Addressing the why behind anxiety & OCD
In a recent podcast, I was asked about why: why people have certain obsessions and compulsions, why do some people have anxiety/ocd and others don’t... I hope to expand and further explain my thoughts about this because it’s super important for both sufferers and their supports. Everyone wants to know why. Here are my thoughts responding to the why’s:
Why do some people have anxiety and OCD and others not?
Many people do not really understand the experiences of people living with anxiety disorders and OCD. Anxiety is not just like anger, sadness or another kind of emotional state. Anxiety is excessive worry. Anxiety is a person’s brain mistaking the idea of danger with actual live danger. Anxiety is physical sensations in the body. Anxiety is doubt. Anxiety is uncomfortable. Anxiety is biological. Anxiety is a normal adaptive feature of all humans. It becomes maladaptive, or a presenting issue in therapy, when it’s getting in the way of: fun and functioning. Anxiety Disorders and OCD are believed to be in both camps of inherited and/or acquired, meaning it can be either/both genetics and life circumstances.
Compelling research of the brain scans of people with OCD show that their brains are literally firing off danger signals more often and rapidly than others (Simon et al. 2014). Anxious brains also have the unfortunately ability to be “over-active” in the area of the brain that processes errors…say like perceiving threats, which is why it’s so hard to just stop being anxious, or slow down when it comes to performing compulsions (Norman et al. 2019).
In my opinion, no one is immune to anxiety and anxiety is not all bad. Sometimes, it’s appropriately felt…and nothing really to do about it except wait it out! It’s when people fear anxiety or become intolerant of feeling it, that it leads to trouble. Regular old anxiety looks like waiting to hear results of a test or job interview, or driving somewhere unfamiliar for the first time, or having to talk in front of a group of unfamiliar people or when something is happening that you don’t really like. There’s nothing wrong with feeling anxious. For many, it gets compounded with self-criticism and makes it stick around way longer. Regular old anxiety can also swing into the obsessional side of things when the feared consequence is more far fetched, and the same worry keeps showing up. Anxiety is bound to show up more often when people are: drinking more alcohol/caffeine, getting bad sleep and encountering stressful situations.
Why certain obsessions/compulsions over others?
People don’t flick a light switch for no reason. For the sufferer who is asking themselves, why this particular idea, theme or topic? Know that your brain is trying to protect you from harm by, ironically, thinking of the scariest sh*t that would bother you. If the stuff you’re thinking about bothers you, it’s a sign that you don’t agree with it (ego-dystonic). There’s no thought or feeling in the world that would make you unlovable or unworthy of getting help. Anxiety & OCD latches on to people’s values. And there’s not a special reason why you were chosen to worry about a particular topic or anything you could have done differently in life to prevent it. I’m sorry you’re suffering and there is hope for recovery. Find your way to an OCD support group or specialist (see below for some websites).
In ERP: Within the ERP model, unwanted thoughts, feelings, images, sensations, and urges are thought to be random…but also related to a person’s value system. So maybe someone is flicking a light switch because they really care about keeping their family safe and this action makes it feel like that’s more possible. Or maybe it just feels right to do that action and there would be a lot of distress if prevented from doing it.
A good ERP therapist is going to help identify what the “core fear” is that drives a person’s worries (check out Yadin’s Underlying Core Fear and Greenberg’s writings on this).
In ICBT: Within the Inference Based CBT model, the why is really at the center of treatment through examining the story that surrounds a person’s doubt. To me, this is the first therapy that really is asking why someone believes their doubt to be true…and most people have a lot of logic and reasoning as to why! Some of the ingredients include: facts, rules, hearsay, personal experiences and it’s possible. So if someone is, for example, flicking a light switch, I might ask them about what they are hoping to prevent happening and what might happen if they don’t do that action. This helps me get toward the doubt itself. If the doubt was “my house might burn down from faulty wiring” and the story was “Well house fires happen (facts), People should turn off their lights before leaving (rules), I read a news article about how an entire apartment building burned down because someone didn’t unplug their straightener (hearsay), One time I flicked the switch and heard an electrical noise (personal experiences) and it’s possible my house could have an electrical problem and burn down (possible)”. With this super juicy story, it’s no wonder the doubt feels so real and potent. In treatment, sufferers learn to identify their own “inferential confusion” about their reasoning process and restore self-trust. So people with Anxiety & OCD likely have stories that fuel their doubt, but it’s really about their self-concept that creates distrust in themselves and attracts a certain kind of story. It’s a very interesting therapy and I highly recommend people learn about it!
To sufferers:
Don’t forget to ask WHY it’s worth it to work on this as a guiding force to managing symptoms: your values and goals in life.
Instead of questioning yourself and second guessing…ask yourself why it’s important to continue working on this? What’s at risk if you don’t? If you could put worry aside, what would you be doing?
To supports:
You don’t have to agree with someone’s anxiety in order to support them. While someone’s anxious thoughts or compulsions might seem ridiculous to others, it’s really not funny. We want to laugh with someone, not at someone, right? I love using humor in life and therapy, but that requires some planning and collaboration to be consensual. For example, when I named my generalized anxiety Veronica…it allowed me to laugh at myself. When I share Veronica with people in my life, they get to be in on it with me. Externalizing anxiety & OCD is a cognitive strategy called Cognitive De-fusion. It essentially allows us to get distance from the thoughts we’re having in order to choose what we do about the thoughts. From a distanced space, people can decide how to act or not act in response. There are some wonderful strategies in Acceptance & Commitment Therapy that help change the person’s relationship to their own thoughts.
If you are reading this and have a loved one in your life with untreated Anxiety & OCD, here are some ways that would be best to support them while seeing their compulsions:
-Maybe ask them at a later time, “Hey, I’d like to ask how best I can support you when I do notice you doing compulsions. Is it better for you to acknowledge it or leave you be?”
-Ask and encourage them to get support from and OCD specialist
-Tell them you CARE about how they are doing and are concerned
-Read and learn more about it
-Get support yourself: empathy is not an endless source for most people!
Hope this helps and if you need more support look at ADAA, IOCDF and ICBT.Online for therapists near you who specialize in anxiety and related disorders.
Best,
Sarah
