Checking compulsions can be very powerful and difficult to resist. In the previous installment of this blog series, I discussed the various forms checking can take and the underlying functions behind them. In this installment, let’s take a look at how these symptoms are treated with exposure and response prevention (ERP).
A major objective of any OCD treatment is to stop doing compulsions. But if checking behaviors are more severe, stopping all at once may not be feasible. A good first step can be looking at everything that goes into the checking behavior and gradually interfering with or reducing it. Some examples:
- Checking a gradually reducing number of times if OCD says a check must be completed a certain number of times to count
- Starting by eliminating the help of others in your checking compulsions (not asking others to check for you)
- Checking while allowing for distractions that may interfere in feeling like the check was complete (e.g. while remembering song lyrics or having a conversation)
- Checking in a different order or random order if OCD says it needs to be done a certain way
- Delaying checking by an increasing amount of time
To get to the goal of renewed confidence in uncertainty tolerance, simply reducing checking (even to zero) may not be enough. Doing exposure to the feared consequences of your failure to check may be an important part of treatment. This can be achieved in a number of ways:
- Writing/reading an exposure script describing the unwanted consequences occurring
- Creating increasing reasons to check (driving more, cooking more, turning appliances off and on more, etc.)
- Using a phone app to send random reminders that you may not be sure if something needs checking
- Using items that you check at a faster pace or with increased levels of distraction to increase uncertainty about whether it has been properly used, turned off, locked, etc.
When checking compulsions are primarily mental, mindfulness strategies become exposure strategies. In this context, mindfulness simply means to be fully aware of what the mind is experiencing as it happens. When you become aware that you are mentally checking, you can label that behavior, leave it incomplete, and choose to return your attention to some other aspect of the present moment experience. It can be helpful to note why you are checking the contents of your body or mind and abandon the process with intention. For example, “I am trying to see if I got a sensation in my body that would prove I am attracted to the wrong thing. Checking.” Next, notice what happens. Perhaps a sense of tension, anxiety, or disgust arises. Perhaps the mind gets flooded with images or stories about your fear. Good. Congratulate yourself for having that experience because it means you defied the OCD. Welcome and lean in to that experience as that is the thing you will need to learn to make space for.
In the first installment of this blog, I shared the story of accidentally locking my cat in the closet. Upon this discovery, the excessive checking for him seemed to go down rather than up. Why would the checking urge go down after I inadvertently incarcerated the poor beast? It makes no sense! You would assume that my urges to check would go up because I got confirmation that sometimes the little furball does follow me in there when I’m not looking. But actually, what I got confirmation of was this: the cat and I can both cope with the consequences. Not only is locking the cat in the closet rare (of all the times I failed to check, only once was there a consequence), but I can live with things not going as planned. He was hungry, had to use the litter pan, but otherwise fine. I was guilty, had to use self-compassion, but otherwise fine.
Today there are some harmful products that cater to compulsive checkers by allowing them take pictures of checked items and send reminders that they are safe. This is the opposite of what actually brings freedom from OCD. The goal is to increase confidence in one’s ability to guess and move along. This is not a plea for recklessness – of course we sometimes want to be extra careful and check to make sure we’ve properly turned off a machine or check that we’ve correctly calculated an expense on our taxes. Once. But for all the suffering we might endure trying to be certain that we have checked enough, we end up damaging our ability to trust our memories and intuitions. If you suffer from obsessive doubt and compulsive checking, you can win your freedom back from OCD by remembering this; It’s not about the specific thing you wanted to check, but about the willingness to feel what it feels like to be uncertain.
Check out Part One of this series here.
Looking for treatment for OCD and anxiety at Sheppard Pratt?
Led by Jon Hershfield, MFT, The Center for OCD and Anxiety is a private pay outpatient center devoted to the treatment of obsessive-compulsive disorder and anxiety disorders.
Jon Hershfield, MFTDirector, The Center for OCD and AnxietySpecialties:Anxiety Disorders, Cognitive Behavioral Therapy, Obsessive-Compulsive Disorder (OCD)