Dr. Blume's Article of the Month

Mental Gardening: Crowding Out OCD Weeds
by Dr. Ginger E. Blume

Opening: When unimpeded, OCD tends to grow like a wild and hearty weed in the mental landscape of the OCD sufferer. The illness can quickly dominate a fertile mind (genetically predisposed field), leaving little space for the flowers and trees of life to flourish. Many of the techniques described in this article are akin to digging up weeds by their roots (altering one’s mental assumptions by making them more conscious). Of course, weeding a garden is not much fun, but the long-term results are certainly rewarding.

For twenty-seven years, I’ve met with clients day after day in my private practice office and have heard many themes repeated like a chorus in a song from those clients who suffer with OCD. Since there are many excellent articles on using cognitive-behavioral or exposure and response prevention strategies, this article will focus on those significant themes in the chorus that are sometimes ignored in treatment.

Theme #1: OCD forces a focus on past and future time frames.
Whether obsessing about what I did (past) or what I might do (future) that is bad/wrong, the mental time frame of the OCD sufferer is stuck in the past or the imagined future. Theoretically and practically speaking, it is nearly impossible to be engaged in obsessions or compulsive rituals when we are living fully in the present moment. When we stay in the here and now, we literally shut off the oxygen supply to OCD. It cannot survive in the “here and now.”

Implication for Wellness: Focus on living fully in the “here and now.” This conscious shift in mental focus creates an antidote to OCD. Various strategies help us to do this, such as gestalt therapy awareness exercises, meditation, mindfulness practices, yoga, etc.

Theme #2: OCD forces a focus on what I “do not want” versus on what I “want.”
OCD obsessive thoughts thrive in a mental landscape of one’s “not wants.” These “not wants” are typically expressed in thoughts such as, “What if…I forgot to shut off the water and the house is flooded?” The OCD mind is focused on various fears about possible unwanted events and outcomes (illness/harm to others/blasphemous thoughts).

The Non-OCD individual is more often motivated by “wants.” These wants are like an internal compass, helping guide one toward what is wanted in life. We naturally notice what the mind is thinking about. For example, we’ve all had the experience of purchasing a new car (i.e. a Saab) and suddenly, noticing all the Saabs on the road that we never observed before. When we scan the world on a daily basis for “our wants” versus our “not wants” we’re more likely to obtain our wants and be happy.

Implication for Wellness: Focus on “what you want,” not what you fear or don’t want. For instance, if I’m aware that I want to get to work on time, I must focus on “keeping moving” versus staying to check and recheck the house. In other words, the “wants” in our mind are an antidote to OCD “not wants.”

Theme #3: OCD forces a focus on “certainty” versus “shades of gray.”
Woody Allen wisely observed that the only thing we can be certain of is death. When he used the word “certain,” he meant something we can know without a shadow (shade of gray) of a doubt. In reality, there are so few certainties, that to live a life searching for them is ludicrous and yet, isn’t that what the OCD illness would have us do? OCD sufferers never consider shades of gray when it comes to life. For instance, the OCD demands that we be “sure” about our advice to our children, so we become inhibited to say anything in case we might be wrong. As a result, one’s entire life sphere is a series of serious black or white decisions and outcomes with no room for reasonable life circumstances.

Non-OCD thinkers experience the world in relative terms filled with numerous shades of gray. For instance, in principle, I am against stealing. However, if an infant were dying and I had exhausted other ways of obtaining food with no success, I would feel morally required to steal food for the infant’s survival.

Implication for Wellness: Role-play with your therapist or coach being able to recognize reasonable shades of gray in your life. This involves learning to identify outcomes that are “good enough” (a shade of gray) versus holding out for “perfect.”

Theme #4: OCD forces one to accept no risks.
In reality, educated risks make life juicy (a shade of gray) versus too dangerous (black or white). In reality, we can’t do anything without acknowledging that the act of living is about risks. Risks come in various forms, but they also allow for joy. Observe an infant playing peek-a-boo. The risk of not finding mother after she disappears is balanced by the joy of finding her again and again. Through this simple game, the infant is unconsciously learning that some risks are fun. Not all risks are terrible and catastrophic.

Implications for Wellness: Seek out risks that have the potential of bringing joy to your life.

Theme #5: OCD focuses on possibilities, not probabilities.
OCD obsessions and compulsions derive some of their bizarre quality from the fact that OCD doesn’t distinguish between possibility and probability. Obsessions and compulsive behaviors occur because the OCD mind says, “This could happen,” or “What if this happens.” The OCD mind is focused on “pure possibilities.” But, while most anything is possible, how probable is it? Again, due to black and white thinking, the OCD sufferer often feels justified in worrying about something that is possible, yet highly improbable because they don’t consider the shade of gray that probability implies.
 

Implications for Wellness: The concept of probability can be used in a graduated fashion to help clients slowly eliminate questionable obsessions and compulsions. Clients can be asked to carry out their OCD compulsion only if the probability of unwanted consequences is 40% or better, hence eliminating a lot of doubt. Then, clients can be asked to eliminate those compulsions with only a 25% or better probability of “X” occurring, etc. The probabilities are jointly chosen by the therapist and client based on an educated guess of likelihood of “X” occurring (with room for moving downward over time).

Summary:
These five themes are all helpful mental frames for structuring a preparation for effectively overcoming one’s OCD. They honor the fact that as human beings, we have a need to “understand why.” When OCD has been a way of life for a significant period of time, it is painful and risky for the individual to restructure their understanding of life (i.e. some of the mental models of reality must change). To often, the OCD sufferer has identified with his/her OCD, rather than realize that the OCD is more like a weed in their fabulous garden. They are “not their OCD,” but rather, “have OCD.”

Oftentimes, therapy is primarily focused on the severe anxiety caused by OCD. This article is designed to acknowledge the pain of reorganizing one’s understanding of life, in all its complexity. Rather than rely on our clients taking a “leap of faith” and following our treatment directives, we can help ease their path by providing the assumptions behind our treatment recommendations.

I’ve come to view the OCD sufferer’s faulty assumptions as invasive weeds that crowd out normal functioning in the garden of life. Because these weeds are genetically hardy and programmed to dominate the mind, sometimes, they are all that is visible upon first glance into the individual’s life. Once the garden is weeded, both the client and I jointly discover the previously hidden beauty of their garden. Talents and creativity that were starved by the OCD weeds sapping all of the individual’s energy and food are finally able to thrive.

Warning: These themes are not a substitute for carrying out daily change strategies. Most of us would agree that it is nearly impossible to learn how to ride a bike by simply hearing or reading a book of instructions. No matter how much talking about the principles of bike riding one does, you must actually get on the bike and locate your own internal sense of balance in order to successfully ride. It is the same with managing OCD symptoms. You can discuss strategies until you are blue in the face, but ultimately, you must do! You must put into practice via action resisting or not giving into the OCD compulsive urges.