cover.eps

Title page image

Managing OCD with CBT For Dummies®

Visit www.dummies.com/cheatsheet/managingocdwithcbt to view this book's cheat sheet.

Introduction

Welcome to the world of cognitive behaviour therapy (CBT) for obsessive-compulsive disorder (OCD). Becoming your own expert on OCD and how to overcome it helps whether you are processing a recent diagnosis, trying out some self-help, working with a therapist, taking medication or perhaps thinking of having another go at recovery. On average, a person waits ten years to get help for OCD, but people really do break free from it. We hope this book helps you do exactly that.

About This Book

We wrote Managing OCD with CBT For Dummies as a resource for people who are struggling with OCD in some way. Whether you have OCD yourself or you know someone who does, we want this book to help you understand the problem well and to show you how to help yourself (or someone else) tackle the problem.

Understanding OCD is the first step in creating change; know your enemy, and you can be well armed to fight against it. When you know the basics, you can create a clear picture of your own vicious cycle of obsessions and compulsions. In this book, we talk you through how to respond to your OCD differently and offer plenty of tips and practical advice to help you work toward your goal of overcoming OCD. But knowing the theory is unlikely to really change anything. You actually have to commit to (and stick with) experimenting with behaving differently if you want to see change. It’s like learning a language; you can study all the grammar rules and even the vocabulary, but you’re not going to become fluent unless you start using the language to communicate.

This book is not only about getting rid of OCD but also about recognising what you may be missing as a result of your OCD. It encourages you to look at the bigger picture and think about your life beyond OCD; it suggests you put more emphasis on enjoyable and rewarding activities so you can create the life you want to lead.

Between us, we have over 30 years of experience in helping people overcome OCD, and we have tried to stick closely to evidence-based practice. We’re not medical doctors; we’ve based our advice regarding medication on the United Kingdom’s National Institute for Health and Care Excellence (NICE) guidance for OCD (www.nice.org.uk/guidance/cg31). It’s compiled by the leading experts in the field, who draw on high quality research to guide their recommendations.

Although this book is meant to help you help yourself, no one expects you to beat OCD entirely on your own. See what support you can get from your doctor and your loved ones and take a look at some of the excellent charities that exist for people with OCD.

Foolish Assumptions

A word of warning: This book is not going to be a perfect fit for your OCD. If you have OCD, our experience tells us that your hope for relief of responsibility and difficulty tolerating uncertainty will mean you will be inclined to focus upon the way in which your OCD ‘is different’.

All we can say is that the principles outlined here almost certainly relate to your OCD so focus on applying these to your personal experience of OCD rather than focusing upon your doubts about whether or not this book is ‘right’ for you.

Icons Used in This Book

To help you pinpoint vital information, we’ve placed icons throughout the text to highlight nuggets of knowledge.

trythis This icon suggests a practical thing to do or try in order to help you put whatever we’re talking about into practice.

remember The Remember icon prompts you to pause and take note of something that is particularly important and worth committing to memory.

warning A Warning highlights typical pitfalls that are worth watching out for. Don’t worry; it’s very common to fall foul of these. That’s how we know to point them out to you.

ocddemon The OCD Demon icon gives an example of the sort of argument your OCD may come up with to try and put you off or derail you. There are many ways OCD tries to do this, so don’t worry if yours comes up with a different argument. Just notice that it’s your OCD talking and take the words with a bucket of salt!

tip Tips are practical ideas we hope make your journey of recovery a little smoother.

Beyond the Book

You can pick up extra tips and tools online. Check out the Cheat Sheet at www.dummies.com/cheatsheet/managingocdwithcbt and some short bonus articles at www.dummies.com/extras/managingocdwithcbt.

Where to Go from Here

This is a reference book, so you can read it from cover to cover to improve your general understanding of CBT for OCD, or you can just dive straight into the page that interests you most. (This is especially good to remember if you have a strong tendency toward being overly thorough.) The important thing is to use the book in the way you find most helpful.

The best place to start is Chapter 1, which introduces CBT for OCD. If you already understand the basics, you may want to jump straight to Part III for details on combating OCD. Lots of topics in CBT for OCD are interrelated, so we provide cross-references throughout the book to point you to other relevant chapters. You can go straight there or save the related information for later – whatever works best for you.

Part I

Understanding OCD

image

webextra For Dummies can help you get started with lots of subjects. Visit www.dummies.com to learn more and do more with For Dummies.

In this part…

check.png Become familiar with the nature of obsessive-compulsive disorder (OCD).

check.png Recognise how cognitive behaviour therapy (CBT) can help treat your OCD.

Chapter 1

All about OCD

In This Chapter

arrow Explaining obsessive-compulsive disorder (OCD)

arrow Exploring whether you may have OCD

arrow Getting an overview of what’s keeping your OCD going

Obsessive-compulsive disorder, usually referred to as OCD for short, is a common disorder that affects many people all over the world. For a long time OCD was considered rare, but research shows that between 2 and 3 percent of people will likely suffer from OCD at some point in their lifetimes, so you aren’t alone!

In this chapter, we explain what OCD is in more detail and help you ascertain whether the problems you’re experiencing are likely to be OCD.

Knowing What OCD Is and Isn’t

Obsessive-compulsive disorder (OCD) is characterised by obsessions (see ‘Observing Obsessions’ later in the chapter) and/or compulsions (see ‘Clarifying Compulsions’ later in the chapter) – most commonly both. Someone with OCD who doesn’t experience both obsessions and compulsions is actually quite rare; however, sometimes people are aware only of their compulsions, such as washing or checking, and no longer notice the obsessions that drive these. Similarly, some people may be aware only of experiencing obsessions and not realise that they’re performing internal, mental compulsions. (For more on mental compulsions see, Chapter 5).

OCD ranges in severity from causing distress and negatively impacting your everyday routine to being totally debilitating to the point where you’re unable to function normally.

remember Contrary to popular belief, OCD isn’t simply a disorder where people wash their hands too much, check things or keep things orderly. You may have heard people say, ‘I’m a bit OCD’, usually referring to a tendency for liking things clean or tidy; however, people can have a strong preference for things to be in order and not have OCD. In these cases, people find their preference for cleanliness or orderliness a helpful attribute from which they may often derive satisfaction.

People without OCD commonly have moments of doubt – ‘Did I turn my hair-straightener off?’ – that lead them to double-check. This tendency is part of being human and doesn’t mean you have OCD. If, on the other hand, you repeatedly check the item in an attempt to feel absolutely certain, then you may well have OCD.

OCD is a complex and often debilitating disorder the sufferer doesn’t find useful or enjoyable. People suffering from OCD tend to feel high levels of discomfort, often in the form of anxiety, guilt or disgust. People with OCD often have an overinflated sense of responsibility for preventing harm and tend to feel high levels of doubt and uncertainty. A person with OCD tends to know that his behaviours or responses to his obsessions are ridiculous but feels powerless to stop performing them.

Some problems are considered part of the OCD family but aren’t strictly the same thing as OCD:

tip If you think one of these conditions better describes your problem, we suggest seeking additional advice that is specific to that problem.

Deliberating upon the Diagnosis

The following is a screening questionnaire from the International Council on OCD and can give you an indication as to whether you suffer from the disorder:

If you answered yes to one or more of these questions and it causes significant distress and/or it interferes in your ability to work, study or maintain your social or family life or relationships, then there is a significant chance that you have OCD. For a diagnosis, discuss your symptoms with your doctor.

Considering Causes

The question of how somebody ends up developing OCD has no simple, precise answer. OCD is a combination of several factors: biological, personality, environment and life events. Like so many other kinds of psychological problems, no single type of person develops OCD. We’ve met people from all walks of life who have OCD, and it certainly has nothing to do with being weak or crazy. However, researchers have identified that some psychological traits tend to be associated with vulnerability to OCD:

For most people, OCD is probably best understood as a misunderstanding of how their minds work, which can lead to some attempts to solve the problem that backfire. Throughout this book, we help you see how you too may have been trying to solve doubts, intrusive thoughts and uncomfortable feelings and that your solutions may very well have become the problem.

Observing Obsessions

Obsessions are defined as unwanted, recurrent, intrusive thoughts, impulses or images that are associated with marked distress. They aren’t simply excessive worries about real-life problems and tend to be the opposite of the kinds of thoughts the individual wants to have. A person with OCD tries to avoid triggering, ignore, suppress or neutralise (for example, try to cancel out) his intrusive thoughts.

The following are common examples of obsessions in OCD:

ocddemon The most likely thing your certainty-demanding OCD demon will say to any list of obsessions is ‘It’s not quite the same as mine; what if something more dangerous than OCD is going on with me?’

Clarifying Compulsions

Compulsions are repetitive behaviours or mental acts in response to obsessions, aimed at reducing distress or doubt or preventing harm. Common compulsions (often referred to as rituals) include things like washing, checking, ordering, seeking reassurance, tapping, repeating phrases or actions, saying prayers, replacing bad thoughts or images with good ones and trying to control thoughts. Over time, compulsions become less effective, and people find that they need to work even harder to get a similar result.

  • The more you check something, the more responsible you feel.
  • The more you check something, the more doubts you have.
  • The more you seek reassurance, the less confident you are in your own judgment.
  • The more you seek reassurance, the less tolerant you are of uncertainty.
  • The more you suppress a thought or image, the more intrusive it becomes. This works in exactly the same way as trying to get an annoying song out of your head; it works backward and makes it more intrusive.
  • The more you analyse a thought or threat, the more significant your brain thinks it is and the more attention your brain pays to it. This tendency can mean that thought or threat really dominates your sense of what is happening in the world.
  • The more you try to reduce and avoid threats (such as contaminants or knives), the more aware of them you become.