old obsessions periodically, in case we start worrying they'll cause us distress again or we start worrying about what'll happen if we expose ourselves to them because we're no longer proving to ourselves that nothing disastrous will happen by exposing ourselves to them. Also, our brains will be far more used to thinking of them as something to be feared than they are as harmless, so we'll need to keep reminding our brains that the old obsessions are harmless by exposing ourselves to them without having a bad reaction to them.

Miserable

She also recommended we make efforts to notice if a thought that used to be an obsession of ours is causing us distress, and if it is, we should challenge the beliefs behind it that we hold that are the reasons it's causing us distress, thinking about all the evidence we can think of against the idea that it's true. We might have lapsed into old thinking patterns, thinking that thoughts automatically lead to actions or something. So we'll have to make efforts to remember and think through all the old reasoning we used and read before that convinced us that thoughts don't automatically lead to actions, or whatever we're thinking.

Crying

She said some people make the mistake of using an old coping strategy that seems like a quick fix at the time. Then because it works so well, they use it again and again. But after a little while, it starts working less and less efficiently, and the obsession keeps happening, so maybe they'll have to do it more often, and before long, they're back to their old patterns of doing things when their OCD was at its worst.

She suggested we think through all the reasons we shouldn't be letting obsessions bother us about once a month even when we're not suffering any OCD symptoms, just so the reasons are fresh in our memory so if we have what used to be an obsessive thought, it might not bother us as much as it would have done if we'd forgotten the reasons it isn't likely to be harmful.

She recommended we continue to expose ourselves to all the things that used to bother us that we wrote down on our list of exposure tasks we went through when we were recovering from the full-blown OCD we used to have. That will probably help us come to terms with them again.

She recommends that about once a month, we refresh our memories about how to overcome OCD.

We shouldn't worry about how often we have the thoughts that used to be obsessions; the important thing is how we deal with them.

Times of Stress

Stressed at work

She said that in times of stress, if we're anxious already because of something, the old OCD symptoms are more likely to bother us, because we're more likely to interpret things as threatening than we will if we're relaxed and have an easy-going attitude, and that'll include thoughts that used to be obsessions. Things play on the mind more when people are anxious. She said that if that happens, we don't have to worry that we're going to experience full-blown OCD again. We don't have to worry that much about the odd anxious response to a thought that used to be an obsession or an urge to do one of our old coping strategies. We don't have to let those things take over our lives again.

She said we should try as far as it's possible to reduce stresses in our lives that aren't linked to the OCD and yet might make us anxious so they might make it worse. She said that if we can't eliminate the stressors, we should investigate ways of managing them so they're not so stressful.

She said we should remember that OCD symptoms aren't out of our control; if they start coming back, we can use the strategies we've learned to stop them getting worse.

Liz recommended we prepare ourselves to recognise times when OCD symptoms might recur a bit by thinking of all the things we can remember that we know cause us stress, and thinking of things that could in the future, and writing a list of them, so we have some idea of the things that might coincide with our symptoms coming on worse because we're stressed. Then if we know a situation like that's coming up, we can remind ourselves of all the reasons obsessions don't need to bother us so we'll be prepared to treat them in the way they should be treated if they do recur at all.

Scared of What's on the TV

She said that all kinds of things can cause us stress, even things we might think of as positive, like family reunions, or job promotions, which might be good in themselves, but they might mean we have the stress of added responsibility till we're used to handling it. But all kinds of things can be stressors, like relationship difficulties, having too much to do in too short a time, money problems or whatever.

So if our symptoms seem to be coming back a bit, it might only mean we're more anxious because we're dealing with something else that's causing us anxiety. So we can plan how to deal with that at the same time as we do something about the symptoms that are beginning to recur if we can.

If we Put Too Much Pressure On Ourselves Because of the Way we Think About Things

Worried

She said that sometimes, reducing stress might be a matter of reinterpreting things, because things might be stressing us out because we're worrying far more about them than we need to, wondering if we'll get into difficulty when perhaps we won't really. Or we might be putting far more pressure on ourselves than we need to, because we might believe things that aren't really true, like:

"It's important to please everyone I know all the time; if I don't, it means I'm a bad person;"
"It's selfish to take time out for myself and do what I want for a while instead of doing things for others;"
Or "If someone asks me to do something, I should just do it".

She said that we ought to try to identify the beliefs we have that might be contributing to our stress, and think through whether or not they're really true.

Techniques for Reducing Some Things That Can Cause Stress

She recommends we also ask ourselves if we could be putting more demands on ourselves than we would on others, since that might be what's causing our stress. She said we can ask ourselves whether we'd place such demands on a friend in our position. If we wouldn't, we should try to reduce the demands we're making on ourselves to the level we'd think fair to put on a friend.

She said that sometimes, reducing our involvement in an activity might be what we need to do to reduce our stress, or stopping doing it altogether.

Talking on a soap box

She said that sometimes, weighing up the costs and benefits of staying in a situation could help. She said there was a man who experienced religious intolerance where he lived and felt that he would like to move house. But he thought that if he did, he'd be letting the intolerant people win, and he wouldn't be able to stand up against them anymore. But he decided the stress was so much that it wasn't worth staying there anymore, so he moved, but he realised he had a choice of a number of different things he could do to continue his fight against religious intolerance, and decided to speak against it in schools and at community activities.

Too much work

She said time management can sometimes help us reduce stress. For instance, if we have a demanding job, we can prioritise the most urgent things and set aside a time to do them, and if anyone asks us to do something else while we're doing them, we can tell them we've got a deadline to meet so we can't help them right now, or something, but that we can schedule a meeting with them for after the time we've set aside to work on what we're doing, which could be later in the day.

She said in other situations, we can try delegating tasks to other people we trust, or offer to do part of something or to compromise on things, like telling someone we'll meet them at the station rather than going all the way to their house to pick them up, or asking if they'd mind waiting for us to bring them something till the next day when we're going to bring them something else anyway so we'll see them. She said people are often willing to adapt their requests or do things to help us if we're polite and firm in asking them, and we don't change our minds back and forth once we've done it.

How Better Communication Can Help Reduce Stress

She said that stress in relationships with others can sometimes be resolved by clear communication.

Arguing

She gave the example of a work situation where someone might be on a computer we need to use or using something else we need for much of the time so we can't get to it. She said that often, in a situation like that, people work around the person while quietly feeling angry, becoming more and more stressed because they can't get what they want done, until something happens and they can't stand it anymore, and they say something angrily like, "You've got no respect for my time!" The other person's likely to get defensive and argue with that, and the argument could end up being about how much they respect their time, and they might not get the issue over the computer resolved. And then it might ruin the relationship for a while.

Liz said that often, people suspect others of being uncaring or callous when the truth is that they just don't understand why something's important to the other person. For instance, someone taking up time on a computer that another person needs urgently just might not realise they need it in a hurry because they have to finish a project soon or whatever. So she said it can be a good thing to give them the benefit of the doubt, assuming they just might not understand the importance of the situation. She said needs that seem obvious to us might not be obvious to others. So it's best to approach them when we're not angry or upset, and explain to them what the problem is that means we need to use the equipment.

Then it can help if we suggest a solution, like suggesting we both work out a schedule whereby we can share the equipment so if possible, we both get enough time on it every day to get a significant amount of work done. Then, the situation will hopefully get resolved without any bad feeling caused by accusations or whatever.

Arguing

She suggested we can do something similar in family situations where we're being irritated by someone's behaviour. She gave the example of someone who never says whether they'll be attending family occasions we're organising, and doesn't contribute anything when they do come. It might be tempting to angrily accuse them of taking us for granted or something. But if we do, like the work situation, it'll be difficult to resolve the situation if we don't specify clearly what the problem is and suggest a solution, and it'll probably lead to an argument where more accusations are made and bad feeling just mounts.

So it'll be better if we can decide what we'd like from them and then calmly ask for it, like saying,

"If you're coming to the meal, I'd like you to bring either a salad or some cakes - your choice, and I'll need to know whether or not you're coming by Tuesday so I can plan the meal. Thanks."

That deals with both problems in one go, meaning they'll hopefully both let us know whether they're coming and bring something. So it's solved the problem in a way that isn't stressful for us.

Being talked at

She said that something that often causes stress for people is when others try to cajole us into taking on responsibilities that are really theirs.

She said that a way of dealing with a request like that is to politely say we can't help them and give them a reason why, such as saying we've got a lot on this week.

Or we could decide on part of what they want us to do that we can help them with, and while explaining that we can't take time out to do everything they've asked us to do, offer to do that.

She said the important thing is to stick to what we've decided on so they don't think they can persuade us to do more if they try hard enough.

She said that if they persist in their request, sometimes just basically repeating ourselves can be the best policy. For instance, if someone at work said, "I really need you to help me with this project I've got to finish soon or I'll be in trouble", we could say something like, "Sorry, I can't help you; I've got some tough deadlines of my own to meet this week". If they asked again, saying something like, "But I really need your help with this", we could perhaps say, "Yes. I understand; but I can't help you, because I've got some tough deadlines of my own to meet this week".


She said strategies like those ones might not solve the problem; work colleagues might decide they need the computer all day and say we'll just have to decide how to manage, or family members might still not bring anything to a family occasion or tell us whether they're coming. But she said that being consistent about our messages over time can help them sink in, or if they don't, we could for instance speak to the management about the computer shortage; or if the family member doesn't start complying with us, we could anticipate that and allow for it.

Other Stress Management Ideas

She said there are bound to be some stressful situations that we just can't change, but we might be able to do things to lessen the stress of them.

For instance, we might be able to take more breaks at work, especially taking our lunch hour out instead of working through it.

Or if we're caring for someone who's ill, we could ask others if they could spend time with them to give us a break so we can do other things we need to do or just go and relax if we can.

And it might be important to go on holiday sometimes.

Having a picnic

She said another thing we can do is to think of several activities we'd enjoy doing outside the stressful situation, and participate in the number we feel we can without our involvement becoming stressful.

She said the more activities we participate in, the less crucial any one of them will seem for us, so the less we'll be stressed by the discontinuation of one of them. For instance, if doing one of them was stopping us feeling lonely, we'd be more upset if we couldn't do it any more than we would be if we were doing several that stopped us feeling lonely, so if one got stopped, we'd still have others.

She said another thing we can do is to create a healthy outlet for our stress. She said talking about our problems to people can help to a certain extent.

Depressed

But she said that if we dwell on problems too much, we'll just become more frustrated, depressed or angry about them. Also, talking about problems too much can wear out our support network. She said some people talk about their problems on their breaks from work and in their lunch hours. She said that while it can be important to discuss stressful situations with others, dwelling on the shortcomings of the job or other people in the workplace can just lead to an increase in annoyance, and no positive attempts to actually solve the problems. Another thing that can happen is that rumours can be spread and be thought of and treated as fact by people. And that can lead to more bad feeling.

So she recommended we spend our breaks and lunch hours genuinely taking a break from work, going for a walk, sitting outside, especially if the sun's shining, reading something enjoyable and unrelated to work, and anything else enjoyable we can think of.

She said people might put pressure on us to join their complaining group at first, but it should die down if we're persistent in doing our own thing.

Sport

She said that physical exercise is a very good thing to do for a lot of people, which can be effective at relieving stress. She said there are a number of different ways we could exercise, on our own, or in groups or classes.

She recommended we write down the five biggest stressors in our life, each on a different page in our notebook, and then take time to think about what we can do about each one, whether it be reducing its severity, perhaps by changing the aspects of it we can or trying to eliminate it from our lives, or working out how to cope with it better, by changing how we respond to it.

Well, I'll try all that.


Notes

This article is written slightly differently from most articles. All the information in most of the articles in this series is written as if by someone finding out a lot of helpful information for the first time, just learning about it. That person themselves isn't real; they're just a representative of a lot of others suffering the same thing. Any little anecdotes they tell about their personal lives or those of people they know almost always have really happened though, usually either to the author or to someone else known to the author. The article comes with a very short story about them to set the scene, and presents all the self-help information as if it's what they're finding out and what they think of it.

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The Story

The Way Things Are Before They Begin to Improve

Fearful

Natalie has a form of obsessive-compulsive disorder where she is plagued by disturbing intrusive thoughts. They give her horrible ideas about physically harming or sexually molesting children and other people, which she finds distressing, because she'd never want to do anything like that. She worries about the thoughts a lot, but the more anxious she becomes about them, the more obsessive thoughts she has.

She was brought up as a Christian in a strict household, and another problem she has is that whenever she has a sexual thought, even just one about having sex with a grown single man, she's convinced she's offended God, and so that makes her anxious. And she worries constantly that she's thought other things that have made him angry, like blasphemous thoughts. They just seem to suddenly come into her head no matter how hard she tries not to have them or how ashamed she feels of them. Again, the more she worries about the thoughts, the more they're on her mind, and so the more they come into her head to torment her.

One day, she finds the number of a help-line run by an organisation that helps people recover from anxiety disorders. She phones it, and is reassured and encouraged that she can get better.

She comes to trust one of the volunteers who works on it in particular, Liz, who talks her through steps to recovery week by week.

She finds the advice helpful, and soon begins to get better.



The End


Note that if you choose to try out some or all of the recovery techniques described in this article, they may take practice before they begin to work.

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This includes links to articles on depression, phobias and other anxiety problems, marriage difficulties, addiction, anorexia, looking after someone with dementia, coping with unemployment, school and workplace bullying, and several other things.


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Literature Used in Creating This Article


Disclaimer:
The articles are written in such a way as to convey the impression that they are not written by an expert, so as to make it clear that the advice should not be followed without question.

The author has a qualification endorsed by the Institute of Psychiatry and has led a group for people recovering from anxiety disorders and done other such things; yet she is not an expert on people's problems, and has simply taken information from books and articles that do come from people more expert in the field.

There is no guarantee that the solutions the people in the articles hope will help them will work for everybody, and you should consider yourself the best judge of whether to follow their example in trying them out.


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