Nov 24, 2017
By Lisa W. Coyne, PhD
When we experience fear, we either freeze, run, or fight. All of our energy fuels our attempt to avoid or escape. In these moments, complex thinking shuts down, blood flows to our extremities, we get a burst of norepinephrine, and our attention narrows: where’s the exit? Fear pares down our sense of the world to a tiny pinpoint in which nothing else matters—the same way looking through a telescope shows just a tiny patch of horizon. We cease being curious. We stop exploring. We simply react.
Like most other organisms, we come by this fear response naturally. Our environment selected these behaviors because they keep us alive. No time to think. Just move.
Unlike most other organisms, our brains cannot tell the difference between an actual threat and a symbolic one. For example, research demonstrates that if we are ostracized from our social groups, our brain registers this in the same area that registers actual physical pain.
What this means is that our brain confuses actual threats with thinking about threats. Indeed, we tend to respond to fearful thoughts as though they are real. If you’ve ever felt like a loser, or a failure, or not good enough, very likely you’ve felt the bite of this kind of thinking. Almost certainly you’ve been compelled to work hard to make those thoughts go away.
Nowhere is this tendency to experience and react to thoughts as if they were real more apparent than in Obsessive Compulsive Disorder (OCD). And nowhere is it more evident how this tendency can trap us. For many, it not only traps us, it takes away all of our sense of wonder and possibility in the world.
I had a session a few weeks ago with an 18-year-old client with OCD who gave me permission to share his story. He’s often disheveled and in need of a haircut, his sandy-colored hair flopping in front of his eyes. He has a mischievous smile, and he’s equal parts brilliant and stubborn. He is a master procrastinator. He loves computer games—both playing and creating them. Today, he talked about writing his college essay for his application to an Ivy League school.
But once upon a time, he thought he’d turn into a zombie unless he engaged in certain rituals to “undo” that possibility.
OCD is characterized by obsessive, irrational thoughts that the sufferer tries to neutralize with repetitive behaviors called compulsions or rituals. An example might be an intrusive, recurring doubt that you might have accidentally hit someone with your car, and repeatedly checking to ensure that this didn’t occur. You might drive back to the spot of the “accident,” or check the newspaper or TV news to ensure that it didn’t happen. Eventually, you might stop driving or avoid anything else that could possibly cause harm to another person. This is very different from what people usually mean when they say, “I’m so OCD.” It can prevent you from doing the most basic things, such as eating, working, or leaving the house.
At one point, my client’s obsession about turning into a zombie was so acute that he was hospitalized. In the hospital, he was prevented from doing his rituals, which sometimes included standing in one spot for hours, repeating certain sounds or words until he said them “just right.” What counted as just right was entirely subjective and rigidly defined by his OCD. Because he feared he would become a zombie if he couldn’t do his rituals, he refused all food, water, and medication in order to take his own life.
The hospital staff had to put in a feeding tube. For two weeks he tried to pull it out. Screaming, strapped down to a bed, he was inconsolable. He’d wanted to die.
He was referred for Exposure and Response Prevention (ERP), a treatment for OCD with a strong body of research behind it. ERP involves deliberately experiencing things that make you afraid, and not doing anything to make you feel safe while you do so. You learn to step back from your thoughts and examine them with curiosity. In essence, he would have to learn to face his fears.
Prior to beginning ERP, he ritualized for hours to get “unstuck,” repeating words and sounds over and over. Anyone watching him would surely think he was psychotic. I wondered too, until one day, after a particularly long attempt to get this verbal ritual right, he abruptly stopped, slumped, said, “Aw, fuck it,” and walked away. That was the first time I saw the kid in there—utterly trapped by his OCD. I wanted to fight to get him out.
We began ERP, and he worked hard every day. We created a list of all the things he was afraid to think and do (including not engaging in his rituals), and then we practiced thinking and doing them over and over until the fear lost its power. We started with looking at, writing, and saying words that had the letter “z” in them, and worked up to words like “dead” and “zombie.” Eventually, we looked at cartoons of zombies, and watched videos like Young Frankenstein. We graduated to walking through graveyards at night on the way to go get some hot chocolate at a local venue. Through this process he discovered, repeatedly, that he could have thoughts about becoming a zombie…without actually becoming a zombie.
After a few months of ERP, he’d developed a different relationship with his OCD. He described it as “a small child, hiding behind a chair in the corner, who needs someone to take him by the hand and show him not to be afraid.” He was discharged and went back to school. He carried his OCD forward, with compassion, as he rebuilt his life. Once in a while, he still has OCD thoughts. But he doesn’t get “stuck” in repetitive behaviors. He just allows the thoughts to exist like any other thoughts.
For his college essay, he wasn’t sure what to write, except that he wanted to talk about his experience with OCD. “What else do I have to offer besides my intellect?” he asked. ERP lets people actually move through obstacles, and see what’s beyond. The best scientists, innovators, and inventors need curiosity—the willingness to see doors where others see brick walls. What better way to learn this than facing fears your brain thinks are real—and have them evaporate before your eyes? He had willingness and curiosity in spades. I suggested he write about that as well as his OCD.
For the rest of that session, we walked and talked about college—me and this kid who two years ago was strapped down, not eating or drinking; this kid who nearly ended his own life. On our walk, I noticed a full moon peeking out ever so slightly from the maple trees in a nearby park. I said, “Let’s walk a little further, so we can see the moon.” We stood for a few minutes in a comfortable silence, noticing the moon. It was beautiful. I turned to him and said, “Don’t forget to make some time to look at the moon.”
“This reminds me,” he said, “of a time when I was with my family, and I was triggered by obsessive thoughts in the middle of the night. I ran out into the snow in my socks. I just wanted to get out of there. It was really cold. My dad was so mad. When I stopped, I noticed the stars, and it was quiet, and clear, and bright.” He stopped. “All of a sudden, I felt…joy. I had a moment of wonder.” After a sheepish pause, he said, “And I thought, if I had killed myself, I never would have seen this.” Then he smiled, his world expanded far beyond that tiny pinpoint it had once been, and turned home, an explorer headed into the beyond.
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DISCLAIMER: The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
ABOUT THE AUTHOR
Lisa W. Coyne, Ph.D. is an Assistant Professor at Harvard Medical School, a Research Associate Professor at Suffolk University, and a clinical psychologist who researches, delivers, and trains acceptance and commitment therapy (ACT) and other evidence-based mindfulness interventions with young people struggling with OCD. She is the founder of the McLean OCD Institute for Children and Adolescents (OCDI Jr.).