I believe the French translation of obsessive-compulsive disorder best describes what the disorder is – the doubting disease. Individuals who suffer from OCD can excessively worry about harming someone, catching a disease, or forgetting to turn off the stove. Imagine not knowing for sure if you did something or not; you are pretty sure you didn’t but what if… The “what if” possibility is enough to send you into an anxiety attack. You do everything you can to reassure yourself everything is okay. You recheck, replay the scenario in your head or seek out evidence that you did not do anything horrible. An individual who does not have OCD may not even be able to comprehend how someone is not sure if they did something or not. I continue to ask myself the same question when I am having an OCD moment how do you not know if you did or didn’t do_____________? OCD is torturous and can be difficult to treat. I know I have been studying and living with OCD for twenty years. Wow- That’s a long time! You would think I would’ve found a cure by now. I have not, but I have lived almost symptom-free for several years. I still get intrusive thoughts, but I no longer ruminate about them forever. My recovery did not happen overnight. Medication helps significantly and I use the Four Steps developed by Dr. Jeffrey Schwartz. I also use mindfulness and other mind tricks to manage my symptoms. I decided a long time ago to share my own OCD struggles with my clients because I wanted them to know if I could get better and live a functioning life they could too! The first step to getting better is to let go of any shame, as Dr. Schwartz’s book (title) states, YOU ARE NOT YOUR BRAIN and it does not define who you are as a person!

Treatment:

• Correct Diagnosis:
  I remember many years ago when a general practitioner asked me about what OCD was like and I said you worry a lot about different things, and he said like what? I don’t remember exactly how I responded but I remember thinking there is no way I’m going to share with you my OCD thoughts, you’re going to think I’m crazy and probably want to lock me up. I share this story because if you have OCD or know anyone with it you should know many of us get the same types of thoughts and they can change or evolve over time. Most of the thoughts trigger a lot of shame and guilt. Due to this reason, many individuals with OCD are misdiagnosed because they are not very forthcoming. If the diagnosing clinician does not ask the right questions the individual will likely get diagnosed with generalized anxiety. It is very important to get assessed by someone who knows the difference between the two disorders.

• Medication:
  If you choose to take medication for OCD, I highly recommend finding a psychiatrist who has experience treating the disorder. Medication, such as SSRI’s, have been shown to decrease symptoms of OCD, but it can take a month or longer for the medication to reach therapeutic levels. You may experience side effects and it’s important to communicate with your doctor if you have any concerns or think the medication is not helping. Unfortunately, some individuals do not give their medication a chance to work and just stop taking it before it kicks in. Please talk to your doctor if you plan on discontinuing it. Don’t just stop cold turkey!

• Psychotherapy:
  A popular type of therapy used to treat OCD is cognitive-behavioral therapy (CBT). It is based on the theory that your thoughts trigger emotions that influence your behaviors. In therapy, you learn how to recognize problematic thinking patterns and challenge them or work on changing them. One of the most effective CBT techniques I found very helpful is reality checking. For example, an individual believes he may have run someone over on the way to therapy when he really went over a bump (this is actually a very common worry of someone with OCD). I would ask him what evidence there is to support his belief. I will ask for hard evidence, not feelings. Many times, people with OCD base their beliefs on how they feel rather than facts. This individual will likely say I felt my car go over something, but he will not be able to provide further proof. The problem is he FEELS like he could have done it and that is enough to start the vicious cycle of rechecking. He will feel the urge to repeatedly re-check where he was driving to be sure he did not hit someone.  This is when Dr. Schwartz’s Four Steps addresses the OCD thought itself.

1. Step One Relabel:
   Once you realize your thought or compulsive behavior/ritual is irrational and due to OCD, it is very important to refer to it as what it is an OBSESSIVE THOUGHT or COMPULSIVE BEHAVIOR! It is important that you train your brain to label the thoughts and behaviors.
2. Step Two Reattribute:
   As I mentioned before OCD triggers a lot of shame and we personalize it-we tend to think we are bad people because of our thoughts. So, once you acknowledge the thoughts or behaviors are symptoms of OCD, tell yourself something like “this is an OCD thought because I have a biological disorder”. I know it sounds weird and your thinking how is that helpful. It is extremely helpful! I have rewired my brain to immediately recognize an OCD thought and attribute it to a brain disorder. This helps me to detach myself from the thought itself and treat it as another physical ailment. For example, living with diabetes can be challenging and it needs to be managed but we would not think we were an awful person for having it.
3. Step Three Refocus:
   

   This step is going to be the most difficult for those who are used to always performing a specific behavior/ritual to decrease their anxiety. Instead of carrying out the behavior, do something else such as baking, walking or playing a video game. The anxiety will not go away but you’re training your brain not to give in to your compulsive behavior when you feel the urge. If you must give in to the behavior wait at least fifteen minutes if you can. This is rewiring your brain to learn that you are in control and not your OCD.

4. Step Four Revalue:
   

   Since you are no longer a slave to your OCD your brain will learn not to take the intrusive thoughts and compulsive urges so seriously or believe there valid. This will help to decrease your anxiety. Dr. Schwartz also encourages journaling to document all the times you were able to successfully refocus your behaviors. If you would like more details, I encourage you to read his book Brain Lock, he also has some good videos on YouTube.

• One of the most successful strategies which has helped me is to not fight the thoughts no matter how horrible they are-it will only make it worse. Start practicing not judging your thoughts as good or bad, they are just thoughts. JUST BECAUSE YOU HAVE A THOUGHT DOES NOT MAKE IT REAL!! & JUST BECAUSE IT FEELS REAL DOES NOT MAKE IT TRUE!!