The OCD CycleFeb 09, 2022
To explain how OCD works, let's talk about the false-alarm model. Since the beginning of time, humans have had an internal alarm to alert us to danger. This alarm system tells us when it's time to run, fight, or play dead. It keeps us safe in the general sense but what happens when this system is broken?
My favorite example of this comes from a support group attendee awhile back.
Think about a little Chihuahua barking at the mailman. As far as the dog is concerned- it's a real threat! It looks, smells, and feels the same as someone who was genuinely trying to break in. He assumes the mailman is there to cause harm and so he steps up to do his part to keep the family safe. Sparky barks and the mailman leaves- which only confirms to Sparky that he is in charge. He gets so good at barking that he hardly even has to see the mailman in order to start. He barks before the mailman is even in driveway. With enough time he might start barking before the mailman is even in the neighborhood! As long as he keeps barking he has no way to know that the mailman actually isn't a threat.
1) The Obsession
Everyone has obsessions- that thought that won't seem to leave you alone, that one question that lingers in the back of your mind...but with OCD these obsessions get stuck. They can be anything from existential questions to relationship concerns to fears of being contaminated. We may experience intrusive thoughts and images that trigger this threat, or we may have it triggered by external stimulus like a religious text or an unknown rash on your arm.
This is the mailman.
2) The Distress
These obsessions cause us a deal of distress. Contrary to old belief, OCD is not just an anxiety disorder and can cause other emotions such as anger, discomfort, or disgust! Regardless, it's distressing and intense no matter how rational the threat is.
This is the feeling of urgency/panic the dog might feel.
3) The Urge to Neutralize our Distress
We obviously dislike these distressing feelings and want to get rid of them. We feel a sense of urgency and a need to be okay. This is when we turn to compulsions. As mentioned in the chart, it may be hard to notice this urge at once as engaging in compulsions may feel very automatic.
This is the urge to bark.
Compulsions are any behaviors we do to neutralize our distress. They look different for everyone but commonly involve some sort of avoidance. They may happen physically or mentally. They may feel obligatory, but with proper ERP we can overcome them! We will examine what this looks like in a minute.
This is barking. Woof, Woof.
5) Temporary Relief
When we engage in our compulsions there is a small sense of relief. After all, we just escaped a threat! But the relief is short-lived because we unintentionally just told our brains that threat was valid. If it wasn't- we wouldn't have ran away! This just leads to the cycle continuing.
He did it! He kept the family safe! The mailman left.... but it just comes back tomorrow where it feels even more urgent.
How Does ERP Break This Cycle?
Let's start with the example of the dog and the mailman. What we do is slowly expose the dog to the mailman while teaching him not to bark. Maybe we say hi to the mailman, maybe we give the mailman a treat to hand the dog. One day the dog doesn't bark and the mailman still leaves. Over time the dog starts to learn that the mailman was less risky than he thought all along.
The way exposure therapy works is the same. We gradually expose ourself to our fears in small (manegable but challenging) ways while we resist the urge to do compulsions. By stopping these compulsions we allow ourself the opportunity to see the threat for what it is. We slowly learn that the mailman still leaves, or in others words: our distress still goes away eventually even when we don't interfere.
These exposures slowly build up your tolerance to the threat.
This is how exposure therapy works. You build up to your threat by incrementally stopping your compulsions. One at a time. With lots of support and tools to help you manage the distress and respond to triggers.
How I Like To Use This Chart:
Recognizing the pattern is the first step to breaking it. I recommending printing out this model (here's a low ink black and white version) or saving it somewhere easily accessible. When you find yourself spiraling or getting caught in compulsive loops, pull it out and practice slowing things down by labeling what stage of the cycle you're in.