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25 Tips For Succeeding in Your OCD Treatment

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Good stuff here. I read this when I'm having a tough day and need to practice therapy. 

25 Tips For Succeeding In Your OCD Therapy

- Fred Penzel, Ph.D.

1. Always expect the unexpected - you can have an obsessive thought any time or any place. Don’t be surprised when old or even new ones occur. Don‘t let it throw you. Be prepared to use your therapy tools at any time, and in any place. Also, if new thoughts appear, be sure to tell your therapist, to keep them informed.

2. Be willing to accept risk. All life is risky business. Risk is an integral part of life, and as such, it cannot be separated out.Remember that not recovering is the biggest risk of all.

3. Never seek reassurance from yourself or others.  Instead, tell yourself the worst will happen, is happening, or has already happened. Reassurance will cancel out the effects of any homework you use it on and prevent you from improving.Reassurance-seeking is a compulsion, no matter how you may try to justify it.

4. Always try hard to agree with all obsessive thoughts - never analyze, question, or argue with them. The questions they raise are not real questions, and there are no real answers to them. Try not to get too elaborate when agreeing – simply say the thoughts are true and real.

5. Don’t waste time trying to prevent or not think your thoughts.This will only have the opposite effect and lead to thinking more thoughts. Studies have shown that you cannot effectively suppress particular thoughts. Your motto should be, “If you want to think about them less, think about them more.”

6. If you slip and do a compulsion, you can always turn it around and do something to cancel it. Try to not be a black-and-white all-or-nothing thinker who tells themselves that they are now a total failure. The good news is that you are in this for the long haul, and you always get another chance. It is normal to make mistakes when learning new skills, especially in therapy. It happens to everyone now and then. Accept it.Even if you have a good sized setback, don’t let it throw you.Remember the saying, “A lapse is not a relapse.” This means that you never really go back to square one. To do that, you would have to forget everything you have learned up to that point, and that really isn’t possible. Also remember the sayings, “Never confuse a single defeat with a final defeat,” (F. Scott Fitzgerald) and as they say in AA, “You can always start your day over.”

7. Remember that dealing with your symptoms is your responsibility alone.  Don't involve others in your homework (unless specifically told to) or expect them to push you or to provide the motivation. They won’t always be there when you need them, but you are always with you.

8. Don’t get too impatient with your rate of progress, or compare yourself to someone else. Everyone progresses at their own particular rate. Try, instead, to simply focus on carrying out each day’s homework, one day at a time.

9. When you have a choice, always go toward the anxiety, never away from it. The only way to overcome a fear is to face it.You can’t run away from your own thoughts, so you really have no choice but to face them. If you want to recover, you will have to do this eventually.

10. When faced with two possible choices of what to confront, always choose the more difficult of the two whenever possible.

11. Review your therapy homework assignments daily, even if you think you know all of them. It is easy to overlook them – especially the ones you don’t look forward to doing.

12. If your therapist gives you an assignment you don’t feel ready to do, don’t be shy about saying so. As half of the team, you should be able to have a say in your own therapy. The goal is for the homework to produce moderate anxiety you can get used to tolerating - not to overwhelm you with it and cause you a setback. On the other hand, don’t be afraid to stretch yourself a bit whenever you can.

13. Procrastination is a feature of many people’s OCD, so start your homework assignments the day you get them. Don’t wait for the perfect moment to start. The perfect moment is whenever you begin doing them.

14. Perfectionism can be another feature of OCD. You may find your OCD telling you that if you don’t do your homework perfectly, you won’t recover. If you do find yourself obsessing about having to do your homework perfectly, you risk turning it into another compulsion. Watch out for having to do your homework according to the same rigid rules each time you do it. Also, don’t do your homework so excessively that it takes up your whole day. Remember that you still have a life to live.

15. Make the effort to read over your homework assignments at the start of each day. Don’t assume that you know them all and will not forget them.

16. Be careful when carrying out assignments to not undo them by telling yourself that “It’s only homework, and the things I’m saying and doing don’t count and aren’t real,” or “My therapist wouldn’t ask me to do something that would cause harm to me or others,” or “I’m only doing this because I was told to, so I’m not responsible for anything bad that happens.”

17. Try to not let yourself get distracted and tune out when doing certain assignments, so that you don’t have to feel the anxiety. People sometimes let the homework become routine and do it in a very automatic way as a kind of avoidance.Also, don’t do homework while you carry out other distracting activities. Give it your full attention, focus on what you are doing, and let yourself feel the anxiety. You are building tolerance to what you fear and for that to happen, you have to be in the moment with it.

18. When faced with a challenging assignment or an unexpected challenging situation, try to look on it as a positive, and as another opportunity to get better instead of saying, “Oh, no.Why do I have to do this?” Tell yourself, “This will be good for me – another chance to practice and get stronger.”

19. Try to not rush through your therapy homework so that you don’t have to feel as much anxiety. Take your time, and see if you can view it in terms of all the good it will do you.Getting it over with as quickly as possible is not the goal.Raising a moderate level of anxiety and staying with it, is.

20. If your homework doesn’t really produce any anxiety, tell your therapist about it. If your exposure homework doesn’t cause at least some anxiety, it isn’t going to be effective in helping you. On the other hand, try doing all new assignments for at least a week before deciding that they don’t make you anxious. Some assignments can cause delayed reactions and it may take doing them a few times before the anxiety occurs.

21. It is sometimes possible for OCD to try to make you doubtful about your homework. It may tell you that you are not in the right treatment, that your assignments cannot possibly make you better, or that you really don’t understand what you are doing and won’t be able to make it work. Remember that OCD was known as The Doubting Disease, and will try to cast doubt on anything that is important to you. To fight this, you may have to agree with it by saying, “Yes, that’s right. I really won’t get better.”

22. Never forget that you have OCD. This means that you will not always be able to trust your own reactions or sensations, especially if they seem to be telling you very negative and extreme things. If you are unsure if something is really a symptom, treat it as a symptom. Better to err on the side of doing a bit more exposure than not enough.

23. Remember that in OCD, the problem is not the anxiety - the problem is the compulsions. If you think the anxiety is the problem, you will only do more compulsions to get rid of it (which will only create more anxiety). If you recognize that the compulsions are the problem, stop doing them, and stay with the fearful situation, then the anxiety will eventually subside as you build up tolerance.

24. Always take a moment to endorse your own efforts and recognize your successes. It’s a good way to help keep up your motivation. Look back at earlier assignments that are no longer challenging if you believe you aren’t making progress.

25. Overall, never forget that OCD is very paradoxical. The things that you thought would make you better, only made you worse, and the things you thought would make you worse are the very things that will make you better.

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Thanks for this post, I really needed these reminders today!

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5 minutes ago, OCDhavenobrain said:

Wooow :thumbup:

Who is this Fred? He really nailed it. Thanks

He's a North American psychologist who is known to specialise in OCD. 

I don't myself find some of his methodology fine, but there we are. 

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18 minutes ago, taurean said:

He's a North American psychologist who is known to specialise in OCD. 

I don't myself find some of his methodology fine, but there we are. 

I agree, for example I'm not sure I really agree with the idea that you should agree with all the intrusive thoughts. I find it more helpful to acknowledge that it is simply OCD and something irrational, rather than telling myself that the thoughts are true. 

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15 minutes ago, taurean said:

He's a North American psychologist who is known to specialise in OCD. 

I don't myself find some of his methodology fine, but there we are. 

I agree that some of his practices are a little outdated, but I felt this advice very helpful and my OCD therapist echoed a lot of these. The one I find most helpful is this: 

2. Be willing to accept risk. All life is risky business. Risk is an integral part of life, and as such, it cannot be separated out.Remember that not recovering is the biggest risk of all

American approaches might be different. :3dflagsdotcom_usa_2faws: but I felt that it was worth sharing.

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2 hours ago, malina said:

I agree, for example I'm not sure I really agree with the idea that you should agree with all the intrusive thoughts. I find it more helpful to acknowledge that it is simply OCD and something irrational, rather than telling myself that the thoughts are true. 

And that is likely why you are at least partially stuck.

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There is this concept amongst some senior CBT psychologists that we need to agree with the thoughts. 

I don't go along myself with that approach either. 

I prefer cognitive understanding as to why the OCD skews our thoughts into being asked to believe falsehoods exaggerations or revulsions. 

Once we have a firm grasp on that, we can make progress using ERP combined with refocusing. 

I suppose you pays your money and you makes your choice. But I don't personally agree with the Penzel and others approach - and I wasn't taught it in my CBT in London. 

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7 hours ago, PolarBear said:

And that is likely why you are at least partially stuck.

Why? I mean no therapist has ever told me or encouraged me to agree with my intrusive thoughts.

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Some psychologists, including Pesner, say that by "believing" the thoughts in a gradual process we take the power and effect out of them. 

Not something I was taught in CBT either, or with which I agree. 

Like you Malina I don't see that we should agree with thoughts that are false, exaggerated or revulsive and so cause us disorder. 

Rather, for me, we need to not connect with or believe the thoughts. 

I prefer the concept - as laid out in Jeffery Schwartz's book "Brainlock" - of labelling, then re-attributing - the thoughts to OCD. 

I have found this very successful. 

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By not being able to say yes to the thoughts you give them.power. And ultimately it doesn"t matter, you won't become what they say and nothing they tell you will become true.

 

Edited by OCDhavenobrain

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35 minutes ago, OCDhavenobrain said:

By not being able to say yes to the thoughts you give them.power. And ultimately it doesn"t matter, you won't become what they say and nothing they tell you will become true.

 

Okay I see what you're saying. I guess it just seems counterintuitive, because isn't the point to understand that they are irrational and untrue. Although, I guess what you're saying is that you will ultimately see for yourself that they aren't true even after agreeing with them. 

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Nope. You shouldn't try to understand them. It will never work

 

Edit: they thing is that people in general and especially peoplr without OCD aren't trying to convince themselves that their aren't a tiger in the fridge or a nuclearbomb in the garage. They just move along

Edited by OCDhavenobrain

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These are all pretty much on the nail. It's obviously homework/ERP based which I guess is the US approach, but I wouldn't disagree with any of them.   Other than this one.

12 hours ago, californiadreaming said:

Remember that in OCD, the problem is not the anxiety - the problem is the compulsions. If you think the anxiety is the problem, you will only do more compulsions to get rid of it (which will only create more anxiety). If you recognize that the compulsions are the problem, stop doing them, and stay with the fearful situation, then the anxiety will eventually subside as you build up tolerance.

I don't actually disagree with this one either, it's right in that the anxiety is not the problem, it's the OCD that is...  where I disagree is he suggests the compulsions are the problem. Well of course we don't want to do compulsions, but he fails to mention that it's usually the obsessions that create the anxiety and drive the compulsions. So addressing the obsessions, the fears, the doubts, the interpretation of the intrusive thoughts (cognitive work) is really important. 

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14 minutes ago, malina said:

I guess it just seems counterintuitive, because isn't the point to understand that they are irrational and untrue

The problem is by trying to justify intrusive thoughts as irrational and untrue we can often end up arguing with our OCD which throws 'what if?' questions at us to try and apply evidence to prove they are irrational and untrue and it becomes a vicious cycle.  So in essence yes you're right Malina that you will ultimately see for yourself over time  by accepting the thoughts being there, but simply not engaging them and actually acknowledging you have thoughts, without agreeing with them or dismissing them (which is tricky to do).

 

 

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11 minutes ago, Ashley said:

The problem is by trying to justify intrusive thoughts as irrational and untrue we can often end up arguing with our OCD which throws 'what if?' questions at us to try and apply evidence to prove they are irrational and untrue and it becomes a vicious cycle.  So in essence yes you're right Malina that you will ultimately see for yourself over time  by accepting the thoughts being there, but simply not engaging them and actually acknowledging you have thoughts, without agreeing with them or dismissing them (which is tricky to do).

 

 

That makes sense, thanks. It sort of seems to me that a lot of things that appear totally counterintuitive (at least to me personally) are exactly the things we must do to get better. I found ERP very hard to begin with, I was convinced that it was going to make things worse. But that hasn't happened, it has actually helped a great deal, so I can definitely agree that something that doesn't necessarily 'feel' right is actually the right thing to do. 

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Surely in order not to engage with the thoughts we need to classify them as OCD thoughts in the first place. That is why one of the biggest reassurances to be found on the site is that the person has OCD and that their thought processes in particular instances are irrational

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Right. My therapist was heavy on ERP with me but always stressed that it’s not just resisting compulsions, it’s understanding WHY you’re resisting the compulsions. 

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7 hours ago, taurean said:

I prefer the concept - as laid out in Jeffery Schwartz's book "Brainlock" - of labelling, then re-attributing - the thoughts to OCD. 

I have found this very successful. 

That's what I was taught too. To relabel and refocus. It has worked for me in the past. What I struggle with is whether this becomes more of a neutralising compulsion, as  I tend to have an intrusive thought, say 'shut up, ocd' and carry on with things.

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36 minutes ago, sufferer said:

That's what I was taught too. To relabel and refocus. It has worked for me in the past. What I struggle with is whether this becomes more of a neutralising compulsion, as  I tend to have an intrusive thought, say 'shut up, ocd' and carry on with things.

You need to drop the "shut up OCD". Spot the intrusion, then gently but wilfully ease your focus away. 

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14 minutes ago, taurean said:

You need to drop the "shut up OCD". Spot the intrusion, then gently but wilfully ease your focus away. 

Good idea, thank you Taurean.

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1 hour ago, sufferer said:

Good idea, thank you Taurean.

Agree with Taurean here. Practicing mindfulness was helpful when this would pop up for me. I started slow like - concentrating when I'm brushing my teeth and really feeling the bristles against them. Then, I would do things like exercise and be like, "OK - I see this thought floating around. I'm going to let it hang out but concentrate on my workout." This was the hardest part of OCD therapy for me. 

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30 minutes ago, californiadreaming said:

Agree with Taurean here. Practicing mindfulness was helpful when this would pop up for me. I started slow like - concentrating when I'm brushing my teeth and really feeling the bristles against them. Then, I would do things like exercise and be like, "OK - I see this thought floating around. I'm going to let it hang out but concentrate on my workout." This was the hardest part of OCD therapy for me. 

I'm trying mindfulness at the moment. Early days but seems to be working.

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20 hours ago, malina said:

I agree, for example I'm not sure I really agree with the idea that you should agree with all the intrusive thoughts. I find it more helpful to acknowledge that it is simply OCD and something irrational, rather than telling myself that the thoughts are true. 

There are certainly different schools of thought (no pun), and that tricky balance between 'it's just my OCD' and falling into reassurance is (I think many would concede) a tricky one.  The thing about upping the ante, if one can do it - is that it can (at its most effective) undermine the disorder. E.G a random thought comes into my mind (not OCD). 'That man is standing near the curb, it'd be easy to push him off.' It's painless ... and cost free, to tell myself, 'Oh, my, God, you must be a monster, or even a potential murderer', because it's not a theme. The idea about accepting OCD related thoughts, or even embracing them, is to treat them like any other random thought, rather than responding to them as relevant. The paradoxical nature of the disorder. 

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