Episode 20

Obsessing about Recovery, Part 1

In this episode of Purely OCD, your show hosts Lauren and Kelley talk about Obsessing about Recovery. They cover typical obsessions and compulsions in this subtype. They also talk about treatment in the form of Exposure and Response Prevention (ERP). The two discuss issues that arise in this form of OCD and answer questions.

One way that obsessions about recovery can arise Obsessions related to “What if it’s not OCD.”

Lauren actually wrote an article about this called Doubt, Denial and OCD.

Obsessions about obsessions include

• When am I going to have an obsession?
• How intense will they be?
• What if they’re going to get worse?

Other obsessions about recovery can include:

• What if treatment isn’t working? 
• Maybe I’m compulsing right now? Is this a compulsion?
• What if I’m not doing exposures “right”?
• The two-tailed spike

Hold up – what’s a two-tailed spike? Dr. Steven Phillipson coined this term to refer to circumstances in which it’s not clear as to which action is compulsive.

To illustrate, Kelley talks about an experience with her daughter at a birthday party. There was a butcher knife by the cake. She walked over to pick it up so her child couldn’t easily get access to it and then had the though “Oh wait, what if I’m doing a compulsion?” She got stuck momentarily trying to make the “right” choice and wasn’t sure whether it would be compulsive to move the knife given her tendency toward fear of accidental harm.

Compulsions performed secondary to obsessions about recovery can include

• Mental compulsions – like rumination and analysis
• Reassurance seeking
• Mental checking (checking emotions)
• Compulsive confessing to therapist (make sure therapist has all the information)
• Avoiding doing exposures on days you’re having a good day
• Avoiding reading about OCD, lest you pick up a new obsession
• Therapist hopping

Some people are made anxious by obsessions like “What if I’m not doing as well as before?”

This comparison happens a lot for people who have gone through the recovery process once and who are worried that their recovery doesn’t look the same as before.

“The all or none thinking around obsessions prevents people from enjoying anything… If you have to have an obsession free day in order to have a good day… that’s part of the problem. It’s the perfectionism around recovery that often prevents people from getting into recovery. Whereas if we can just accept the presence of obsessive thinking intermittently then it comes and goes and it’s not such a big deal.”

Lauren Rosen, LMFT

When doing exposure and response prevention, it’s critical to do it with the proper aim in mind. 

Kelley: Having no expectation that all of a sudden those obsessions will go down.

Lauren: The acceptance of thoughts and feelings has to be unconditional or it doesn’t help. If you’re using acceptance of thoughts and feelings as a strategy to try to control them then it will not support… recovery.

Exposure and Response Prevention for those obsessing about recovery can include

• Exposures
  • Setting reminder to obsess
  • Putting stickers or sticky notes in the environment to remember to have an obsession
  • Doing exposures on days you don’t feel like doing them.

• Response prevention could look like
  • Resisting the urge to research
  • Resisting the urge to ruminate

There are a lot of passive exposures that come up in this subtype. By passive exposures we mean exposures that come up “in the wild” that we can practice response prevention in the face of. As a result of this, and because of the tendency toward rumination with this subtype, treatment can benefit from being “heavy on the mindfulness.”

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Disclaimer: This information is meant to be general information not unique to any individual. Before following any guidance or advice found on this site or in the Purely OCD Podcast a visitor or listener should always consult with their own licensed healthcare practitioner. The Purely OCD Podcast and Website are not therapy or intended as a replacement for therapy. They are for educational purposes only.