Obsessive-Compulsive Disorder (OCD) is often referred to as the “doubting disorder” because it is characterized by pervasive feelings of uncertainty. To better understand OCD, it’s useful to examine the terms “obsession” and “compulsion” as they relate to the disorder. Dr. Jeffrey M. Schwartz, a leading expert in OCD treatment, defines obsessions as “intrusive, unwelcome, distressing thoughts and mental images.”1 These thoughts are sticky and unpleasant. Schwartz further explains that compulsions are “behaviors that people with OCD perform in a vain attempt to exorcise the fears and anxieties caused by their obsessions.”2 Together, these obsessions and compulsions create an endless cycle of anxiety-inducing thoughts and ritualistic responses that reinforce the anxious thoughts.
For a more developed approach to counseling OCD, check out my article Better Biblical Counseling for OCD
Landmines in OCD
The purpose of this article is not to fully explain what good counseling for OCD entails. Instead, it aims to caution against two unhelpful tactics often used by those with OCD in response to intrusive thoughts—and sometimes even encouraged by counselors. These two tactics are: (1) Avoidance and (2) Reassurance.
Because avoidance and reassurance seeking can be so detrimental in the battle against OCD, I have titled this article “Landmines in OCD.” Like landmines, avoidance and reassurance can catch people off-guard and present unforeseen dangers. My hope is that readers experiencing OCD will walk carefully (Ephesians 5:15) to avoid being overtaken by these landmines in their fight against OCD.
God’s Grace is up to the Challenge
If you are reading this article, it’s likely because you either struggle with OCD or know someone who does. Regardless of your reason, I pray that this article leaves you better than it found you.
To the OCD sufferer: there is great hope in Christ. As my friend Dr. Kevin Carson often says, “God’s grace is up to the challenge” (1 Corinthians 10:13). To those reading about OCD in order to help someone who is struggling: know that you are doing a good and godly thing (1 Thessalonians 5:14). With just a little time and effort, you can become a valuable resource and support for your friends and family. I hope this article aids you in your pursuit of serving those who are hurting.
Avoidance
The first unhelpful tactic commonly used by those with OCD symptoms is avoidance. People who struggle with OCD often learn through experience that certain triggers provoke their intrusive thoughts. These triggers can include sights, smells, sounds, numbers, letters, people, situations, and experiences.
Those with OCD may become so distressed by the intrusive thoughts associated with their triggers that they will do almost anything to avoid them. The goal of avoiding the trigger is to avoid the anxious state that accompanies the intrusive thought and, by extension, the exhausting compulsive behaviors. In order to help fully depict what this tactic looks like in real life I have included a couple of snapshots.
Snapshot of Avoidance: Kathy
Kathy, a woman in her mid-40s, experiences intrusive thoughts whenever she smells cigarette smoke. These thoughts revolve around the fear of having undiagnosed cancer or other life-threatening illnesses. Once the thought enters her mind, it takes over, consuming all of her mental space like a relentless torturer. To prevent this, Kathy avoids any situation where she might encounter the smell of cigarette smoke. For example, she no longer visits her family’s bar and grill and avoids driving with the windows down on hot summer days, fearing she might catch a whiff of smoke from another vehicle at a stoplight.
Snapshot of Avoidance: Xander
Xander is a married man in his mid-20s with a newborn at home. He experiences an intrusive thought whenever he sees a knife, envisioning himself using it to harm his family. Although Xander knows he doesn’t actually want to do this—he deeply loves his family—he struggles to understand why such a terrible thought would cross his mind unless it might be a sign of something he could act on in the future.
To prevent these intrusive thoughts, Xander keeps the kitchen knives locked in a drawer, separate from the rest of the silverware, so he doesn’t see the objects that trigger his anxiety. He has also asked his wife to handle any tasks that require using a knife.
These snapshots illustrate the great lengths those who suffer from OCD will go to in order to avoid triggering intrusive thoughts in the future.
Reassurance
The second unhelpful tactic frequently used by those with OCD is reassurance seeking. People experiencing OCD symptoms often feel a persistent sense of uncertainty, as if something bad is about to happen. This uncertainty often manifests as lingering questions or intrusive thoughts, such as:
• How can I be sure I won’t get AIDS if I use this public restroom?
• How do I know for certain that I turned off the stove?
• How can I be sure that the bump I heard and felt while driving wasn’t actually a small child I ran over?
To combat these lingering doubts, individuals with OCD often seek reassurance in various ways. This might include double-checking, obsessively thinking about a topic, searching for answers online, or asking friends to reassure them that their fears won’t come true.
Snapshot of Reassurance: Franky
Franky is a teenager plagued by intrusive thoughts about whether or not he is truly saved. When you counsel Franky, he frequently seeks your opinion on this topic, specifically asking whether you believe he is a true believer. Essentially, Franky desires confirmation from an outside, trusted source to help resolve his internal uncertainty. He mistakenly believes that if you reassure him of his salvation, the intrusive thought will finally be put to rest.
Additionally, Franky prays for exactly 60 minutes each day, explaining that this routine helps him feel saved, reasoning that only a saved person would commit to praying for an hour each day.
Snapshot of Reassurance: Shane
Shane offers another example of reassurance seeking. In his 50s, Shane is troubled by a recurring intrusive thought about whether or not he turned off the water in his kitchen sink. In response, he frequently checks the faucet multiple times—double, triple, or even quadruple checking—to ensure it’s off. He then decided to buy a Wi-Fi camera, positioning it to overlook the kitchen sink, so he could drive to work without the urge to turn back. If he feels the need to check the faucet while at work, he uses the camera app.
Shane also seeks reassurance by enlisting help from his wife. Within five minutes of leaving the house, he often calls or texts her, asking her to check the faucet for him.
These snapshots illustrate how reassurance seeking can become an unhelpful and exhausting cycle for those struggling with OCD.
Why are Avoidance & Reassurance Unhelpful?
These tactics and habits used to combat intrusive thoughts in OCD may seem harmless, but they are not. They not only waste time, but they also actually make things worse.
- Avoidance and reassurance cannot stop intrusive thoughts. Intrusive thoughts are a normal part of everyday life. Everyone experiences them, and they are not easy to stop. Intrusive thoughts are slippery. What makes them so elusive is their ability to constantly evolve, often outpacing the person trying to combat them. Take Shane, for example. He bought a Wi-Fi camera, thinking it would give him solid proof that his kitchen faucet was off. But almost immediately, Shane began having new intrusive thoughts about whether the water line to his kitchen sink was leaking and damaging the subfloor. This happened because the problem was never about a specific intrusive thought, but rather the pattern of thinking Shane had adopted and ingrained in his mind and body.
- Avoidance and reassurance only intensify intrusive thoughts. While these strategies might seem harmless, they are a serious miscalculation. When someone with intrusive thoughts resorts to avoidance or reassurance as a coping mechanism, they reinforce the belief that these thoughts signify real danger. As a result, the intrusive thoughts become more deeply ingrained because your brain becomes convinced that these thoughts actually belong and deserve thought space. Biblically speaking, engaging in avoidance and reassurance likely means unintentionally nurturing the desires of the flesh (Romans 13:14) because these actions validate unfounded fears.
- Avoidance and reassurance become compulsions. At the beginning of this article, I referenced Schwartz’s definition of compulsions as “behaviors that people with OCD perform in a vain attempt to exorcise the fears and anxieties caused by their obsessions.”3 A compulsion is any ritualistic behavior aimed at alleviating the fear and anxiety triggered by intrusive thoughts. Since avoidance and reassurance are responses to intrusive thoughts, and are intended to ease the resulting anxiety, they fall under the category of compulsions. The great irony is that avoidance and reassurance often become the very things they are meant to prevent.
As biblical counselors, we must be careful not to reinforce or participate in the habits of avoidance or reassurance, even though it can be challenging. Resisting the urge to reinforce these tactics is difficult because, as a friend or counselor, you see the distress caused by intrusive thoughts. Out of genuine love, you want to do anything in your power to spare the person from unnecessary and avoidable distress. However, while avoidance and reassurance might seem appealing, they are ultimately hopeless endeavors. There is hope available that far surpasses these tactics.
How to Help Those Who are Struggling?
By God’s grace, it is entirely possible to help our counselees without becoming complicit in harmful behaviors. The Word of God provides guidance on how to support our hurting friends.
- Set Bigger Goals than Removing Distress. The goal should not be to avoid intrusive thoughts. Instead, the focus must be on pleasing God (1 Corinthians 10:31). In line with this goal, those dealing with OCD should aim to place intrusive thoughts in their proper place by responding to them in a god-pleasing way (see pt. 4 below). This means being equipped to quickly dismiss these thoughts and continue living as God intended, without letting the thoughts disrupt your life.
- Be Present in the Midst of Chaos. When someone is enduring the chaos of intrusive thoughts, it can be a disorienting and exhausting experience. One of the most helpful things you can offer is the ministry of presence. Proverbs 17:17 tells us, “A friend loves at all times, and a brother is born for adversity.” You don’t need to have all the right answers or be an expert counselor. Simply being willing to sit with your friend in the discomfort of their uncertainty is incredibly valuable.
- Be a Trusted Confidant. Your friend struggling with intrusive thoughts likely feels as if they’re going crazy, and their thoughts may be very bizarre. Allowing them to express what they’re feeling without fear of judgment or gossip is a powerful act of grace. Proverbs 11:13 says, “Whoever goes about slandering reveals secrets, but he who is trustworthy in spirit keeps a thing covered.”
- Intrusive Thoughts Cannot Be Stopped, But They Can Be Disempowered. The most effective way to combat intrusive thoughts is by starving them of the attention they need to survive. Intrusive thoughts feed on your analytical skills, constantly seeking your problem-solving focus. Dr. Michael Greenberg suggests that by withholding that problem-solving attention, you can train your brain to respond differently over time.4 This process of changing your thinking by consistently denying your intrusive thoughts the attention they crave is what Dr. Jeffrey Schwartz refers to as “refocusing” and “revaluing.”5 As you intentionally refocus your attention away from intrusive thoughts to something more productive, your mind learns to assign these troublesome thoughts as less valuable and less worthy of your attention.
Biblically speaking, I am suggesting that by choosing to not give an intrusive thought any mental attention beyond the initial thought itself, the person struggling can take the thought captive and limit its potential damage (2 Corinthians 10:5).
From a medical perspective, Dr. Patrick McGrath gives helpful insight as to why the discomfort of OCD must be pushed back against without using a tactic like reassurance seeking, “recovery from OCD requires habituation to the distress caused by uncertainty. And habituation– the lessening of a physiological or emotional response after repeated exposure to a stimulus– cannot occur when reassurance keeps the person from getting that exposure to uncertainty.”6 For example, if going to the grocery store has consistently triggered intrusive thoughts and distress, it’s important to keep going to the store just as you would if OCD weren’t a part of your life in order to retrain your brain. In order to grow in how you respond to uncertainty, you need to be exposed to uncertainty while demonstrating self-control in your response.
In short, your mind and body needs to be habitually put through paces of enduring under the burden of the distress caused by uncertainty. As you bear up under this heavy burden you grow in endurance and the thing which once felt unbearably heavy, becomes lighter to carry.
Conclusion
While intrusive thoughts are a common part of life, they do not represent reality. These thoughts are simply your brain acknowledging that something is possible, not necessarily that it is true or meaningful.7 The reason intrusive thoughts exist is because your brain, like the rest of your body, has been negatively impacted by the Fall (Genesis 3). Intrusive thoughts are a reminder that you live in a broken world with a broken body, and sometimes your brain considers broken things.
Intrusive thoughts can seem like an unbeatable foe, but God’s grace is more than enough to meet the challenge. Talk to your doctor, talk to your pastor, and find a good friend who will weather this storm with you.
Credits:
The Holy Bible: English Standard Version. (2016). (all Scripture). Wheaton, IL: Crossway Bibles.
Photo by British Library on Unsplash
Footnotes:
- Jeffrey Schwartz, Brain Lock: Free Yourself from Obsessive-Compulsive Behavior (New York: Harper Perennial, 2016) xxviii.
↩︎ - Schwartz, xxx.
↩︎ - Schwartz, xxx.
↩︎ - For a more detailed explanation of why distinguishing awareness from attention is necessary in combatting intrusive thoughts see the work of Dr. Michael Greenberg and his article “How to Stop Ruminating.” Michael Greenberg, Ph.D., https://drmichaeljgreenberg.com/how-to-stop-ruminating/. Accessed 12 June 2024.
↩︎ - Schwartz, xxxv-xxxvi.
↩︎ - Patrick McGrath, Learn Everything About Reassurance & Know If It Really Helps
https://www.treatmyocd.com/blog/is-reassurance-seeking-good-or-bad-for-ocd (accessed Aug 9, 2024).
↩︎ - Many people who experience intrusive thoughts mistakenly believe, “This troubling thought must mean something terrible about who I really am and what I really want.” However, if they reveal anything, it might be that intrusive thoughts reveal the opposite of what you truly value or desire, as they often contradict what you truly desire.
↩︎
gospelmercies.com 