Print People with obsessive-compulsive disorder (also called compulsive disorder) experience a lot of anxiety due to recurring obsessive thoughts. To reduce this anxiety, they act on it by showing compulsive or avoidance behaviour. With a compulsive disorder, there is a vicious circle of obsessive thoughts, compulsive behaviour, avoidance behaviour and fear.
Intrusions and obsessive thoughts
Intrusions are thoughts that suddenly come to mind. People without compulsive disorder also experience intrusions. Almost everyone experiences intrusions sometimes, such as when they are waiting for the train and suddenly experience the thought “If I step off the platform now, I will jump in front of the train”. Most people don’t dwell on these kinds of thoughts and carry on with their lives. For people with a compulsive disorder, these thoughts lead to a lot of anxiety. When the intrusions keep imposing themselves on you, we call them compulsive thoughts. These kinds of thoughts continually imposing on you can lead to you worrying about the thoughts being real and experiencing feelings of guilt and shame.
Some people try to suppress the thoughts. Unfortunately, this has the opposite effect. Instead of disappearing, the thoughts come up more often.
Compulsive thoughts can arise spontaneously, but can also be triggered by, for example, reading a news article about someone who has jumped in front of the train.
If-then expectations
It is not always clear to people struggling with compulsive disorder whether the compulsive thoughts are real. This leads to anxiety and expectations about the compulsions. We call these if-then expectations.
Looking at the example of the person who has obsessive thoughts about jumping in front of a train, this thought can lead to the following if-then expectation: “If I am at the station, I will jump in front of the train”. This is an incorrect expectation, but it can feel very real and, therefore, can cause a lot of tension.
Compulsive behaviour
The compulsive thought and if-then expectation lead to a lot of anxiety. Because of this, the person will want to suppress this obsessive thought. Instead of taking the train, he prefers to take the bus. By doing this, he avoids going to the station and, in turn, this prevents the compulsive thoughts. An alternative reaction is that they do take the train but ensure that they are far away from the track. We call this a compulsion.
People perform compulsions to suppress the fear that arises due to a compulsive thought or an if-then expectation. But by performing this type of behaviour, you actually reinforce the idea that the expectation is just and that the obsessive idea is true. If you do this often enough, you will strengthen the credibility of the expectation and the obsessive thoughts will become increasingly anxiety-inducing. People with a compulsive disorder are generally stuck in this vicious circle.
Exposure
Treatment for obsessive-compulsive disorder focuses on breaking this vicious circle. The first step is to investigate which compulsions and what if-then expectations are involved. Subsequently, treatment focuses on testing these expectations with experiments.
For every if-then expectation, you will come up with exercises that can be used to test whether the expectation is correct with the help of your practitioner. We call this type of treatment ‘exposure’. You will, with the guidance of a therapist, expose yourself to the things you fear.
An example of exposure: if you are often afraid that you have not locked the front door and, therefore, your house will be broken into, a good experiment would be to not double-check the lock of the door before leaving. Then you will find out what this will result in. Did you forget to turn the lock on the door? And was your house broken into? If you perform this experiment often enough, the credibility of the if-then expectation will decrease. As a result, the obsessive thoughts will evoke less anxiety.
Good to know
This form of treatment will generate a lot of anxiety in the beginning. This can be tough, but thankfully, anxiety decreases over time. It is the most effective treatment for compulsive disorders.
