Ways to Cope with Obsessions
Most of us have anxiety-laden, intrusive thoughts that we manage to overcome in daily life. If we can keep these difficult thoughts from lingering in our minds longer than necessary, and get through them without experiencing intense anxiety, it means we're already coping with them well. Most of us have double-checked the iron even though we're sure we unplugged it, or checked over and over whether the water was left running as we left the house. These are common, easily observable worries that most people can shake off without much trouble. For people who can cope with these anxious thoughts, leaving the house is usually followed by an internal reassurance like "I personally unplugged the iron and I'm sure I checked all the taps," which brings lasting relief and lets them go on with their day. But coping with these thoughts and inner voices isn't this easy for everyone. Some of us get caught in such an intense struggle with the anxious thoughts entering our minds that we do everything we can just to feel brief relief, and if we're lucky, we escape the worry for a few hours before the distressing thoughts return. We call it an obsession when such repetitive, unrealistic thoughts, which make daily life considerably difficult, are followed by a compulsion (a dysfunctional behavior developed to rein in the obsessive thought).
In this article, I focus on what is referred to in Turkish as an obsession and compulsion disorder, but is better known in the literature by its clinical name: obsessive-compulsive disorder (OCD). I'll share the mechanism underlying this problem and techniques for what can be done to overcome it on your own. Of course, this isn't a difficulty that can always be reduced to something a person can simply overcome alone. Still, understanding the underlying factors of the process and knowing how to move forward toward recovery can be quite helpful.
Why Do Our Obsessions Develop and Persist?
Different people can develop obsessions about different topics. This is usually related to a person's general areas of sensitivity. For example, someone who cares deeply about moral values might become obsessed with whether they have a deviant sexual desire. A religious person might develop obsessions about whether they have offended God, or whether they carried out their worship fully and correctly. In general, losing flexibility around one's own values seems to be linked to developing obsessions. Still, there's no clear finding on exactly why people develop obsessions. We only know that some individuals are more prone to this due to genetic and social factors. On the other hand, how obsessive thoughts are maintained is better understood. What we need most to break free from obsessions is actually understanding how this mental phenomenon sustains itself.
There are different views on why obsessions and the compulsions that follow them are maintained. In this article, however, I'll focus on the cognitive-behavioral model's perspective, since one of the most effective treatment approaches has been developed based on this model
According to the cognitive-behavioral model, our obsessions actually stem from faulty and dysfunctional thoughts. Thoughts that interpret a particular situation as dangerous or harmful to us, or that make us feel excessively responsible for a possible negative outcome affecting others, are what keep our obsessions going. When we develop such an intrusive thought, we come up with dysfunctional ways of coping in order to calm down. These coping strategies can be avoidant or confrontational — for example, constantly staying away from something to avoid encountering it, or constantly checking to make sure nothing has gone wrong. Unfortunately, though, these coping methods, which we call compulsions, end up strengthening our dysfunctional, intrusive thoughts even further in the long run, and we get caught in a vicious cycle.
We touched on the importance of thoughts — let's clarify this with a few examples. The reason a person who has thoughts of exposing themselves in crowded places develops an intense obsession around this is that they believe the thought of exposing themselves will be followed by the act itself. Yet if they could truly recognize and internalize that a thought is just a thought, that behavior is mostly under one's control, and that they are someone aware of moral norms, their anxiety and obsession would be far less.
Let's give another example through a person with religious obsessions. Suppose this person believes that only pure and wholesome thoughts should cross their mind while worshipping. Oddly enough, this belief will cause thoughts that the person doesn't consider pure and wholesome to come to mind even more. Yet if this person could develop a more flexible outlook and internalize the thought, "As a human being, unpleasant thoughts can sometimes cross my mind, but that's normal and it isn't a major problem for my worship," they would largely free themselves from their obsessions.
I've tried to explain, through a few examples and according to the cognitive-behavioral model, how obsessions are sustained — a phenomenon that is actually explained by quite extensive theories. For more detailed information, you can read the book I've cited as a reference.
What Purpose Do Compulsions Serve?
Beyond a certain point, the obsessions we have start to make us quite anxious, and at that point we feel the need to intervene. These interventions are usually ones that are dysfunctional and perpetuate the obsession in the long run, while providing relief in the short run. Sometimes they're related to the obsession we have, and sometimes they can seem completely unrelated.
Constantly washing one's hands, performing certain activities while counting up to particular numbers, or continuously checking whether something has or hasn't happened are all examples of compulsions.
From the outside, doing certain activities up to a specific number, or other compulsions, have no logical explanation. But when a person doesn't carry out these compulsions, they believe their related fear will come true, and they see the rituals they perform as protective factors.
What Can We Do to Cope with Obsessions?
When we try not to think about something, we end up thinking about it more. The phrase "I shouldn't think about this" actually reveals the importance we're placing on a particular thought. For this reason, the first step to take when fighting obsessions is to reduce the importance given to the underlying obsessive thoughts. The way to do this is by reappraising these thoughts and continuing to do so systematically.
Let's consider a person who has an obsession about performing an inappropriate act in a crowded setting. This person first needs to objectively evaluate their active thoughts. These thoughts will probably look something like this: "Am I an immoral person? If a thought like this crosses my mind, it means part of me actually wants this, and that's a very bad thing. The more I keep thinking about these kinds of things, the more likely it is that it will actually happen. I'm a bad person for thinking these things." Afterwards, the thoughts that arise alongside the obsession need to be reappraised. Here's an example of a reappraisal for this case: "Actually, I do a lot of things right, I try to respect people's rights, and I haven't harmed anyone so far. I've never actually done the thing I'm thinking of doing, and there's a big difference between thinking about doing something and doing it. Just because it crosses my mind doesn't mean I'll do it or that I'm immoral. My actual behavior toward people is the most important indicator of my morality."
These kinds of reappraisals about the obsessive thoughts we have should be realistic and systematic. Learning to think in an alternative way on its own isn't always enough to eliminate obsessions, but it's a good first step.
The second step in coping with obsessions requires taking risks. By taking risks, I mean gradually phasing out the compulsions or balancing behaviors that follow our obsessions. If we don't phase these out, it will become harder to fully believe that our obsessions are actually unimportant and harmless.
One of the most effective ways to eliminate our compulsions or balancing behaviors is to build ourselves a risk-taking ladder. Let's look together at the example of a person whose obsession requires constant handwashing:
Going about 30 minutes without washing my hands: stress level 30
Going 10 minutes without washing my hands after touching things at home: stress level 50
Not washing my hands right after eating: stress level 70
Sitting down to eat without washing my hands: stress level 85
Not washing my hands after using the toilet: stress level 100
After building a risk-taking ladder like this, we should start by consistently taking the simplest risk we can manage. Once we're convinced we're sufficiently comfortable with the first step, it means it's time to move on to the second step. The time between steps can take several weeks, and the number of steps can be around 10.
Conclusion
Coping with obsessions is not always a process we can manage entirely on our own. It's worth encouraging yourself to learn more about this, do further reading on the subject, and seek professional support.
We can describe a two-stage therapy process for managing obsessions and reducing the anxiety associated with them: reappraising our thoughts and systematic risk-taking. Alongside this, life stress is of course also one of the factors that needs to be managed throughout the process. Below, I've provided as a source the book "Overcoming Obsessive Thoughts" which, even if it doesn't have a therapeutic effect on its own, will shed much more light on the subject and give you an in-depth look at various types of obsessions. In this article, I've discussed the concept of obsessions in general, but there is quite a bit of additional information available on its specific types. So if you feel you're struggling with an obsession you find hard to cope with, I recommend doing some reading and seeking professional support.
Malik Kubilay Çadırcıoğlu, Psychotherapist
Source: Overcoming Obsessive Thoughts: How to Gain Control of Your OCD / Christine Purdon - David A. Clark
