Graduate Story #1
by Margaret, a graduate of Dr. Phillipson's OCD support group
My OCD. This is how I refer to this "Disorder." I put it in quotes because I have a very hard time accepting that it is a condition that I did not bring on myself. I mean, I always thought that my obsessiveness was me -- brought on by me. But I guess it doesn't matter whether it is a mental condition, or a way of thinking which became a habit. What is important to me, is that I take steps to change.
By steps, I mean risks. I learned of the concept of risk taking for treating OCD in my therapy sessions with Dr. Steven Phillipson, a clinical psychologist at the Institute for Behavior Therapy, in New York City. The key element of the treatment is learning to live with uncertainty. It is taking the risk of not ruminating (problem solving) about things that I am afraid might happen. If you will notice, most obsessions concern things that we are not sure about. For example, I can obsess endlessly about people that I think may not like me. The subjects of my obsessions are usually people I don't know well but that I come in contact with on a regular basis (e.g. neighbors), so I could never really know whether they do or do not like me. With therapy, I learned to say "Yes, maybe the neighbors don't like me, but I'm not going to take the risk of ruminating about it, and I will not attend to any other thoughts related to these people."
To not actively attend to a thought (called a "spike" in therapy), is another risk. We usually pay attention to thoughts that we think are worth our time. The more we pay attention to a thought (by ruminating), the more our brain becomes sensitized to it. That is, our brain gets the impression that the thought must be very important; moreover, when we don't attend to the thought, our brain will try to warn us by way of anxiety.
Accepting anxiety is a critical part of treatment. The anxiety one feels when not doing a ritual (my ritual is to ruminate), can be dreadful. But it gets easier with time and practice. By not ruminating, or giving the thought any importance, the brain will start getting the message that this thought is not so important, and therefore will not try to warn us. One of the first things Dr. Phillipson and I tackled was my "checking" with people. For example, I would ask my family to describe their feelings about the neighbors. This was really my only compulsive overt behavior. (Let me point out that I realize that many people might have the same concerns, e.g., people not liking them, but most people would not spend hours and hours every day going over the same thought. Also, most people would not feel terribly anxious when they could not ruminate or do a "check."). I learned to take the risk and not check things out with my family.
Another technique I use is what Dr. Phillipson calls the "flagging" technique: any thought related to people not liking me is flagged as an OCD spike and therefore is not to be attended to. That is, instead of actually saying that I will take the risk ..., I don't say anything at all. I just let the thoughts come and go.
By all means, the treatment is not easy. It requires a tremendous amount of courage. Obsessing was something I did practically all of my life ( I was 5 when it began; I am now 27). Ruminating felt right. I always thought I had to do it; that it was my duty. To not ruminate was the scariest thing I ever did. Dr. Phillipson helped me to conjure up courage by sharing with me some of his views on life. For example, he says that we don't have to do anything; we choose to do things. Concepts such as these helped me to be less rigid and to allow myself to take risks.
Since this treatment is based on changing our behavior (in my case, not ruminating), it is crucial to do the homework assignments. This may require a lot of self-discipline (and again, courage). Most of my homework assignments entailed purposely bringing on frightening thoughts and not ruminating about them. It helps to set a specific time and place, so that it almost becomes a habit when it's that time, and you're at that place. For example, I do my homework on the train on the way to work every morning.
I've been going to group and individual therapy with Dr. Phillipson for almost 3 years. I still struggle, but not nearly as hard as before. The urge to ruminate is not so great anymore. I used to ruminate about 70% of the time; now I ruminate about 10% of the time. when I get thoughts that might be OCD related, I try to let them come and go, along with the mild anxiety. I may never be "cured," but I feel confident that I will be able to cope. I now experience feelings other than anxiety, and I get concerned about issues other than people not liking me. In other words, I feel so much more alive.
Originally printed in the Obsessive-Compulsive Newsletter, 5 (4), 1991, published by the OCF