Overcoming OCD through Psychotherapy
By Carol Goh | Published on 22 May 2021
OCD is known as the doubting disease. People suffering from OCD are always uncertain about themselves in their daily lives that it causes great pain to their functioning. Because of the constant need for assurance, they will have the urge to check and re-do activity to seek certainty, but always ending up more unsure and having to re-check or re-do the same activity umpteen times.
In the process of checking, fear and anxiety build up and affect emotions and clarity of thoughts. This forms a vicious cycle ending up tormenting sufferers in this constant battle of the mind.
Symptoms of OCD
OCD can manifest in many forms:
1. Checking stoves, locks, alarm clocks, etc.
2. Washing hands many times
3. Taking hours bathing
4. Counting - the need to do things a specific number of times, such as open and close door in set number of times
5. Hoarding - keeping things that are no longer needed or useful
6. Need for symmetry - such as arranging things in a particular order
7. Having blasphemous thoughts about God
8. Having thoughts that might harm self or someone
9. Fearful of dirt, germs, harm - especially during COVID-19
People with OCD normally feel a great sense of responsibility to:
OCD sufferers often experience a state of thought-action fusion, which means they have an unpleasant or scary thought which they fear has happened.
For example, John (not his real name) always fears that he may have run over someone while driving. Hence, whenever he drives and reaches a destination, he has the tendency of going back to his route to check if he has run over someone.
For people with checking OCD such as locking the door, the thought of ‘what if’ they forgot to lock the door often creeps into their thought. They then begin to doubt themselves, and that causes them to go back to the door to check the lock again. They can repeat this process many times, causing them to be exhausted emotionally. In more serious cases, this process may lead to anxiety and panic attack.
Due to obsession of a particular thought, OCD sufferers will set up rituals of compulsion acts which they thought could neutralise their negative thoughts.
"OCD sufferers will set up rituals of compulsion acts which they thought could neutralise their negative thoughts."
Such rituals are “safety-seeking” behaviours to provide relief to them and are in accordance with their self-made rules. OCD sufferers depend on these rules to help them ward off potential dangers or threat. Unfortunately, such acts are only temporary and counter-productive. In the long run, they may prove unhelpful and may even worsen the mental state of the OCD sufferers.
Jane (not her real name), a college student, has a constant fear of bad events such as failing her exams or being laughed at by classmates that could happen to her. She ends up creating several rituals she believes will prevent such bad events from happening over the years:
- Always going out of the house at exactly the same time
- Carrying the same school bag everyday
- Saying her prayer at exactly 7am and 7pm daily
- Need to hit her bed every night at 11pm sharp
She realises she has to keep adding on new rituals to the list in order to gain greater assurance.
June (not her real name) who works in a hospital is staying with her mom and 80-year-old grandmother. She is in constant fear of bringing germs and viruses home from the hospital and infecting her grandma whom she is close to. June becomes so paranoid that she experiences high anxiety both at work and at home. She will repeatedly wash her hands at work and also at home. These constant washings cause her hands to become dry, flaky and discoloured. Such is an example which started out as a fear of germs which led to repeated washing of hands resulting in frustration and anxiety.
Scientific explanation of the mind causing anxiety
Many books have provided the scientific explanations on how anxiety attacks the brain. Basically, the main part of the brain that sets off such body sensation is the amygdala.
A neuroimaging research by Shin and Liberzon (2010) reported relatively heightened amygdala activation in response to anxiety. This amygdala is always on the lookout for potential harm. It will set off the fear alarm to alert the body of any impending danger lurking. Its role is to protect us from harm by preparing us to fight or flee.
The amygdala reacts very fast and even bypasses the cortex, which is the centre of logic. The brain is hard-wired to allow the amygdala to seize control in times of danger. And because of this wiring, it’s difficult to use reason-based thought processes directly to calm the mind and body. You may realise that your anxiety rarely makes sense to your cortex, and that your cortex can’t just reason it away.
"Your anxiety rarely makes sense to your cortex, and that your cortex can’t just reason it away."
For repeated checking case of OCD, lack of “confidence” contributes to constant fear. Once fear is triggered, it activated the amygdala, causing doubt in yourself and this vicious cycle spirals on. Such a sequence happens so fast that it becomes autopilot mode of behaviour without you realising, leaving you drained emotionally.
OCD sufferers are constantly gripped with fear of uncertainty. The amygdala in them is always on hyperalert mode, never resting, and can be activated at the slightest trigger. The reality is that certainty in life which they are seeking (such as getting a promotion or getting distinction in exams) may not occur. As a result, many OCD sufferers end up having anxiety problems.
Prevalence of OCD in Singapore
In a Singapore Mental Health Study conducted in 2016 among 6126 residents aged 18 and above, it found that lifetime prevalence of OCD was 3.6% (Subramaniam, 2020).
In another Singapore Mental Health study, it found that the average time gap between the onset of symptoms and treatment was nine years. About 20 – 30% of patients make significant improvement with treatment, 40-50% make moderate improvement, and the remaining 20-40% remain ill despite treatment. One-third of OCD patients develop depression which is a risk factor of suicide (Ng, 2011).
To prevent the OCD sufferers from sinking into depression, early treatment is highly recommended. The survey results have provided encouraging results that OCD sufferers condition can be improved with the right treatment.
Psychotherapy Intervention for OCD
According to Dr. Leslie Lim, a psychiatrist who has written several books, contrary to common understanding, medication alone is not sufficient for changing the thought patterns and beliefs ingrained (Lim, 2012). You will need psychotherapy intervention to help you overcome your OCD problem.
Facing your fears on your own is key to recovery from OCD. I believe there is no one single method to treat OCD. Based on my experiences, for OCD treatment to be effective, it is important to assess the nature of the fear and the background and beliefs of the OCD sufferers. This will determine the types of psychotherapy techniques to be administered.
Techniques used to treat OCD include:
1. Eye Movement Desensitization and Reprocessing (EMDR) - to address high anxiety caused by OCD
2. Exposure Response Prevention (ERP)
3. Cognitive Behavioral Therapy (CBT) - understanding and aligning thought patterns and beliefs
4. Self-calming techniques
6. Mindfulness – to provide calmness to increase consciousness in actions
"Do the thing you fear and the death of fear is certain."
Ralph Waldo Emerson
During the treatment, you will learn to first accept your condition (together with the range of emotions that come with it, particularly anxiety). Acceptance is important as it helps to diminish anxiety’s power and control over you. Feeling the fear and do it anyway will disarm the power that fear has over you. In this stage, I will guide you on how to tame and overpower the aggression of anxiety.
Once you have learnt to accept your condition, I will apply various techniques to work on your different aspects of OCD. Techniques such as mindfulness have been found to be very effective to tame the anxiety portion of OCD (Cludius, Landmann, Rose, & Moritz, 2020). Exposure methods can also be applied to desensitize the fear of facing the event/behaviour (Daflos & Whittal, 2012).
I will apply a series of anxiety releasing procedures to help you desensitize your anxiety. Once your anxiety does not spike and is within a controlled range, I will normally apply techniques such as EMDR and CBT to help you gradually break free from the rituals and compulsions that have been tormenting you.
One thing to take note is that there is no shortcut to OCD treatment. Working on OCD is hard work and you need patience and persistence. Treatment duration can last for months.
To release yourself from the pain of OCD, start your treatment early.
Your life can be renewed.
Client’s healing journey…
"When the pandemic hit, I started to become very conscious of both my own hygiene and the hygiene of those around me. At first, I didn’t think much about it and sought to deal with these obsessive thoughts through various rituals such as repeated washing of my hands and long showers (more than an hour) but these only brought temporary relief and soon I began to have anxiety attacks when I was overwhelmed with emotions. That was when I sought help from Ms Carol and spoke to her about the various fears that I had and shared that the thought of getting sick due to the virus terrified me. Through the sessions I had with Ms Carol, I learnt to identify the various heightened emotions and irrational fears, and how to face them boldly. It helped speaking to Ms Carol as she guided me through this painful season patiently and through the multiple sessions, I learnt techniques such as visualization and mindfulness to calm my anxiety down. In addition, I began exposure exercises with Ms Carol to face my fears and overcome them. It helped to have someone alongside such as Ms Carol processing my feelings and emotions when I was at my lowest point. I am now less fearful of my surroundings and better able to go on with daily routine functions without anxiety plaguing me anymore."
Male, working professional
"I was suffering from OCD with obsessive thoughts in my mind. It had affected me so badly that I could not really concentrate well in doing my daily activities. I could not sleep too. Anxiety, worry and fear were all over me as I keep on wondering whether I could recover. I consulted Ms Carol for counselling and was advised to remain positive and to regain the confidence that I had lost due to OCD. I was taught breathing exercises and other procedures to reduce my obsessive thoughts. I even attended mindfulness course recommended by Ms Carol and found it very helpful. When I was doing the above mentioned on my own, I also took time to attend counselling sessions with Ms Carol who gave me strong encouraging advise and techniques which eventually led to my recovery from OCD. Now I am a happy and confident person. I am also enjoying my life. All thanks to Ms Carol!"
Male, working professional
1. Being Me with OCD by Alison Dotson
2. Brain Lock by Jeffrey Schwartz
3. Break Free From OCD by Fiona Challacombe
4. Rewind, Replay, Repeat by Jeff Bell
5. Stopping the Noise in Your head by Reid Wilson
Cludius, B., Landmann, S., Rose, N., & Moritz, S. (2020). Long-term effects of mindfulness-based cognitive therapy in patients with obsessive-compulsive disorder and residual symptoms after cognitive behavioral therapy: Twelve-month follow-up of a randomized controlled trial. Psychiatry Research, 291.
Daflos, S., & Whittal, M. (2012). Exposure Therapy in OCD: Is There a Need for Adding Cognitive Elements?
Lim, Leslie (2012) Freedom From Fear: Overcoming Anxiety Disorders. Armour Publishing Pte Ltd.
Ng JY. ‘I am not mad.’ Most people here with mental illnesses leave it late to seek treatment: survey. Today. November 19, 2011.Subramaniam, M., Abdin, E., Vaingankar, J., Shafie, S., Chang, S., Seow, E., Chua, B. Y., Jeyagurunathan, A., Heng, D., Kwok, K. W., & Chong, S. A. (2020). Obsessive-Compulsive Disorder in Singapore: Prevalence, Comorbidity, Quality of Life and Social Support. Annals of the Academy of Medicine, Singapore, 49(1), 15–25.
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