“Give Me Your Threats—Let Them Come”
The alarm clock glows pale green in an otherwise pitch-black room. It’s minutes after 2 am, and Bob is standing outside his bedroom door, racking his brain to come up with the opposite of water. This word, whatever it may be, is the only thing standing between him and slipping back into bed and under the covers. But at two o’clock in the morning, he’s drawing a blank. Nothing’s coming to mind.
He eventually settles on sky. Strike that. Atmosphere, he tells himself, “I’m sleeping in the atmosphere.” And that thought, at this hour, is comfort enough so he can step back into his bedroom and settle into bed . . . that is, until the next fearful thought pops into his head moments later.
For Bob, every day is opposite day. It’s the only way he’s able to accomplish the most banal activities, things as fundamental to our existence as eating dinner or going to work or even falling asleep. Right now his theme is water. “So as I’m getting into bed I might think, Well, I’m sleeping into the water. I have to walk out of the room and correct that. First I have to decide what the opposite of water is.” * Subvocalizing that new statement brings relief, and he can climb back into bed. It’s a respite that often will last only a few seconds.
*Reid Wilson, Treating the Severe OCD Client, video, psychotherapy.net, http://www.psychotherapy
.net/video/treatment-severe-OCD-Reid-Wilson, n.d. See Appendix B.
His behavior—“correcting” or “fixing” his negative thoughts by saying the opposite thought, or by replacing it with a positive thought—now has become a complex and taxing ritual, occurring five or ten or twenty times in any given night. Certain negative thoughts he’s already “corrected” sometimes return, thus creating a vicious cycle with no promise of relief.
This routine, Bob’s current compulsive behavior, is not restricted to bedtime. “It can happen when I’m eating,” he says. “It can be when I’m getting into the car, thinking, Oh, I’m breathing in the water. I would have to get out of the car and mentally change that to I’m breathing in the sky.” The most rudimentary of tasks can turn into a series of repetitious actions.
Bob suddenly developed OCD at an early age. On a trip to New York City, walking through the streets of Manhattan, he was highly disturbed by the graphic propaganda on placards and bus stops, particularly a set of posters depicting babies and abortions. Within a day, ten-year-old Bob began obsessing, associating everyday objects like ketchup with blood and afflicted by thoughts and images of death. And when he returned home, these thoughts escalated into a genuine fear of dying: Do I have cancer? Do I have a tumor? Is there blood in my lungs? This young, confused boy couldn’t figure out why these worries were plaguing him fifty or more times a day. He only knew that he had to find a way to get rid of them.
Sitting across from me now, Bob is noticeably well-built, confident, and charismatic. A passionate physical therapist, he immerses himself in his work and loves helping others reach their goals. He has goals for himself, too, and places he’d like to go in his career, but at this point in his life, he simply wants his mind back. “Whether other people notice it or not, I feel like I’m going crazy all the time. I want to be able to turn on the TV and watch it, not turn it on and off a million times, getting into some crazy, weird, complex ritual. Just to be able to put on my clothes without thinking about it, to be happy and excited about what I’m doing. That’s all I want.”
The last few months have been particularly hard, as Bob’s compulsive behaviors are now impeding him from accomplishing daily tasks. Some nights he chooses to avoid going to sleep as a means to escape the incessant repetitions. That, of course, makes him exhausted and so he becomes weaker in his struggle against these intrusive thoughts. As he prepares for work, he can feel compelled to change his clothes a few dozen times. As he’s finally ready to leave, he can get stuck repeating the process of walking out the front door. “By the time I get to work, I’m a wreck. Even if no one else sees it, I feel it.” The threats of OCD are currently dominating his life, dictating his actions, and he’s desperate to take back control.
Taking the Power Position
Bob’s problem represents what most people with anxiety go through, whether it’s panic disorder, a specific phobia, social anxieties, or the broad worries of generalized anxiety disorder. You perceive a threat in front of you, and you automatically begin to look for protection or escape. If you can grab a protective mechanism or an escape hatch, you’ll take it. If not, you’ll face the threat with continued anxious worrying. This is the pattern you and I are going to interrupt.
Let me take you back to that first session with Bob. We’re in the last fifteen minutes, and we’re now discussing how he might experiment with some of these tactics over the next five days, specifically with his concerns about his bedtime rituals. Tonight, for instance, let’s say Bob gets disturbed by one of his statements like, “I’m breathing water.” And let’s say he decides to experiment with tolerating doubt and distress by not getting out of bed and not replacing this statement with one that is more acceptable, such as, “I’m breathing air.” Now he’s faced with the fear of never being able to fall asleep. Here’s how I introduce the new tactic:
Reid: Have you ever trained in any of the martial arts?
Bob: Yeah. Karate and Okinawan.
Reid: So that’s what we’re going to do. We’re going to take advantage of OCD’s energy. If OCD wins when I fight against uncertainty and distress, then I’m going to ask for more doubt and distress instead. You know this tactic, because you’ve been training in the martial arts.
I remind Bob that OCD is focused on the distress of doubt. It doesn’t care at all about the theme of breathing water or any other topic. It takes advantage of whatever it can in order to generate a sense of insecurity in his mind. I want Bob to take a power position over his disorder, and he can accomplish that by adopting a new point of view: “Wait a minute. OCD needs me to fight against uncertainty. If I want to break free from OCD, I need to do the opposite of that. So I ought to ask for more doubt. Ha!” Bob is a quick student. Read this brief exchange.
Reid: Our goal is to shift your relationship with OCD. The disorder lives in you only if you respond in a particular way. It needs you to take this stance: “I’ve got to get rid of my anxiety, and I’ve got to get rid of this preoccupation with this phrase in my head.” Let’s flip that. What’s the opposite of “I’ve got to get rid of my anxiety”?
Bob: “I want it. I want my anxiety. I want it to stick around.”
Reid: Okay, great. What’s the opposite of “I’ve got to get rid of uncertainty”?
Bob: “I’m never going to be certain.”
Reid: And . . .
Bob: “And, that’s okay. I want it to be that way. I don’t want to be sure about anything.”
Let’s see if Bob can apply this strategy to one of his most difficult challenges, his sleep routine. If he wants to conduct an experiment by not getting out of bed to repeat a corrective statement, he must be ready for worry to show up. He’s going to feel dread that withholding his ritual will cause him to stay up all night. Does he have the courage to purposely take an action that may cost him a whole night’s sleep?
Reid: This is when you might ask OCD to keep you awake all night. “Please, what I live for is for you to make me stay awake all night.” It’s a crazy way of talking. But the reason you want to talk that way is that you keep scaring yourself by saying, “Oh, God. I hope I don’t stay awake all night. If I can’t get rid of this thought, my night is going to be miserable.” That fires off your amygdala in your midbrain, and that’s your fight-or-flight response. So of course you’re going to feel even more anxious when you talk like that. When you send a ridiculous message like “Come on, more, please,” you are taking the game to OCD. You already know how to step forward. My job is to give you the move to step forward with, even though it might sound crazy to you.
Bob: Yeah, I need to talk to myself in a bring-it-on type of mentality, I think.
Reid: So you might say, “Hey, you can’t give me enough doubt tonight. I am totally willing to stay up all night and dwell on this because you’re forcing me to.” I don’t want you to purposely dwell on anything. I want you to go to sleep when you’re able to go to sleep. Or watch a channel when you’re able to watch a channel.
Now I’m going to quiz him on this seemingly insane plan. And he will let me know whether he’s catching on. I want him to realize that he’s going to be on the receiving end of two mental events. First, his challenger, OCD, is going to give him the threatening message. Second, he will find himself immediately responding with an anxious urge to get rid of that message. There’s no way he can interrupt those two events; they come as an automatic package. He needs to step back, notice that he’s now getting played by OCD, and then deliver to his challenger a paradoxical response to the threat.
You need to understand this, too. You are going to receive a threatening message, and then you will feel intimidated. That’s why I am saying to you (perhaps more times than you want to hear) that you must expect and allow both doubt and discomfort to show up. They come bundled together and arrive at your doorstep in the blink of an eye. You cannot consciously stop something that is generated by your unconscious. So we’re going to let these two in the front door instead of trying to lock them out. Now let’s find out what happens when we invite Anxiety to help them stick around.
Reid: When you turn on the TV and you have that negative thought, your job would be to do what? Think what?
Bob: “That’s good that I got that thought.”
Reid: So the negative thought will show up, and you will automatically respond, “Oh, no. There it is. I’ve got to get rid of it!” That’s going to happen automatically. But then you want to pair that with a something like, “Okay, great! Time to practice. I’m going to leave the TV on this channel and allow myself to feel freaked out. That’s what that crazy psychologist today told me to do.” You can say, “Thank you, OCD. I want this. But I am not preoccupied enough. Would you please make me even more freaked out right now?” Then turn your attention back to the TV or whatever you want to do. As soon as another negative thought comes in, you say, “Okay, good. That’s what I want.” You are looking to score points, and that’s how you score a point. Not by enduring the fearful thought, but by pairing it with a response opposite of what OCD needs to fuel its fire. Okay?
Learn to step back from the provocative messages of your anxious worries and obsessions. Push yourself away from those mental distractions just enough so that you can engage in the task of mastering this kind of provocative response. That’s what I’m about to tell Bob. He must detach himself from the specific topic of his fear so that he can absorb himself in this experiment. He tells me he’s ready to make this a competitive sport, and he’s up for the challenge. That’s what I want to hear.
Reid: Your job is to find opportunities to get this exchange going. So instead of dreading nighttime, when you are desperate to fall sleep, you say, “Okay. I’m looking for as many opportunities as I can to score points against OCD.” How do you score a point? First, you notice that OCD is disturbing you. Then you say something to OCD, like, “Give me more, please.” Or you say something to motivate yourself, like, “I want this.”
Bob: Right. Yeah. I have a competitive spirit. I need to get my fighting spirit going. I need to motivate myself to say, “I’m going to attack it.” Make it a competitive sport.
This Is Not Your Job
We are near the end of his first session, so I ask Bob if he has any further questions before I turn him loose for five days of experimentation. He has had to absorb a lot of information and a completely new way of thinking about how to handle his problems. So it’s no surprise that I need to clarify one more point for him. (I’ll assume you need to review this, too.)
Bob: Is part of my job to actually call up that negative thought in my mind, to say, “I want to think about this”?
Reid: Wait, hold on. Your job is to ask OCD to make you think about it again. I don’t want you to purposely think about it again. When it pops up spontaneously, ask OCD to “Give this to me again, please.” Then you’re done with the transaction. You’re going to immediately return your attention to the task at hand, whether it is to close your eyes to go to sleep, or to continue to watch the current TV show. Don’t go get the negative thought again. Make OCD go get it.
Bob: Yeah. So, it’s more like my asking. It’s not me saying, “Oh, I want to think of water now.”
Reid: That’s right. Your job is to create an activity, like turning on the TV, so that you might provoke the negative thought. That will give you a chance to score a point, because if the threatening thought pops up, you score a point by asking OCD to make that thought stay around and to make you feel worse. And then you go back to focusing on whatever your valued activity is at that moment, until OCD distracts you again. When it does, you say, “Thank you. That’s great.” Any message you deliver that is similar to “Great! Give me more!” will score you a point.
Bob: Okay, got it. I’m talking down to it, or talking back to it. That’s how I score a point.
Reid: Yup.
If he will actively engage in that project, he will further detach himself from the urge he feels to get rid of those thoughts and feelings.
Five days have now passed, and Bob is back for his second session. He’s still the sturdy young man I met a week ago, but he’s visibly more comfortable in his skin. He rubs his palms together and breathes deeply, trying to best articulate what he’s discovered over the last days. Obviously, I’m curious whether Bob was able to apply the skills he learned here, and what effect they had, if any. Aren’t you curious?
Reid: Welcome back. Tell me what’s been happening. What have you noticed?
Bob: Well, I’ve definitely been using a lot of the techniques. I’ve been challenging the OCD more. I’m seeing a lot of fast progress, I’ll tell you that. It’s nice to see. In the past, the problem has been that I never challenged it. Or at least I didn’t challenge it enough. The phrases you gave me have helped. And I’ve come up with my own, to make it my own.
Reid: What kind of messages have you been using?
Bob: It changes a lot. But for me, a big one is “What’s next?” It’s like I mock it.
This is going to be so helpful to Bob. He’s not regurgitating some self-talk message I gave him. He’s looking for messages that match his competitive spirit, and pretty quickly he adopts some excellent, aggressive phrases of his own. This is exactly what you need to do, too: find messages that fit you. Remember, using an aggressive tone with Anxiety is not your only option. You can even take on a more submissive stance by begging Anxiety to give you more distress, or pleading with it to make you more confused and intimidated.
It’s clear that Bob’s inner monologue has changed. He’s as introspective and contemplative as he was a week ago, but now his thoughts are less fearful and more strategic. He’s asking himself how he can get the most out of this experience, how he can adapt and personalize this experiment to get the best results in the shortest amount of time. It’s wonderful to see this quality in Bob in his second session. It shows a resolve that surpasses simply committing to the work. He’s learning to become the architect of his own treatment. “Doc, I did everything we talked about—and then I tried this, too!”
Bob: I tried to be mindful of when I’m starting an action that tends to be a trigger. One for me is when I’m going to the closet to change my clothes. That’s an activity that triggers a lot of my obsessions.
This “mindfulness” is something you can adopt as well. Be alert when you’re approaching a scene where you tend to worry, and then mentally prepare yourself for how you want to respond. Because once you enter the scene, once you begin the activity, you will become more vulnerable to your worries, and it will be harder to break out of the pattern.
Let’s say you’re afraid of having a panic attack in public, and you decide to practice walking through the mall alone, this time without the crutch of your cell phone. Before you get out of your car in the parking lot, remind yourself of how you want to manage your fear. In the same way, if you are about to practice taking an elevator, before you step into the building, remind yourself of how you want to handle your anxiety. If you wait until you’re standing in front of the elevator or the entrance to the mall, your anxious feelings and worries may get overwhelming. Plan your moves before you get there so that you’re ready when they show up.
Like a quarterback discussing tactics and what he’s learned from his experiences on the field, Bob explains what he does now when approaching that fearful activity.
Bob: For me, a big thing is vocalizing it to myself, actually saying it aloud. I will say, “Okay, I’m ready. I’m going to do this. I’m going to change my clothes now. I know I’m going to feel anxiety. I know things are going to come at me, things I don’t like.” And, I’ll say, “I’m ready for the threats.” And then I’ll talk directly to OCD. “Let it go. Let them come. Give me your threats. I’m ready. I’m ready for whatever comes my way.” I actually get pumped up about it. I try my best to feel that competitive spirit. Because I know it helps to talk to yourself. But you gotta feel it, you know? When I actually do it that way, I don’t get a lot.
Reid: What does that mean? “When I actually do it, I don’t get a lot”?
Bob: When I start the activity, after having that mentality, I don’t get a lot of obsessions.
Reid: Oh? What do you make of that? Let’s make some sense of that.
Bob: I can get a little scared, especially if it catches me off guard sometimes. But for the most part, if I can really take that mentality, then I tell myself beforehand, “I don’t care what threats I get. I don’t care what happens, or what obsessions come, or how much something bothers me, I’m not going to act on any threats I get.” I say, “I’m not playing this game.” I say, “You want to go? Let’s go.” I say, “Give it to me; give it to me. Let’s go.”
The best moments for me are when Bob relishes his tactical maneuvers—when he shares a clever approach or a devastating blow he delivered to Anxiety. It’s natural for him to derive some enjoyment from this. In fact, I encourage it. Because that means that the man who was crippled by his obsessions, who couldn’t get himself to sleep without a complex and exhausting ritual, is now taking the dominant stance. He’s taking charge, and it’s evident in his posture, in the assurance in his voice, and in the way he illustrates his encounters with Anxiety. Bob is eager to share more discoveries.
Bob: A few of the days I started even getting to the point where I mocked it a little more. I’d say, “I can’t hear you. I can’t hear you anymore.” Sometimes when an obsession slips through, it does shock me a little bit. But then I’ll say, “That’s a good one. That’s a good one. Now give me more. Give me another one. What’s next? What are you going to do? Let’s go.” And then I tell myself, “I’m going to keep doing what I’m doing, and I can handle this.” Even before I start changing my clothes, I’m having that attitude of “Come and get me.” You know what I mean? I feel I’m ready for it. And at least these last two days I have actually let a lot of those obsessions be there without redoing anything.
Reid: What tends to happen then?
Bob: The obsessions tend to dissipate, as long as I keep that mentality, and as long as I don’t back away. Some of the obsessions do hang around longer. But if I continue that mentality as I go through the day into my next activities, they all dissipate.
Are you listening to this? It’s quite important. Bob doesn’t say, “When I talk to OCD like this . . .” He doesn’t say, “When I talk to myself like this . . .” No. He tells me, “When I take on this mentality . . .” That’s the key. He is trying on a new point of view. He’s taking on a fresh orientation toward his problem. He’s shifting his attitude about how he is going to tackle this difficulty. And that’s when I know he’s getting a taste of what it’s like to win. At that moment I say to him, “Now, if you’ll keep that attitude the rest of your life, you’ve got it made.”
Another crucial message is here. Bob is not just testing out a new frame of reference. He is committing himself to stay on course. Right now he is determined. No matter what he experiences, he’s not going to fall for OCD’s message. I encourage you to follow Bob’s lead. If anxious worries have a grip on your life, make a strong-minded commitment to break that hold. Listen to Bob’s expressions: I don’t care what threats I get; I’m not going to act on any threats I get; I’m going to keep doing what I’m doing; it dissipates as long as I don’t back away. Bob’s sending you a message: Learn to become unyielding in the face of your fear.
Remember, Bob was deeply entrenched with his OCD, and he was able to accomplish all of this with only twenty minutes of instruction. One of the keys to his success is that he makes the protocol his own. He’s not complying with a set of instructions handed to him by some psychologist. He listens to what I say, he chews on it, and then he metabolizes it. Who knows how long he can maintain this stance in the face of OCD, but for this first week he’s got it.
The same goes for Mary. I gave her only about thirty minutes of instruction before she took it on as her own. As she was approaching that parking garage, she ran the logic through her mind as a reminder of what she needed to do. She deliberately entered that garage to face her fears. When the threat didn’t become strong enough, she went right toward the most threatening location she could find. Far from withdrawing, she literally drove her car toward her doubt and discomfort!
You are receiving far more guidelines on how to challenge Anxiety than Bob or Mary did. If they can do it, then I’m certain that you can, too.
Anxiety is going to pitch you uncomfortable physical symptoms and insecurity about your future. It wins if it can get you to worry, to avoid threatening activities, and to fight the symptoms with the hope that they will go away. If you can switch that up and purposely encourage Anxiety to increase those symptoms, and if you can act as though you want them rather than dread them, you can begin to turn the tables. This is just one more way for you to discover that when you do anything other than resist symptoms, they begin to fade on their own.