Planning for Recovery

Planning for Recovery

The plans below can be used to help you think about how to take action to
transform your obsessions and compulsions. If possible, choose a family
member or friend to work with you. They can help you stay in contact with
feared objects or situations, refocus on body sensations of anxiety, playfully
exaggerate your imagery stories, and postpone or prevent urges to
ritualize. Before getting started it is necessary to prepare by:

Identifying repetitious thoughts or habits and making lists of them.

Examining how realistic your fears are by rating the distress each
concern causes (0–10 units) and the chance of it happening (0%
–100%).

Relabeling these thoughts and habits as a part of obsessive-
compulsive disorder (OCD).

Reattributing the causes of OCD thoughts and habits to your unique
physiology.

Revaluing the occurrence of OCD thoughts and habits as
opportunities to practice strategies that can change brain chemistry.

GENERIC PLAN 1

This plan relies on postponing and refocusing and generates gradual but
steady reduction in OCD thoughts and habits without requiring large time
commitments.

Practicing observing your obsessions and compulsions. Tell yourself,
‘I’m repeating this ‘What if worry’ or silly ritual because my brain
cannot detect that it is irrational (even though my mind knows better).’
Use rhymes and positive thoughts to replace repetitious thoughts
and habits—This isn’t me, it’s OCD, I’m still complete when I need to
repeat, It’s just stress that makes my mind regress, When thoughts
are bogus, I change my focus, I repeat my fears till I’m bored to tears,
When fears are faced, they get erased.
Begin refocusing whenever you catch yourself obsessing or acting
out rituals. Put your attention on something enjoyable that takes
concentration: play with a yo-yo, work a crossword puzzle, recite a
poem or Bible verse, breathe with awareness, go for a walk, or tap
acupressure points.
Do not be concerned if your mind is only half on your chosen activity.
At first, OCD thoughts and urges will seem to ‘fight’ to get your
attention. You have still begun the process of refocusing. You will
gradually get better at it.
Do not stay busy to keep OCD thought and urges away! This will
deprive you of opportunities to practice refocusing. Instead, tell
yourself, ‘I can relax and only get busy if any thoughts come.’

GENERIC PLAN 2

This plan makes use of special behavioral techniques that can produce
rapid change. It involves a three-week recovery program in which you
intensely practice up to two hours a day. This may mean rearranging daily
commitments, obtaining child-care, or even taking time off from work.

Write or make tape recordings of stories exaggerating the details of
one thing you fear (rejection, humiliation, defectiveness, disorder,
being harmed, harming people, or other concerns). Identify any
catastrophic fear behind your obsession or compulsion and
incorporate it into your story. Start with concerns that cause
moderate distress.
Use imagery practice to repeatedly read, listen to, or imagine the
story you created until it no longer causes you distress. Do your best
to practice 45 minutes daily for three weeks. Start with moderately
upsetting situations and proceed to the most distressing. Do not use
imagery practice to avoid exposure (number 3).
Systematically, expose yourself to upsetting concerns by acting out
or coming in contact with the things you have already practiced
through imagery:

Send a letter to your support person with several missing periods.

Watch violent movies, hold knives, and go to restaurants.

Go to the grocery store without taking a shower and examine people’s faces to see if they notice.

Throw out hoarded items, little by little.

Touch ‘unclean’ objects and focus on anxiety until sensations
decrease.

Have a friend create a disorder and look at it for ten minutes, 4–5
times a day.

Stop yourself from checking to see if the stove is off or the door
locked.

Stand on a sidewalk crack without crossing your fingers to prevent
bad luck.

Intentionally think ‘dangerous’ thoughts or imagine a misfortune.

     4.   Immediately focus on your catastrophic fantasy until anxiety
           lessons or you stop obsessing.
     5.   Do not engage in rituals that accompany your concerns during
           and after practice.

Make it impossible to avoid ‘contamination’ by touching a tissue with
an ‘unclean’ object and rubbing it over your clothes, counters, or
sheets and use imagery practice until distress lessens.

Symbolically reinfect your hands with your ‘contamination’ tissue after
washing them.

Keep your house disorganized or go through the kitchen often
without checking the stove when you first start your recovery
program.

Make sure all of your routines for cleanliness, caution, and order are
within normal limits.

Do not let yourself cross your fingers or repeat ‘good’ words to ‘undo’
misfortunes you are imagining.

     6.   Be alert to situations or objects that you avoid and face them
           with imagery and exposure until you have markedly reduced
           anxiety and frequency of obsessions.
     7.   Regularly do ‘risky’ things (disorganize a corner of a room, use
           ‘dangerous’ objects, throw something out, leave a faucet dripping,
           imagine something awful, or ‘infect’ yourself with your
           ‘contamination tissue’ to symbolically show your obsessions that
           they can no longer worry you.
     8.   Repeat this plan with all of your obsessive concerns or compulsive
           habits until they are no longer distressing. Gradually focus on
           more upsetting concerns.
     9.   If obsessive thoughts return, postpone them, refocus on enjoyable
           activities, or modify something about them and schedule an
           imagery practice session as soon as possible.

References

This first plan is based on ideas in the book, Brain Lock by Jeffrey M.
Schwartz (HarperCollins, 1996).

This second plan is based on the book, Stop Obsessing! by Edna Foa and
Reid Wilson (Bantam Books, 1991).