This article was initially published in Fall 2020 of the OCD Newsletter edition
By Lisa Levine PsyD
Rationalizing. Predicting. Mentally reviewing a sequence of events. Attributing meaning. Sound familiar? These are examples of what I refer to as compulsive reasoning (CR). While obsessive compulsive disorder (OCD) can involve myriad mental compulsions, in this article I am talking specifically about mental efforts aimed at reasoning or figuring something out. While CR goes on inside a person’s head, it is a compulsive behavior, just like hand washing or checking. Like any mental compulsion, it is not something we can see, but particularly because it is so easily confused as an obsession, it is a compulsion that often flies under the radar.
COMPULSIVE REASONING AND “MENTAL PING PONG”
While it was previously thought that some types of OCD involved only obsessions (aka “Pure O”), we know now that OCD (almost) always involves compulsions, even when those compulsions are not outwardly observable. Although obsessions are embedded within the CR process, like all compulsions, it is a goal directed behavior — albeit a “thinking behavior” — intended to alleviate anxiety and resolve uncertainty. Like any compulsion, CR involves striving — in this case, striving to think something through in order to reach an answer and relieve distress, usually in the form of a type of back-and-forth internal dialogue, or “mental ping pong.”
A person may spend hours every day trying to “figure out”:
• If he ran over someone with his car…
– What if that bump was a person? … No, that’s ridiculous; I’m not even sure I felt anything. Hitting a person would’ve jolted the whole car … well, I think it would have … maybe the responsible thing to do is to drive back and check … c’mon, if I hit a person I would know it! But maybe I was distracted … I could be charged with a hit and run … no, I know I didn’t hit anyone! But do I really know? If I’m wrong, my life would be destroyed … etc.
• If the cashier was offended…
– Shoot, I didn’t say “thank you”; maybe I really offended him … but I was preoccupied; I didn’t mean to be rude … even so, what if he was already having bad day? What if I made it worse? That’s silly, why would he care, he doesn’t even know me … still, he might think I’m incredibly rude…etc.
• If he is in the “wrong” relationship:
– I loved the movie but he hated it. What if that means we’re not right for each other? N, people can like different things … but maybe it says something about our values … that’s silly, its just one movie … but he hated it … still, we have plenty in common aside from our taste in movies, don’t we? What if I’m just wasting my time? … etc.
Even when both therapist and client are aware that CR is occurring, it is often difficult to stop. How do you stop your brain from figuring things out, especially when you are desperate for an answer?
NON-ENGAGEMENT RESPONSES
Let’s turn to the often-used metaphor of OCD as a bully
— a bully that is highly invested in getting you to play
its tormenting game of mental ping pong. You can be empowered to refrain from playing OCD’s game, from giving it the reaction it so desperately wants, by “responding” in a way that allows you to actively disengage from its attempts to bait you, using a strategy I call “non-engagement responses” (NERs). NERs are statements that purposefully affirm the presence of the anxiety or uncertainty OCD insists you run away from, empowering you to assert yourself in a way that makes it impossible for OCD to successfully draw you in and engage you. The key here is active disengagement, rather than any kind of attempt to simply refrain from thinking. By using NERs, you are strategically “agreeing” with the message the bully counts on you trying to dispute, thereby disarming it. Understandably, doing this may sound very difficult, and it can be, but it sure beats the alternative of falling deeper and deeper into the pit of anxiety with every moment spent engaging in CR.
The NERS include:
- Affirmation of anxiety
- Affirmation of uncertainty
- Affirmation of possibility
- Affirmation of difficulty
While NERs are most helpful when used together, for teaching purposes I’m going to talk about them individually, using separate examples for each NER.
Affirmation of anxiety, the “gentlest” NER, and the one I teach clients first, involves purposefully acknowledging that you do indeed feel anxious, rather than trying to compulsively reason yourself away from the anxiety OCD wants you to strive to resolve. By choosing to purposefully affirm and acknowledge the feeling of anxiety, rather than trying to desperately scramble away from it, you’re able to remain immune to OCD’s attempts to goad you into the futile game of mental ping pong.
Example:
Obsession (O): “The HIV test result could have been a false negative.”
NER: “I’m feeling anxious about that.” (Rather than reassuring yourself that the results were accurate)
O: “You should be feeling anxious. You could give your partner a terrible disease because of your denial.”
NER: “Feeling really anxious about that idea.”
O: “It’s not an idea; it’s reality.”
NER: “Feeling anxious about the idea that it’s a reality.”
Affirmation of uncertainty involves acknowledging the fact that you will never know with 100% certainty the “answer” OCD demands you must reach. Rather than scrambling to find certainty, you’re affirming the reality that certainty is simply not something you are going to achieve and, therefore, you are not going to waste your time and effort trying.
O: “You didn’t say ‘thank you’ to the cashier a minute ago. What if you really offended him?”
NER: “I don’t know for sure whether or not I offended him.” O: “What if he was already having a bad day and you just made it worse?”
NER: “I don’t know if he was having a bad day, and I don’t know if I offended him. No matter how much I try to think it through, I’m not going to know.”
O: “But he might think you’re incredibly rude.”
NER: “I don’t know what he thought, and I’m not going to know.”
Affirmation of possibility asserts “maybe so” — anything is possible. Acknowledging that what you fear is possible effectively shuts down OCD’s attempts to bait you into a futile quest to achieve certainty. Though you may know the pursuit of certainty is doomed to failure, when you are desperate,
it can be hard to stop your mind from trying. Assertively acknowledging that, “sure, anything is possible,” is not an act of hopeless resignation. Nor is it an agreement that the thing you dread did or will happen. It is simply an acknowledgment that the feared circumstance, like virtually anything else, is possible. It’s possible that a plane will crash into your home; or that we will have a terrorist attack tonight, or even that unicorns exist! Anything is possible — including your fears. Embracing this is difficult, but it’s worth it. It puts you in the driver’s seat, no longer at the mercy of OCD’s taunts. It is something you can actually DO to break free from CR.
O: “That bump you just ran over — it could’ve been a person.”
NER: “Maybe, anything is possible.”
O: “The responsible thing to do is to drive back and check.”
NER: “Maybe so, maybe not, but I’m not going to check.”
O: “You’re leaving yourself open to being charged with a hit and run.”
NER: “Maybe. Anything is possible in this world.”
O: “You’re going to risk that? Your life will be destroyed.” NER: “Maybe, anything is possible.”
Affirmation of difficulty: If someone advised you to respond to OCD’s terrifying threats by simply agreeing that the feared outcome would “suck,” you might assume he/she was an insensitive jerk. The key is to use affirmation of difficulty in a matter-of-fact, unabashed, and even slightly condescending way— in a tone that implies that the answer is glaringly obvious. The idea here is that the ANSWER to the question “what if” is pretty simple. The answer is, “it would suck.” Because it would. Obviously!
O: “What if the fact you loved the movie and he hated it means he’s not the one?”
NER: “Well, that would suck.”
O: “Yeah, it would — he seems great in so many ways. What if this is a sign?”
NER: “Clearly, that would also suck. Duh.”
O: “No, seriously, you could end up wasting years of your life with the wrong guy.”
NER: “That, like millions of other bad things that could happen, would most definitely suck.”
OCD: “But what if you waste so much time that you never find anyone and end up alone…”
NER: “That too would of course suck. Obviously.”
You may wonder, don’t people have to figure things out sometimes? The answer is, yes — sometimes. But not when a sense of urgency and desperation is present. Note
the presence of urgency and desperation and use this as a guideline to help you recognize when OCD is trying to get you to engage.
THE NER ATTITUDE: CONFIDENT, CONCLUSIVE, AND PERSISTENT
That attitude in which one uses NERs is of utmost importance. First, NERs must be used in a masterful, strategic way. Agreeing that anything is possible, for example, is not an act of defeat. It’s a brave, assertive action that shuts down OCD’s attempts to ensnare you. Because each response involves purposely affirming exactly what OCD insists you scramble to deny, NERs enable you
to beat OCD at its own game. Second, NERs must be used
as conclusions. Saying “maybe,” for example, is not an invitation opening the door to further consideration of endless possibilities. “Maybe” is the answer. Period. Lastly, we must match OCD’s persistence. OCD certainly does not give up easily. You must consistently continue to respond to any and all of OCD’s attempts to draw you into the endless cycle of CR in the same way — with NERs as your only response, until OCD is convinced the ping pong paddle has been abandoned and that you simply are not playing. When this happens, OCD stops trying — often only for 30 seconds, or three minutes, or five hours — after which NERs are used again and again, until they are no longer needed.
CR, like any compulsion, is an attempt to escape anxiety, inadvertently feeding OCD. With NERs, we show OCD that we see through its efforts to mobilize desperate striving and that we are able to remain immune to its attempts to draw us in. While disengaging from the often overwhelming compulsion to “think it through” can feel impossible, with practice, determination, and persistence, freeing yourself from the tormenting game of mental ping pong can become a reality.
Lisa Levine, PsyD is a licensed psychologist at the Behavior Therapy Center of Greater Washington.