Episode 37
Our “Favorite” Things About OCD, Part 2
Mental Compulsions
In this episode, your show hosts Kelley Franke, LMFT, and Lauren Rosen, LMFT, continue to discuss their “(not so) favorite things” about OCD. To set up the theme, Lauren sings, “Raindrops on roses and whiskers on kittens.” Kelley adds, OCD can be a “pain in the rear, reindeer”! In this episode, Kelley and Lauren cover the “not so favorite” experiences of mental compulsions.
Lauren shares that her mind loves mental compulsions – particularly ruminating. It’s her mind’s “favorite thing”. She is not alone. People listening to the podcast agree by sending lots and lots of hearts in a sign of recognition.
A discussion about ruminating would not be complete without a definition of Pure O.
So what is Pure O? Kelley explains is a phrase coined by Dr. Steven Phillipson. People were being seen for OCD, but not presenting with clear physical compulsions like hand washing, counting, etc. What goes on with Pure O are mental compulsions that people typically don’t see. Of course, in the end, OCD is OCD no matter what you call it. People’s compulsions just look different. Lauren agrees and says subtypes are a shortcut and used as a way for people to understand OCD.
Lauren asks, “how do we determine what’s an obsession and what’s a mental compulsion?” The short answer is: anything we are trying to figure out is probably a compulsion.
Kelly sarcastically notes:
“So when a thought pops in and says, hey, you aren’t busy today? Oh good, because for the next 8 hours we’re really going to try and solve whether or not this is really a real universe or an alternate one or solve the mystery of your sexual orientation.”
Kelley Franke, LMFT
Lauren responds:
“The thought will continue to pop in for the next 8 hours but whether or not you spend a lot of time looping over it and trying to figure it out is your call. You can decide to say to the thought, “hey buddy, I see you are still alive. Thanks for checking in, great job!”, and you can go back to doing something you value. There’s so much freedom in that choice.”
Lauren Rosen, LMFT
Lauren and Kelley talk about problem-solving vs. rumination.
Problem-solving is something most people get rewarded for.
Yes, whether the typical mind, generalized anxiety or OCD…everyone ruminates to a varying degree. However, in generalized anxiety the term used is usually “worrying”. Worrying is not helpful, but problem solving can help.
“The difference between problem solving and rumination is that problem-solving is geared toward actionable steps. Generally it’s time limited, while rumination is not time limited; you can do it forever. In terms of rumination or active worry, it’s when you are going over and over the same information and there really is no answer to be found. For example:
– Am I in the right relationship?
– Am I actually living in reality?
-What if I’m bisexual?
Lauren Rosen, LMFT
Questions related to general anxiety can seem rational.
“What if my child has covid, will she have to stay home for the next two weeks? How will I work? This seems like a rational concern, but this rumination is not helpful. Problem solving, on the other hand, might look like: I need to get her tested, and I have to send the test back, and I need to allow for the feelings of fear to be there.”
Kelley Franke, LMFT
Considering whether or not a behavior is helpful is really important when it comes to determining whether a behavior is compulsive or productive.
You can simply ask yourself “is this helpful?”
“Basically what OCD does… what Generalized Anxiety Disorder does is say: “Listen, let’s spend a bunch of time trying to figure out something; you’ll always be a moment away, a breath away from ‘the’ answer and in the meantime you’re going to ignore all of the things that actually probably do need your attention because you’re too busy trying to figure out this thing that has no answer.”
Lauren Rosen, LMFT
Mental compulsions manifest in ways other than rumination. For example:
– Worrying: will this happen, won’t this happen
– Checking, counting, praying
– Reviewing: reviewing the past and compare to the future
– Over analysis: Analyze every single thing. Figure out why you were triggered and find meaning in it.
– Rehearsing
Kelley and Lauren talk about the actual definition of rumination which involves an animal chewing their food, swallowing it and regurgitate it in order to chew it some more. Like a cow.
The gold standard treatment for OCD is exposure and response prevention. Response prevention involves dropping unhelpful behaviors – including mental ones.
“So, what we are asking you to do, is to say – and every cell in your body is saying we ‘have to figure this out,’ because this could mean (fill in the blank: your identity, your current state of your life, your partner choice, your mental health, your physical health –[something is wrong. Figure it out!) And we’re saying don’t do that, don’t figure it out. That’s a tall order and really hard to do”
Kelley Franke, LMFT
“We’re not saying that it doesn’t make sense to briefly reflect on “is there anything to this or is this the random thing that just popped into my brain today?” And if there are no strong facts that suggest you spend a lot more time on it, then we’re saying, at a certain point, it doesn’t make sense to keep going with it. That’s just going to detract from you’re life. And it’s going to make you more dependent on that behavior too.”
Lauren Rosen, LMFT
Q&A
At the end of every podcast Lauren and Kelley go into depth answering listener’s questions. Below are those covered during this episode.
Question 1:
What should the ultimate goal of treatment be? Thought stopping? Managing your thoughts?
(The short answer to the question of thought stopping is no. You can listen in for more details)
In their answer, Kelley talks about a time when she and Lauren went to see Yongey Mingyur Rinpoche – a Buddhist monk – speak. When he spoke, he discussed his personal experience with panic He was saying how no matter what he tried to do to get rid of panic it was just constant. If he ran up a hill, panic followed. When he came down the hill, panic followed. Finally he came to this confusion: “I have to welcome panic, I have to let panic in, I have to have tea with panic.”
You can read more about Yongey Mingyur Rinpoche here.
Accepting the presence of thoughts and feelings is really the goal of treatment we are talking about. Sometimes you have to do all of these safety behaviors before you hit rock bottom and finally decide “all right, I’m going to do it the way all of these ‘experts’ are saying I have to do it, and see what happens.”
Question 2:
I notice the thought, then do I purposely redirect to something totally random?
Lauren says, “It doesn’t need to be totally random. If we are redirecting toward anything, almost grasping, trying to put our attention somewhere else, I would be suspect of some potential for sneaky thought stopping and trying not to think about it, which is not the idea. The idea is redirecting toward something that matters to you more than rumination So that might be a tv show, which somebody might think is random, but it’s more important for me to relax and watch my television show then to figure out whether or not I’m living in an alternate reality. So, thank you brain, I’m back to the tv show. And then you’re watching the TV show for 20 seconds and then all of a sudden there’s this other invitation to come back and figure it out. And you’re like “Ooooh, ok, and back to the TV show.”
Kelly says, “Accept it’s going to be really hard… but you are capable of doing it, you just have to be willing to experience that hot shot of anxiety.”
Lauren: Right to the amygdala. Right there. Pow.
Kelley: Straight to the old brain gonads… Initially it’s going to be very challenging… it’s going to be you building a muscle and that’s just going to take time.
Question 3:
A therapist asks: with ERP should the goal be complete lack of compulsions or is reduction ok?
Kelley: “I think we would both say there is no possible way that somebody is going to be totally free of compulsions. That’s just not possible…The average person is going to ruminate…There is a lot of behavior that gets pathologized in OCD treatment. So if you are a treatment provider who treats OCD and doesn’t have OCD… Oftentimes people be like “well that’s a compulsion. That’s a compulsion” Not everything is a compulsion!”
Question 4:
How do you know if ruminating is part of OCD?
“We know it is because the behaviors that are done in rumination… [are] trying to actually, directly solve for or get rid of, neutralize [the obsession].”
Kelley Franke, LMFT
When in doubt, get assessed by a Therapist.
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