Coping vs. Compulsions for OCD

(Below is a transcript for those who would rather read than watch the video)

I am making this video because some of my clients, who are really hard working, sometimes get themselves tripped up over confusions compulsions with coping skills. So I wanted to bring some clarity into how you know when you're successfully coping with OCD and when you are accidently falling victim to a compulsion (which we know only exacerbates the OCD). [The compulsion] gives us temporary relief and makes us feel like we're doing a good job managing our mental health, in the long run, it totally takes away and allows OCD to gain more power in our lives and takes away our freedom.

So first, quick review of the OCD cycle: We always start by identifying a trigger. I am going to use contamination OCD as an example because It's just so, what I consider kind of common sensical and easy to understand. So a trigger could be shaking somebody's hand. The next step in the cycle is the doubt or the obsession. So that fear "Did that person's hand have germs on it?" A consequence could be "Oh my gosh! If that person's hand does have germs on it, I could be contaminated, I could get sick, it could develop into a serious disease." The next step is the compulsion. I want you to think of the role that compulsions play in our lives in the cycle is we view them as the protector of ourselves. "But I know if I wash my hands I will be safe and I will protect myself from any danger of getting that disease."

Coping skills on the other hand will not protect us. When we use an effective coping skill to address an obsession that we have, it actually does not give us any certainty over our feared obsession. So for example, that obsession, "Oh my goodness, I just touched somebody's hand and I might have gotten a disease from them;" We could address it with an effective coping skill such as being able to just label that thought. "I just recognized I had one of my OCD thoughts...I don't need to pay attention to that. If I pay attention to that and I linger on it and I worry about it, it actually just takes away from my day rather than adding any benefit to my life." So just in that moment when we recognize that thought and say, "That's an OCD thought, that's not a helpful thought. I'm not going to do any more work to try and solve this feared problem of potentially being contaminated." We're not gaining certainty over this problem. [Compared to] ok, I am going to wash my hands and now I know for certain I have zero germs on my hands. We're kind of saying, "Maybe I do and maybe I don't have germs on my hands, but I am not going to worry about it." That is an effective coping skill, when we are addressing it and trying to detach ourselves from that obsession while still sitting in some level of uncertainty, not knowing if there's a germ on our hand our not.

So that is the big difference and that's the thing that I encourage my clients to do; is do some of that internal work and identify when they are responding to an obsession whether their behavior (whether it's an external or internal behavior). [Ask yourself] "Is it a protection thing, is it trying to make yourself feel safe from the obsession from the germs or did you dismiss the thought? Did you detach the thought and allow your brain to kind of sit in that uncertainty? [I encourage] not trying to solve the problem in your head.

So what ends up throwing off some of my clients is that their coping skills start to feel like they're becoming kind of ritualized. And, they know that is a big telltale sign of a compulsion. Just like you used to worry about contamination on somebody's hands and then do this ritual of hand sanitizer, hand washing or something; [clients] are saying, "Oh my gosh, this coping kills that Drew has given me, it's now turned into my new ritual. I am doing this, I'm repeating this, labeling my obsessions as 'OCD or not helpful,' every time I have them. So I've just have swapped out this old ritual of hand sanitizer and hand washing for this new ritual of labeling my thoughts." And then they say, "Oh my gosh, I must not be making any progress." I will hit the pause button right there and I will ask them to go back and ask them what their motivation is behind that behavior, behind the idea of labeling that thought. Because the ritual of continuing to hand wash or use hand sanitizer, I would label that a compulsion because even though it's ritualized, just the way our coping skill is, the motivation is different. The motivation is to protect and gain certainty rather than our new behavior, which is the coping. Even thought it feels ritualized, if it helps you tolerate the distress and sit in the uncertainty of knowing whether or not there's a germ on your hand and not doing anything about it, then it's a coping skill. So I don't want people to be thrown off by this ritualized idea. I am going to continue to encourage you, think back to what your motivation is. Is the way you're responding to the obsession allow you to sit in uncertainty, allow you to not protect yourself? That's what I would have you focus on. If you find this helpful, please reach out me. I would love to help you with your OCD symptoms.