Response Prevention for OCD and Controlling my Compulsions

Following my initial diagnosis of OCD, I was pretty insistent with my therapist that I didn’t have any compulsions. Therefore, I was diagnosed with the “Primarily Obsessional” type of OCD (also called Pure-O). But, as I started to fill out my OCD Workbook, and as I began to mindfully record my actions when I felt a bodily sensation that caused me anxiety, I realized that I had a ton of compulsions. When I’d think of someone with OCD, I’d think of them repeating the same actions, over and over.  But, as I learned in therapy, compulsions don’t always have to be the same activity. 

I also learned that compulsions don’t necessarily indicate a specific action.  Compulsions can also be an “avoidance” activity.

First, the Obsessions

The pages of my OCD workbook had checkboxes that I could select of potential obsessions and compulsions.  From the workbook, here are the obsessions I identified:

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• Excessive fear or disgust in regard to, and preoccupation with avoiding household cleaning agents or chemicals (I noted this one as “maybe mild.”  But, it does bother me when I spray even mild cleaning chemicals wondering if it’s “dangerous” for me to be using it.)
• Excessive fear, worry, and preoccupation with the possibility of having a catastrophic illness despite being told you are healthy
• Excessive fear, worry, and preoccupation with the possibility that you may be responsible for causing or not preventing a potentially catastrophic illness in yourself or a loved one. (I was thinking of my fear of hiking in this one.  That avoiding a hike is a way to prevent a broken ankle and subsequent problems).

Next, Identifying my Compulsions

For my compulsions, I checked the following boxes:

• Checking over and over (despite repeated confirmation) that some aspect of a physical condition, such as appearance, or of health, such as pulse or blood pressure.
• Excessively checking your body for signs of disease (remember the petechiae incident?)
• Spending excessive time on the Internet researching symptoms of catastrophic disease.

Granted, those checkboxes from the workbook are pretty general.  But, once I had a better idea of what OCD was, it was like the floodgates opened helping my identify my own, specific compulsions.

Here are some my specific compulsions I quickly identified after I started paying attention to them:

• Immediately touching the spot that was causing me aches or twinges.  In most instances, I would also push on the spot to see if that caused additional pain.
• If I experienced a pain that seemed to be caused by some specific action, like bending over or laying on my side, I’d repeat that action.  Bend over again and again to see if I’d experience the pain each time.  Roll onto my back and then back onto my side to see if I could recreate the pain.
• Immediately stopping whatever I was doing when I’d experience an unusual bodily sensation.
• Googling my symptoms, sometimes for excessive periods of time, and reading online forums about people experiencing the same symptoms.
• If the pain or ache was in the evening, I would frequently pour myself a glass of wine or open a beer to relax from the anxiety I was feeling about my unusual bodily sensation.
• If the pain or ache lasted for a few minutes, I would go lay down and try to force myself to fall asleep to take my mind off the worry, and in the hopes that when I’d wake up, the pain would be all gone.  This one was continually reinforced because more often than not, I would, in fact, wake up with the pain gone.

This next one is a bit gross and deals with bathroom-related things, so if you have a weak stomach, I’d skip this one:

• After going to the bathroom, I’d spend a several seconds looking at the toilet bowl, inspecting whether I thought my urine or stool “looked normal” before I would flush.

I wouldn’t do each of these compulsions for every ache or twinge.  Sometimes it was just one or two.  Sometimes, it was several. The only two compulsions that I did fairly consistently were immediately touching or pushing on the spot causing me pain, regardless whether it was in my abdomen, arm, or forehead; and immediately stopping what I was doing to concentrate on the pain. Sometimes that pause was only for a few seconds. Like if I was in the middle of typing something, or cooking dinner, I would immediately stop what I was doing to “process” the pain sensation.

Avoidance Behaviors

I also learned that compulsions included avoidance behaviors. As I went through my therapy journey, I was able to identify a lot of things that I avoided in the name of my OCD and health anxiety.

• I avoided sitting and playing on the floor with my nieces and nephews for fear that when I’d stand up, I’d twist myself in such a way that I’d get a hernia or pull a muscle in my back causing permanent damage.  Even though I realize hernias are generally easily treatable, I’d start catastrophizing. (A hernia means surgery. Surgery can mean complications. Complications can mean death!)
• I avoided wearing tight fitting clothes, like tights or shapewear. The waistbands of tights always seem to dig into my abdomen, and I would occasionally have some residual pain the following days.  The pain is always very minor and can very clearly be linked to the tights, but since I hate feeling any sort of discomfort, I stopped wearing them.  I always worried that I might be misattributing the source of the pain. For example, maybe it WAS something serious, but I would be ignoring it thinking it was just from the shapewear or tights I wore the previous day. Since I wouldn’t wear tights, I never wear skirts or dresses in the winter either.
• I avoided hiking or other things were I had even a slight chance of hurting myself.  I even didn’t enjoy taking baths anymore because I was afraid I would slip and fall getting out of the tub, breaking a bone or hitting my head.
• I avoided going to the gym because the slight muscle soreness that would occur the next day would drive up my anxiety levels, thinking I might have damaged a muscle permanently, or worse, that I actually had something seriously wrong with me, but I was just mistaking it for muscle pain, much like my infected gallbladder incident that began this whole hypochondria thing.
• I would immediately stop doing any activity, even something as simple as cleaning the house, if I felt an ache or pain.  I didn’t want to “exacerbate” the pain by straining myself too much.  So, I’d avoid any sort of movement or physical activity after experiencing an ache or pain.

No, Googling my symptoms actually HELPS me.

In therapy, I learned that acting out the compulsions simply feed my anxiety and my obsessive thoughts.  In other words, although I thought that thinks like avoiding wearing shapewear, avoiding hikes, or Googling my symptoms made me “feel better,” it wasn’t.  It was actually making my anxieties worse.  So, in order to get control of my obsessive thoughts, I’d need to control my compulsions.

I spent a lot of time talking to my therapist one session about Googling symptoms.  I told her that a lot of times I find it helpful and soothing.  I recalled one time that I was hearing a strange rustling sound deep in my ear.  I was certain that a bug must have crawled in my ear in the middle of the night. I Google all sorts of related terms.  “Rustling noise in ear.” “What to do for bug in ear.”

And, my anxiety eased, because nothing seemed to indicate that this was any sort of life threatening, get-in-the-car-right-now-and-go-to-the-ER symptom.  With that knowledge, I was able to roll over and go back to sleep.

In another circumstance, I woke up one morning with an incredible pain in my right hip.  Like, almost severe enough that I was considering going to the ER (and remember, despite being a hypochondriac, I do not run to the doctor for every ailment).  However, the hip pain was only severe when I would first stand up.  As soon as I’d start walking, it would be fine.

So, I Googled something like, “severe right hip pain.”  And there were zero instances in which severe hip pain was something that would require immediate medical attention.  Sure, bone cancer was a result on there, but even for a hypochondriac like me, I was pretty sure that bone cancer symptoms didn’t just magically appear overnight.  So, I was able to calm myself about my hip pain, took some Advil, and by morning it was gone and it has never come back like that again.

I had these “positive” instances of googling my symptoms to reinforce to myself that researching my symptoms could often be a positive thing.

Learning to Control my Compulsions

I have to admit, I was extremely skeptical that “controlling my compulsions” would do me any good. Since I never really noticed my compulsions prior to starting therapy, I didn’t think they played much of a role in my health anxiety and hypochondria.

But, I figured, I had started (and was paying for) therapy in order to help myself get better and to stop constantly worrying about my health. So, I was going to try everything that the doctor recommended and every little task in the accompanying workbook.

Wow, this is Really Helping!

I must say, I was shocked at the outcome. Controlling my compulsions helped me far more than I ever thought. It wasn’t overnight, but, it happened.

Within two months of actively controlling my compulsions, I estimated that my health anxiety OCD (hypochondria) had improved by probably close to 75%.  I really couldn’t believe it.  All this time, nearly a decade of worrying about my health, and THIS was all it took to get a dramatic improvement???

Don’t get me wrong. Despite my efforts to control my compulsions, an ache or twinge would still cause me an immediate moment of anxiety.  But, I was able to move on from it more quickly compared to before.  Previously, I would have obsessed probably all day about one quick little jab or ache that had only lasted an instant. Within about two months of controlling my compulsions, I realized that I would move on from that moment of anxiety much more quickly. So, yes, in that moment of the jab or ache, I would still get anxious.  But, I was no longer dwelling on it all day long. (And it got even better as I started to implement more CBT techniques)

Actions I Took to Improve my Health Anxiety and OCD

For those wondering, here is what “controlling my compulsions” involved:

• I stopped Googling my symptoms, cold turkey.  Even if I thought for sure that it would help ease my anxiety, I don’t Google them.  If it’s something I’m worried about, I’ll make a decision about whether to go to the doctor.  At this time of writing, I have not Googled a single symptom in nearly 18 months. At first, it was difficult.  But now, it really doesn’t even occur to me to Google a symptom.  I have made an agreement with myself though. If I ever am diagnosed with a real ailment, I will allow myself certain restricted times to Google the ailment so that I can remain an informed patient.  This scenario has never arisen though, but I know it’s there as an exception that I’ll allow to my No Googling rule.
• I stopped touching, pushing, or pressing on any spot that was causing me pain.  This compulsion ended up being a lot more difficult to control. It was almost instinctual and mindless. I’d feel an ache and my hand would be there. This took several weeks to get control of. And even today sometimes I find my hand reaching for some spot that is bothering me.  I just bring my hand back and tell myself, “Do not act out on your compulsions. That just feeds your OCD and anxieties.”
• I stopped doing things like laying down at home when I started to have anxious thoughts about some sort of twinge. That was always a go-to activity when the situation would allow it (like when I was at home).  I figured if I could take a quick nap, it would take my mind off the worry.  So now, when I feel a bodily sensation that causes me anxiety, I just keep doing what I’m doing.  No laying down, no sitting down to watch TV.
• I made alcohol a social-only activity. Prior to seeking therapy, if I had an unusual bodily sensation that was causing me anxiety late in the evening, I’d often pour myself a glass of wine or open a beer, convincing myself that it would help ease the anxieties I was feeling.  After all, I wanted to get some sleep that night, not be up all night worrying about that dull ache in my abdomen. I learned that this is just a different type of compulsion which, despite how it would seem, was feeding my anxiety, not easing it.

And, a few things I didn’t do yet

At the time, I did not try to “force” myself to do any of the avoidance activities that I had identified. I did not make myself go on hikes despite being afraid of breaking a bone.  I did not force myself to sit on the floor despite being afraid that I’d get a hernia or pull my back getting up off the floor.  I didn’t start all of a suddenly going to the gym or wearing shape wear. I took things slow.  Only after several months, I slowly started to integrate avoidance activities into my daily life.  I started going to the gym again instead of avoiding it. I don’t allow myself to overthink getting outdoors and going on hikes.

And, like I mentioned, even just with these few compulsion controls in place, my health anxiety improved significantly. And, compulsion control (referred to more formally as “response prevention,”) was only one part of CBT. I was actually becoming excited to integrate other parts of therapy into my life, and was finally getting hopeful that I could, in fact, be cured.  Or, as they call it, have my OCD symptoms “managed.”