Living with Obsessive-Compulsive Disorder OCD can feel like a small, personal hell. Even folks without an OCD diagnosis can find themselves caught in obsessive or compulsive cycles that feel maddening to escape. No matter the severity of your struggle with obsessions or compulsions, learning how to navigate and manage them can be life-changing.
Here are some tips for managing OCD, from a therapist who has been there.
Mindfulness
This one may seem simple, or obvious, but I encourage you not to dismiss this tool just because it seems boring or basic. Mindfulness won’t cure all of your OCD struggles, but it can be an essential aid for our healing journey.
Mindfulness can help us improve emotional regulation, interrupt the compulsion cycles, increase our tolerance for uncertainty, ground using our senses, reduce our reactivity to obsessive thoughts, promote a non-judgmental awareness, and improve attunement to our avoidance behaviors.
Mindfulness can look like many things:
Mindful breathing
Grounding yourself by focusing on your breath, moving your thoughts from the obsession or compulsion to the sensations and feelings in your body. Gently raising your awareness to your breath is one of simplest ways to do this.
Body scans
Notice the places in your body that feel tense or clutched. Then release it, gradually.
Present Moment Awareness
If you are caught up in real-event OCD, or just ruminating on the past, take a moment to bring yourself back to the present, to the “hear and now.” The present moment might be uncomfortable or intense, but it is better than being stuck ruminating in the past.
Labeling you thoughts
Gently label your obsessions and doubts for exactly what they are: thinking, worrying, spiraling, etc. Instead of engaging/reacting to the thoughts, try to label them and let them go. “Oh, I’m just worrying again, I don’t need to do that right now,” or “I’m going to let go of that thought.” (Some folks find it helpful to simply note “thinking,” “feeling,” “sensation,” etc, without further engagement.)
OCD Therapy
Working with a therapist that is specifically trained in obsessive-compulsive disorders is crucial. The complexity of living with OCD makes managing it therapeutically a rather niche project. A trained OCD therapist will be able to tailor the work to meet your specific needs, and can utilize evidence-based approaches that will target OCD symptoms. Not all clinicians are properly trained for OCD work, and your run-of-the-mill talk therapy can unintentionally worsen OCD symptoms and actually reinforce negative patterns or behaviors.
When looking for an OCD therapist, it’s helpful to ask what modalities or approaches that therapist uses for OCD treatment. Have they taken any OCD-specific trainings? You will want to find a therapist who works with one of the following: ERP (Exposure and Response Prevention) Therapy, ACT (Acceptance and Commitment Therapy), or I-CBT (Inference-Based Cognitive Behavioral Therapy). DBT (Dialectical Behavioral Therapy) is another form of psychotherapy that can be helpful with some OCD management.
Always remember to PDA: Prevent, Delay, Alter
Compulsions are the fuel for OCD cycles, so preventing, delaying, or altering them is a vital part of taking away their power. An OCD therapist will help you come up with a plan for how to manage this, including how to proceed if preventing the cycles is too distressing.
Our compulsions reinforce the obsessive-compulsive cycle, only provide temporary relief, and they increase anxiety over time. OCD is fueled by a need for certainty and control, something that compulsions momentarily satisfy, but also reinforces the belief that uncertainty is intolerable. Resisting compulsions teaches us that we can tolerate distress (and ERP approach) without relying on our rituals, building resilience and reducing our fear of the unknown.
Preventing compulsions can help us regain control over our lives as we let go of time-consuming rituals and fill that time with meaningful activities. Over time, this fosters a sense of control over OCD, rather than feeling captive to its endless demands.
OCD is a Liar
Just because we think something doesn’t make it true. OCD will use any thought it can get its hands on to keep you caught in its cycle. But not every thought we have is true, and feelings are no facts. Just because we feel like the world will collapse if we change our bedtime routine, does not make it fact. OCD’s greatest skill is making us think that the feared outcome is true, and then generating physiological responses as if it is in fact true. But these are lies, and if we push the boundaries of the lie, test its edges (an ERP approach), we often discover that it’s hollow.
Not every thought that crosses your brain needs your time or attention. The intensely urgent feeling generated by OCD is a lie, and calling it as such helps you regain some power.
Name That Shit
This is one of my personal favorites. Giving your OCD a name can help with what Acceptance and Commitment Therapy calls “cognitive defusion.” Naming your OCD (something like “Bob,” “Kevin,” “Alice,” etc) helps you to externalize the OCD; meaning that it separates the OCD from the self. We are not our OCD and our OCD is not us.
For example, let’s say I name my OCD Jeff and I have an obsessive-compulsive cycle related to public transportation. I have to take the bus to work, and when I step on board I get a mental image of the bus exploding. Jeff tells me “you’d better not ever get into a bus because they will explode and kill you.” I can respond internally with something like, “Shut up Jeff, you’ve watched the movie Speed too many times and I’m tired of hearing you talk about it.” Or, alternatively, I could respond internally with a sarcastic, dismissive tone, saying something like “Okay Jeff, you’re right, I guess I have to avoid roads and transportation for the rest of my life.” Always remember that Jeff is a liar and a bully, and his comments are just there to degrade you, so there’s no reason to give in to him. Fuck off, Jeff!
Self-Care is Key
When we live with something as distressing as OCD, it can be easy to let the basics of self-care slide. It’s important to remember to take care of the essentials:
Eat food
Drink water
Take your medications
Sleep!
Exercise (even the smallest amount of movement can make a difference)
Avoid mood-altering substances
Be in community with others navigating OCD, it helps!
Be Nice to Yourself
Living with OCD can be debilitating, exhausting, isolating, depressing, and more. It’s important to be patient with yourself as you navigate this healing journey. Practicing self-compassion is an important way to address the emotional toll of living with OCD. It can help reduce self-criticism, guilt, shame, and the frustration we have with our obsessive-compulsive behaviors. Practicing self-compassion helps create a healthier, more balanced relationship with ourselves, which is critical for recovery.
Try speaking to yourself like you would speak to a friend. Offer yourself the same kindness you would offer a friend. Use a gentle tone, even when you’re stuck in a self-critical cycle. Remember that you’re just a human, doing their best, and no one is perfect! You are not weak or flawed because you struggle with OCD. Whenever you experience a setback, remember that it’s not a failure, it is just part of the recovery journey.
OCD can feel like a mighty foe, but it doesn’t have to dictate our path. There is help, hope, and healing out there, waiting for you. Every journey begins with a single step, so pick one and let’s see where this road can take you.
Resources:
“Overcoming Unwanted Intrusive Thoughts,” by Martin N. Seif and Sally M. Winston
“The Self-Compassion Workbook for OCD,” by Kimberley Quinlan
Read more about Therapy for Anxiety here.