The Four Challenges: A Cognitive-Behavioral Tool for Addressing OCD

Obsessive-compulsive disorder (OCD) is characterized by rituals aimed at reducing the anxiety and distress caused by intrusive thoughts. We will explore the 'magic cycle' that perpetuates the disorder and learn about the four challenges we need to confront to break this cycle. From these challenges, we will derive four statements to help overcome OCD.

Starting Point: Together with Hashem

The portion Bo opens with the verse: "And Hashem said unto Moses, Come in unto Pharaoh" (Exodus 10:1). Moses fears he is unfit to be Hashem's representative to speak to Pharaoh. In response to his fear, Hashem tells him "Come in unto Pharaoh." We might expect Hashem to send him to Pharaoh with "Go to Pharaoh," but by using 'Come,' we learn that Hashem accompanies Moses. In all struggles that Hashem presents us, we must assume that Hashem is with us, holding our hand.

Those suffering from OCD carry a certain pride, taking all responsibility upon themselves and forgetting that Hashem is with us in all situations (this does not mean one can be negligent; there is room for effort, but also for trusting Hashem).

What is Obsessive-Compulsive Disorder (OCD)?

In the book "Stop Obsessing" by Professors Edna Foa and Reid Wilson (2019), it is explained that OCD sufferers are anxious about harming themselves or others due to neglect in fulfilling their duties. As the feeling of personal responsibility increases, the likelihood of making mistakes with potentially serious consequences rises. Those with OCD tend to exaggerate both the probability and importance of these mistakes. Most experience fleeting fear of losing control, like accidentally dropping a baby, but dismiss this thought and move on. In contrast, those prone to worry see such thoughts as threats, wondering why such an image appeared, what it means, and fearing loss of control, thus causing anxiety. Then begins the 'magic cycle': the more terrified of the obsessive thought, the more you fight it, and this resistance intensifies its power. For example: try not to think of a white elephant; the more you try to avoid thinking of it, the more it appears in your thoughts.

The disorder also links to low self-esteem. Those with high self-esteem understand that people make mistakes and don't see them as disasters, so they don't work as hard to avoid mistakes. In contrast, individuals with low self-esteem suffer high distress from errors, viewing certain decisions' negative outcomes as catastrophic. Thus, they invest heavily to prevent mistakes. In such cases, people may develop special behavior patterns (rituals) to alleviate anxiety and distress.

Rituals and Their Significance

A ritual is a symbolic event consisting of a sequence of actions carried out in a certain environment and regular cyclicity, often meaningful for the performer (Wikipedia). In Judaism, there are numerous rituals, from reciting the Shema before sleep, to Kiddush and Havdalah weekly, and special events like circumcision, marriage, and burial. Through rituals, we testify to the significance we attribute to the occasion.

What is a Compulsive Ritual and Its Purpose?

A behavior pattern termed as a "compulsive ritual" involves a fixed sequence of actions (often in a specific order), repeated daily to reduce anxiety. The ritual indeed offers temporary relief from anxiety but is not a long-term solution. Sooner or later, the obsessive thought returns, necessitating the ritual's repetition. For instance, fearing you left the gas on might lead you to perform a ritual like: unplugging all electrical devices before leaving home, checking every electrical socket’s functionality with a touch, and turning each gas switch three times including closing the gas valve inside and outside.

Performing the ritual offers temporary relief and a sensation of "erasing" the obsessive thought. Whenever it returns, the OCD sufferer uses the same ritual to alleviate distress, fear, shame, and guilt associated with the thought. The ritual provides relative security since relief is short-term. The ease encourages repeating the compulsive behavior.

Sufferers from OCD often experience social isolation, embarrassment, and feel misunderstood. If you think "no one worries like me" or "I’m the only one in the world with such problems," you're not alone. Many suffer from OCD. Understanding the problem is the first step towards solving it. There are seven primary types of OCD: washers and cleaners, checkers, repeaters, arrangers, hoarders, obsessive thinkers, worriers, and obsessives. We will explain them with Hashem’s help on another occasion, but what they all share is the 'magic cycle.'

The Magic Cycle

The 'magic cycle' process: An event (thought or other) triggers anxiety > you start feeling troubled and stressed > the thought doesn’t leave, intensifying distress and discomfort > the urge to end it emerges > previously, you found a compulsive action (ritual) eased distress > you succumb to the urge to perform the ritual > temporary relief until encountering another anxiety-triggering event.

Treating the Rituals

The goal is to break the 'magic cycle.' In therapy, various tools are learned to help stop compulsive rituals. The book "Stop Obsessing" explains that one way to eliminate compulsive behavior is through four challenges, allowing you to break the cycle and improve your quality of life.

Challenge 1: Be determined to overcome your problems. Believe you have the right to feel good. The disorder's symptoms have troubled and disrupted your life for too long. You deserve comfort, success, and peace. Thus, you are ready to invest the effort needed to rebuild your life. Gather courage. Gradually, you will change your obsessive-compulsive habits with alternative behaviors. Letting go of these habits is not easy, requiring determination and belief that change is possible. Know that many with similar problems have done it before you. You can and deserve to change. Though likely, you will confront discomfort, temporary doubts, disappointments, difficulties, and insecurity during treatment. Your determination and belief will help you overcome obstacles.

Challenge 2: Recognize that your worries are illogical.OCD is based on excessive focus on unrealistic worries. The obsessions overwhelm you with intensity, seemingly representing a genuine threat. Thus, you excessively seek ways to protect yourself and others. Admittedly, thinking logically is difficult while in panic. However, reinforcing recognition that these beliefs are baseless will help counteract obsessive thoughts. This recognition will allow more effective responses to concerns.

Challenge 3: Understand that performing rituals isn't the only way to reduce distress. Most OCD sufferers believe rituals are the sole means for relief. Thus, they continue performing rituals for short-lived peace. Challenge this thinking style to discover new distress-reducing methods. You'll need to abandon familiar rituals. Believe and be ready to experiment with new behaviors for distress reduction.

Challenge 4: Accept the obsessions instead of fighting them. Studies show that fighting thoughts and avoiding them increases their recurrence. Specifically, the harder you resist thoughts, the more they appear. Thus, attempts to resolve the problem actually worsen it. Acceptance of intrusive thoughts allows them to fade. For instance, say, "It’s okay to think this way." Welcome the thoughts, thereby transforming unwanted thoughts into freely chosen ones, reducing the ritualistic urges to avoid obsessive thoughts.

Conclusion

To break the 'magic cycle,' you must face the four challenges: 1. Believe in your ability to overcome the problem. 2. Admit that your worries aren't realistic. 3. Be willing to try new alternatives to your rituals for anxiety and distress reduction. 4. Accept the obsessions rather than fight them. By adopting these challenges, you can change your response to obsessions. The urge to avoid thoughts significantly decreases if you remember that worries are exaggerated. Welcoming thoughts reduces pressure to perform rituals to counteract them. From adopting this challenge, here are four recommended statements:

1. Instead of thinking: "The problem will always control me" > say: "I’m determined to overcome the problem."

2. "My obsessive worries are real" > "My obsessions are exaggerated and illogical."

3."Rituals are the only way to reduce my distress" > "There are other ways to reduce distress."

4. "I must stop obsessive thoughts" > "I accept my obsessions."

An additional tip, instead of viewing the experience as a test of success or failure, treat it as practice. This way, you can evaluate what worked and identify where changes are needed, what requires more effort, and where things come easier. You can appreciate your effort, avoiding disappointment or discouragement from the process.

Shira Polon, M.A., specializes in cognitive-behavioral therapy(CBT).