OCD Recovery Center (Obsessive Compulsive Disorder): OCD: Obsession Inoculation Training

Obsession Inoculation Training

By Dr. Christian R. Komor
OCD Recovery Center

Obsessions are normal thoughts exaggerated with increased duration and intensity. Everyone has unwanted thoughts some of the time. Doubt makes the thoughts stronger. It is important to remember that no matter what the content of the obsessive thoughts, people with obsessions are very unlikely to actually carry out the negative ideas themselves. Obsessions do not have anything to do with the character and morals of the person or what is really happening or about to happen in a person's life. Always remember that obsessive thoughts don't really mean anything - they are just static from the striatal area of the brain. Do not judge yourself because of the obsessive thoughts or search for meaning in them. Obsessions are stimulated by anxiety and anxiety is stimulated by the brain as well as other events like sleep, diet, exercise, stress, etc.
Obsessive tendencies tend to be cyclical based on life-phase, environmental stressors, and even season of the year. Most people with obsessive tendencies do not totally eliminate that part of their personality, but it is possible to reduce the obsessions in strength and frequency so that they are not bothersome.
Performing compulsions to try and take away the obsessive thoughts only tend to make them stronger. (See number 6 below.)
Our main task in dealing with obsessions is to separate ourselves mentally from them. To see that we have obsessive thoughts, but we are not our thoughts. A good way to start this process is by writing down your obsessions in list form, rating their intensity, listing what comes before the obsession (A "trigger".) and what comes after the obsession (A "neutralizing strategy".)
Becoming aware of obsessions, when we have them, what triggers them, what course they take and how they lead us to behave is the initial step.
The primary skill needed to transcend obsessions is to shift your focus inward (through centering, physical techniques, etc.) and then actively relax.
Think of obsessions like quicksand. Analyzing the obsession simply makes it worse. The more you focus on them, try to figure them out, struggle against them, etc. the worse they become. Remember that obsessions are not really important. Instead, visualize the obsession like a small cloud - notice it and then let it drift away. Realize that obsessions are of no real consequence - they are "just brain noise".
Seeking reassurance from others people, or in some other fashion, just makes the obsession stronger - or at the very least does nothing to confront the anxiety surrounding the obsession. Be unilateral in dealing with obsessions.
View anxiety as the fuel that causes obsessions to appear. Developing active methods for anxiety reduction tends to reduce obsession.
Give yourself the opportunity to feel the anxiety that comes up when you are confronting an obsession. This is very important. If you do not give in to an obsessive thought your anxiety is almost certain to rise. This is normal. Watch the anxiety and allow it to be there. It will gradually drop over 20 to 60 minutes and this is how real positive brain change happens.
Apply the 3-Second Rule. If you are tempted to obsess about a body sensation, thought, or other item allow yourself 3 seconds to think about it. Then redirect your attention to something closely related (e.g. another body sensation). Finally, redirect your attention to something else you would like to do or think about. This is sometimes called "selective attention".
Obsessions are "projections" of our self into the past, the future, other people, etc. Focus on the present and what you are doing and this diminishes the hold obsessions will have over you.
"Centering" is an excellent mind-body tool for keeping the focus on ourselves and not projecting. Centering involves focusing attention on the geographic center of the physical body - known as the "hara" in Japan.
Sometimes obsessions can be the result of blocked emotions. If you suspect this is the case, find a safe way to feel and express feelings (tears, anger, fear, grief, etc.). For people with OCD this is not usually the whole answer however.
Focus on your positive circumstances or behaviors rather than the obsessions and what might be "wrong". A good way of doing this is by making a "gratitude list" at the end of each day - listing what you are grateful for in your life.
Provide yourself with rewards and positive feedback for any and all progress dealing with obsessions. Remember, obsessions can be very, very strong and powerful. Be kind to yourself.
Encourage in yourself a "Just be and don't think." approach on a continual basis. Obsessions live in the mind. Redirect your attention always to experience versus thoughts.
If you are having trouble getting free of an obsession, try changing the setting. Take a day off and go to the beach, grandparents, visiting friends, hiking, etc. Make note of positive changes experienced and take these experiential learning's back to the regular routine.
To combat obsessions give yourself some time each day to practice "Non-doing". This means just sitting without any purpose or activity and working to just be aware of sitting and experiencing your environment with your five senses.
Saying "No" to shoulds tends to lead us away from obsessions. Giving ourselves freedom of choice and the ability to listen to our own desires is the opposite of obsessing.
Sometimes obsessions can be the result of difficulties with memory. Explore if this might be the case for you. If so, develop memory tools to assist you.
Keep in mind some helpful words and phrases: Relax. De-escalate. Disinhibit. Spontaneity. Detach. Let go. Accept. It's ok to have things be imperfect. Lighten up! Say "So what!". Live in the now.
Here are several additional specific techniques for overcoming obsessive thinking. These are particularly helpful for what is known as "obsessional slowness" and for times when you "get stuck".
- The Head Shake Technique. If you find yourself obsessing simply shake your head as if you were shaking the thought right out of your head.
- Thought Stopping. When you notice yourself obsessing actually shout, "STOP" in your head and then move on to another activity or direction. This is different than trying not to think about an obsession - which only makes the obsession stronger. Rather it is interrupting the obsessive process.
- Ritual Delay. This involves delaying acting out a compulsion, which will reduce your anxiety about an obsession. For example, waiting 60 minutes and then asking yourself if you need to do the neutralizing ritual or if the obsession is "just brain noise" to be ignored.
- Massed Imaginal Exposure. Develop your own script of the worst fears you obsess about. Read the script onto an audiotape and play it for 30-60 minutes. Note your anxiety level (0-100) when you start and keep at it until the anxiety goes down by 50% or more. Feel the anxiety and don't do any behaviors to avoid it.
- Rubber Band Technique. Place a rubber band on your wrist and snap it when you notice yourself obsessing. Can be used in conjunction with Thought Stopping.
- Shadowing. Follow someone your trust through a behavior that has been difficult for you due to obsessing. This can sometimes break you through the mental barriers caused by the obsession.
- Thought Backtracking. When you notice yourself on an obsessive train of thought, think of the though like a train and reverse the direction. What was the thought you had before the current one? What was the one before that? What was the initial thought that started you off? When you get back to something involving your five senses and real, present-time experience stop and enjoy that.
- Slow Motion Focus. If you tend to have physical obsessions - getting stuck in a particular behavior - try going very, very slowly. For example: Put in the key...wait...turn the key...wait...pull the key out...wait...turn the knob slowly...wait...open the door slowly.

* Additional helpful information on overcoming obsessions can be found in the books: The OCD Workbook (2000) and OCD and Other Gods (2000)