THINK GOOD FEEL GOOD Controlling Worries and Habits We often have obsessional thoughts that go round and round in our heads. Sometimes these thoughts keep happening and are about worrying things like germs, danger or bad things such as: Thinking that people will be hurt or involved in accidents. Catching or giving others germs or diseases. Thinking that you will be rude or behave inappropriately. Obsessional thoughts like these can be difficult to stop. Because they are very worrying you may feel uncomfortable or anxious. To feel better, people often try to stop or cancel these thoughts by doing something to make them better. These are called safety behaviours, habits or compulsive behaviours and could be anything such as: Washing hands or clothes. Checking things like doors, light switches, windows. Doing things (like getting washed or dressed) in a special way. Repeating words, phrases or numbers a set number of times. Compulsive behaviours like these can take over. Each day becomes a struggle as more and more time is spent doing these compulsive behaviours. This is called Obsessional Compulsive Disorder or OCD for short. When this happens you need to learn how to regain control of your life. Dealing with obsessional thoughts We all have worrying thoughts We don t usually tell anyone that we have worrying thoughts. We keep them a secret. We may worry that other people won t understand, will become cross, or think that we are silly, and so we keep them locked up in our heads. 158
The first thing you need to know is that you are not silly. We all have worrying thoughts at some time or another. You may spill or touch something and wonder if you might catch any germs. You may forget to unplug the TV and worry that it will catch fire. You may have an argument with somebody and wish that something horrible happens to them. So everybody has bad or worrying thoughts. Just because you think something doesn t mean that it will happen Worrying thoughts are very common but the difference for people with OCD is that they believe their thoughts will come true. So, someone with OCD might: think that their mum will have a car crash and believe that this will happen. think that they have a serious illness and believe that they will give it to other people if they touch them. It is only the bad things we believe we can make happen. Thinking that you will win the National Lottery or that you will get an A grade in your maths doesn t make it happen. So the second thing we need to know is that just because we think something doesn t mean it will happen! Check the chain of events Because you hear your obsessional thoughts so often you simply believe them and don t bother to check them out. Sometimes it is useful to test them and check whether they really can be true. Mike worried that he would pass germs to other people and make them seriously ill. He was worried that if he touched a door handle he would pass germs to the next person who touched the handle. Mike worked through the chain of events that needed to happen before this could come true. CONTROLLING WORRIES AND HABITS 159
Mike must have a serious illness. This illness has to be passed to others through touch. Germs would have to be on his hand when he touched the door. The germs would have to move from his hand to the door handle. The germs would have to stay alive on the door handle. The germs would be picked up by the next person who touched the door. The germs would have to get inside their body. The germs would have to be strong enough to beat their body defences. They would then become ill. Writing down the steps involved is useful and can show how many things need to happen before the worry could possibly come true. How likely is it that each step will happen? The big problem with OCD is that it tricks you into thinking that bad things will definitely happen. We need to watch out for this trick and check it out. Look at your chain of events and rate how likely it is that each step could happen. For each step ask yourself How likely is it that... and choose a number between 1 and 1 to show how likely it is to happen. 1 means absolutely certain and means extremely unlikely. Mike did this to rate his chain of events: How likely I have serious illness (6) How likely I can pass this on by touch (4) How likely I have germs on my hands when I touch the door (74) How likely that the germs would move to the door handle (7) How likely that germs would stay alive on the door handle (25) How likely that germs would be picked up by the next person (2) How likely that germs would get inside their body (18) How likely that the germs would be stronger than their body s defence (45) How likely that they would become ill (6) This helped Mike to see that the chances of him making someone seriously ill were actually very, very small. 16
Don t try to stop your thoughts Some people try very hard not to think about their obsessional thoughts. It may seem to make sense but we know that this doesn t work. The harder you try not to think about them, the more they will happen. Don t try to stop them. Let them happen but learn to live with them. Learn to control anxious feelings Obsessional and worrying thoughts will make you feel anxious or uncomfortable. You can try to control these feelings by learning to relax. You can do this in different ways but remember: There is no one way of controlling your anxious feelings. Different methods may be useful at different times. It is important to find what works for you. CONTROLLING WORRIES AND HABITS Physical exercise Physical exercise can be a good way of relaxing. A good run, a quick walk, cycle or swim can help you to get rid of any anxious feelings and can make you feel better. Absorbing activities There might be some things that you really get into which take over your mind and make you forget about everything else. These can help you switch off and relax. Computer games, reading, watching the TV DVD, playing an instrument, listening to the radio or music may be helpful. If you notice yourself feeling anxious or uncomfortable, then try to become lost in one of the activities you really enjoy. Controlled breathing There are times when you may suddenly notice that you have become anxious and need a quick way to relax and regain control. Controlled breathing is a quick method that can help. The idea is to concentrate on your breathing and this will help you to relax. You can use this method anywhere and often people don t even notice what you are doing! 161
Slowly draw in a deep breath, hold it for five seconds and then very slowly let it out. As you breathe out, say to yourself relax. Doing this a few times will help you regain control and help you feel calmer. My relaxing place With this method you chill out by thinking about a special place that you find restful. Think about your dream place. It could be somewhere you have been or a pretend place. Imagine a picture of it and make the picture as restful and peaceful as possible. Try to make the picture as real as you can and think about: the colour of the sand, sea, sky the noise of the waves crashing on the beach the sound of the wind blowing in the trees the smell of the sea the warm sun shining on your face the wind blowing gently in your hair. This way of relaxing can help you prepare yourself so that you feel more relaxed before you face your problem or difficult situation. Remember, the more you practise, the more it will help. Learn to beat your compulsive behaviours To beat OCD you need to learn that you don t have to do your compulsive behaviours or habits when you have a worrying thought. List all your compulsive behaviours Put them in order Make a list of all your compulsive behaviours the habits or routines you use to make your worrying thoughts safe. Write each one down on a piece of paper. Choose a number between 1 and 1 (1 not at all upset 1 very upset) and for each behaviour rate how upset you would be if you couldn t do it. Now arrange your pieces of paper so that they go from the lowest numbers (least distress) to the highest (most distress). 162
Nisha was very worried that her parents would have a serious accident if she left them. She listed all the compulsive safety behaviours she used to make sure that this didn t happen and rated how distressed she would be if she didn t do it. Say to my parents I love you very much three times when I go out to my friends (Distress 4) Say to my parents I love you very much three times when I go to school (Distress 6) When they go out, check the time they will be home and repeat it three times (Distress 7) Phone them every 15 minutes when they go out to check that they are OK (Distress 8) Start with the easiest and STOP doing it Take the habit that causes you the least distress and STOP it. If you have to say things three times, then try saying them only once or twice. If you have to wash your hands as soon as you touch something you think is dirty, then try waiting 5, 1 or 15 minutes before you wash. If you have to change all your clothes after bumping into someone, then try changing only your jumper. You can break habits in different ways so choose the way you think you can do it. For Nina the habit she started with was saying I love you very much to her parents three times when she went to her friends. Nina tried to break her habit by saying this only once. Face your fears People often learn to cope with worries and anxious feelings by avoiding the thing that makes them worried. Mike, worried about catching germs from door handles, might avoid touching them. Nina, worried that bad things might happen to her parents, might avoid going out to friends or school so that she can stay with them. CONTROLLING WORRIES AND HABITS 163
This may make you feel better but it doesn t help you learn that you actually don t need to do habits. You need to face your fears. Mike has to learn that he can touch doors and that bad things won t happen. Nina has to learn that she can go out and that her parents are safe. You will feel anxious but... it will get easier When you face your fears and try to stop your habits you will feel anxious or uncomfortable. You will worry that your obsessive thoughts will become true and this will make you feel very anxious. Don t give in! What you will find is that these feelings will get less. You can check this out by rating your feelings and seeing them get less over time: Immediately after you have stopped your habit, rate how you feel (1 very anxious worst ever felt 1 calm and relaxed). After 5 minutes rate yourself again and keep doing this and see how you feel after 3 minutes. You will find that even though you haven t done your habits, the unpleasant anxious feelings get less. Use positive self-talk A way of helping yourself through a difficult or worrying situation is by using self-talk. Self-talk helps you to feel more relaxed and confident. By repeating encouraging and positive messages to yourself you can boss back your worries. I am going to beat my habits. I have managed not to do this for 5 minutes so I can do another 5. I will be able to do this. Remember to praise yourself as you beat your habits. You may want to give yourself a special treat after all, you do deserve it. 164