What does it mean to Rise above your OCD theme? And why would that be important?

Jackie came to see me because she had Relationship OCD that was putting her marriage into jeopardy. She did well with ERP and then, she described thoughts about Sexual Orientation OCD. She did great with ERP again and then stared struggling with Scrupulosity. Hmmm. What was going on here?

Hi, I’m Paige Pradko, a psychotherapist that specializes in treating people with OCD, health anxiety and anxiety disorders. Welcome to Therapy for a Better Life. If you are wondering if you have OCD, I left you a free OCD self assessment at paigepradko.com. 

What was happening with my client, Jackie is what OCD therapists call Whack a Mole. One OCD subtype or theme is treated, and then another one pops up. Have you ever noticed that your OCD theme changed? Maybe it used to be one thing when you were younger and then it changed? Or maybe you have several OCD themes? Your OCD theme is centered around your content, what bothers you, the specific subject matter of your obsessions and mental and/or physical compulsions. It is very common for people to have several OCD themes and for some people to experience rapid change and cycling of themes. So, why would I suggest that you rise above your OCD theme? At the core of OCD are threats, something that scares you, that put you into a state of relentless doubt. Then, it manipulates and trains you to respond to it in specific ways. But OCD wants you to respond NOW, it has an urgency to it, doesn’t it? There is that sudden feeling of an adrenaline rush when the fear hits you. That’s epinephrine, a hormone released as a result of your amygdala being activated in the brain. OCD has trained you to do certain things to get that anxiety and discomfort to calm down. But OCD doesn’t care about your themes or your content at all. OCD is a disorder. Everyone has slightly different content and slightly different fear triggers and things that bother them. OCD is a disorder; it doesn’t care what theme you have. It just wants to grab your attention and control you and convince you do something to make the anxiety go away. When you respond to OCD, you are training your brain to make your OCD stronger. If I wash like this, if I tap this 3 times, if I turn this switch on and off 4 times, if I analyze it, if I say something positive maybe it will cancel out that negative, if I walk into the building again maybe I will get the just right feeling. These compulsions are all these little made-up behavior experiments. And as soon as you notice your anxiety go down, your brain associates those rituals and compulsions with the reduction in your anxiety or discomfort. You never gave yourself the chance to learn that it would have gone down on its own anyway. Those little behaviors that develop into compulsions and rituals give your OCD power. They are just like giving your dog a treat when he sits. He will want that treat every time. Your OCD wants those behaviors every time. OCD is a disorder that scares you, creates doubt in you and trains you to respond in specific ways. The specific theme doesn’t matter at all. OCD works the same way regardless of your specific content whether it be contamination, just right feeling, checking, relationship doubt, etc. You may know this logically. That OCD is OCD. But you may still be stuck in your theme and not know how to get out of it. There is an answer. First, you get unstuck from your theme and your content with ERP. Then, you gradually incorporate and shift to a more global treatment approach to OCD. Once you make this shift, your theme no longer has control over you. I have a method for doing this. First, I will teach you how to do an easy to follow 3-Step process for ERP (Exposure and Response Prevention) so that you can get unstuck from your content and your OCD theme. Then, you will gradually incorporate a more global treatment approach to OCD. The more global or macro approach includes Incidental ERP like the I. A.M. technique. I. A.M. is an acronym. The (I) is for Identify the OCD. The (A)is for Allow it to just float there in the background, and the (M) is for shifting your attention to something else in the moment and Moving ON. Notice that the I. A.M. approach does not recognize your theme at all. That’s important in your recovery. You have to separate yourself from responding to your theme. The I. A.M. method is a global approach, and it gives you a technique to use whenever OCD pops up, in any form. It doesn’t matter if the theme changes or not. You will always know what to do. The I. A.M. method separates you from the OCD, just by identifying the thought, image, or sensation as OCD. And it reminds you to not respond to it or attend to it. The I. A.M. method is a method of keeping you in response prevention. Remember my client, Jackie? The one that seemed to be playing whack a mole with her OCD. Jackie shifted to identifying her doubt and what-if thoughts as OCD. Then, she used the I. A.M. method every time she noticed the doubt and shifted her attention in the moment and moved on. This more global approach to treating her OCD took Jackie above her content and prevented her from checking her emotions, ruminating, questioning her thoughts, trying to answer her “what-if” questions and seeking safety and reassurance. The global approach using the I. A.M. method helped her to maintain her response prevention and not do her compulsions. I realize, that right now, you may feel exhausted and frustrated and stuck in your theme, not knowing how to stop compulsing or shift out of it. This is where most everyone is at the beginning. You are not alone. You are right where you should be. I will walk you thought what to do. Even though I am going to be encouraging the eventual shift to rising above your, I first help you to get unstuck from subtypes and your OCD themes in my course. I cover ERP treatment for 16 different themes in this OCD course. And I will help you develop specific ERP plans to get unstuck from your theme. But, because of the nature of OCD, I encourage you to vary your ERP by adding in days where you only use the I. A.M. method while staying in response prevention. My clients actually prefer these global, incidental ERP days versus their planned exposures. Here you will be rising above your OCD themes by not responding to your content and shifting to a more global protocol for OCD. This is where you eventually want to go in your treatment to have lasting relapse prevention strategies and sustained recovery. If you are wondering if you have OCD, I left you a free self assessment in the description below this video. And, if you need help for OCD, please leave me a message on PaigePradko.com. Until next time, I will see you in session.