Overcoming OCD: Veale and Wilson

Overcoming OCD.. 1

Chapter 1. 1

Chapter 2 What caused your OCD.. 3

Chapter 3 CBT and OCD.. 6

Chapter 4 Overcoming OCD: How it actually works p147. 9

Chapter 5 Getting Ready for change. 12

Managing obstacles to overcoming OCD.. 12

Shame and OCD.. 13

Overcoming shame. 13

Pride and OCD.. 13

Depression and OCD.. 13

Rumination: 13

CT and depression. 14

OCD and LSE. 14

OCD and general mood. 14

OCD and the comfort trap. 14

Guarantee trap. 14

Anger. 14

Guilt 15

The martyr trap. 15

The on the safe side trap. 15

Perfectionism.. 15

Ive tried it all before. 15

Techniques to help you overcome OCD.. 15

Chapter 1

Obsession=persistent thought\image\urge

Obsession	Percentage of those with OCD
Fear of contamination	38
Doubts about harm occurring (e.g. door not closed, oven still on)	24
Excessive concern about symmetry\exactness	10
Body\physical symptoms	7
Blasphemous, sacrilegious thoughts	6
Immoral sexual thoughts, rape\paedophilia	6
Hoarding	5
Thoughts of violence or aggression	4
Intrusive thoughts or music	1

People with OCD have intrusive thoughts, and they ascribe meaning to them, then do things to prevent the feared thought coming true, e.g. I could get contaminated from that door handle, therefore I must put on gloves to protect myself.  Sometimes the threat of the thought is external to them, e.g. contamination, sometimes internal with TAF and they have a dystonic thought, which they believe represents a desire.  As the threat is the thought, which causes anxiety, then the compulsion is action, then the thought becomes more frequent as it gets more significance. After time the thought might recede and all that is left is the anxiety.

The key thought in OCD is that harm could occur to someone and I have the power to stop it.  Underpinning this is an inflated sense of responsibility

Compulsion=repetitive acts, overt or covert, in response to obsessions. The aim of the compulsion is to reduce the threat of harm until it feels just right or comfortable.

Compulsions are signs that the problem is one of anxiety. Someone without OCD washes their hands until they are clean, which they can see, or they have followed a rule of how to wash hands. Someone with OCD washes until they feel comfortable, which will vary dependent on how uncomfortable they felt before hand. The aim of treatment is to break the relation between the behaviour and the feeling uncomfortable, the idea being that to start off with not doing the behaviour when you feel uncomfortable will feel jarring but after a while it will fade.

Avoidance behaviour

A key part of OCD is the situations that are avoided to prevent having obsessions.

Safety seeking behaviour

A behaviour that is done to keep yourself safe and reduce anxiety.

But the outcome of this is that it keeps you finding out that there was nothing to be frightened of is known as a safety seeking behaviour. Safety seeking behaviours maintain obsessions. The solutions of OCD via SSB become the problem, as they maintain the fear, indeed enhance it.

Pure obsessions

Obsessions without compulsions. Thinking an answerable question such as why do I exist, then trying to answer it. Answers that are given, fail the absolute certainty test, then the what if comes in and the questioning happens all over again, it’s like philosophic GAD

Emotions in OCD

The emotions that drive OCD can be discomfort\distress, or for people trying to prevent harm then this could be anxiety, or for people with a moral element it could be disgust\shame driving it.

Obsessional slowness

Carries out everyday tasks very meticulously and in a precise and ordered manner or sequence.

OCPD

Perfectionist, excessively tidy, excessively concerned with rules, constantly making lists, inflexible, unemotional and overly devoted to work.

Chapter 2 What caused your OCD

A Cognitive behavioural model for the maintenance of OCD

If you believe the intrusions are the problem then it is obvious to neutralise them.

If you believe intrusions are normal then you may find your attempts to neutralise them are the problem.

The initial point is CBT view is that avoidance, safety seeking behaviours, compulsions and the meanings that you attach to your thoughts are keeping OCD going.

Learning theory

Avoidance, compulsion and safety seeking behaviour is negatively reinforced because it reduces the anxiety\disgust\shame\discomfort for the client. It can also be negatively reinforced around the belief that it stopped bad things happening.

However all that has happened here, is that you think you have prevented harm from happening. However what they do is to focus your attention on the content of the obsession, make it seem more likely that it can happen as you are often thinking about it.

Key treatment then is ERP where you find out that what you feared would happen doesn’t.

Key theory is theory A theory B

Theory A there is a high risk of harm coming to self or other

Theory B I am worried about harm coming to self or others and my solutions are the problem

First question, what theory has the client been operating to? What’s been the consequence? To test Theory B we have to act as if it were for a time to collect the evidence, act like a scientist.

CT

The CT component of OCD treatment is the appraisal that the clients make of their intrusion. People with OCD have an inflated sense of responsibility, in that they think they can stop bad things happening. 

Burglary is going to happen whether you locked your house or not. A burglar isn’t going to go to each house and test the door to see if it’s open. A postman may well pull the door to if he spots it open.

With contamination, then there is a reasonable level of care you take to protect yourself wash your hands after going to the toilet, then beyond that its chance whether or not you get infected. Bad events can happen as you are in the wrong place at the wrong time. OCD sufferers believe they can prevent this.

Another aspect of OCD is magical thinking.  This gives the feeling that they have more control over something even when they don’t.  You can also challenge this by dong anti superstitious things to find out if it creates bad things.

So the OCD problem.

I believe I am responsible and capable of stopping harm from happening.  So if I am the last leaving the house, I am responsible and I need to be absolutely certain the door is shut, as this will stop burglaries, if I have left the door open it will cause a burglary, and the outcome of me being responsible for this would be awful.

So I have anxiety about the bad thing happening. I feel responsible for stopping it because I can so I feel anxiety about this and will make absolutely certain I have done what is needed to stop the bad thing happening.

The effect of this, is to remind me every time I do a compulsion about bad things can happen, I am responsible for stopping them and I can. This heightens my sensitivity to bad things happening, increases the frequency of thoughts, changes my perceptual bias.

In assessment terms then you need to find out what the harm the person fears will happen and what the nature of the intrusion is. It could be logical if I don’t then, or it could be a thought. The former is more likely if the OCD has been around for sometime.

So the first thing to find out is what do they think would happen if they stopped their compulsions? Would it be harm happen, or would it be it would be so bad if it did happen I have to do my compulsions just to be sure. (Awfulness=certainty).

 In so far as responsibility being the compulsion beliefs in the power to stop the bad thing happening, then contamination this seems true, TAF and thought suppression this seems true, however with checking to prevent bad thing happening to house it doesn’t as it seems more about responsibility. With TAF then the significant aspect is the meaning associated with the thought

OCD

Key elements

Contamination=I can prevent being ill

Checking to prevent problems in house=I could be responsible for being careless and lose something I care about

Rituals to prevent harm coming to others=I can prevent harm happening.

The obsessions tend to be the worst fear the client can have. This is especially true in TAF, and contamination and possibly within house checking and responsibility for something that is important to me

Predictions

Central to all OCD is the over estimation of the probability of danger

Intolerance of uncertainty

The feared harm is so bad that people have to be absolutely sure that it isn’t going to happen. Through being preoccupied with the object of harm, then this reduces the amount of uncertainty in this area they can tolerate

The paradox of OCD is that people want certainty that something won’t happen. To achieve this then they work hard to reduce the uncertainty and be able to predict something won’t happen, but the irony is the harder you try for certainty, the more you increase your ability to doubt, your ability to believe in how probable the bad thing is.

Anxiety paradox: the harder we try to resist it the worse it feels and the longer it takes to go away

Awfulizing, seeing a situation as a catastrophe, makes it seem awful, which enhances anxiety.

If you believe anxiety is intolerable, then this can make the anxiety seem worse.

The problem with OCD is that as opposed to a rule that is shared by other guiding the action, or by a visual inspection, so I wash my hands until I see there is no dirt on them, or for 2 minutes, people with OCD do wash\check until it feels right so until their anxiety reduces.  However this seems similar to how people would deal with a major decision in their life like buying a house.  Another aspect with how long people do compulsions for is either to reduce the anxiety or on the other side to reduce the amount they can doubt what they have done, which ties up with a certainty criteria

Part Two Overcoming OCD

Chapter 3 CBT and OCD

Erp is the most effective cure for OCD. When you your obsession triggers anxiety, then the compulsion brings it down. When you first do your exposure, then the anxiety is going to go higher, but then is going to come down by itself, then what’s going to happen the next time? The curve is going to reduce.

What is the criteria for finishing compulsion?

Standardly it is an emotional one, when it feels right.  So someone without OCD would do something which had objective evidence, e.g. someone else could see that it had been done, someone with OCD does it until it feels right. However what you should do is not do something until it feels right, rather change this to use objective evidence and focus on the environment

Use a feared hierarchy of things you avoid or cause you anxiety and stay with the fear until it reduces and you haven’t done a compulsion, in the first instance this might take an hour

With exposure the idea is to accept anxiety, welcome it give it a seat, get to know it and allow it to go of its own devices.

The trouble with exposure is 25% drop out or refuse to do it

Cognitive therapy offers us Theory A and Theory B, and to test which one is true. So we might say our obsessional thoughts to us to see if we act on them. If we don’t then we can see that the problem is more one of worry about what our thoughts mean, not that they means something specific like us being a paedophile for instance.  The heart of the OCD problem is normal intrusive thoughts are taken as dangerous, abnormal and unacceptable.

CT shows us that there are thinking styles that make us vulnerable to OCD, details in a bit!

CT shows us that OCD sufferers believe in magical thinking, that thinking can cause events to happen, or rituals can cause events to happen.

Thinking errors common to OCD

1. Catastrophisation
1. Catastrophic misinterpretation of the thought
2. Black and white thinking
1. Either I’m clean or I’m dirty
2. Either its complete done, or its not
3. Demands
1. We start from preferences and move to demands, however we cannot achieve absolute certainty that something will or will not be the case. With intrusive thoughts (TAF) this can lead to giving the thoughts more significance which can increase the amount of intrusions we get. With protecting ourselves or others from harm, then with protecting ourselves then if we imagine the probability of catching a disease then our increasing the amount we wash as we should take every care not to get disease, then this increases the probability by a very small percentage of protecting from diseases but then creates another problem, time taken protecting self.

Certainty

With OCD there is a desire to be certain of preventing undesired outcomes, the house blowing up, getting a serious disease or your children getting hurt. However no matter now certain you try to be, there is still a possibility that this will happen.

Thought control

A common OCD belief is that you can control your thoughts. However this is both impossible and undesirable. If thoughts didn’t pop into our head it would affect our ability to be creative.

Avoiding CBT becoming a ritual

Challenging the content of an OCD thought can be counterproductive if it happens at the time the thought is had, as the sufferer can take a long time challenging their thought until it feels right that they have challenged it. This can become another safety behaviour and act as a reassurance.

OCD is a problem about believing that your thoughts mean you are bad or dangerous or that you are responsible and that you are capable of stopping harm coming to yourself or others.  Questioning the content of an intrusion just increases doubts and worries.

Intrusion= (having this means I’m bad\dangerous) (Harm can happen I can\should prevent it and be certain that this is the case)

P132 aim p192

OCD is a problem of misinterpreting normal thoughts as evidence that you are bad (TAF) and that you are able to prevent harm from happening (contamination). Your aim with treatment is to not engage with the content but rather with the process, your appraisal of them.  Cognitively restructuring an OCD thought, is to say it seems to be significant so let’s challenge, but actually it’s just a thought and means nothing.

Thoughts with a sexual content

So I have a thought I may be gay, this fills me with dread as I believe this would be awful. The fact that I have a thought I may be gay provides me with evidence that I am. Because of the evidence of this thought I now need to prove to myself absolutely that I’m not gay. You can test whether this gives you evidence by going into a gay bar and seeing if you are attracted to the same sex (but isn’t this giving the thought significance in the other way, we’re not trying to prove its just a thought), Going into a gay bar would also expose you to your thought of being gay, and this may well reduce the terror of being gay, so reduce the fear of the thought.

So the OCD mechanism is have a thought, which gives me evidence to something which terrifies me, treatment is to show me that it was just a thought and didn’t mean anything and also if the really bad thing happened it would be so bad after all.  However how does this work with contamination, I could get aids.

Contamination works slightly differently, there is a thought I could get blood born disease and then if I clean all germs off a handle then I won’t. In this instance the you are dealing with a feeling of probability, when clean the handle you reduce your probability of getting disease from 0.01 to 0.02 but you increase your fear in getting the disease which in turn makes it seem more likely. So you perceive that the likelihood of diseases is higher. There also seems a belief that you can stop yourself getting the disease.

Trying too hard to control your behaviour

When you do this, then you become acutely aware of bodily sensation, spasm, change etc. This shows you that you aren’t completely in control of your body, so you fear losing control and now have some more evidence that you might.

Contamination also falls foul of safety behaviour, you never know that you didn’t need to do your behaviour as you would have been fine anyway.

As if principle

If you intellectually agree you have OCD and it’s not right but act as if you believe you haven’t and you are protecting yourself then act as if, is a good way to make that move from intellectually believing something but behaving as if that’s not true. If you want to know how to act as if you don’t have OCD then

1. Survey friends

Techniques

1. Survey
1. Normalise intrusive thoughts
2. Find non OCD behaviour
2. Responsibility pie chart
1. Put all the aspects that contribute to the responsibility for something bad happening add yourself last
3. Correcting bias (what’s on our minds affects what we notice)
1. If your bike steers to the left steer right, so if you continually notice danger, then start to notice how safe you are.
2. Change your focus of attention to something around you, or the task that you are doing

Perceptual bias

When you are anxious about something you notice its possibility more, so increase the sense of its probability happening. When you are anxious then you also focus internally and think because I feel anxious therefore there is something to be anxious about

A biased perception will lead to biased conclusions.

Taking physical exercise

Taking physical exercise helps you overcome mild depression.  What functionally are the things that you could do, which would mean you wouldn’t do your routines, something more important than your routines maybe?

Chapter 4 Overcoming OCD: How it actually works p147

Contamination

Fear that I could catch a serious disease and this would be terrible so I must stop this by preventative action. There is the belief that you have the capacity to stop this.   Key around this is to distinguish between Theory A and Theory B, Theory A she had a problem of being contaminated by germs and catching a serious disease from germs and she need to do what she did to keep herself safe by avoidance and washing and Theory B being you are worried that you could get a serious disease and that all her protective measures keep the worry going.

So the approach here is start testing if theory A or theory B is true,, you can do this by seeing how the amount of compulsions change and whether or not this is related to changes in anxiety, if so, this would be evidence for theory B.

When theory B becomes a possible explanation then you can start to do ERP. You need the client to see that continual safety behaviours keeps the fear up. So questions: what do you think would happen if you stopped your safety behaviour (id be horribly anxious, I would get a serious illness). Theory A would say you would get a serious illness, Theory B would say, if you keep everything else stable, then it will start to reduce how much preoccupation, how much worry you have on contamination.

When you do ERP, then if you do a compulsion make sure you do an exposure straight after

Moral fear

Here is the fear that you will or have done something morally repugnant.  The thought that is had is given as evidence that I am bad, or I could do bad things if I lost control, or I have done bad things. Theory A is that you are a bad or potentially bad person and you must prevent this. Theory B is that you are worried about being a bad person and that through trying to prevent this you are maintaining your worry about being bad person.  Given that some evidence that is given to support theory a is that having a bad thought means that you are a bad person, then it’s the meaning that is attributed to the thought that maintains the problem.

Test the effect of safety behaviours on intrusions. If increasing safety behaviours increases intrusions then that would be evidence for theory b.  You can also expose yourself to the bad thing happening, so that you can take the horror out of the mental picture, rather than of belittling the event.

Also get someone to imagine their twin who didn’t have OCD, how would they act? Get the client to act as if they are their OCD twin.

Responsibility can come into the moral fear, if you are afraid you have knocked someone down, this would be different to sexually\violently abusing someone, where morality not responsibility seems the main aspect.

The sense of preventing harm in OCD is:

1. I must make sure that I don’t do something that will cause harm to myself or others
2. I must make sure that I don’t fail in doing something that might protect myself or others from harm.

With checking, contamination then you only reduce the chances of something bad happening by an infinitesimal amount.

Reassurance

When you seek reassurance, then you doubt your own view point. When you seek more reassurance, then you doubt the original reassurance. Thus you perpetuate doubt.

Checking

The more you check, the more you doubt the last check and your memory and the more you have to check. Checking also increases how responsible you feel for what you are looking after and also the probability that a bad thing will happen.

OCD and memory

People with OCD don’t have poor memories, rather they have poor confidence in their memory.

Checking

Theory A: I have a bad memory which means my judgement that I have locked the door cannot be trusted and I must recheck

Theory B: I am worried that I well be burgled and lack confidence in my memory, however trying too hard to be certain I have closed the doors increases my worries.

Checking

I must be sure that I don’t fail in doing something that could protect me\others from harm.

I can prevent bad things from happening. My problem is I don’t trust my memory theory A says it’s because I have a bad memory, theory b says I don’t have confidence in my memory and that trying to be certain about my memory causes the problem

Checking Treatment

1. Have a responsibility holiday, sign responsibility over to someone else and see if it decreases your anxiety

Contamination

I must be sure that I don’t fail in doing something that could protect me\others from harm.

I can prevent myself being sick by avoiding germs. Theory A says I can be contaminated by germs and need to keep myself safe. Theory B says I am worried about becoming ill and that trying to keep myself safe is keeping this worry about illness going

TAF#

I must be sure I don’t do something that will cause harm. I fear that my thoughts give me evidence that I could or have done something bad. I must

To increase confidence then you need to exposure yourself to places where you are unconfident to find out that your lack of confidence is misplaced. This means finishing routines to objective standards not emotional ones.

Symmetry

Symmetry can be associated with magical thinking, in that something bad will happen unless things are done\arranged symmetrically. Often the bad thing that could be happened can’t be identified and client regards their behaviour as perfectionistic.  When a desire for order, precision and exactness are very severe and rituals are performed very slowly then this may be termed obsessional slowness. People often can’t see their feared consequences as they have always done their rituals, so get them to stop, to see what they fear. With symmetry it could be representational of need for order in life and a feeling out of control, it could be symbolic of doing this will ensure something else doesn’t happen, i.e. bad things to loved ones.  At the centre of symmetry can be a fear of losing control.

Do the ERP with a view to testing Theory A, Theory B. ERP gives you a lived experience of this truth. If ERP struggles then you may want to do a CBA on change and CBA of staying the same.

Health anxiety

This author reckons this is an OCD subtype. So here if you’ve acted on theory A where you think you have Aids, its hasn’t been diagnosed properly and you need to be absolutely certain you haven’t got it to Theory B you have a problem caused by worrying about having aids, and trying to be certain increases the worry and keeps it going. Once you can get this in, then you can test it. So increase checking and see if the worrying increases, this being the case, and the anxiety levels and other safety behaviours go up, then theory b seems more likely, as it seems through increasing checking, you are increasing worrying and it seems more likely that you have an illness, and you don’t get intelligent diseases.

End 192

Start 192

Theory A I have a problem with my memory, and judgement and  I can’t  trust myself  to do things

Theory B I am very worried if things go wrong, and don’t have confidence in my memory and judgement

Theory A I have a problem with my memory not working correctly, my judgement not working correctly and I need to fix these up, if they were muscles I need to exercise them more

Theory B I am worried about the consequences of the problem, and I don’t have confidence in my memory or my judgement. Here I need to reduce my worry, increase my confidence in my memory and judgement.

Start 194

Hoarding

The difference between hoarding and collecting as a hobby is that the latter generally gives the one pleasure and the former doesn’t.

Chapter 5 Getting Ready for change

Initially you need to define the problem and set the goal:

1. What has made you vulnerable to OCD
1. Early experiences around responsibility

Managing obstacles to overcoming OCD

Don’t spend too long trying to overcome obstacles to treating OCD or this might be OCD at work.

Shame and OCD

Shame: intense negative emotion when you fall short of your ideal which is revealed to others. Most people put off seeking help for over 10 years due to shame.

Shame can mean you may be critical of other people to draw attention to them, as you fear attention being drawn to you.

Overcoming shame

1. Move from comparison to others and judging yourself as weak. To seeing yourself as complex, ever changing and OCD is one part of you
2. Think realistically about whether how long people would condemn you if they knew about your OCD
3. OCD is high standards, strong morals and a desire to prevent harm, is this something to be ashamed of

Pride and OCD

Pride can prevent people from trying to treat it as they may feel shame that they have some responsibility in the maintenance of OCD.

Depression and OCD

OCD can often lead to depression, which impacts motivation for change.

Depressive cycle

Do less, see less people (negative reinforcement)

Criticise self as doing less (increases depression)

Get less pleasure from the world (increases depression)

Ruminate about why you are depressed, how everyone else is happier and what it means about your personality (increase depression)

Rumination:

1. Compare self with others, or when I was ok
2. Ask why questions, why did they treat me like that, why have I got depressed
1. These questions are generally very general and can’t be answered
3. Consequences
1. Depresses mood
2. Reduces  energy
3. Avoids problem solving
4. Leads to labelling and self-criticism

One useful way to deal with rumination questions is to change the why to a how can I question.

Worrying is solving non-existent problems, with non-existent solutions but you do have real outcomes. Some problems can’t be solved, e.g. what people think.

CT and depression

If BA and not responding to rumination doesn’t work then you can use CT. So challenge the CBs, IBS and NATs which may be supporting low activity. Treat thoughts as theories to be tested as opposed to facts.

OCD and LSE

You see perfectionism, total control, absolute certainty in OCD, this may be a reaction to low feelings of self-worth, out of controlness and difficulty with feeling out of control

OCD and general mood

OCD can be helped by lifting depression, so improving sleep, eating healthily,  exercise, drinking minimal amounts of alcohol can be a help, albeit indirectly

OCD and the comfort trap

This stems from low frustration tolerance and means

1. Can’t stay long enough with anxiety to habituate, so new learning doesn’t take place

2. Prorastinating when it comes to exposure

So anxiety may be hard to bear, but it is not too hard, and if you do nothing about it, it will get harder.

If you wait until you feel more confident then you are putting the cart before the horse, through doing this, you will build your confidence. Doing exposure is hard, but then living with OCD is harder.

Guarantee trap

Needing guarantees that no harm will result from dropping safety behaviours

Certainty criteria drives the need for endless checking.  Guaranteeing certainty only guarantees you OCD not certainty. The goal is to accept there are no certainties or guarantees in life. To challenge this do a CBA of your need for certainty that no harm will come to you.

Anger

With OCD you can get angry at yourself and others. Self because you do your rituals others because they won’t give proper reassurance that no harm will happen, or that they don’t understand your difficulties. Getting angry with other people means that you pick the wrong enemy, the right enemy is OCD.

Guilt

People who develop OCD frequently have a strong sense of responsibility and morality and high personal standards. Thus they can feel very guilty about the impact that their OCD is having on others. Guilt can lead to depression which can weaken the motivation to do something about OCD. Likewise if they feel guilt, then they might fear that they are going to be punished, which can lead to a fear of harm coming to themselves and could exacerbate ocd symptoms

Feeling guilty about resisting compulsions and taking risks.

When people reduce their compulsions they frequently feel guilty. To tackle this consider why you might want to put others well-being so ahead of your own.

The martyr trap

Here the person thinks it’s better to sacrifice their quality of life rather than expose a person who they feel responsible to a possible threat. 

Questions to challenge martyrdom?

1. Do those you martyr yourself for think this is a good ideas
2. Will they be grateful in years to come
3. How would you respond to these questions if you were in a similar place to those you are a martyr for?

The on the safe side trap

How high up on your list of problems is OCD?  Is erring on the safe side part of OCD. Are you overcautious with regard to your fears, should we not get you to err on the incautious side.

Perfectionism

You can wait to treat your OCD until you are absolutely certain your understanding is complete. However this will stop you acting, aim for a good enough understanding and act on what is probably right.

I’ve tried it all before

However it’s not what you do, rather it’s the way that you do it.

Techniques to help you overcome OCD

1. CBA
1. Becoming free of OCD might put pressure on you to address other problems in your life.
2. Do this for short term and long, for yourself and other people
2. Tic Toc
1. Task interfering cognitions

                                                               i.      Write down all the beliefs and attitudes that are getting in the way of treating your OCD in a consistent manner

2. Task orientating cognitions

                                                               i.      For each tic, write an alternative toc that can help you overcome the tic and develop a more consistent way to treating your OCD

3. Big I, Little I
1. The big I is the whole person, and the little I is the many facets that make up a human being
2. See that there are many aspects that go to make you up and that if one is negative it wouldn’t make the whole thing: One banana in a fruit bowl, doesn’t make a bowl of bananas
4. Bill of rights
1. OCD is an oppressor, but you have rights so write them out to live by them:

                                                               i.      Right to live free from ritual and avoidance

                                                             ii.      Right to place happiness as a high priority in my life without feeling guilty

                                                            iii.      Right to enjoy physical contact without fear or guilt

                                                           iv.      Right to take everyday risks without undue anxiety

                                                             v.      Right to enjoy my life without ocd telling me what to do

                                                           vi.      Right to allow intrusive thoughts to pass through my mind without having to spend time making sure I’m safe

Chapter 6 Taking it Step by Step

Steps to overcome OCD

1. Define problem and set goal
2. Understand your obsession (conceptualise and get functional analysis)
3. Understand that it is the meaning you attach to the intrusions that are causing the problem
4. Identify the way that you avoid  experiencing your intrusions, ie rituals, thought suppression, reassurance seeking, neutralising and avoidance
5. Understand how your attempts to solve the problem is keeping the problem going
6. Develop Theory B and cognitive statements eg (100% sure is impossible and a reasonable number of precautions is still responsible)
7. Act as if Theory B is true to gather evidence to find out which is true Theory A or Theory B
8. Turning OCD on its head becoming anti obsessional

Things to help overcome OCD

1. Monitor to see your progress
2. Reward yourself for progress
3. Get a co-therapist an OCD supporter, someone who will support you in your work with OCD