Facing – even inviting – uncertainty into your life is definitely the way to go with OCD. Check out this perspective.
I know a secret–a deeply profound, life-changing secret–one learned through the school of hard knocks in one of its most grueling courses. It is nothing short of the very key to living with uncertainty, this secret; and because you, dear bloggie (is that what one calls a reader of a blog?), have been so supportive of this outreach project, I will share it with you, free of charge and with no obligation. (You are very welcome.)
To prepare yourself for the sage, paradoxical wisdom I am about to impart, I suggest you close your eyes and imagine a dramatic drum roll. Picture, if it helps, the clouds in the sky parting above you. Take a deep breath in. Exhale slowly. Ready?
Okay. Here goes: The secret to living with uncertainty is . . . learning to sit with the discomfort of uncertainty.
Hmmm. Nothing but crickets.
Here, I’ll repeat it: The secret to living with uncertainty is . . . learning to sit with the discomfort of uncertainty.
‘Say what, Bell???!!’ I can almost hear you protesting. ‘I’ve wasted my precious websurfing time on this?!!’
But wait. Before you redirect your browser to that site with the water-skiing chipmunks video, please allow me to pass along two important footnotes: first, this ‘secret’–while counterintuitive to most of us–is at the very core of treatment for OCD (a.k.a. The Doubting Disease); and second, its efficacy is scientifically proven.
Sure, the whole concept seems paradoxical. Trust me; as someone who’s battled the extremes of OCD uncertainty, I get that the very last thing we want to do when we’re consumed by uncertainty is to sit with that uncertainty. On the contrary, we want a quick escape from the discomfort that our uncertainty creates (hence, as I described in my last blog, we are lured to ‘trapdoors’ in ‘the shadow of doubt’.)
But where do our best efforts to rid ourselves of doubt get us??
Stuck even further in doubt. That’s where!
And here’s the ‘secret’: IF we simply allow ourselves to sit with the discomfort of uncertainty, that discomfort (anxiety) will decrease all by itself. I call this phenomenon ‘The Uncertainty Paradox,’ and–while I fought it for far too many years–ultimately, it allowed me to wrest my life back from the grips of my Doubt Bully.
At work here is the concept of habituation, and the best analogy I’ve run across comes from a terrific book called Freeing Your Child from Obsessive-Compulsive Disorder, by Tamar Chansky, Ph.D. Dr. Chansky likens the process of embracing uncertainty to jumping into a cold swimming pool. At first, the coldness is extremely uncomfortable, and our brains send us messages of ‘cold, cold, cold’ and ‘Get out! Get out! Get out!’ BUT, if we stay in the pool, the water seems to warm up. Of course, it doesn’t really get any warmer; instead, we habituate ourselves to the discomfort of the coldness.
This habituation concept is at the crux of OCD treatment and is applied through a process called exposure/response-prevention (ERP), an especially effective form of cognitive behavior therapy (CBT). In a nutshell, ‘exposure’ involves having an OCD client deliberately face a feared situation or object (trigger). And ‘response-prevention’ involves having that client refrain from the compulsive response that has traditionally brought her temporary relief. To this end, a therapist and client develop a hierarchy of fears, moving from the least anxiety-producing to the most anxiety-producing. With this hierarchical ‘ladder’ as a guide, the client then learns to systematically face down her fears-and, in so doing, habituates to the discomfort of her anxiety.
So, what does all this look like in practice? Here’s an example–for someone with contamination obsessions and washing compulsions associated with a home bathroom–courtesy of Robin Zasio, Psy.D., Director of the Anxiety Treatment Center of Sacramento [and one of the aforementioned OCDF Scientific Advisory Board (SAB) members who have graciously agreed to contribute to this blog]:
Based on a scale of 0 to 10 (0 = no anxiety, 10 = complete panic)
Exposure (with Response Prevention) . . . Anxiety Level
Standing in the bathroom (without washing) . . . 1
Standing in the bathroom without shoes (without washing) . . . 2
Touching the bathroom’s outside door knob (without washing) . . . 3
Touching the bathroom’s inside door knob (without washing) . . . 4
Touching the bathroom faucet (without washing) . . . 4
Touching the toilet handle (without washing) . . . 6
Sitting on the toilet seat without a protector (without washing) . . . 7
Dr. Zasio points out that the higher levels of triggers listed above will decrease in intensity as a client works on lower level exposures. So, a trigger initially labeled a ‘6’ will likely be labeled something lower down the road.
ERP treatment, like habituation itself, is rather straight-forward in principle. In practice, however, its implementation can be extremely tricky, which is why it’s so important for OCD clients to seek out well-trained OCD specialists who understand the nuances of ERP and its application. (If you’re having trouble finding such a therapist, by the way, I suggest you visit the ‘Find a Doctor’ resource at the OCDF website.)
As for the challenges ERP presents those of us who most need it, well, let’s just say they are many and mighty. This stands to reason, of course, since the process requires us to confront our very worst fears, head-on and without the counterproductive, but very familiar coping mechanisms (compulsions) that we’ve developed in response to our fears. Unfortunately, because of these challenges, far too many people with OCD try, but give up on, ERP. They jump into the ‘pool’ of anxiety, but climb out before habituating to the discomfort that their anxiety creates. I was one of those people for many, many years. I paid lip service to the whole process–going through the motions with my therapist week after week–but never really allowing myself to stay with the discomfort of my anxiety long enough to reap the benefits of habituation. For me, what was missing was motivation, a topic I will take up in my next blog.
I’d be remiss at this point not to at least mention a second key component of OCD treatment, one I will also explore in much greater detail in future posts: medication. It’s relevant here because, used effectively, medication can be a great tool for tackling the rigors of ERP. In my own experience, meds have helped ‘turn down the volume’ (that is, intensity) of my obsessive thoughts, thereby giving me some additional leverage to sit with my anxiety. It’s important to note that medication is no substitute for cognitive behavior therapy, and its effects vary greatly from person to person. I’ve asked Bruce Mansbridge, Ph.D., author of The Complete Idiot’s Guide to Obsessive-Compulsive Behavior (and another OCDF SAB member), to weigh in on this, and here’s what he writes:
While cognitive behavior therapy (CBT) is the best treatment for OCD, medications can also help make the therapy go faster and easier, so the combination of CBT and medication is often recommended. Medication alone is not as effective as CBT at reducing symptoms, and symptoms almost always return when you stop the medication.
Again, we will take a much closer look at medication in the coming months. If you’re interested in learning more in the meantime, I would suggest you visit the relevant articles at the OCDF web site.
So then . . . back to my profound secret: The Uncertainty Paradox. If it remains a ‘secret’ today, I’m convinced that’s only because far too many of us don’t want to accept its truth. Doing so means accepting that, when it comes to confronting the discomfort of our uncertainty, there are no shortcuts, no substitutes for the hard work involved in sitting with our fears. The reality is, philosophers and scholars have been touting this secret for millennia, and today’s brain imaging technology offers scientific evidence of its efficacy.
Now, aren’t you glad you chose this blog over the water-skiing chipmunks??
A Few Notes:
My apologies for the brief hiatus in this blog project. I have been on the road for the past several weeks as part of what I’ve come to call the Jeff Bell Dog and Pony Show. (My publisher calls it a publicity tour.) I was very fortunate to have had opportunities to talk about my new book in New York, Boston, Seattle, Los Angeles, San Francisco, and Sacramento during this trip, and I very much appreciate your patience.
I also want to remind you that, should you have specific questions or comments about these blogs, please feel free to weigh in below in the comments forum or, if you prefer, email me directly at jeff@BeyondTheDoubt.org. If I can’t answer your question, I will point you to an OCDF SAB members who can.
As always, thank you for the fantastic support!