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Constructing a treatment plan that emphasizes ERP can include three styles. This would include exposing to actual objects, situations, or environments where unwanted violent thoughts may arise. It may include doing exposures with sharp objects, or being alone with a triggering person, or standing close to someone near a ledge. The point of all of this theater is to show the brain that you are capable of removing your safety barriers, having the thoughts and feelings you believe you need safety from, and resisting compulsions anyway.

You might feel like Harm OCD is the downside of creativity, but nonetheless your creative mind can be used as a major asset in your treatment. Imaginal exposures may include writing stories scripts describing your fears coming true and you having to cope with the consequences. Watching triggering videos or reading triggering stories while imagining yourself in the circumstances can also be useful.

But this only works if you do it without the intention of reassuring yourself. Many Harm OCD thoughts are connected to internal physical and emotional states that trigger concern about the unwanted violent thoughts.

Obsessive Compulsive Disorder Practical Tried And Tested Strategies To Overcome Ocd

For example, feeling angry or over-stimulated may make you feel less controlled, and this sense of reduced control may trigger your obsessive fear of acting violently. Strategies aimed at generating these internal states could be as simple as jogging in place to increase your heart rate or listening to an audio clip of someone yelling to make you feel tense. Your most effective ERP is going to involve a variety of the above approaches, as well as combinations of these styles done at the same time.

Before you conclude that OCD therapists are just training secret squads of suicide clubs and serial killers, remember the following guidelines, which create the essential conditions for effective ERP. Mindfulness is a word used to describe a perspective we take when we are observing the present moment as it is instead of being distracted by our ideas of what it could be.

Intrusive thoughts are, by the very nature of them being perceived as intruders, major distractions from the present moment. Developing mindfulness skills is therefore useful both in rolling with the day-to-day experience of having unwanted thoughts and with resisting compulsions in the midst of doing ERP.

The unfortunate truth is that many people still do not have access to accurate information about OCD from a trained specialist in the disorder. You can increase the success rate by making sure the therapist you choose is trained in treating OCD, but still your first act of courage and your first exposure is asking for help. Harm OCD is a common and treatable manifestation of the disorder and with the right tools, you can develop mastery over it.

ADAA is not a direct service organization. ADAA does not provide psychiatric, psychological, or medical advice, diagnosis, or treatment. For the Public For Professionals. Overcoming Harm OCD. Like any form of the disorder, the thoughts often arise as what-if questions, such as: What if I impulsively commit an act of violence against someone? What if I lose control and harm or kill myself? What if I harm or kill my child or someone else I care about?

What if I harbor a violent identity and I am going to act out in the future? Here are some compulsions common to Harm OCD: Avoidance of triggering people or pets that trigger harm thoughts of objects knives, chemicals, medication, etc. Start the process of Refocusing by refusing to take the obsessive-compulsive symptoms at face value.

Obsessive compulsive disorder (OCD) - causes, symptoms & pathology

Say to yourself, "I'm experiencing a symptom of OCD. I need to do another behavior. You must train yourself in a new method of responding to the thoughts and urges, redirecting your attention to something other than the OCD symptoms. The goal of treatment is to stop responding to the OCD symptoms while acknowledging that, for the short term, these uncomfortable feelings will continue to bother you. You begin to "work around" them by doing another behavior. You learn that even though the OCD feeling is there, it doesn't have to control what you do.

You make the decision about what you're going to do, rather than respond to OCD thoughts and urges as a robot would.

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By Refocusing, you reclaim your decision-making power. Those biochemical glitches in your brain are no longer running the show. Refocusing isn't easy. It would be dishonest to say that dismissing the thoughts and urges and moving on does not take significant effort and even tolerance of some pain. But only by learning to resist OCD symptoms can you change the brain and, in time, decrease the pain. To help you manage this task, we have developed the fifteen-minute rule. The idea is to delay your response to an obsessive thought or to your urge to perform a compulsive behavior by letting some time elapse--preferably at least fifteen minutes--before you even consider acting on the urge or thought.

Psychotherapy for OCD

In the beginning or whenever the urges are very intense, you may need to set a shorter waiting time, say five minutes, as your goal. But the principle is always the same: Never perform the compulsion without some time delay.


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Remember, this is not a passive waiting period. It is a time to perform actively the Relabeling, Reattributing, and Refocusing steps. You should have mindful awareness that you are Relabeling those uncomfortable feelings as OCD and Reattributing them to a biochemical imbalance in the brain. These feelings are caused by OCD; they are not what they seem to be. They are faulty messages coming from the brain. After the set period has lapsed, reassess the urge.

Ask yourself if there's been any change in intensity and make note of any change. Even the smallest decrease may give you the courage to wait longer. You will be learning that the longer you wait, the more the urge will change.

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Obsessive Compulsive Disorder: Practical, Tried-and-Tested Strategies to Overcome OCD, 2nd ed.

The goal will always be fifteen minutes or more. As you keep practicing, the same amount of effort will result in a greater decrease in intensity. So, in general, the more you practice the fifteen-minute rule, the easier it gets. Before long, you may make it twenty minutes or thirty minutes or more. It is vitally important to Refocus attention away from the urge or thought and onto any other reasonable task or activity.

Don't wait for the thought or feeling to go away.

Obsessive compulsive disorder - family and friends

Don't expect it to go away right away. And, by all means, don't do what your OCD is telling you to do. Rather, engage in any constructive activity of your choosing. You'll see that instigating a time delay between the onset of the urge and even considering acting on it will make the urge fade and change. What is more important, even if the urge changes hardly at all, as sometimes happens, you learn that you can have some control over your response to this faulty message from the brain.

This application of mindful awareness and the Impartial Spectator will be empowering to you, especially after years of feeling at the mercy of a bizarre and seemingly inexplicable force. The long-range goal of the Refocus step is, of course, never again to perform a compulsive behavior in response to an OCD thought or urge. But the intermediate goal is to impose a time delay before performing any compulsion.


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  • You're learning not to allow OCD feelings to determine what you do. Sometimes the urge will be too strong, and you will perform the compulsion. This is not an invitation to beat yourself up. Keep in mind: As you do the Four Steps and your behavior changes, your thoughts and feelings will also change. If you give in and perform a compulsion after a time delay and an attempt to Refocus, make a special effort to continue to Relabel the behavior and to acknowledge that this time the OCD overwhelmed you.

    Remind yourself "I'm not washing my hands because they are dirty, but because of my OCD. The OCD won this round, but next time I'll wait longer. This is very important to realize: Relabeling a compulsive behavior as a compulsive behavior is a form of behavior therapy and is much better than doing a compulsion without making a clear mental note about what it is.

    A tip for those who are fighting checking behaviors--checking locks, stoves, and other appliances: If your problem is, say, checking the door lock, try to lock the door with extra attention and mindful awareness the first time. This way, you'll have a good mental picture to refer to when the compulsive urge arises. Anticipating that the urge to check is going to arise in you, you should lock the door the first time in a slow and deliberate manner, making mental notes, such as "The door is now locked.

    I can see that the door is locked. It is OCD. You will remember, "It's not me--it's just my brain. You will Refocus and begin to "work around" the OCD urges by doing another behavior, with a ready mental picture of having locked that door because you did it so carefully and attentively the first time.

    You can use that knowledge to help you Refocus actively on doing another behavior, even as you Relabel and Reattribute the urge to check that has arisen, as you anticipated it would. It is important to keep a behavior-therapy journal as a record of your successful Refocusing efforts.