Issues Treated in Therapy:
Persistent unwanted thoughts that lead to repeated, irrational behaviors are called obsessions and compulsions. For example, some people feel they must wash their hands hundreds of time each day, must count to ten every time they enter or leave a room, must check the locks on their doors repeatedly every night, or must engage in any number of behaviors that have no real purpose other than to manage the anxiety felt when the person does not give in to these impulses.
Obsessive compulsive behaviors are repetitive and ritualistic actions that are motivated by intrusive and compelling thoughts. Some of the behaviors that are characteristic of obsessive compulsive disorder (OCD) are hand-washing, tapping, checking-rechecking door locks, feet wiping, counting before performing actions (opening or knocking on a door), collecting, hoarding, organizing, and arranging things. OCD is a way of coping with extreme anxiety and people who struggle with OCD feel their behaviors help them maintain a sense of control. These behaviors can be so extreme that they interfere with daily life. The rituals of OCD can damage careers, impair daily functioning, and put immense stress on interpersonal relationships.
Sensorimotor obsessions, also known as body-focused obsessions, are often symptoms of obsessive compulsive disorder (OCD). People who experience these behaviors find themselves unable to shift their attention away from the obsessive or compulsive action. They feel as if they are stuck on a particular act, such as focusing on their blinking, breathing, or swallowing. The acute level of awareness of these otherwise involuntary bodily functions can create a debilitating and overwhelming cycle of frustration. Not only do people with sensorimotor obsessions get stuck on these actions, but they tend to over analyze them as well, concentrating on every minute detail of their speech, breath, or eye contact between blinks. These obsessions can cause people to become consumed with the details of their every movement and many times, mental and verbal rituals accompany the cognitive process. People who experience sensorimotor obsessions may count the number of times they blink or may over emphasize positive thoughts while they are obsessing about their heart rate in an attempt to control their pulse. These behaviors lead to increased stress, anxiety, and a decreased ability to function, causing the person to feel even more out of control and unable to shift their awareness away from their obsessions.
Sensorimotor obsession is a form of OCD and can be effectively treated with exposure and response prevention (ERP). This technique addresses the obsession and the ritual so that the client reduces their anxiety and their behavior simultaneously. The process of ERP involves setting a realistic goal, identifying the triggers that cause the anxiety, and confronting the triggers one at a time until they can be managed without rituals or obsessive behaviors.
The treatment of obsessions and compulsions has been researched and written about extensively. Obsessions are present in people of all ages, economic classes, and ethnic groups. Their presence can be an incredible burden, causing shame and frustration, interfering with ordinary life activities, and sometimes causing depression. The behaviors can also interfere with relationships and lead friends and family members to feel very frustrated themselves. OCD behaviors seem to have some chemical component, and can also be triggered or worsened by environmental factors, especially anything that leads to anxiety, fear, or anger. Helping children and adults to express their emotions and relax can be part of an effective treatment protocol.
People with OCD can receive help through various therapeutic approaches. Psychotherapy for OCD usually includes both cognitive therapy and exposure therapy. Exposure is as its name implies and involves exposing the client to the obsession while refraining from acting on their compulsion. This is done in small increments of time initially, and is gradually increased. At each interval, the therapist asks the client to gauge their anxiety and using cognitive techniques, helps the client put their anxiety into perspective. Over time, the client learns that their thoughts are unrealistic and distorted. They develop the tools necessary to cope with their anxiety without resorting to obsessive and compulsive behaviors.
Jason, 14, has begun being teased in school because he repeats himself constantly, and sits down and stands up over and over. When asked why he does this, he cannot explain, and hangs his head sadly. The therapist recognizes obsessive-compulsive behaviors, and investigates Jason’s environment for stressors. It is discovered that his father has an anger problem, and his father is referred for anger management therapy. This lessens but does not eliminate Jason's obsessive compulsive behaviors. A psychiatric evaluation is completed, but the family chooses not to place Jason on medication due to the potential for some troublesome side effects. In therapy, Jason learns to accept his condition, but also gains some relaxation skills, problem-solving skills, and some tools to delay the unwanted behaviors so that they are not embarrassing to him in public. A few years later, the behaviors diminish significantly, and slowly disappear as Jason reaches adulthood.
Ruth, 47, washed her hands every ten or fifteen minutes for as long as she can remember, until she was in her 30’s, at which time her first husband left her and she was forced to get a job outside the home. She learned to control her behaviors, which since then arise only in spurts. She has replaced the hand washing with counting and praying. Lately, the hand washing compulsion has returned and she seeks therapy. The therapist uncovers feelings of guilt and shame dating to childhood. Several months of therapy are needed for Ruth to work through those difficult feelings, and she also accepts an anti-anxiety medication to take when her compulsions are at their worst. Therapy enables her to function reasonably well, and to relax more often.
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Last updated: 05-14-2013
Obsessions and Compulsions / OCD Articles