STRATEGY #7 POSTPONE OR LIMIT A RITUAL
At the fine UCLA OCD partial hospitalization program they teach the “fifteen minute rule.” If you can put off performing a compulsion for that amount of time, you will find that it’s strength is greatly lessened. Often it seems to take fifteen or twenty minutes to really feel the reduction in a compulsion’s strength, but even to put off a ritual for five minutes is a victory.
A middle-aged woman suffered from handwashing compulsions that left her sinks clogged with soap and her hands chapped and occasionally bloody. Group members gave her the homework assignment of resisting the urge to wash her hands for ten minutes after using the toilet. This caused her tremendous anxiety, but she did it–holding up her hands like a surgeon, fearful to touch anything at all. Over subsequent weeks she stretched the interval to twenty minutes, then thirty, and finally to two hours, after which the obsession lost its strength. She did it by telling herself: I’ve just got to hold off for a few more minutes, then I can wash.
Another group member reported that when no other strategy worked, postponing did. When faced with an agonizing need to analyze a conversation over and over, it was all she could do to put off the compulsion by telling herself: Just wait for twenty minutes, and then think about it. There will still be plenty of time to call and apologize if I need to. By the end of the twenty minutes, her need to review the conversation was no longer powerful, and she could use reason to deal with it.
If you can’t postpone the ritual, try to limit it in some way. This is an imaginative strategy that sometimes pays results. A junior student named Laura majoring in education suffered from severe, chronic OCD. As a freshman, she had had to take a medical withdrawal because of disabling symptoms. Now she was once more falling behind in her studies and, quite discouraged, she was again considering dropping out of school. Particularly oppressive were harm obsessions involving friends and loved ones, and mental rituals that could occupy her mind all day long. One day in group, when asked how she was doing, she told us tearfully:
Laura: My OCD is getting bad, again. It’s the same routines over and over–I mean like all the time, all day long. I have to imagine dozens of different faces; I have to clearly picture a face, and have a positive thought at the same time I’m doing it, or something bad will happen to that person. First I do family members, then close friends, and then acquaintances. This involves everybody that’s important to me. There must be twenty or thirty different people. While I’m doing it, other pictures come into my mind, “interrupter people,” who mess things up. Then I have to start over. I can’t even read a book.
Student 2: Can’t you fight them? You need to remind yourself that those people are going to get alone fine without your thinking about them.
Laura: Nothing works. The thoughts are too strong.
Group leader: (after a pause) Can anyone else relate to this?
Student 3: I used to have the same rituals. I couldn’t go to sleep until I clearly visualized the faces of all the members of my family–and I’ve got a big family–with a certain expression on their faces, and all this had to happen while I was lying a certain way, and saying a certain prayer. But a big problem happened when I came to college: I didn’t see these people for months at a time, and I would lose their images in my head. That drove me nuts. Like nuts. I would lie there and get so mad at myself that it gave me insomnia.
Group leader: What was helpful to you to break those compulsions?
Student 3: I told myself: “You’ve got to stop this. You’re a big girl, now.”
Laura: I can tell myself to stop but the thoughts come back even stronger. I’m like totally gone.
Student 2: Linda, maybe you can try this. Just cut down on the faces you are imaging, don’t stop the ritual all together. Maybe that will work. Just visualize the five most important people, then stop for while.
To my surprise, Laura benefitted from this suggestion. When it was brought up, I had thought it overly simple. In fact, I was ready to write Laura another medical withdrawal. This experience clearly demonstrates one of the great benefits of group therapy: People who are actively fighting OCD have insight into what works that others lack.
Limiting a ritual also worked for a middle-aged woman in our community mental health center group who suffered from compulsive reading and hoarding. Picking up Good Housekeeping, for instance, her eye would catch an article on aging. Even though the subject was boring, she would feel that she had to read the article so that she wouldn’t miss something important for her family’s health. Attempting to do so, however, she would find that she wasn’t able to attend fully to the article. She would then have to reread it. Invariably, she would never gain certainty that she had sufficiently absorbed the article’s information; and she would have to save the magazine so that she could refer to it later. Stacks of magazines lay in piles on her floors and littered her attic. Group members helped her break her compulsions by suggesting that she throw them away a half-dozen at a time. It worked. She was able to accomplish this by telling herself: “There are so many magazines here that throwing away a few of them isn’t going to matter.”