Yesterday, I highlighted two dimensions of OCD that are ripe targets for cognitive intervention. In thinking about the second one, the client’s cognitive experience of fear and anxiety, I realize that I’ve left out a bit of the back-story. Here goes:
When we speak of fear and anxiety, we’re speaking of a massive multi-system experience. In fact, like the difference between speaking about baseball and playing baseball, speaking about fear, even as cognitive therapist, is nothing like fear itself. Fear is so important to our survival and the survival of human relationships that it hits us with all the ferociousness of a tsunami. Fear captures our attention even before we’re aware of what we’re afraid of. Fear mesmerizes us, focusing our senses on the story which fear demands to tell us. Fear activates our endocrine system; in turn, our bodies, from top to bottom, become aroused and activated.
So when our sixty year old client, despite understanding that his repeated checking is un-useful (and if anything, will undermine his safety and peace of mind), says that he cannot-not check the door, we are speaking of someone who is immobilized by his internal state of fear. He may be convinced that his front door is the reason for his terror; but it’s in fact fear of his own fear. And while I don’t have OCD myself, I can definitely identify with that kind of immobilization. Fear after all is an embodied experience; it literally comes to life as all consuming.
Where does that leave our sixty year old? It leaves him at the open door of his prison. One of fear’s illusions is that it puts us a million miles away from safety. Or so we believe. In reality, the distance between abject going-out-of-my-mind terror and the most delicious sense of safety is the half micron that lies between two neural dendrites. That’s why we often feel silly for having made such a big deal about whatever immobilized us.
So what do we do? How do we help our clients step through the door so that they can go free? By breaking fear down; by deconstructing it. That’s why psychoeducation is such a central part of the cognitive approach to the neutralization of OCD.
Psychoeducation alone however will probably not fully get us moving. That’s where we come in along with some mindfulness tricks.
More on that next week.
Shabbat Shalom to all!