A while ago I worked with a middle aged man who cleaned and washed for several hours every day. Most of his time was occupied by various contamination fears. He stayed by himself, living a fairly impoverished existence. We tried all the usual approaches to improve his symptoms, such as ERP, ritual delay, and cognitive reframing. Nothing worked. He seldom completed the homework I assigned, and attempts to motivate him with “encouraging scripts” were fruitless. It was a frustrating experience. After a couple of months, in a moment of truly admirable insight, he told me quite seriously, “You know, Doc, I guess I really don’t have anything better to do than my cleaning.” A striking statement!
It is only too true that if we don’t have anything better to do than our compulsions, we will just continue to do them. OCD therapy requires a concerted effort to stop compulsions, and in the absence of such an effort, it does not improve. Motivation, therefore, is necessary. This is where scheduling can be very helpful. Many of the people I work with benefit from preparing an agenda with entries for every hour of the day. It is helpful because it reminds us of our goals when obsessions suddenly strike. In those moments of fear and confusion, we need to know what we want to doing. This knowledge provides us with the motivation we need to resist compulsions, as well as an objective on which we can focus our attention.
Is this too “compulsive?” No it’s not! The schedule is not designed to make us more productive or get more work done. It is not a prescription for frantic activity. Rather, it is a thought-out listing of activities that are in service of our life-goals. It includes things like “watch TV with family,” “go for a walk,” “nap,” and “enjoy dinner out.” It is surprising that this critical process—identifying the goals that we feel are important, and planning activities that will help us achieve them—is often neglected by OCDers. People without OCD know what they want to be doing. OCDers have to remind themselves, because in the moment an obsession strikes—with all its tormenting fear and uncertainty—we tend to forget.