Obsessive compulsive disorder (OCD) can hide in plain sight because it involves common experiences that grow into disruptive, difficult cycles. Just like depression isn’t just sadness, and anxiety isn’t just being a little nervous sometimes, OCD isn’t just liking things clean or organizing things the way you like them.
The OCD cycle: a cycle of caring and compulsion
OCD creates a cycle, where someone experiences recurring intrusive thoughts, impulses, or doubts, also called obsessions. These thoughts are often about something the person with OCD both cares deeply about and doesn’t want to have happen. Some examples include getting sick, a relationship ending, their loved ones getting hurt, accidents, disasters, etc.
In response to these intense obsessions and the anxiety they bring up, someone with OCD will start to perform rituals to try to soothe this anxiety. This cycle of obsession-anxiety-ritual becomes a consistent response, escalating to the point where it gets disruptive.
What are OCD rituals?
First, let’s look at what an OCD ritual actually is. Because of the anxiety that obsessions bring about, and the deep desire to make sure bad things don’t happen, someone with OCD will develop rituals to help soothe the anxiety and try to prevent the outcome the intrusive thought brings up. Someone may worry about their child’s safety at school, so every time they hear a song their child likes, they have to listen to it all the way through. Or they may be scared they might get their family sick, so they repetitively wash their hands and check their temperature.
Some of these rituals are purely thought-based. Avoidance, like not leaving the house because you might catch a cold, or rumination, where you try to prevent harm by going over a situation again and again in your mind, are both examples of thought-based OCD rituals.
OCD rituals can include:
- Repetitive thoughts
- Rumination
- Counting
- Repetition
- Checking over and over again
- Arranging things repeatedly
- Seeking reassurance
- Doubting
- Excessive cleaning
- Avoidance
- Hoarding
Why does OCD lead to rituals?
OCD obsessions can be highly compelling and highly disturbing; OCD attaches to what you most care about, after all! People with OCD often have heightened empathy and find the idea of the suffering of others (and themselves) more distressing than people without OCD. That makes these obsessions particularly anxiety-inducing, and they can be intense.
Rituals often provide some soothing of that anxiety, but they only bring about temporary relief. Rituals often escalate, becoming more frequent or more elaborate. The need to perform these rituals can become more intense, and it can be very hard to let go of rituals when you have OCD.
When you have OCD, this constant cycle of intensifying obsessions and intensifying rituals can feel permanent, and disrupting the OCD cycle can feel dangerous and threatening. You may find yourself wondering how to stop OCD rituals. Is it even possible?
Thankfully, you can safely disrupt the OCD cycle with the support of a Long Island ExRP therapist (especially one dually trained in DBT therapy). You can still be a caring, careful person, while also letting go of rituals and using dialectical behavior therapy (DBT) skills to make sitting with obsessions easier.
Why does OCD lead to rituals?
The most common treatment for OCD is called Exposure and Ritual Prevention, or ExRP. At our Long Island therapy office, we offer ExRP therapy for people with OCD, but we also know that having as much support as possible is invaluable when working on your mental health. DBT can offer just that support, with skills that make it easier to cope with the anxieties of OCD, so you can stop performing rituals.
DBT therapy for OCD
The four pillars of DBT therapy—mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance—all offer life skills that can help you experience obsessions and anxiety, while still avoiding rituals.
Mindfulness for OCD
Obsessions pull the mind away from the present moment, and into doubts, what-ifs, and potential problems. Focusing your mind by pulling your attention back to what’s happening around you, and within you, in the moment can help you cope with the anxiety that obsessions bring up.
Noticing that you’re experiencing a compelling obsession, that it’s making you anxious, and that it’s a thought in your mind, not a reality you must respond to, can make it easier to stop and consider whether a ritual is worth it in the moment.
Mindfulness in DBT also encourages non-judgment over thoughts and feelings; keeping an open mind about your mind. People can judge themselves harshly for experiencing obsessions. With mindfulness, you can look at your thoughts and feelings without judgment, it becomes easier to sit with them even when they’re difficult or disturbing.
Emotional regulation
The four pillars of DBT therapy—mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance—all offer life skills that can help you experience obsessions and anxiety, while still avoiding rituals.
OCD and interpersonal effectiveness
One common OCD ritual is reassurance seeking, including asking others to reassure you over and over. DBT can teach you how to set strong boundaries for yourself around reassurance seeking, and to support others in your life in setting and defending boundaries around providing you with reassurance.
If you set a boundary with yourself, for example, that you’ll only discuss something with someone once, or even not at all, when it is an OCD ritual, you can then remove yourself from the situation if you notice you’re compelled to break your own boundary. And for those close to you, encourage them to support your OCD recovery by gently refusing to offer reassurance if they suspect you’re involved in an OCD ritual. These boundaries can support both you and those close to you in navigating OCD rituals without damaging your interpersonal relationships.
Distress tolerance and OCD
Distress is difficult for people with OCD to sit with, both their own distress and the distress of others. Expanding distress tolerance with DBT can make avoiding OCD rituals easier.
The DBT self-soothing skill is a great example; once you’ve used mindfulness to note you’re experiencing obsessions, you can direct your attention toward your five senses, finding soothing things that engage them like enjoyable scents, beautiful scenery, delicious food, or the warmth of the sun. Obsessions make the world feel narrow, and expanding your experience of the world through soothing sensory experiences can help you sit with anxiety without resorting to rituals.
Suffolk DBT can help those with OCD stop the cycle
Suffolk DBT has compassionate therapists on Long Island and in Manhattan well-versed in supporting those with OCD to let go of the need to perform rituals. People with OCD are caring and empathetic, and while OCD can lead to anxiety, self-judgment, and compulsive rituals, therapy can lead you to a life of freedom, where you don’t need rituals to cope. You can break the cycle, and Suffolk DBT is here to empower you with the skills to change your life!
If you’re looking for in-person OCD treatment on Long Island or in Manhattan, Suffolk DBT can help!