Skip past the following quotes if you'd like to get straight down to reading the self-help article.
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
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
If this article turns out to be not quite what you're looking for, or you'd like more detail on similar topics, try looking at the related articles on this website.
Go to the end of the article if you'd like to know the main sources used in creating it.
She thinks:
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.
Liz said we can tell if we've got compulsions or we do neutralising acts if what we do has certain characteristics:
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.
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:
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.
Liz said it's understandable that people with OCD should 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. 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.
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:
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 should be labelled:
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, we should write what day it is in the first column, and then in the obsession column, we should write a short note of what it was. In the feelings about it column, we should list what they were. She said we should 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.
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.
Liz said it's important to try to write those things as soon as possible after we get the obsession and do the strategy to try to get rid of it or whatever. Otherwise, we might forget things.
She said we should 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.
Liz suggested that people with OCD should 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.
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.
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 it 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.
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, we should 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 obsession that's put it into my head to trip someone up". And then we should 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 a 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. 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.
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 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.
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 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.
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:
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 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.
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.
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.
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.
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.
Of course, 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 was 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 should 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.
Liz said a good exercise 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 we should draw a line down a page in the notebook. We should 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 should imagine how bad that 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 should 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 the 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 best to make sure there's absolutely no risk of harm coming to people whatsoever. Our notes might all be nearer the top of the line or lines than the bottom.
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.
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.
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 should 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 should 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.
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
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 should 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 go down by itself after a while. So if a person's willing to tolerate it for a little while, they shouldn'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.
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 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.
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, 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, to prove to themselves that the thought will just go away if they ignore it, and that it won't make them act on it.
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 encountering an object that's likely to prompt thoughts of each of those images. 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.
She said for people whose obsessional thoughts are doubts, like worries over whether they could be a paedophile, they should sit down and focus their thoughts on the doubt without trying to find information either for or against it, like reassurance, or like 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.
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 should 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.
Liz said we should 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.
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 so we have 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 at the bottom, 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.
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.
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.
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 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.
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 should 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.
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.
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 should just do the exposure exercise again without using them as soon as possible, even though it'll mean we have to discipline ourselves.
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.
She said that 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.
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, we should 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 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.
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 should 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.
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. 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.
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, "Oh, I've just had an obsession about harming someone". Then we should 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 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.
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.
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 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 said we should 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 we should 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 should 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.
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.
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.
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 should 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.
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 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.
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".
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 reassuring that although our distress might be high at first, it won't be dangerous, and it should 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.
Getting well is 50 percent of the job, staying well is the other 50 percent.
--Fred Penzel
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. 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 them that the old obsessions are harmless by exposing ourselves to them without having a bad reaction to them.
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. 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.
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 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 recommended a number of things we can do to make sure they don't:
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 should help us come to terms with them again.
About once a month, we should 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.
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. Those things might not cause us any bother with symptoms, but 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.
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.
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.
She said we should 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.
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.
She said that 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 them, which could be later in the day.
She said in other situations, we can delegate 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.
She said that stress in relationships with others can sometimes be resolved by clear communication. 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.
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.
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, like saying we've got a lot on this week.
Or we could decide on part of it 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.
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.
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 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.
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.
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.
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.
Feel free to print this article out to look at in the future if you think it will help, or to add it to your favourites or save it to your computer. If you know of anyone you think might benefit by reading any of the self-help articles in this series, whether they be a friend, family member, work colleagues, help groups, patients or whoever, please recommend them to them or share the file with them, or especially if they don't have access to the Internet or a computer, feel free to print them out for them. You're welcome to distribute as many copies as you like, provided it's for non-commercial purposes.
This includes links to articles on depression, phobias and other anxiety problems, marriage difficulties, addiction, workplace bullying and other things. You can also find contact information there if you'd like to comment on this article for any reason.
Disclaimer:
The articles are not meant to convey the impression that they're giving personal advice to you. They are meant to be taken as they are represented - someone's thoughts on how they might solve their problems, based on the self-help books and articles they have come across.
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.
Go back to where the story at the beginning of this article starts.
If after reading the article, you fancy a bit of light relief, visit the pages in our jokes section. Here's a short one for samples: Amusing Signs.
(Note: At the bottom of the jokes pages there are links to material with Christian content. If you feel this will offend you, you're advised not to go there.)
To the People's Concerns Page which features audio interviews on various life problems. There are also links with the interviews to places where you can find support and information about related issues.