Last week I was talking to an OCDer with the obsessional fear that she is not contributing enough to her church, because what she gives is less than a full ten percent tithe. She worries that she is displeasing God. What blessings will she miss? What if something terrible happens? When the obsession strikes, fearful images run rampant in her mind: losing her job, a fire in her house, her son in a car accident. She reminds herself over and over: “My pastor said it was enough. I have other responsibilities. Everyone understands my situation.” After a half an hour, drained of energy, the fear usually lets up; but only to come back with a vengeance.
The big problem is her mental ritual: compulsively reassuring herself. This compulsion, just like repeated hand -washing and all others, has the devastating effect of making a fear stronger. What started, perhaps, as a reasonable concern has turned into an irrational terror. In our work together, we have been trying to find ways to break her destructive ritual. Any time you can shorten or postpone a compulsion it is a victory. She told me how she finally realized the importance of this.
“I had this idea,” she explained to me. “Obsessions are like lawyers. Once you start talking to them, you can’t get away from them. They bring up all kinds of different problems, and nothing gets clarified. They’re always saying, ‘Well, on the one hand this might happen, but on the other that.’ You’re worse off than when you started.” She had finally discovered that what worked best was not to engage the obsession in conversation at all. “Now I just say, ‘I’m not talking to you!’”
A similar line of thought, employing a rather imaginative metaphor, was expressed by a suburban homemaker with an obsessional fear of hurting people’s feelings. Every day, sometimes every hour, she needed to repeat conversations over and over in her mind in order to make sure that she had not offended anyone. “I know that If I get going with repeats of conversations in my head,” she told me, “I’m never going to stop. So, I’ve learned to tell myself, ‘There is no off-ramp on Compulsion Crescent!’” Compulsion Crescent, as she explains it, is a Kafkaesque street that, once driven onto, you can never get off. You keep driving around and around forever, looking for an exit. What a great image!
It is well to keep this in mind: Obsessions will always argue endlessly with you. Once you engage them in conversation, they will point out critical difficulties in whatever course of action you favor, raise your anxiety to new levels, and prevent you from making any confident decision. If you drive into their trap, you’ll keep going in circles.
Here’s the strategy. First, as soon as an obsessional fear strikes, make the call that it is an obsession. (Rules: If you have previously labeled the fear as an obsession; or if it ‘feels’ like an obsession, or if you think it ‘probably is’ an obsession, then it is an obsession.) Then say, “This fear can bother me as much as it wants; but I’m not going to talk to it, I’m not going to go there. I’m going to do something else.”
4 Response Comments
I love this post! I’m curious…would you prescribe ERP in a case like this, or just have the person ignore the thoughts and trust that God will lead him/her in His timing? If one does ERP for an obsession like this, is it possible to “dull” the conscience too much?
Well, it depends on what’s working. No need to go on to intensive ERP if the obsessional fear is treated by taking a new attitude towards it. In fact, that is a form of ERP since it involves exposure and not responding to the fear. But intensive, purposeful and repeated exposure such as behavioral therapists use, and is usually what we mean when we say “ERP” is of course also an excellent approach to treatment. No, that never results in too much loss of conscience. It just knocks the fear down to a more acceptable range.
That makes sense. Thank you for the reply!
Coming back to re-read this post, as I find myself struggling with similar issues. I’ve been thinking a lot about this kind of issue lately, and would really appreciate your thoughts if you have time to respond. What do you find is an effective way to address something like this, that is a real issue gone too far? For example, for the past few years I’ve found myself fixated on the idea of “fasting” (usually a dessert or entertainment since I have low blood sugar). It hasn’t become a full-blown obsession, but it keeps rolling around in my head, trying to get me to decide if it’s something I need to do, how often, etc. I think about it at least once a week, and often do decide to fast something, usually in response to a specific need/person I want to pray for, and try to dedicate extra time to praying for that need/person. Not necessarily a bad thing, but it feels like I’m always trying to decide whether to do it or not. My thought process goes like this:
– It feels like I’m being hyper-responsible, but as a Christian I do think fasting/praying has power.
– It feels like my prayer has more “weight” or like God will pay more attention if I sacrifice something, but
– Sometimes it feels like I do it arbitrarily, like if I have time in my day earlier to pray I still wait until my dessert/entertainment time in the evening to pray so that I’m sacrificing something while I do it.
I know these things are areas of personal judgment, so my theory for now is to keep experimenting; sometimes I will go ahead and “fast,” other times I’ll skip it to try to play with the OCD. I know sometimes when fighting OCD we give the compulsion-like thing up altogether until the obsessive feelings or hyper-responsibility has faded, but we can’t always give up something completely, like praying or fasting, right? In that case, how do we treat the thing? I also have trouble identifying what parts of my thinking process stem from the OCD. Do any of the thoughts above seem to be affected by obsessive thinking?