OCD and Anxiety: Expert Answers to Your Questions

Understanding Mental Checking

How do you stop mental checking? I know that's what's keeping me in my state of anxiety. I constantly check "Am I thinking that thought? Okay, I'm not right now. Let me check again..."

Here's the thing: we can't control our thoughts. Thoughts are going to be thoughts. Mental checking is a way for the brain and body to say, "Let's see if you're good. Let's see if you're still feeling this." It's going to want to do it automatically.

Instead of saying "How do I stop mental checking?" we might change that to "How can I respond differently to the mental checking?" For instance, if I don't want a specific thought and I'm checking to see if I have that thought, my brain might say, "Are you still having that thought?" I can give it a response like "I sure hope so! That's not really what I want."

If I can take value away from checking, the brain doesn't want to keep checking. If I check and I'm like "I'm not actually having that thought. That's great!" And then I say "Wait, no, that's not great. I want the thought!" It almost tricks the brain. "Wait, if you want a thought, then I'm not going to actually warn you that you're potentially having this thought."

So you're worried, "I'm going to be thinking about it"? Then go ahead and think about it! I'm doing that 30-something times a day. Guess what? The brain's going to stop checking to see if you have that thought because you already did it.

But what if it's a blasphemous thought? What if it's about harming? It doesn't matter. A thought's a thought. So be excited for it! If I have a thought—yoo, I'm having a thought! Amazing! We're not saying it's a good thought or a bad thought.

Practical Strategies for Managing OCD

Writing Down Feared Thoughts

How writing your feared thought again and again on paper can help take value away from it?

Love it! I do this 'cause it's easy. You take a feared thought, you write it on paper. But for me, I don't just write it on paper—I write the thought and then I write how I'm going to respond to it:

• Is God disappointed in me? God's disappointed in me. I'm going to respond: Maybe he is, maybe he's not.
• I'm going to hurt this person. Maybe I will, maybe I won't.
• I'm going to give in to this thought or this fear. Maybe I will, maybe I won't.

We're writing the thoughts out, getting them out of your brain. And then we're practicing the response—writing those out too. It can help take value away from it because when it's stuck up there, it just wants to roam around. Ruminate, ruminate, ruminate. Let's get it out.

It's a way for you to say, "Let me see it. Let me feel it. Let me be with it. I'm not going to do anything to fix it."

Handling Contamination OCD

What can you recommend I tell my brain to help differentiate between touching whatever and touching something that is contaminated? I normally just wash my hands when I touch anything. It's exhausting since I can't tell what is danger and what is not.

If we sit on the fence and try to figure out what's contaminated and what's not, that is going to keep you stuck. We just say, "What do you want to do?"

I want to use a tissue when I leave the bathroom and open the door. That's actually what I do—a paper towel. But if it's not there, cool too. That's a preference for me. But if I just need to leave that bathroom, I'm just going to leave that bathroom and touch the door handle.

Kind of one of my rules is: if you're even questioning "Is this contaminated? Is it not?" We're going to touch it. We're going to do it. We're going to engage with it and say, "Maybe it is, maybe it isn't," because we actually don't have the answer to begin with. We're just guessing.

And even if it is? Cool. I guess we'll deal with the catastrophe, whatever you think that's going to be. So if it's even a thought, let's go engage with it.

But there is definitely a difference between somebody who's like, "Hey, I have COVID. Can I give you a hug?" No, no, no. Do we know there's a problem? Yes, because they just said it. You see the symptoms—I'm sorry, I'm not engaging with that.

But if I have the thought, "I wonder if that person has COVID? I don't know. Better not touch it." No, we're touching it. We're doing it.

For contamination, I have people create different guidelines for themselves:

• I only wash after I use the bathroom
• Right before I eat
• If I physically see dirt on my hands
• Maybe that's about it

Understanding Specific OCD Themes

Harm OCD and Violence

Do people who suffer from harm OCD usually have a history of violence, whether it be themselves being violent or a violent childhood?

When I see this question, my first thought is: reassurance, reassurance, reassurance. But actually, I don't know. Sometimes we just need some knowledge.

Here's what I know about OCD: It attacks what you care about, what you value. It waits sometimes for specific things to happen in someone's life. It could be a trauma of some kind, something small.

A history of violence? I mean, it could be anything. But what I do know is it's attacking what you care about, and obviously you care about people, whoever it is. So it's not really about what happened in your past. It's about what's happening right now.

What can I do right now to show myself I'm willing to do exposures? I'm willing to risk whatever I think is happening so I can continue living life? If my brain's like, "You want to do that. You could do that." Maybe, maybe not.

Ultimately, for any theme, OCD can attach to any experience in somebody's life.

Religious OCD

The intrusive thoughts scare me. I don't want to think about it, and I think I might have religious OCD. So it is tough to think it's okay to have these kind of intrusive thoughts about God. How can I handle this?

Here's my personal take. Everyone has different beliefs. God—this is for me—God created this treatment for OCD. He knows this works. This is the thing that works.

So for Him to use this against you after you die, to be like, "You know what? Can't believe you said this phrase. Can't believe you used this. I wanted you to suffer all of your days on earth. I'm so glad you didn't say this phrase though." No, no, no, no. I don't think that's how God works.

I think we have to trust and have faith. "I'm not so sure, but I need to say it." So my brain takes away that power. And then I don't say these phrases anymore 'cause they don't matter.

A phrase might be like, "I'm having a blasphemous thought about God." Maybe I'm writing that phrase out. It's already there. Maybe I'm saying "bad God" or something worse—what my brain says is worse.

What we're doing is we're taking thoughts and we're just making them be thoughts. It's not about whatever you're saying—whether it's harm, whether it's about God, whether it's about hurting whatever. It's not about the thought. Let's just bring it out.

And if guilt joins the party, guilt is there when we're doing something wrong and we need to correct it and fix it—not when it's mixed with tons of anxiety.

So we're not saying it's okay to have these intrusive thoughts. What we're saying is it's okay to have thoughts, and for me to get them to reduce over time, to change the way your brain's responding to it, I need to keep doing it. Just like exercise—I got to keep doing it if I want to get strong.

So I think a lot of it has to come down to faith. I'm not so sure, but I know this is what I need to do, and I trust that God's got me at the end of all this.

ERP Therapy and Effectiveness

Is ERP an effective treatment for a person who has had OCD for 30 years but was finally diagnosed late in their early 50s, or is the behavior too ingrained at that point?

No, man! What's really cool is that the brain can change at any age. I've seen clients who are in their 70s and above, first time they're doing exposures, and guess what? 50 years of compulsions—at the end of their life they're living free.

And it's because they do the work. They're like, "I'm done. I should have done this earlier." But it didn't take 50 years to reverse all the compulsions that they did.

You are not too ingrained. It just takes a lot of motivation at this point to say, "I know I've gone this long doing all this stuff, but let me do treatment." And trust that everything's going to work out—go really hard with it. It's not an exposure here and there. It's a lot of exposures.

Addressing Complex OCD Fears

Reality and Identity Fears

Can OCD make you feel like you have thoughts that your family isn't really your family, like they're imposters or something, and it feels real but you also kind of don't believe it, like you're scared of becoming delusional?

OCD can make you think anything. Am I real? Is my family real? Am I an impostor? And then it's like, "If I'm even thinking this, I must be delusional or schizophrenic or whatever."

If that thought is happening, do you know the answer? Maybe, maybe not. Maybe my family is not real. Maybe I'm an impostor. "Ooh, free—living in this house, I don't even have to pay anything. That's super cool!"

Am I becoming delusional? I guess so, maybe. Those are kind of those responses. And it's not to take this lightly, but it's to say if I'm feeling anxious, I don't physically see a problem that I know 100%, I'm willing to risk it.

So we take whatever we think the actual fear is, and we're just going to keep saying maybe, maybe not to it. Or we're agreeing with it. "Oh yeah, I want to become delusional, if I'm not already. Dang it! Oh, now I think they're real. Oh, I'm not delusional. Oh man, I want it to be."

How can we take value away from this?

Managing Consistent Intrusive Thoughts

I mostly have Pure O. What should I do when intrusive thoughts are way too consistent and hard to ignore? How can I deal with the fear, disgust, and anger they cause?

Well, we don't want to ignore them. I think that's the thing. Let's not ignore the thoughts. Let's let them be there. Let's let them cause feelings—disgust, anger.

For Pure O, I love to set out times for people to actually have the thoughts on purpose and not do the typical compulsions in your brain of pushing a thought away, ignoring, avoidance.

I have random timers go off throughout the day. And once there, I'm going to go sit on the couch and let you go have all those thoughts. "Hey, you're welcome! Here, let me just open the gate. Come on in, bro! Let me think of you. Yeah, that might happen. Yeah, maybe not. I don't know."

"Oh, I love that I'm having this thought right now. Thank you for being here! I hope you come while I'm in the meeting. That would be really cool too. Oh, I'm at this really important event? Please, please, please let me have all these thoughts. I would love that!"

"Oh, this disgust feeling? I hope I feel this all day long. Let me just, like, even just rub more of this disgust on me. Oh, I'm feeling anger? What a cool emotion, man. I love it! This is great. Hope I feel it all day."

How we respond to the intrusive thoughts is more important than what the thought actually is. If they're consistent, let them be there. Let's just change the way you're responding to them.

Sometimes it's hard in the moment when you're just living life and you're having thoughts. That's why we go out of our way to give time to it. Say, "Let me think about you on purpose." And sometimes it's not even bringing the thoughts, it's just giving yourself space to say, "Hey, for the next 3 minutes, I'm sitting here. If you want to come, come." If you're not coming, that's great too.