We’ve already covered medication and Exposure and Response Prevention as treatments for OCD. But there are other treatments too that also are helpful.

Cognitive techniques work well in combating OCD. I often begin work with an obsessional person by explaining the four-step, self-help program of Dr. Jeffrey Schwartz, author of Brain Lock. Step One is to LABEL obsessions as such. Dr.Schwartz teaches that obsessional (weird, irrational, often torturous)thoughts are OCD thoughts, the product of a neurological disorder. Labeling is important because it allows you to separate OCD thoughts from your own thinking. Step Two is to ATTRIBUTE. It is here you explain to yourself why you have these thoughts. The answer: people with OCD have some skewing in their neurology, causing the brain’s circuitry and alarm system to be overactive. In other words, people with OCD get the thoughts they do because their brains are not processing information properly. Due to this improper functioning, their brains offer up false (OCD) thoughts.

The third step in Brain Lock is DISTRACTION. OCD thoughts are relentless in their determination to get your attention. It is up to you to distract yourself with an activity that is intriguing. OCD thoughts will not hang around for long unless you give them attention. So, refusing to give attention to your OCD thoughts is essential. And the only way to do this is to distract yourself. The fourth step is to REVALUE. Here, you tell yourself the the messages that cause you so much pain are false, the result of a medical condition and not worth any attention. Telling yourself that you are going to stab your children or contract AIDS from touching a table has no more validity thab telling yourself you are really a rhinoceros.

I call another technique, which I have found successful with my clients, ‘PIGGY-BACKING REALITY.’ I explain to my clients that because of their neurological problems, it is understandable that they are flooded with false, scary messages. Further, I explain that they buy into these false messages because their warning system (meant to alert them to danger and causing them to panic) is activated falsely. Translated, OCD sufferers are bombarded with repeated, terrifying thoughts while their bodies respond as if they are in horrific danger. Because they feel terrified, they believe their thoughts must be real. People with OCD cannot evaluate OCD thoughts logically, at least without a lot of training. Piggybacking reality teaches them to ask how a person without OCD would evaluate a thought. For example, a person with OCD might go over a bump while driving and fear that he has hit someone, causing him to turn around repeatedly to check. To attack this fear, I teach the person to piggyback. The person chooses someone without OCD who he trusts greatly, and metaphorically, puts that person on his shoulder. When hit with an OCD thought, the person asks himself how the person on his shoulder would evaluate the situation. In the situation above. the shoulder person likely would say, “If I hit someone, I would know it.” Taking it further, the person on the shoulder would say, “If I hit someone I would have heard something, seen something, and felt something. I certainly would not turn around.” Because the person with OCD is piggy backing his reality onto the reality of the person on his shoulder, the person with OCD will not turn around.

Reality Testing is another technique that is helpful. As I talk about in If I Could Just Snap Out of It, Don’t You Think I Would?, reality testing means asking yourself how likely it is that an event occurred or will occur. Further it asks what evidence you have for believing this and whether others, who do not have OCD, would interpret your evidence as you do. For example, suppose your jacket brushes by a wall and you notice that there is some dried blood on the wall. Immediately, you worry that you could have contracted AIDS from this blood. Reality testing will have you ask questions such as: What is the liklihood that you could contract a disease from your jacket brushing against blood on the wall? How likely is it that the blood contained the AIDS virus? If the blood was dried, how likely is it that a virus could still be transmitted? How can you contract something via the wall passing it onto your jacket? Would other people who do not have OCD worry about this?

Time Delays are another good technique. Here, when you have an obsession, you determine that you will wait a certain amount of time before engaging in a ritual. For example, perhaps you are obsessing that maybe you said something off-color to the priest. Rather than immediately checking with your sister who was with you when you spoke to the priest, you determine to wait at least ten minutes before checking with her. The idea here is that when the ten minutes is up, your obsession may have worn off. If it has not, try to delay you checking for another ten minutes. Then repeat the process.

Watching your OCD morph is also very helpful. People with OCD believe that they are really worried about whatever their current obsession might be. But this is not true. The fact is that once they hold out and give this obsession enough time to pass, another obsession will take its place. Realizing that OCD constantly changes form is helpful because it helps you realize that it is not the particular worry but your neurological condition that has you so upset.