- Exposure-response prevention focuses too much on full-blown anxiety and not enough on underlying emotions.
- Learning how to identify and become more mindfully aware of your ambivalent emotions can dramatically improve your OCD.
- Disentangling our jumbled emotions can provide greater order, meaning, and peace of mind than obsessions and compulsions themselves.
If you have obsessive-compulsive disorder (OCD), you're probably familiar with exposure-response prevention (ERP), allowing yourself to stay through the anxiety of your obsessions and compulsions until the spike dissipates and a space opens up for a new response: not giving in to the compulsion or obsession itself. We're going to take ERP and dial it back down further to its source: the underlying feelings themselves.
Untangling Your Emotions
Before we get to the anxiety of OCD, there are other hidden feelings that get glossed over and jumbled into the anxiety mix. As part of this new ERP, we're going to give ourselves more space to feel some of these feelings, and tolerate the discomfort—and even better embrace the opening—of being more directly in touch with them. It's like the meme that showcases a therapist helping their client untangle the mixed-up yarn inside of their head into separate colors and threads.
Underneath the anxiety of OCD is an ambivalent mixture of fear and desire, anger and sadness, or some other antagonistic combination. We're going to practice getting to the core of one or both of these so that we can 'stay through' so that we don't just have to deal with the much bigger anxiety that results. And this will be so much kinder, gentler, and more effective than ERP that tries to tame your anxiety when it's at a crescendo.
Burning Down the House
If anxiety is the inferno, these other feelings are the sparks, and we'll do much better to be with them and get back to them rather than trying to put out the whole blaze. In fact, wouldn't it be better if we took care of our metaphorical house before the sparks spread all over? Anxiety is the fire, and it moves very quickly and is hard to extinguish easily.
But, the feelings underneath are much easier and more effective to work with and prevent your OCD from getting to the point of burning you up.
Are You Really Going to Eat That?
Adam had obsessive worries about his wife's health. He was consistently triggered when she ate junk food or large portions of fatty, unhealthy food, or even worse, when she had too much to drink, or on occasion, took a smoke. What from the outside might look like mere anxiety and controlling behavior was actually coming from several emotions Adam had largely avoided: fear, anger, and desire.
Adam was terribly afraid that if his wife continued to eat the wrong things, he would lose her and his sense of security would be gone. At the same time, he often felt angry that she didn't understand how important this was to him and how her lack of self-care made him feel even more responsible for being on top of it. Finally, his biggest desire was to know that his wife was healthy and well so that he could enjoy their good life together.
It wasn't totally surprising that Adam should have these worries. His mother was a lifelong smoker who had died young of emphysema despite so many begging her to quit. Adam could remember from a child feeling an angry desire to swat the cigarette out of her hand as well as the haunting nightmares he had about losing her as a child. He had loved his mother very much, and had much difficulty holding the ambivalence of such strong hateful and loving feelings.
Straight to the Anxiety
Most of the time, Adam would go straight to the anxiety, the mixture of fear, anger, and desire that nobody had ever shown him. By the time it got here, it was very hard to control, because each of the underlying feelings—fear, anger, and desire—joined together to fuel a very big fire. He had tried ERP with his anxiety but it often made him feel even more out of control and helpless. Instead, we tried to identify, isolate, and begin to make room for each of the other component feelings.
Going for the Lowest Hanging Fruit
Sometimes, it's easiest to go to the least dangerous one, like desire. We could talk fairly openly about how much he cared for and loved spending time with his wife and how much he wanted to live to old age with her.
It is often easy for people with OCD to focus on fear as well—they are very familiar with the fears of losing. Who am I afraid of losing and why are they so important to me? What do I feel like I was lost inside as well as outside myself? If we can be more present with that feeling and thought, we are very far along with working through this perennial OCD fear.
Anger is an emotion that OCD therapists often have to introduce and model as something okay to explore, noting that it doesn't negate the love and fear, and won't also destroy the person that is so loved. As for the anger, we noticed with Adam how little room he allowed himself to feel because he was concerned that it wasn't fair and would hurt his wife or his mother, who he was already concerned about. Why add any more negativity to the mix?
By focusing on each of these component feelings that led to the bigger anxiety, we were much more able to tame Adam's OCD. Even better, it made Adam feel a greater sense of understanding and control over his OCD—that it wasn't just random, but instead had some meaningful connection to his emotional experience and trauma—and that we could ask, as Dr. Bruce Perry and Oprah Winfrey say in their book, not "what is wrong with you?" but "what happened to you?"
Now, Find Your Feelings
What are the feelings underlying your OCD anxiety?
- Let's locate the desire first. What do you most wish to maintain and keep in your relationships? Write it down here with the fullest context of why and how this person and relationship is important to you. Write down how it might connect to other important relationships from the past like Adam did with the connection of his fears about his wife and his early childhood fears of losing his mother. Put down how it connects to important values and attributes you want to carry inside yourself as well. So much of our relationships are connected to what we most desire to carry ourselves to.
What are the specific fears you have about losing the other person and, by extension, a part of yourself?
Adam was worried that his wife would do all sorts of unhealthy things and die young and he wouldn’t have a partner just as he felt that losing his mother young would mean he wouldn’t have an anchor.
- What are your fears and how do they try to scare you with worst-case scenarios? What if we could compassionately accept these fears as part of an understandable and profound love and importance that these people serve for you and the importance of the relationship in your life? Write about how these fears express something valuable about what you cherish and need in your life.
Is there any anger that you have a hard time giving yourself permission to express even to yourself about this situation? Working as your own defense attorney as to why you are healthily entitled to have this feeling, reminding yourself that it is a part of the many feelings coming together to make up your anxiety, write down why it angers you that this person sometimes does things that make you upset at them—or even dislike them!—even though you love them in so many other ways.
Connecting Your Mind to Your Body
When you allow yourself to isolate and name the different feelings, how do you feel in your body? Do you notice that you can breathe a little more easily? Do you notice the energy moving away from just the worried mind above your neck and down into your heart, your hands, your feet, or any other places in your body?
Making a New Order
Do some of the tangled-up thoughts in your anxiety start to feel a little less chaotic in your head? Do you feel connected to a higher order than the compelling order of OCD?
Good. That’s the new creative way we’re going to approach your OCD and use it to get to the core emotions so you can feel better, calmer, and more powerful.