Note: All parts of the guide have been updated as of Sep 2022 after much discussion from those suffering from SOCD and my own experience. In particular I have considerably adjusted the ERP approach, as I now believe that is better to simply avoid doing any explicit rituals, rather than trying to literally do nothing, which seems to have been causing some issues for people.
This unit is part of a guide. To see all units in the guide, click here.
In this unit, we’re going to build on what we talked about earlier. There’s various beliefs people have associated with consciousness of bodily functions which cause their anxiety. As mentioned in the previous unit, it’s these beliefs that are the problem, not the consciousness of bodily processes.
Note often these might be beliefs which are in the subconscious; you might not even believe them on a rational level, but they still cause you fear. It’s like someone who knows there’s nothing to be afraid of when public speaking, but stills feels a lot of anxiety all the same.
Regardless, the first step to removing our SOCD is to challenge these faulty beliefs. The idea is to break down the entire set of beliefs and see where they don’t make sense, and replace it with something more accurate.
Challenging a belief can be thought of in terms of a trigger, automatic belief and a challenge.1 The trigger is the situation in which we end up feeling anxious, the automatic beliefs are the ‘faulty’ beliefs we hold which ultimately cause the anxiety, and the challenge is about how that automatic belief might not really be true. When we internalise the ‘challenge’ as to why this automatic belief might be wrong, anxiety is reduced.
Challenging SOCD beliefs
Let’s take the example of being conscious of blinking. The trigger in this case is simply awareness of your own blinking (it could be situation specific as well, e.g. when you are reading, but more on that later). The automatic beliefs can vary a lot, but often are something like ‘while I have this consciousness, I can’t do anything normally or enjoy things since I have to worry about this.‘ Worse still there’s often the belief that ‘this might follow me for the rest of my life, so I’ll NEVER have a normal happy life’, which is even more anxiety inducing. You might feel horrible right now, and every time you are triggered you think that this feeling will be there for the rest of your life. Naturally, the thought of living an anxiety ridden life forever is about as bad as it can get.
Let’s try challenge this. Why can’t you live a normal life with this consciousness? Maybe because it makes you anxious; but why are you anxious at all? Usually, it’s because people think they can’t perform their normal functions while they have this consciousness. But in reality, so long as you’re not spending time trying to consciously control them, if you just get on with your life, you’ll find you CAN pretty much operate as normal. You can drive a car, take a test, watch a movie, talk with people, and so on. It really doesn’t affect you much (if it all) if you don’t give it conscious attention. Even if there was some effect, like sometimes it being a tiny bit awkward when you recognise your blinking, it really isn’t a big deal; it doesn’t have a big impact. So there’s no reason to be anxious; if you didn’t have the anxiety associated with it, there’d be no reason why you can’t live a more or less normal life.
In table form:
As you can see above, often these beliefs are in sets and related to each other. There’s many many variations of such faulty beliefs, and it’ll be specific to your situation. In the end though, you end up with severe anxiety, usually worrying about how you’ll escape this for the rest of your life. Generally there’s some kind of feared consequence.
Some common SOCD themes include:
- Health related e.g. ‘If I don’t do my breathing correctly, I’m going to not get enough oxygen and pass out’ or ‘what if I choke on my saliva’. These focus on consequences to do with health
- Social anxiety related beliefs: e.g. ‘what if people notice my weird blinking and judge me’.
- Not being function or do something normally e.g. ‘what if I never live a normal life again, or what if I can’t take my exams?’ (as above)
- Not being able to enjoy life e.g ‘what if I can’t ever enjoy reading a book again because I keep noticing my blinking?’
There’s many more out there. You can see in most of these cases there’s some feared outcome. I’m not going to challenge all of these now, but I’ll do one more on health anxiety since it’s a common one. The trigger for example is being conscious of your breathing. The automatic belief is usually something like ‘if I don’t breathe correctly, I’m going to pass out and/or die’ . The challenge to this is that your body automatically regulates your breathing; no more how hard you try to hold your breath, your body will force you to breathe if it needs to. It doesn’t matter that you are conscious of it or control it. No matter what, your body will sort itself out, and this is true of everything. As long as you’re not anxious about it, there’s nothing to worry about it. We can also look at the ‘evidence’ thus far; in breathing ‘incorrectly’, has anything bad actually happened? Probably not, which suggests there’s nothing to worry about.
A key belief to be challenged: that it will last forever
From my experience, one of the common anxiety-inducing beliefs is that this condition will last for the rest of your life. As above, this can be broken down easily. Once you’ve removed any anxiety associated with consciousness of a sensation and you realise your feared outcomes won’t occur, there’s no reason why the rest of your life won’t be great. It wouldn’t matter that the consciousness is there for the rest of your life (not that it will be), because there’s no anxiety and it doesn’t really have an effect on anything. I’m emphasising this because for most people, knowing that while you may not have it sorted out right now, believing that soon enough you’ll be anxiety free and living a normal life is hugely relieving.
Don’t aim for complete certainty
When challenging your faulty beliefs, you often can’t say things for certain. Perhaps you can’t say for SURE that you can do things normally while being consciousness of some sensation, but that’s okay; you can say it makes sense that it shouldn’t cause me any major problems. Then you go out and live life, and the proof will you be in doing things properly. My point is that don’t get caught up trying to prove beliefs for sure. One of the issues people with OCD have is they often want complete certainty, which unfortunately isn’t possible a lot of the time. Sometimes you just have to say ‘I don’t know for sure, but this seems like it should be the case’.
Exercise 1: Challenge your beliefs – Using the table provided above, challenge your own beliefs you’ve built up surrounding consciousness of bodily processes. Being able to break down your own beliefs is such an important skill in dealing with anxiety. It can be difficult when you’ve had them for a long time. And there’s usually multiple faulty beliefs, working in a chain. Break it all down, and question each one. If you do this properly, you should be able to come to the conclusion that there isn’t a whole lot to be feared by having the consciousness of a sensation in of itself. However it doesn’t mean much (or any) of your anxiety will be gone; this is just the first step.. Feel free to post these or any questions in the comments section below.