Obsessive-compulsive disorder as practice for COVID-19

People who live with obsessive-compulsive disorder, especially those who have learned to manage it with cognitive-behavioral therapy tools, may actually be psychologically well-prepared for this pandemic. The techniques those of us with OCD practice to handle anxiety, intrusive thoughts, and all-consuming compulsions are well-suited to dealing with worries of infection and the endless what-ifs about what lies ahead. Those fortunate enough to have been treated for OCD with cognitive-behavioral therapy, often in combination with medication, are usually pretty comfortable being uncomfortable. (If you're suffering and not being treated, please seek help; you really can feel much better.) From the International OCD Foundation:

Accept anxiety instead of wishing it away and making it worse. No one enjoys anxiety and it's normal to wish you weren't anxious. But when you label your anxiety as "bad" and try to get rid of it, your brain then misinterprets the anxiety as a problem and dumps more stress chemicals into your body to help you manage this "threat." The result? You feel more, not less, anxious.

Instead, accept that it's likely you will continue to feel anxious during the pandemic, and that this is okay. Anxiety is uncomfortable, but it's not going to hurt you, and if you tell yourself you can handle being anxious, your brain is less likely to get confused and think anxiety is a threat. Accepting anxiety, not being afraid of being afraid, is how to keep it manageable.

Tell yourself you can handle uncertainty, because you can. This situation is scary because there are so many unknowns. But you have huge muscles for tolerating uncertainty already: you drive or ride in a car every day and that's one of the most dangerous and uncertain activities people do. You willingly accept that uncertainty without even thinking about it! Recognize you have the skills to handle the current uncertainty, too.

Recognize there's always very little in life that we can control. If we believe we have control over outcomes, we feel a sense of safety and comfort. But it's unfortunately an illusion. While we have some control of our actions, we have almost no control over results. We can follow guidelines, practice social distancing, etc. but we still may get sick or spread coronavirus to others. Beyond our immediate actions, the outcome is out of our control.

Accepting this lack of control is empowering. Instead of exhausting yourself trying to micromanage everything you do and then blaming yourself when things go wrong, you can turn your focus to what you can do and find freedom in letting go of the rest.

Be self-compassionate. During difficult times, it's reasonable to experience strong emotions. Not only are we experiencing fear and uncertainty, but we're also managing sadness, anger, irritability, overwhelm, and stress. While we cannot choose our emotions during the pandemic, we can choose how we respond to them. We can create a hostile psychological environment where we are harsh and critical of ourselves and our feelings, or we can create an environment that is kind and self-compassionate.

And more in Scientific American:

Elizabeth McIngvale, director of the McLean OCD Institute in Houston, said she has noticed patients struggling to differentiate reactions, as Carli described. Her response is that whereas guidelines such as hand-washing from the Centers for Disease Control and Prevention are generally easily accomplished, OCD compulsions are usually never satisfied.

McIngvale was diagnosed with OCD when she was 12, with behaviors like taking six- to eight-hour showers and washing her hands for so long they bled. McIngvale receives therapy weekly.[..]
Lately, she's found herself consumed with fears of harming or infecting others with the COVID-19 virus—a symptom of her OCD. But, generally, with the tools she's gained through treatment, she said she's been handling the pandemic better than some people around her.

"The pandemic, in general, was a new experience for everybody, but for me, feeling anxiety and feeling uncomfortable wasn't new," McIngvale said.

"OCD patients are resilient," she added. Treatment is based on "leaning into uncertainty and so we've also seen patients who are far along in their treatment during this time be able to manage really well and actually teach others how to live with uncertainty and with anxiety."

"COVID-19 Worsens Obsessive-Compulsive Disorder—but Therapy Offers Coping Skills" (SciAm)

image: Lars Klintwall Malmqvist (public domain)