We all have random thoughts that pop in and out of our minds. For most of us, these thoughts do exactly that, pop in and pop out, and we are able to move on with our day. For people who struggle with an anxiety disorder, and especially those who struggle with Obsessive-compulsive Disorder (OCD), getting a thought to “pop back out” of your head is much more difficult.
Obsessive-compulsive Disorder is characterized by unwanted thoughts, images, or urges (obsessions) and behaviors the person does (compulsions) to try to minimize how upsetting these obsessions are to them. People with OCD have trouble recognizing thoughts as random and not a priority to act on. One example is: I have the unwanted worry thought that my house is going to burn down. Every time this thought pops into my mind, I check the stove to make sure it’s off. This works to reduce anxiety in the short term – right after you check the stove you’re reassured that it’s off, and anxiety goes down! In the long term, however, this reinforces more and more “checking” because the person learns the only way to cope with the distress from that worry thought is to do the checking behavior.
The most effective treatments for OCD symptoms are Exposure and Response Prevention (ERP), and/or medications (typically a class of antidepressants called SSRIs). In ERP, a client will create a hierarchy of worries and, along with their therapist, will be exposed to those worries without engaging in the compulsive response behavior (i.e., they worry about the house burning down, but don’t check the stove). By doing this repeatedly, they give themselves the opportunity to see that there are a lot of different outcomes that can come from that worry thought. For example, if they had that thought and didn’t engage in the checking/reassurance-seeking behavior they might learn:
- That they remain anxious for a while, but the house isn’t burning down right now and they’re physically safe
- That their anxiety goes down after 20 minutes, and the house isn’t burning down
- That the house actually is on fire, they smell smoke, and are able to put it out with a fire extinguisher
- There are probably many more outcomes as well!
Some people turn to substances to relieve these worry thoughts. Anywhere from a quarter to a third of people who are struggling with substance abuse meet criteria for a current anxiety disorder. In up to 75% of cases, the anxiety disorder precedes the substance use disorder. These numbers go up even more when considering lifetime likelihood of an anxiety disorder. OCD symptoms are often greatly improved with the right kind of therapy. If you think you might be struggling with both substance use issues and OCD, it’s important to find a treatment provider who can effectively address both.