OCD - 8 Simple Steps to Stop Compulsively Checking
1. Reduce self doubt and Learn to Trust Yourself: OCD causes us to doubt our memory of events, "Did I actually lock the door?" Remind yourself of all the times that you actually did lock the door or turn the faucet off. Give a percentage of how many times you were right and OCD was wrong (ex. 90% ?). So tell yourself "This is just OCD and it's lying to me. I locked the door."
2. De-Personalize the Symptoms: You are not the OCD. You are not defective.
3. Identify ‘What If” Thoughts: You will expose OCD’s unhelpful “What If” thoughts and change them to more helpful “If Then” thoughts.
4. Create Powerful “If Then” Thoughts: “If Then” thoughts and statements set behavioral intentions or goals with the power to create feelings of certainty. This will help reduce self-doubt.
5. Devalue the Obsessive Thoughts: Instead of focusing on the fearful content of the thought (“What if I left the gas on?”), label it as just a thought that produces self-doubt and anxiety. “That’s just an obsession.”
6. Create a fear ladder: Start with a Weaker Compulsion and use Mental Rehearsal. Create a hierarchy of things that you check from those that cause the most anxiety to least anxiety. Then start with the one that causes the least amount of anxiety and mentally rehearse performing the task once and not returning. This technique is called "Imaginal Exposure."
7. Delay Checking and The Point of No Return: Actual real-time exposure can be gradual. Set a timer for 5 minutes and then check the door one time and state, “I checked the door and it is locked. No one will get in.” Soon there will be a place when turning back will be more difficult for you or unacceptable to do.
8. Choose not to Check: After successfully delaying the compulsion to check and identifying your point of no return, you are now ready to challenge yourself with not checking at all.
Overview
Obsessive Compulsive Disorder (OCD) is classified as an anxiety disorder and is considered a chronic condition. Effective treatment, however, can significantly reduce the symptoms and produce a full remission of the disorder.
Obsessions are unwanted intrusive thoughts, images, or impulses/urges that cause intense feelings of shame, guilt, and doubt. This can trigger uncomfortable levels of anxiety, including panic attacks (aka anxiety attacks).
Compulsions are behaviors or rituals that are used to decrease the intensity of the obsessions and anxiety. Compulsive behaviors can also be said to neutralize the feeling of anxiety caused by the obsessive thoughts and beliefs. But the compulsive behavior only provides short-term relief from anxiety.
When the compulsive behavior reduces a person’s anxiety, it also confirms that the obsessive thoughts are dangerous or somehow true. Because anxiety is reduced, the compulsive behavior or ritual is reinforced and is more likely to be repeated again in the future. This becomes a vicious cycle.
Symptoms
Obsessive Thoughts, Images, or Impulses
Obsessive thoughts and images may not be about real or actual events. These intrusive thoughts are repetitive and focus more on getting it “right” and involve the fear of something that has not happened yet, such as “What if I didn’t lock the door, someone can just walk in my home and take everything.” Or more disturbing, “What if I can’t control myself while using a knife and I stab everyone in the room.” These are not fantasies or actual urges. These are unwanted fearful thoughts that can cause feelings of shame and self-doubt.
Types of Obsessions
Contamination Obsessions
Fear of Germs
Fear of Chemicals
Fear of Bodily Fluids (urine, saliva, and blood)
Losing Control Obsessions
Fear of acting on impulse and saying inappropriate things
Fear of acting on an impulse to harm oneself
Fear of acting on an impulse to harm others
Fear of violent thoughts and images
Harm Obsessions
Fear of inadvertently causing another person’s harm (by thinking it or not being careful enough)
Moral Obsessions
Unwanted Sexually Explicit or Perverse Thoughts and/or Images
Over-concern with right and wrong judgements
Over-concern with sin or angering God
Self-Doubt Obsessions
Fear of losing or forgetting important information when throwing something out
Fear of making mistakes or doing something wrong
Perfectionistic Obsessions
Over-concern about things being exact and precise
Over-concern with a need to know something or to remember something
Compulsions
Compulsive behaviors only temporarily reduce obsessive thoughts and the resulting anxiety. These behaviors attempt to get things rights, remove doubt, and to avoid some future calamity. Compulsions are time consuming and often interfere with important obligations such as getting to school or work on time.
Types of Compulsions
Avoiding
Staying away from people, places, and things that trigger obsessive thoughts, images, and/or impulses
Checking
Checking to make certain that you did not make a mistake
Checking that you did not harm others (calling them, calling hospitals)
Checking anything to remove feelings of doubt
Asking the same question over again or repetitively seeking reassurance
Cleaning and Washing
Cleaning and then re-cleaning
Excessively washing hands
Excessively showering (too many times or too long)
Mental Compulsions
Mentally counting to land on a specific number (ex. “Must be an even number”)
Praying or reciting
Repeating
Repeating a task (ex. locking the door 3 times)
Repeating body movements (tapping, blinking)
Other Symptoms
Tics
Tics are sudden, uncontrolled, and repetitive movements or vocal sounds that are common with OCD, Tourette’s, and ADHD. There are 2 kinds of Tics, motor and vocal.
Motor Tics
Simple motor tics include head twitching, eye blinking, nose twitching, facial grimacing, and shoulder shrugging.
More complex motor tics include skipping, jumping, kicking, and smelling hands or other objects.
Vocal Tics
Simple vocal tics include throat clearing, coughing, grunting, barking, and hissing.
More complex vocal tics include yelling, making animal sounds, and repeating words and/or phrases.
Risk Factors
It is estimated that 1 out of 200 kids and teens, and 1 out of 100 adults can be diagnosed with OCD.
It can begin as early as 8 years of age and typically develops between the ages of 15 and 44. OCD is the 4th most common mental illness after phobias and depression.
Risk factors for developing OCD include a family history of OCD, trauma, and chronic stress.
Causes
To this date there is no definitive cause for OCD.
Most theories suggest a possible genetic link, changes in brain chemistry and functions, and environmental factors such as infections (PANDAS).
Unhelpful reactions to intrusive thoughts or obsessions and poor coping skills can contribute to the development of OCD.
Exaggerated and catastrophic beliefs about the importance of the obsessive thoughts triggers anxiety and anxious behavior.
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is a type of OCD that develops in children after being exposed to infection. The body reacts to the infection, causing sudden and severe symptoms of OCD.
Treatment
If you believe you could have Obsessive Compulsive Disorder (OCD) it will be helpful and important to seek consultation with a mental health professional to first verify the diagnosis and then receive appropriate treatment.
Medication
Please consult with your primary care physician or a psychiatrist regarding the use of medication.
Anti-depressant medications are also effective at reducing symptoms of anxiety on a daily basis. This helps dampen the physical and emotional effects of anxiety and increases a person’s capacity to cope with stressful situations.
Commonly prescribed anti-depressants are:
Citalopram (Celexa)
Escitalopram (Lexapro)
Sertraline (Zoloft)
Paroxetine (Paxil)
Fluoxetine (Prozac)
Medication alone, however, is usually not enough for treating OCD. Certain medication can be more helpful when combined with psychotherapy.
Psychotherapy
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is a well-researched and highly effective form of talk therapy that focuses on learning more helpful ways of thinking and behaving. You learn different ways of responding to the symptoms of OCD and to your feelings of anxiety.
CBT helps challenge and change unhelpful beliefs that cause anxiety by restructuring automatic thinking and changing the way you behave in response to obsessive thoughts.
CBT sessions also provide education on the symptoms of OCD and how to manage the emotional and physical symptoms of anxiety.
Exposure and Response Prevention (ERP)
A form of Cognitive-Behavioral Therapy (CBT) known as Exposure and Response Prevention has been the most effective method for treating the symptoms of OCD.
With Exposure and Response Prevention, a mental health professional trained in CBT conducts a series of sessions to gradually expose the person to situations that trigger his or her obsessive thoughts and compulsive behaviors. Over time, the person learns to respond differently to these triggers, leading to a decrease in the frequency of compulsions and the intensity of obsessions.
As with most anxiety disorders, in order to learn how to overcome the symptoms of anxiety and to know that you can cope with anxiety and master the symptoms, you need to have the experience of successfully managing the symptoms. This often means exposing yourself to the thoughts, images, and impulses related to OCD and preventing from engaging in the compulsive behavior to reduce the anxiety.
Exposure and Response Prevention is an evidence-based treatment that interrupts the link between the anxiety produced by the obsessive thought and the compulsive behavior or ritual.
With the help of a mental health professional you are exposed to the obsession that triggers anxiety and then you are prevented from carrying out the compulsive ritual that usually decreases the anxiety.
For example some with an obsession about contamination, will touch something dirty. Their anxiety will increase and they will sit with the anxiety and not engage in their ritual of hand washing. The anxiety will reach a peak and then it will naturally decrease and return back to normal levels, all without engaging in the compulsive ritual.
This process will be repeated until touching the dirty object no longer produces anxiety.
The exposure is gradual at first and then the exposure becomes more prolonged overtime.
Cognitive Behavioral Therapies, such as ERP, can actually change the biochemistry in the brain that causes the symptoms of OCD.
Treating Intrusive Obsessional Thoughts without Compulsions
Most people experience intrusive thoughts. Intrusive thoughts by themselves are not the problem. It’s the reaction you have to the intrusive thought that’s the problem. If you react with the belief that the thoughts are dangerous by trying to stop the thoughts or use avoidance, then you will experience anxiety and fear. Your reaction causes the anxiety, not the intrusive thoughts.
To conquer intrusive thoughts see 7 Steps for Overcoming Intrusive Thoughts.
8 Steps to Stop Compulsively Checking
1. Learning to Trust Yourself
The checking compulsion is a symptom of OCD and is related to self-doubt obsessions. You don’t trust your own thoughts, memory, and actions. OCD makes you question your reality.
Example: You fear that someone will enter your home or car and rip you off if you don’t lock your doors. Because of OCD you experience doubt and uncertainty about whether you actually locked the door. This uncertainty causes feelings of anxiety and more fear. So you go back and check the lock again to be certain and to reduce the anxiety. Then you walk away, but wait, that pesky OCD says, "Maybe you unknowingly unlocked the door instead of locking it." So you decide “I better check again.”
This self-doubt and lack of trust in yourself can cause you to feel helpless and defective.
Remind yourself of all the times that you actually did lock the door or turn the faucet off.
Give a percentage of how many times you were right and OCD was wrong (ex. 90% ?).
So tell yourself "This is just OCD and it's lying to me. I locked the door."
2. De-Personalize the Symptoms of Obsessive Compulsive Disorder
You are not the OCD. You are not defective.
The first step in learning to trust yourself is to stop blaming and doubting yourself.
Detach your “Self” from the symptoms of obsessive compulsive disorder by telling yourself, “It’s the OCD, not me.”
These are symptoms of a medical disorder that can be successfully treated.
The symptoms of OCD are caused by biological imbalances in the brain. The feelings produced are a false alarm that have little or no basis in reality. They are false and misleading messages from parts your brain that contradict the logical part of your brain that says “But I did lock the door.”
Start trusting your knowledge about the symptoms, causes, and treatment of Obsessive Compulsive Disorder (OCD).
3. Identify ‘What If” Thoughts
You will expose OCD’s unhelpful “What If” thoughts and change them to more helpful “If Then” thoughts.
Your subconscious mind and your sympathetic nervous system will respond to the “What If” thoughts of your conscious mind by increasing the level of adrenaline and other stress hormones in your blood stream.
If your “What If” thought is focused on fear and anxiety, then you will experience more fear and anxiety. If your “What If” thought is focused on a desired positive outcome or what you want, then you will feel less anxious.
Identify the fear or what is going to happen if you don’t compulsively check.
Example: “What if I don’t check the front door to make sure I actually locked it? Someone will get in and steal everything!” “What if I forgot to lock my car door? Someone will steal my car.”
These “What If” thoughts trigger more self-doubt, anxiety, and more compulsive urges to check.
4. Create Powerful “If Then” Thoughts
“If Then” thoughts and statements set behavioral intentions or goals with the power to create feelings of certainty. This will help reduce self-doubt.
These are logical statements that the human brain is very good at encoding.
This is the language of your brain. Your brain is more capable of processing, “If X happens, then Y will happen.” It’s very simple, specific, and not at all vague.
Example: “If I lock the front door and check it one time, then the front door is locked. No one will get in!” “If I walk away from the door without checking, then my feeling of anxiety and self-doubt will eventually go away and I will feel proud of myself.”
You are telling your sympathetic nervous system that there is no danger. This will reduce the symptoms of anxiety.
You are instructing your sympathetic nervous system how to respond appropriately instead of reacting with anxiety.
5. Devalue the Obsessive Thoughts
Take the power away from the “What If” thoughts.
Instead of focusing on the fearful content of the thought (“What if I left the gas on?”), label it as just a thought that produces self-doubt and anxiety. “That’s just an obsession.”
This will move you away from the emotional content of the thought. Say, “This (what if) thought is just an anxiety provoking thought.”
They are just thoughts. They have no physical weight to them. No one can see them in your head. You can’t touch the thoughts. You can’t cut your finger with a thought.
Just because you have a thought, it does not mean that it is true or will come true.
6. Create a fear ladder
Start with a Weaker Compulsion and use Mental Rehearsal
Create a hierarchy of things that you check from those that cause the most anxiety to least anxiety. Then start with the one that causes the least amount of anxiety.
This could be something like checking to make sure the faucet is turned off. When you are able to stop checking the faucet, you will feel more confident to tackle the bigger ones.
Begin by using mental rehearsal (Imaginal exposure). Sit back, close your eyes, and visually imagine yourself performing a task and not going back to check it. Take some deep breaths and ride out any anxiety you feel in the moment. Continue doing this until you no longer experience any anxiety.
Then you can move to the next step which is real-time exposure (In vivo).
7. Delay Checking and The Point of No Return
Delay your compulsion to check. This is called gradual exposure.
Allow yourself time to monitor your “What If” thoughts and to create a more powerful “If Then” thought.
Delay going back and checking while stating your “If Then” thought. You can use a timer on your phone to wait 2 minutes, 5 minutes etc. You can continue to delay for longer periods of time and eventually not check at all.
Example: You experience doubt and anxiety about locking the door to your home after you get in your car. After identifying your “What If” fear, create the intention of “If I locked the front door and checked it one time, then the front door is locked. No one will get in!”
Set a timer for 5 minutes and then check the door one time and state, “I checked the door and it is locked. No one will get in.”
Each time you delay checking, try delaying for longer periods of time. This is how you gradually expose yourself to the anxiety. Using a timer can help you feel more in control and give you specific feedback about improvement. This can improve your level of confidence.
This is how you begin to take back control over something that you feel out of control with.
Identify your point of no return
Soon you will be able to delay checking that the door is locked by driving away or finally falling alseep at night without the usual compulsive checking.
If you are leaving your home and going to work or school, there will be a place when turning back will be more difficult for you or unacceptable to do.
As a result you will tend to just keep on going to work or school without going back to re-check.
Your goal is to get to this place of no return without re-checking or even checking one time, and then praise yourself for doing so.
Know that any anxiety you experience will subside as you begin to shift your focus to work, school, or other task that you are heading towards.
Be proud of yourself for reaching this point of no return, continuing on, and not going back to re-check.
Resisting compulsions can actually change the biochemistry and functioning of your brain that is causing the symptoms of OCD.
8. Choose not to Check
After successfully delaying the compulsion to check and identifying your point of no return, you are now ready to challenge yourself with not checking at all.
As you initially lock the front door state to yourself, “If I lock the front door, then it is locked!”
As you walk away from the door state, “I locked the front door, I can go to work” and/or “If I walk away from the door without re-checking, then my feeling of anxiety and self-doubt will eventually go away and I will feel proud of myself.”
“Resisting the urge to check and not checking at all will change how my brain works and will decrease the symptoms of OCD.”
