Obsessive Compulsive Disorder - Coping Yourself

Overview

What is self-help?

Self-help is any activity or lifestyle choice that a person makes in the belief that it will have a therapeutic benefit. Self-help is recommended for some people with OCD and is a way of self-managing your difficulties and feelings. This can be something you do by yourself or it can be facilitated by a healthcare worker who will check your progress as you go along.

If you are being seen by your GP or someone in Primary Care you may be given materials for guided self-help. For young people with OCD (when it only minimally impairs the person), guided self-help may be used along with support and information for the family.

Some different types of self-help are listed below:

(1) Bibliotherapy (Guided Self-help)

This is the use of written material to help people understand their psychological problems and learn ways to overcome them by changing their behaviour and is based on Cognitive Behavioural Therapy (CBT) principles. This is something you can learn at home and in your own time and then discuss with your therapist. There are a number of companies providing self-help products, including books, workbooks, and CDs and DVDs. Be careful as the quality of these is variable so look for ones produced by people with recognised professional qualifications.

If you are being seen by your GP or someone in Primary Care you may be given self-help materials for guided self-help. Guided self-help is an intervention managed by you; it may make use of a range of materials such as books, a self-help manual or online programmes that is based on research and designed specifically for the purpose.

For self-help and some ways on how to manage anxiety and avoidance behaviours go to the next tabs, Changing your thoughts and Changing your Behaviour.

(2) CCBT

Cognitive behavioural therapy (CBT) is a popular model of therapy that you may undertake with your therapist or support worker. Whereas CBT is often carried out face-to-face you might also be given the option to access Computerised CBT (CCBT) where you complete similar tasks via an online programme. This can be useful if there is a waiting list for therapists in the NHS or if your symptoms are mild. Working in this way allows you to plan your therapy either at your GP centre, health centre or at home with an interactive CBT package. You have control over the sessions which you can do whenever you like or as planned with your therapist.

There is one CCBT programme - ‘OCFighter’, which is designed to support people with OCD by helping them to plan and use CBT techniques on a day-to-day basis. A review by NICE (National Institute for Health and Clinical Excellence) did not find enough evidence to recommend it as a treatment for OCD at the present time but the company that produced it believes it to be successful. For more info see www.nice.org.uk/TA097.

(3) Psychoeducational groups

Psychoeducational groups may also be available at your GP surgery or other Primary Care premises and are another support option for people with OCD. The group sessions will be delivered by a trained practitioner and may include presentations and use of self-help manuals on OCD that teach you about OCD and how you can manage it.

(4) Support Groups

Support groups in your local area are often another source of help. Attending these is often free and you can choose which groups you would like to attend. Support groups may provide face-to-face meetings, telephone conference support groups (which can be based on CBT principles), or additional information on all aspects of OCD plus other sources of help. Support groups may be useful to you or for members of your family / friends. Find support groups in your area.

(4) Relaxation

Relaxation is one of the most easily accessible self-help techniques to improve everyday wellbeing and is an effective way to manage difficulties such as stress, poor sleep or anxiety. Stress can build up for any of us and make us feel anxious, tense and wound-up. Learning to relax by doing something you enjoy (having a bath, going shopping, reading a book) usually helps how we feel but not everyone is able to 'switch off' so easily.

Planned relaxation is definitely a skill and takes time to learn so make sure you set aside time to do this. Mastering relaxation techniques can help you to regain a sense of calmness by reducing the severity of any physical symptoms you have (such as heart racing, tension in shoulders etc) and helping you to gradually unwind. Watch our short films on relaxation with instructor Shebina and learn a variety of breathing techniques and deep muscle relaxation. Or if you prefer, download a written information sheet on breathing techniques, the seven-eleven technique and deep muscle relaxation.

 

In the next sections we will look at:
  • Identifying the problem
  • Changing your thoughts
  • Changing your behaviour


 

Overview

Step One: Identifying the problem

As you can see, OCD comes in many forms and can really disrupt your thinking and behaviour, putting constraints on your life and stopping you feeling free to live how you want to. OCD is an anxiety disorder - having intrusive thoughts which frighten us (e.g. that we are going to harm someone or going to become ill from germs) create anxiety.

People with OCD often find that the only way to reduce this anxiety is to carry out a behaviour such as hand washing, counting or making certain gestures. The behaviour temporarily reduces the anxiety which helps the person feel relieved but likely to repeat the behaviour next time they feel anxious. The cycle is often very hard for people with OCD to break without support.

This exercise may help you to start thinking about your difficulties using psychological techniques. In this exercise you can start to identify the thoughts, feelings and behaviours that appear when you feel anxious as well as your body’s reaction to this. The following exercises are best done with a health professional that can support you.

 

Example

Here is an example of how Michelle looked at her difficulties using these techniques. Michelle is a teenager mother and her difficulties were around anxiety and OCD; specifically an intense fear of germs. She is scared that she will become contaminated with germs that will make her young son very ill. Michelle used this technique to see how these intrusive thoughts ‘your son will die’ made her feel anxious, frightened and guilty that it would be her fault if something happened, made her behave differently; by washing her hands 12 times per day, washing her son’s face every time he eats and avoiding public places like shopping centres or friend’s houses where there might be germs and made her body react in an anxious way; heart racing and ‘butterflies’ in her tummy.

Michelle's cycle of thinking, feeling & behaviour might look like this: 

 

As you can see from the example, finding out how your thoughts, feelings and behaviour are connected can show you how a problem can be maintained through a cycle which is hard to break. You might be able to see from this example how this may be true for you - a health professional can help you do this.

For example, using Michelle’s experienceabove, she was able to see how thinking differently could help her to consider alternative ways of looking at her situation.

Unhelpful ways of seeing a situation

Thoughts

·         Bad Thoughts, words, phrases

·         Images, pictures in your mind

·         Something bad is going to happen

·         I will hurt my son and it will be my fault for not keeping him safe

More helpful ways of seeing a situation

Thoughts

·         Do not be afraid of the thought, a thought is just that, it does not mean that it will come true or be able to hurt me / anyone else

·         I am assuming I will be responsible for this worst possible event. I cannot be responsible for this.

·         Is my reaction in proportion to the actual event? Check this out with a friend.     

Feelings, Behaviours and Reactions

·         Anxiety

·         Repeated washing to ‘keep safe’

·         Avoidance

·         You get ‘butterflies’ in tummy

·         You feel shaky or hyper-alert

 

Feelings, Behaviours and Reactions

·         Is there any evidence that he will be hurt if I don’t repeatedly wash to ‘keep safe’?

·         Reduce gradually the time I spend on the behaviour or the number of times I do it.

·         Gradually begin to face some of the things I fear.

·         Begin to feel more confident and in control


Once you have identified what happens to you when you feel anxious you can start to address the problem bit by bit. This is no easy task and if you need help to achieve this then please contact your GP (find a GP) or one of the agencies listed on the Contacts & Links page.

 

 

Overview

Step Two: Changing your thoughts

Negative thinking and OCD

People with OCD sometimes get depressing thoughts especially when they begin to try and break the cycle of obsessions and compulsions. Depressing thoughts could be criticisms of yourself, such as, “I’m, not a caring mother if I don’t wash my hands and keep my child safe” or “If it happens it will be my fault”. These thoughts can lead to you feeling unhappy and it is important to challenge them.


Tips for tackling negative thoughts
  • write down the unpleasant thoughts you are having at the time
  • try and counter these thoughts by writing down arguments against them, download the OCD thought record sheet 
  • imagine what you would say to a friend if they had such negative thoughts about themselves? 
  • challenge the evidence for theses thoughts - why do you believe that the compulsion will stop X happening? 
  • concentrate on and emphasise the good things about yourself and your life, don’t focus on the bad things

 

Tips for tacking intrusive thoughts
  • Everyone has odd thoughts at times which may be about something negative, about doing something inappropriate etc but remember that it is just an odd thought, it doesn’t mean anything, it doesn’t mean you are a bad person. The more you think about and give meaning to it, the stronger it becomes. Write it down, read it, say it aloud and try to accept this rather than avoid the thought.
  • Do not be afraid of the thought, a thought is just that, it does not mean that what you are thinking about will come true or be able to hurt you 
  • Do not neutralise a bad thought with another calming thought; this is still maintaining the cycle and taking up your time 
  • Don’t rely on using alcohol or using drugs – this is temporary stress reliever and is only avoiding the problem and probably giving you others to contend with.

How can I tackle negative thoughts where the compulsion is another thought?

If you are having a negative, intrusive thought about something (e.g. germs and illness) the compulsion doesn’t always have to be an action (like hand washing), the compulsion can also be another thought to neutralise the first unpleasant thought.

For example - Charlie would sometimes get a picture in her mind of her daughter and the words “your daughter is dead” would run through her mind. She was so upset by this that she would “neutralise” the thought in her mind by staying “she is alive and well” and would picture her daughter looking healthy which made her feel relived. This started to take up hours of her day and she felt there was something wrong with her and she became very upset.

If you are experiencing something similar it is important to break the cycle fully and not replace a negative thought with another neutralising thought.


 

 

Overview

Step Three: Changing your behaviour

The most successful way to tackle OCD and the most commonly used in therapy is Exposure with Response Prevention (ERP). This type of intervention involves gradually exposing yourself to the things that you fear whilst at the same time stopping yourself from carrying out your usual compulsive behaviour (like counting, checking etc). By stopping yourself from reacting to the fear you will learn that not doing the behaviour does not lead to disastrous consequences (if you don’t check the plug sockets / counting to 13 / wash your hands repeatedly.) If you want to try setting yourself tasks to gradually expose yourself to what is making you anxious you might find a daily exposure practice form helpful, you can try this yourself or use this as part of CBT therapy.

Exposure

If you can make yourself remain in a situation where you feel anxious, gradually the anxiety will reduce – your body will become used to the situation and your anxiety and fear will reduce because it has nowhere else to go but back down. This is called exposure. If you have OCD and feel very anxious this task may feel impossible. It may be helpful to break it down into smaller steps and exposure yourself to anxiety-provoking situations bit by bit.

Task 1 – the ladder list

Begin by making a list of all situations or thoughts you find difficult. Next make an “anxiety ladder” where those situations that you only fear a little are at the bottom and your worst fears are at the top.

Example 1…..Michelle is a teenager mother and has an ongoing fear of germs. She is scared that she will become contaminated with germs that will make her and her young son very ill, causing feelings of anxiety and guilt that it would be her fault if this happened. To counter these thoughts she washes her hands 12 times per day, washes her son’s face every time he eats and will not go to public places like shopping centres or friend’s houses where there might be germs. Her anxiety ladder is below:

    Most Feared

ladder

8. going to toilet in public toilets
7. going to eat in a restaurant
6. touching doors and objects outside the home,
e.g. the button in the lift
5. going to the toilet in friend’s house
4. Eating dinner at a friend’s house
3. touching objects in friend’s house like the door handle
2. touching the bin without gloves on
1. touching own bin with rubber gloves on

    Least Feared

 

Example 2 …Neil spends so much time checking all the plug sockets and electrical appliances in his house that it takes him three hours to leave the house and go out. He likes to check that they are off to know that he is safe and there will be no electrical fires whilst he is out. His anxiety ladder of what he finds most difficult not to check is below:

    Most feared:

ladder

5. the doors
4. the cooker
3. the windows
2. the lights
1. the taps

    Least feared


Neil’s first step was to check the taps only once before he left the house and he did not allow himself to go back in and check again. At first he felt very anxious about this but gradually his fear was reduced and he then moved on to step 2, checking the lights… etc

Starting with the easiest step and moving up the ladder will build your confidence and make you more likely to succeed with later steps. Most people will at first feel greater anxiety when they begin to face the things they fear and feel an urge to perform their compulsion or ritual. It is important that you try and resist the urge to do this (see below). When you can complete step 1 without feeling overly anxious, move onto step 2. Make yourself try it!


Response Prevention

It is important to break the cycle and stop carrying out the compulsive act or thought following exposure to the situation that you fear.

Stopping the compulsive act

1. If you have managed to stop the compulsive behaviour (e.g. checking the locks 5 times) make sure your family tries to help you by not offering to reassure you and not checking for you. This is just substituting one behaviour for another and can stop you from breaking the cycle. It also inconveniences them.
2. Praise yourself for not carrying out the compulsion or neutralising activity. This is an important step forward and builds your confidence.
3. Keep a note as you are carrying out the exposure therapy to show how your anxiety begins to drop, for example touching the bin with no gloves on without washing your hands.
4. Don’t substitute new compulsions for old ones, for example substituting rubbing hands continually for hand washing.
5. If stopping all compulsive behaviours at once seems impossible, try to reduce gradually the time you spend on the behaviour or the number of times it happens.


Summary for coping yourself
  • Recognise that you have a problem
  • Identify your intrusive thoughts and compulsive behaviours – record them, rate them and keep a record of when they are better or worse and what triggers them.
  • Accept the intrusive thoughts rather than avoid them
  • Do not carry out compulsions to reduce or neutralise your anxiety when you are facing the feared situation
  • Gradually begin to face some of the things you fear. It is difficult but is a necessary step as OCD is unlikely to go away without doing this.
  • Work out an anxiety ladder to help you do this and begin with the easiest step.
  • Break the obsession compulsion cycle
  • Challenge any depressive or critical thoughts you may have about yourself. If you think you may be depressed, check out our information on depression.
  • Talk to someone you trust for support, maybe a parent, friend, doctor. This is difficult to overcome alone and you will need their support.
  • Attend support groups for OCD
  • Buy or loan a self help book or CD for exercises to do
  • See your GP if you feel you can’t do this by yourself. Some people find that they can deal with mild OCD symptoms themselves. If you feel that you are unable to cope and live the way that you want to live then please contact a professional on the list below.

 

 

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