November 4, 2010

That UNCERTAINTY thing.....

I’ve been doing a lot better these last few days.  I had a session with my psychologist on Tuesday morning.  We talked a lot about the elusive idea of “accepting uncertainty”.  We also talked about what to do about mental ritualizing. 
I have always been stuck on the ritualizing portion of my OCD.  During times of intense struggle, when I’ve gone waaaaay down the “rabbit hole”, I’ve often thought that this horrible disorder would be so much easier to tackle if my rituals were behavioural in nature.  No offense to my fellow OCD sufferers who have behavioural rituals – this disease is horrible in its own right.  These thoughts come during periods of self-pity when I wish everything in my life were easier.  That being said, several experts in the OCD field have commented that the Pure Obsessional sub-type of OCD can be more difficult to treat, due to the fact that our rituals don’t tend to be behavioural in nature.  Of course, this “black or white” rule is not necessarily accurate either.  I actually think that most people with OCD have some behavioural rituals, and some mental rituals as well.  Anyway – I digress….back to my original thoughts. 
Since most of my rituals are mental compulsions, I have struggled with not only recognizing them and catching my thoughts, I have also struggled with the fact that I can’t do "typical" response prevention.  I can’t stop thinking.  With OCD treatment, we are counseled that we cannot stop our thoughts.  Just as we cannot stop our obsessional thoughts, we cannot stop any thought.  Dr. Jonathan Grayson emphasizes this idea in his book “Freedom from Obsessive Compulsive Disorder”.  So what do I do?  I have been doing exposure for several weeks now, some weeks with greater success than others.  The weeks that I have less success, I know that I am doing a lot more “figuring out”, mental checking and mental reassuring.  However, it sometimes takes me several days to recognize this, and I think this is one of my greatest hurdles that I will need to overcome in order to fully recover.  I brought this concern up with my psychologist on Tuesday and she said that awareness (ie: mindfulness) is essential.   She suggested that whenever I notice an obsessive thought, to agree with it.  She said that not only should I agree with the obsessive fear, that I should EXAGGERATE the fear; take it to the next level.  We practiced a few times during my session.  Wow – did that do the trick!  She could visually see the discomfort I was feeling.  So, rather than arguing with my thought, trying to diminish the importance, or telling myself that this thought will never happen, I am actually purposely making it worse.  I’ve practiced this “skill” for the last few days and it has made such a difference.  It has also helped me to “thicken my skin” with regards to living with uncertainty. 
I am almost finished Dr. Grayson’s book, and I will definitely be reading it again.  There are so many little snippets of information and motivation contained in that book.  In my last post, I wrote about my concern that I may not overcome my OCD because I didn’t feel ready to accept the uncertainty related to my OCD fears.  Dr. Grayson actually includes a great exposure script that addresses this concern exactly.  (Go figure!  I’m not the only person with OCD who struggles with this! Sarcasm.) I read it, and will read it as many times as I have to, especially when I feel myself struggling with this notion again.  I have also been challenging myself a lot more in the living with uncertainty area.  For example, yesterday after I took my dog out to the bathroom, picked up her poop, and dropped it in the garbage can I thought “There could be some germs on my hands now.  I could get worms or something.”  I thought of the OCD sufferers who have contamination issues that would never take the chance that there were germs on their hands.  Or worse yet – worms.  Those sufferers would immediately go into the house and wash their hands, most likely several times over.  I didn’t do that.  I noticed the parallel between my OCD theme and my inability to function with any sort of uncertainty, and compared it to this situation.  I then went inside, went to the fridge and pulled out something to eat. 
I really can’t be sure of anything in life – no one can.  There are some things that I feel sure of, but that doesn’t necessarily mean anything.  I have been reminding myself of this, and though my OCD mind still chirps in and wants to argue with me, it is a fact.  And I can’t argue with that. 
I think I’ve had a few steps forward.  I’ve got a long way to go.  But at least I’m moving in the right direction. 


  1. At the beginning of your post when you were talking about the difficulties of addressing mental compulsions and doing exposures for them, I immediately thought, Jonathon Grayson's book would be perfect! And then in the very next paragraph you went on to say you're reading it :). His book is without a doubt one of my favorites as he deals with OCD with a level of depth and insight that goes beyond some of the basics. And it's great for addressing mental compulsions!

    I agree that most people with OCD have some behavioral and mental compulsions. For me, at least, I have always felt that the physical compulsions were really just an extension of all the mental ritualizing going on in my head. When mental rituals fail to mute my obsessing, my compulsions spill over into the physical world - a second line of attack that is really no better than the first and just as counter-productive in overcoming my OCD.

    I can see why "purely obsessional" types are often viewed as being harder to treat, but with more and more information coming out about the nature of mental compulsions, hopefully therapists will become more adept at recognizing them. This is just my opinion, but I think that pure o is only harder to treat because it is harder to identify the compulsions. But if you have a mental health professional who is skilled at identifying and treating mental rituals, I think that it is just as treatable as other forms. It seems like you just have to get past the initial hurdle of learning to identify the mental rituals and how to address them. This is certainly something that I will have to work on more when I get some of my more distressing behavioral compulsions cut down on!

    Are you by chance in the yahoo discussion group pure_o_ocd? There are a variety of people out there with a variety of mental compulsions, and though some give better advice than others, the discussion board is pretty well moderated and some people have great advice! I always like reading what people have to say and how they deal with and challenge their own OCD thought processes!

  2. Fellow - no I'm not on the yahoo discussion group for pure o - I'll definitely take a look at it. I completely agree that Pure O is harder to treat probably because of the difficulty in identifying the compulsions. Thanks for your post!

  3. Awesome blog! I can really relate to what you are saying. Most of my obsessions are mental as well. I suffer from bad thought OCD as well as some checking etc. I think Dr. Grayson's book is almost bible like for OCD.

    I have been in therapy for about a year and a half. I have found that if I do my exposures I am much better.

    I think we with OCD have a confidence problem becuase of our disease. We need to learn to have faith in ourselves!

    Keep up the hard work and thanks for writing a blog on OCD!

  4. Doubter - thanks very much! As you can tell - I'm doing exposure therapy at the moment. Very hard!!!! But I have almost worked my way up my hierarchy. I have some good days, and some not-so-good days. I really do believe that ERP is the answer though. I'm about to start Dr. Grayson's book again....thanks for reading!

  5. "Exagerate" my scarey thoughts? And you actually DID it? I'm very impressed. I read that but I've spent today trying to lower my anxiety level about a naturally occuring stressful event in my life. I feel like gloom, doom, and disaster are coming. Agreeing with it seems... really hard. But I guess I should think about what is easier in the long run, not just today.

  6. Abigail - it is definitely harder on some days than others! But - it works. Ramp up that anxiety and face your head. Sure beats the alternative - that horrible feeling of internal debate that happens so regularily when I mentally ritualize. I've been struggling with it the last couple of days though....

  7. Hey! Thanks for posting a link to my blog! I will check yours out often.