Entering the cave you fear the most.
Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts that lead to compulsive, or ritualistic, behaviors that aim to reduce the amount of anxiety and fear connected to a perceived outcome, if the thoughts were true.
It makes complete sense that one would engage in anything that would protect them from a feared outcome; no matter how probable the outcome may be. We all desire to have insurance as it protects us from the high costs of healthcare. It would allow us the safety net in case highly negative events become us. This “insurance policy” is what compulsory behaviors provide: Protection from harm.
Unfortunately, the analogy breaks down a bit. When you access your insurance policy in real life, it provides an adaptive way for you to navigate that process. Accessing your insurance won’t necessarily correlate with bad things happening in the future regarding your health; however, when individuals with OCD access their “insurance policies” via compulsory behaviors, it very much correlates with the probability that those intrusive thoughts will happen again.
One major reason that compulsatory behaviors, or ritualistic behaviors, reinforce the intrusive thinking patterns, is because the compulsions bring about a sense of relief regarding those feared, or anxiety provoking outcomes. This is majority a biological process that is hard wired into our biology. The sympathetic nervous system (one could think of this system as the fight-or-flight portion of our nervous system) reacts to perceived threats in our environment ramping up our responses to prepare us to engage with and overcome said threat. What is the threat is a thought; something conjured from within the depths of our own mind? The threat LITERALLY lies within our minds. What makes them so hard to dismiss, is that there can be a string of truth in them. For instance: If I touch a dirty door knob, the probability increases that I could contract a disease or illness. Somebody who struggles with intrusive thoughts would replace “could” with “will.” This type of absolutism is a cognitive distortion (for more information on that, check my earlier blog here. This would be an all-or-nothing types of distortion.)
These distortions allow for intense physiological reactions that activate that sympathetic nervous system. The compulsions drive down the physiological response providing relief. One way to break that cycle and find new ways to find relief is to sit with that anxiety or fear until the body naturally comes down from that high. This is the aim of Exposure Therapy with Response Prevention. Joseph Campbell, and American philosopher put it this way: “The cave you fear to enter hold the treasure you seek.” Geoffrey of Monmouth, in his famous King Arthur’s tales, exemplified this in the tale of the search for the Holy Grail. Each knight entered the forest where there was no path and appeared darkest to them. The thoughts that OCD produces are terrifying; but when examined with logic and rationale, we find they unlikely will come true. By sitting with the uncomfortableness the thought produces, we allow our body to naturally process the reaction, and allow us to see that the fear itself is the biggest threat, not the perceived outcome.
By voluntarily entering the cave, you accept the challenge of staring fear in the face and not backing down. You no longer cower to possibilities; but rather confront potential with truth and create a reality in which none of those fears control you as they had before.
If you or somebody you know would like to learn more, please do not hesitate to contact me at firstname.lastname@example.org or at 405-513-0282.