CBT for checking behaviours?

[OCDcontrolsme]

Hi!

I'm really struggling with understanding how CBT might work for me with OCD. I just can't get my head round it.

Please if anyone could explain how CBT works with checking behaviours, I'd really appreciate it.

For example, I worry that I haven't closed my window. I know that through CBT I'm meant to fight the anxiety and not check the window is closed. But then how do I know it is actually closed in the first place in order to not check?? Because it genuinely might not be closed. I have forgotten in the past (which led to it being added to my roster of checks!). Am I supposed to mindfully close it in the first place? But then if a sound distracts me, the mindfulness is interrupted and I'm not sure if I closed it. So where do I go from there without checking?

My doctor keeps suggesting CBT again but I've tried it twice now and still don't get how it applies.

[jayb1]

I read about this in one of my numerous self help books and I used this method for a time . get some card in different colours and cut into shapes circle triangle etc and use one coloured shape for each thing you need to check so for example red triangle is window . you close the window go and pick up your red triangle and put it in your pocket or bag . so then when you question yourself you can look and say I've got red triangle so its shut. Eventually in time you don't need the card you just say window red triangle. Try it see if it helps.

[MyNameIsTerry]

Hi and welcome to NMP

With a checking behaviour CBT would likely use Exposure Relapse Prevention (ERP). With this you create a hierarchy of easiest to hardest exposures (and usually a step beyond to ensure extinction has taken place).

So, for a window checking form you could decide to phase out the number of checks you make bit by bit until you don't make any at all. With each reduction you experience anxiety and have to stick with it and resist further checks until the anxiety fades (50% is the typical expected reduction). You keep doing this and move on to the next reduction and repeat. The stage after the final is usually a step that would not be done in normal life by anyone so it can be one for the experience of a therapist as some forms of OCD make this complicated to design but an example would be someone with contamination fears putting their hands down the toilet bowl, something any non anxiety disorder sufferer would never do.

ERP is an exposure method that is based on Pavlovian Conditioning. Pavlov's Dog might be how you know it. Pavlovian Extinction just being the reverse of how to condition to do something. So, it takes Fear Conditioning and turns it to a positive use.

---------- Post added at 05:29 ---------- Previous post was at 05:27 ----------

I read about this in one of my numerous self help books and I used this method for a time . get some card in different colours and cut into shapes circle triangle etc and use one coloured shape for each thing you need to check so for example red triangle is window . you close the window go and pick up your red triangle and put it in your pocket or bag . so then when you question yourself you can look and say I've got red triangle so its shut. Eventually in time you don't need the card you just say window red triangle. Try it see if it helps.

Thats interesting Jay. From what you have described this appears to be replacing one compulsion with another and the second one will still need extinction. Was the aim to change to something that could be neutral, so outside of the cycle, so that the person finds less attachment to it and extinction is easier?

How did you find detaching from the symbols?

[jayb1]

To me it was a way to save having to go back to check numerous times or spend the whole time out being obsessively worried . I switched out to numbers in the end and I'm happy with that ,sometimes it's about finding a way to tolerate it than the pressure of the exposure exercises that you describe. Sometimes the exposure if done too quickly can cause more damage than good

[MyNameIsTerry]

Thanks Jay.

Yes definately, ERP can be quite a trigger. I just always insert as many steps as needed but I think with these limited therapy sessions we get we end up pressurised by them into fitting with the course rather than just taking as long as is needed. As long as we are moving forward, thats all that matters really.

I think I know what you mean, sometimes you shift to something else and find it easier to take and then that becomes easier to shake off because it's less intense overall. I did that with touching light switches. I changed from the constant touching to holding it on the first press and telling myself it was ok. It didn't always work but it could do and reduce the inevitable frustration of having to constantly repeat the touching. A therapist may not approve since it was still a compulsion but I went into it willingly so as to remove the fear as the driver. I did the same with reading the lampposts and if I feel my GAD spiking my OCD, I sometimes willingly read or touch them whilst telling myself I chose to do that, I wasn't forced and I find this can help to stop it starting up again.

Sometimes those little strategies pay off instead of going for the full monty therapist route.