for a lot of people ocd can seem like a very strange or unusual condition characterized by
bizarre thoughts and weird superstitious rituals or behaviors but once you understand what's going
on in ocd it actually makes a lot of sense in today's video i'm going to be talking about how
obsessions and compulsions work together to drive ocd
hi everyone in today's video we're going to be talking about obsessive-compulsive disorder and
a behavioral model for understanding how ocd works and how obsessions and compulsions come
together to really drive and fuel ocd before i get into that just a couple of disclaimers to go over
i'm a registered psychologist in the province of british columbia canada
and this video is for informational purposes only it is not intended as a substitute or replacement
for advice from your doctor or mental health professional now with those things out of the
way let's start talking about a model of ocd so in a previous video i talked about what
ocd is and the difference between obsessions and compulsions today we're going to talk about how
obsessions which are those intrusive unwanted thoughts or images or impulses
really fuel and drive the compulsions which are the repetitive behaviors that are aimed
to try and reduce the distress or the impact of the obsessions so i want you to think about uh
an example so for example uh i'm driving my car one day and i'm driving out on the road and i
feel a bump in the road and when i feel that bump in the road i start to think to myself
did i just hit somebody what if i just hit somebody with my car
well how do you think that's going to make me feel if i had the thought or had the belief that i just
hit somebody with my car and they might be lying on the side of the road hurt or potentially dying
well it's probably going to cause a fair bit of distress or anxiety for me so i'm going to feel
really anxious so if i'm feeling really anxious that's a that's an uncomfortable feeling to have
so i'm going to want to do something to try and eliminate that anxiety so what am i likely to do
well i'm likely to drive my car around the block and come and see if i actually hit
somebody if there is somebody actually hit and hurt on the side of the road
this is actually a very common thing that happens in ocd and a very uh common type of process
that occurs so uh with ocd you usually have some sort of trigger so in the example that
i just gave the trigger situation is that i felt a bump as i was driving
that trigger leads to the intrusive thought this is the obsession right and so the obsessions
are these unwanted intrusive thoughts images or impulses well as i talked about in the example
the obsession is associated with anxiety so when i have these thoughts that i just hit somebody
with my car or my hands are contaminated because i touched that doorknob or i saw
a pretty woman and i thought about kissing her and so that must mean i want to have an affair
and that causes anxiety so these obsessions all trigger this anxiety and this fear
about the obsession and so when i'm feeling really anxious what i want to do is i have this urge to
neutralize or an urge to try and eliminate or reduce that anxiety or distress and the way i do
it is by engaging in the compulsion so in the example the compulsion was to go around
the block and to check to see if i had hurt somebody if my hands are contaminated the
compulsion might be to go and wash my hands if the obsession was around having cheated on my
wife because i thought about having an affair with somebody then the compulsion might be to
repeatedly tell my wife uh how much i love her or the compulsion might be
to uh repeatedly remind myself about why i would never do something like that
so these compulsions are designed to reduce or eliminate the anxiety and the compulsions have
kind of two phases of effect in the short term this compulsive behavior this urge to
neutralize an associated compulsion what it does is it actually eliminates the anxiety so
if i've touched something and i feel my hands are contaminated i go when i wash my hands well
what's that going to do to my anxiety it's going to reduce my anxiety in the short term
and a reduction in anxiety feels good so that behavior is going to be reinforced
when i go back and i check and i see that i haven't hit anybody with my car
that's going to reduce my anxiety that's going to feel good so the idea is the
compulsions are actually reinforced by the reduction in the anxiety that's associated by
doing the compulsion so in the short term compulsions really work but the key is short term
the reduction in anxiety that comes by doing these compulsions doesn't actually last
and in fact it can be extremely fleeting so i can feel my hands are contaminated i go wash my hands
but then as i start walking away from the sink i can get another intrusive thought of did i really
wash my hands did i wash my hands well enough so what do i have to do then i have to go back and
i have to wash my hands again and i walk away did i did i really wash them did i wash all the
soap off i have to go back and wash them again so while the compulsions can help reduce the anxiety
and the distress in the short term what they do is they actually fuel the intrusive thoughts because
i'm behaving like the intrusive thoughts are actually valid or a real concern and the anxiety
and the distress that comes down by engaging in the compulsions actually reinforces the compulsion
so every time i have the intrusive thought i have to engage in these compulsions because
that's how i learn and that's what i've learned is the best way to reduce the anxiety
so these compulsions have sort of two effects in the short term they reduce my anxiety but in the
long term they actually fuel the intrusive thoughts and keep the anxiety and the ocd
going additionally this urge to neutralize and the engaging in the compulsions which is designed to
eliminate the distress that's caused by the intrusive thought well by eliminating the distress
what i'm trying to do i'm trying to neutralize the thought i'm trying to eliminate the thought i'm
trying to stop thinking about the thought and this is something we call thought suppression
and i've talked about uh what i've referred to as the paradox of thought suppression in a number of
previous videos and i've used an example of trying not to think about a pink elephant
the more you try not to think about a pink elephant the more you end up thinking about
a pink elephant and so the more you try and eliminate or neutralize these thoughts the more
you try and convince yourself that you didn't hit somebody with a car
the more you're going to question and doubt whether or not you've hit somebody in the car
and so it becomes this self-driving engine of obsessive thoughts
leading to anxiety leading to this urge to neutralize and have to engage in a compulsion
which reduces the anxiety very briefly for a short period of time but then fuels that
intrusive thought and the cycle just drives and drives and drives and that's what pushes
the engine of ocd forward and that's why a person can't stop having these intrusive thoughts
that's why a person can't stop engaging in these compulsive behaviors
because the ocd has taught them that this is the only way to deal with these thoughts
and that you have to engage in the compulsions to reduce the distress that the thoughts cause so
when you understand it it makes a lot of sense and it helps explain
why these obsessions and compulsions even though they may seem so bizarre and seem so
unusual that a person would have to engage in these types of behaviors and thinking patterns
but it actually makes a lot of sense if you understand that the obsessions are
intrusive thoughts that cause anxiety and the compulsions are a person's desperate attempt
to try and eliminate the anxiety and to try to eliminate the thoughts so it's really important
to understand this model of ocd because the treatment that we talk about for ocd specifically
exposure and response prevention comes directly from this understanding of how ocd works and i'll
be talking about exposure and response prevention in an upcoming video so i hope that makes sense i
would love to hear your thoughts and questions about this so please leave me some comments
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