On this website is a list of ten strategies for dealing with obsessional fears when they strike. They are taken from my groups—the approaches students found most helpful. Most of them fall under the general heading of “cognitive therapy.” They represent ways to change perspective on an obsession—the way you look at it or evaluate it—so that it becomes more acceptable and less scary. It must be pointed out, however, that in some cases these strategies don’t work. Sometimes the fears are just too strong, and a new understanding, or “cognitive appraisal,” is not going to do the job.
Take, for example, the strategy of confronting OCD with the insightful and helpful statement, “It’s not me, it’s OCD!” Sometimes, fully grasping this bit of wisdom can be a full cure in itself. A young woman I worked with recently had the rather common obsessional thought, “I want to kill my child.” Upon realizing that OCD was the cause of the thought’s stubborn persistence—that the awful idea was not from her true self—she felt a breathtaking sense of relief and ceased to be bothered by it at all. Yet, in an individual with a more severe case of OCD, this realization will probably not hold. Another young mother explained to me, “It really helped at first, telling myself that it wasn’t really me. But lately I’ve just been all the time obsessing that maybe that’s not true, and it is really me.”
One of my favorite strategies is “Ignore obsessions.” This is a time-honored way of dealing with tormenting thoughts that has been used for millennia the Christian church. Saint John Climacus (570-649) relates the story of a religious brother who was overcome by “wicked, detestable thoughts and horrible temptations to blasphemy.” The advice that cured him? “My son, I take upon myself all the sins which these temptations have led you, or may lead you, to commit. All I require of you is that in the future you pay no attention to them whatsoever.” Ignoring is really a good strategy. Luther himself said in a letter to a parishioner tormented by doubts of salvation, “The best thing to do is to let them vanish as they came and not to think much about them or dispute with them.” Yet, unfortunately, “Ignore obsessions” also often fails. As a patient said to me, “I’m spending all my time trying to ignore them, and it isn’t helping. My OCD is getting worse.”
Even trusting in God, the ultimate strategy for all who are called, can be foiled by a strong case of OCD. A student studying information technology, a gentle young man and very devout, explained to me (this one hurt!), “I read your book, and it’s sort of become an obsession, to give God the responsibility. It’s like ‘Oh!, I have to give God these fears!’ And then I freak out that I’m doing it wrong, and I don’t know how to do it right, and I’ll never get better because I’m not a good Christian.”
The truth is that anything we do simply to lower the anxiety of an obsession can be to be overwhelmed by fear and uncertainty. That is why it is usually necessary in the treatment of anything more than mild OCD to use exposure and response prevention exercises. In these exercises, we purposefully and repeatedly expose ourselves to our fears without escape, so that we can habituate to them. In Christian terms, these exercises can be viewed as a cross that must be borne in order to receive the gift of faith.