Obsessive-Compulsive Disorder (OCD) and Obsessive-Compulsive Personality Disorder (OCPD) are said to affect two to three percent of the population for OCD (that is: more than 500,000 Australians) and one percent for OCPD, although three to ten percent of the psychiatric population is said to have it (Long, 2011). Many cases probably go untreated.

As a therapist, what can you give to obsessive clients and their families to encourage personal initiative toward conquering symptoms? That is the focus of this article.

Four Steps for Conquering Symptoms of Obsessive-Compulsive Disorder (OCD)

Psychiatrist Jeffrey Schwartz advises clients dealing with OCD to take the following steps:

1. Relabel. Challenge yourself to recognise that intrusive, obsessive thoughts and urges are being engendered by OCD and relabel them. For example, you can get in a habit of saying, “I don’t think or feel that my hands are dirty. I’m just having an obsession that my hands are dirty.” Or, “I don’t feel that I have the need to wash my hands. I’m having a compulsive urge to perform the compulsion of washing my hands.”
2. Reattribute. Intensive, intrusive thoughts or urges are caused by OCD via a biochemical imbalance in the brain. You can say to yourself, “It’s not me—it’s my OCD,” to remind you that OCD thoughts and urges are not meaningful, but are false messages from the brain.
3. Refocus. Focus your attention on something else for a few minutes when experiencing OCD thoughts and urges. Do another behaviour instead. Say to yourself, “I’m experiencing a symptom of OCD. I need to do another behavior.” You could walk, exercise, listen to music, make a phone call, or work on a creative project. The point is to do something for at least 15 minutes which distracts you from the obsessive thought. At the end of the period, reassess the urge; in many cases, it will be less intense. The more you can delay the urges, the more likely they are to change.
4. Revalue. OCD thoughts are not significant in themselves and should not be taken at face value. Here you can tell yourself, “That’s just my stupid obsession. It has no meaning. There’s no need to pay attention to it.” You can’t make the thoughts go away, but neither do you need to pay attention to them. You can learn to go on to the next behavior.

(Westwood Institute for Anxiety Disorders, in Robinson et al, 2013)

OCD: Further tips for self-management

In addition to the four steps above, OCD sufferers are encouraged to follow three general tips for successful self-management. They revolve around challenging the obsessive thoughts and compulsive behaviours, maintaining good self-care, and reaching out for support. Beyond that, we have included a list of tips for well-meaning family and friends, which your OCD client can give them in order to ensure that your client is supported in the most helpful way possible.

Challenge the obsessive thoughts and compulsive behaviours. In addition to refocusing, the OCD client can learn to recognise and reduce stress. Some of the strategies here are counterintuitive. You can urge clients to “go with the flow” by writing down obsessive thoughts, anticipating OCD urges, and creating “legitimate” worry periods. Tell them to:

Write down your obsessive thoughts or worries. Keep a pen and pad, laptop, tablet, or smartphone nearby. When the obsessive thoughts come, simply write them down. Keep writing as the urges continue, even if all you are doing is repeating the same phrases over and over. Writing helps you see how repetitive the obsessions are and also causes them to lose their power. As writing is harder than thinking, the obsessive thoughts will disappear sooner.

Anticipate OCD urges. You can help ease compulsive urges before they arise by anticipating them. For example, if you are a “checker” subtype, you can pay extra attention the first time you lock the window or turn off the jug, combining the action with creating a solid mental picture of yourself doing the action, and simultaneously telling yourself, “I can see that the window is now locked.” Later urges to check can then be more easily re-labelled as “just an obsessive thought”.

Create an OCD worry period. Rather than suppressing obsessions or compulsions, reschedule them. Give yourself one or two 10-minute “worry periods” each day, times you are allowed to freely devote to obsessing. During the periods, you are to focus only on negative thoughts or urges, without correcting them. At the end of the period, let the obsessive thoughts go and return to normal activities. The rest of the day is to be free of obsessions and compulsions. When the urges come during non-worry periods, write them down and agree to postpone dealing with them until the worry period. During the worry time, read the list and assess whether you still want to obsess on the items in it or not.

Create a tape of your OCD obsessions. Choose a specific worry or obsession and record it into a voice recorder, laptop or smartphone, recounting it exactly as it comes into your mind. Play the recording back to yourself over and over for a 45-minute period each day, until listening to it no longer causes you to feel highly distressed. This continuous confrontation of the obsession helps you to gradually become less anxious. When the anxiety of one worry has decreased significantly, you can repeat the exercise for a different obsession (Robinson et al, 2013).

Maintain good self-care. A healthy, balanced lifestyle plays an important role in managing OCD and the attendant anxiety (generally present with OCD, even though the disorder is no longer classified as an “anxiety disorder” per se), so the helpfulness of the following practices – truly not rocket science – cannot be underscored. Encourage OCD clients to:

• Practice relaxation techniques, for at least 30 minutes a day, to avoid triggering symptoms.
• Adopt healthy eating habits, beginning with a good breakfast followed by frequent small meals – with much whole grain, fruit and vegetable – throughout the day to avoid blood sugar lows and to boost serotonin.
• Exercise regularly; it’s a natural anti-anxiety treatment. Get 30 minutes plus of aerobic activity most days.
• Avoid alcohol and nicotine, as these increase anxiety after the initial effects wear off.
• Get enough sleep; a lack of it exacerbates anxious thoughts and feelings (Robinson et al, 2013).

Reach out for support. Staying connected to family and friends is the best defence an OCD client can muster against intrusive obsessions and compulsive urges, because social isolation exacerbates symptoms. Talking about worries and urges makes them seem less threatening. Also, involving others in one’s treatment can help maintain motivation and guard against setbacks. To help remind the client that s/he is not alone in the struggle with OCD, ask him or her to consider joining a support group, where personal experiences are shared and attendees also learn from others facing similar problems.

Helping a loved one with obsessive-compulsive disorder (OCD)

Give the following list of tips to your OCD client to give to friends or family members who want to support them. Stress how crucial it is for supporters to educate themselves about the disorder, as reactions to a loved one’s OCD symptoms can have a big impact.

• A calm, supportive environment helps improve treatment outcomes. On the other hand, criticism can make OCD worse; as a support person, focus on your loved one’s positive qualities.
• Don’t tell someone with OCD to stop doing their rituals. They can’t, and pressure will only worsen the behaviours. Remember, you are seeing OCD symptoms, not character flaws.
• Praise any attempts to ignore urges. Each sufferer needs to overcome problems at their own pace. Encouragement to continue healing and a focus on positive elements in the person’s life will go much further than scolding.
• Do not go along with your loved one’s OCD rituals. You want to support the person, yes, but not their rituals. Aiding them in carrying out those will only reinforce the behaviour.
• Do not let OCD take over family life. Work out how, as a family, you will tackle your loved one’s OCD symptoms. Aim for as normal a family life as possible in an environment as low-stress as possible.
• Stand up to the OCD by communicating directly and positively. Find a balance between maintaining boundaries around the OCD and not further distressing your loved one.
• Find the humour. If you can get your OCD sufferer to see the humour and absurdity in some OCD symptoms, it can really help them become more disidentified (detached) from the disorder. Naturally, this strategy only works if the OCD person really finds the thing funny (Robinson et al, 2013).

OCPD: Self-help strategies for survival

For both the person diagnosed with OCPD and also for his family and friends, dealing with this disorder requires patience, compassion, and fortitude. To start with, the ego-syntonic nature of OCPD means that the person does not necessarily agree that he has anything wrong at all. For those who staunchly continue to insist that their relational problems arise because of others’ faults, treatment is complicated. Given the OCPD’s general world view of “I am correct; you are wrong”, the prognosis for change is often poor. Transformation is likely to occur only when the OCPD’s relational skills and outlook are shifted. This is not a job for medication (at least not for long and not alone), and yet psychotherapy is not always available. When it is, the OCPD is not always willing to avail himself of it.

Regardless of this less-than-ideal context for managing OCPD, there are some things that the client himself and also friends and family can do to alleviate some of the tension and conflict that goes with living with the disorder. As a therapist, you can encourage the client and those around him to utilise some of these strategies.

Bibliotherapy. It’s a good idea to read up on OCPD, not only in order to know what to expect, but also for tips in dealing with it. Your client may also come upon writings that link some behaviours and lifestyle choices to the disorder in ways not understood before. When comprehension deepens, so, too, does the prospect of compassion.

Gentle confrontation (agreed beforehand). While we agree that OCPD clients have a mammoth need to be right, those clients who truly seek to feel better may be willing to make agreements with family and friends in which OCPD behaviours, when noticed, are gently challenged; the operative word here is gently.

Self-insight through journalling or tape-recording. We noted above that many OCPD clients are intelligent, sensitive people. Thus, keeping a diary or making voice recordings to note anything upsetting, anxiety-provoking, overwhelming, or depressing is a step toward the self-insight that will eventually help to manage the disorder. Too, family and friends may agree to note their observations and share them in a constructive, non-confrontational manner.

Good self-care. OCPD is a disorder about exaggerated need for control, so keeping on an emotional even keel can help reduce the unconscious need to micro-manage all of life. Strategies to achieve this are listed above under Tip 2 for maintaining self-care with OCD. They revolve around the basic life efforts of practicing relaxation techniques, adopting healthy eating and exercise regimens, getting decent sleep, and avoiding excessive alcohol/drug consumption (the last is not hard for the OCPD).

Reaching out for help. OCPD individuals tend to be loners, and relationships are hard for them to build and maintain. Nevertheless, it is helpful to the ultimate reduction of OCPD-engendered tension to go for support. This can be in the form of self-help groups, informal support from partner, family, and friends, or even from joining online communities of people dealing with the disorder. Whatever the form of the support, it may be helpful for OCPD clients to own their places of dysfunction when they see others owning their imperfect humanness – and surviving (Robinson et al, 2013)!

This article was adapted from the Mental Health Academy CPD course “Understanding Obsessives”. This course is about understanding what is constituted in each disorder, and how you can recognise the symptoms in clients and others.

References

• Long, P. (2011). Obsessive-Compulsive Personality Disorder. Internet mental health. Retrieved on 18 April, 2013, from: hyperlink.
• Robinson, L., Smith, M., & Segal, J. (2013). Obsessive-Compulsive Disorder: Symptoms and treatment of compulsive behaviour and obsessive thoughts. Helpguide.org. Retrieved on 24 April, 2013, from: hyperlink.