Do I still get Intrusive Thoughts? (What does Recovery look like?)
Something that I get asked relatively frequently is: “do you still get intrusive thoughts or anxiety once you’ve recovered from OCD? What does recovery even mean? Is that even possible?”
It’s a great question, and I also think it deserves a nuanced answer. OCD is such a complex mental disorder that it’s difficult to set one standard of recovery for everyone, because every person has different obsessions, compulsions, and mindsets. For something like the flu, it’s very easy to understand if you are recovered or not. It’s a black and white answer: either you have the flu or you don’t. But it’s much trickier to say this for OCD.
My high level definition of OCD recovery means having the knowledge, skills, and mindset you need to handle any uncertainty, thought, or feeling that may pop up in every day life. Note that I did NOT say OCD recovery means "never" getting anxious, or “never” getting intrusive thoughts. Indeed, I think that is a fundamental fallacy that many people who are beginning their OCD recovery journeys fall for. You might say: “I hate these intrusive thoughts! I can’t stand the sense of anxiety I get from them. I can’t tolerate uncertainty. I want to recover from OCD so that I never get these thoughts and feelings ever again!”
It’s an understandable mindset to have, but once you learn more about OCD and how it works, you realize quickly how flawed that approach becomes. If your goal in OCD recovery is to remove the feelings of anxiety and intrusive thoughts, you will never achieve that goal. Think about this simple exercise: someone tells you not to think of an elephant. So naturally what do you do? You think of an elephant. The more you try to prevent yourself from thinking of an elephant, the more and more that image pops up in your head. Actively trying to suppress thoughts actually makes them occur more frequently. That is why avoidance and thought suppression are not effective OCD recovery techniques. They are actually compulsions and only worsen the disorder.
The same is true about feelings of anxiety and uncertainty. OCD thrives on making you feel these emotions. That is the trick it plays, time and time again, to force you into performing compulsions (rumination, checking, etc…) which will temporarily “relieve” those bad feelings and provide reassurance. But as I’ve mentioned many times on this blog, this only reinforces bad behavior in your brain. It teaches your brain that every little OCD obsession needs to be responded to with compulsions, and if you don’t perform the compulsions, the sense of anxiety and fear skyrockets. Thus, you get into a very negative feedback loop where you either have to waste time and effort performing senseless compulsions, or suffer from severe feelings of anxiety, doubt, and uncertainty. It’s a lose-lose situation.
That is why, for OCD recovery, you should be striving to break this cycle. How do you achieve this? You equip yourself with the toolkit you need in order to beat OCD. As I said in my introduction, this means having the knowledge, skills, and mindset to handle any situation that pops up.
Knowledge: Understanding fundamentally how OCD works and why performing compulsions only deepens the cycle. As I mentioned previously, compulsions only trap you in a no-win state where you are forced to perform compulsions or feel huge waves of anxiety. And the more you perform compulsions, the more your brain becomes reliant on you executing these senseless actions in order to relieve yourself from feelings of anxiety and fear. As I wrote about in my blog post, Know Your Enemy, in order to beat OCD, you must first understand how it works and why it is such a tricky thing to recover from.
Skills: Once you understand how OCD functions, you can learn the proper skills to beat it. For many OCD sufferers who struggle with recovery, their “skills” are coping mechanisms such as avoidance and compulsions - all things that only worsen OCD and make it harder to break the cycle. Instead, we need to learn the proper skills and techniques to disregard intrusive thoughts and refuse compulsions, and accept feelings of anxiety without allowing it to control our lives. Exposure Response Prevention is the classic “Gold Standard” approach for learning how to refuse compulsions. I wrote more about ERP techniques on this blog post. In my opinion, pairing ERP with Acceptance Commitment Therapy is incredibly powerful as well - ERP essentially teaches you how to refuse compulsions, and ACT teaches you how to separate yourself from your feelings & thoughts. Both of these Cognitive Behavioral frameworks give you the skills you need to accept any thought, feeling, or uncertainty, no matter how big or small they may be!
Mindset: And the last piece to tie everything together for OCD recovery is having the proper mindset. We should be approaching OCD recovery like an athlete approaching a physical workout. A weight lifter doesn’t spend his entire life lifting the same 15 lb dumbbell, does he? Of course not - how would he ever get any stronger? Instead, a weight lifter may start with 15 lb weights, and once that feels comfortable to him, he may progress to heavier weights and/or different exercises to stimulate different areas of growth. And as he develops and gets stronger, he can go from lifting 15 lb dumbbells, to 30 lbs, to 50, etc… But - and this is important - each development in strength is a struggle. The 15 lb weights might feel comfortable after awhile, but maybe the 30 lb weights are a struggle, and he needs to spend a few weeks training with those. And once the 30 lb weights are manageable, he may find that he needs to spend more time building up the strength to lift the 50 lb weights. The point is - building physical fitness is tough, sweaty work. You are constantly choosing new stimuli and progressively increasing your workouts in order to get stronger and stronger. Mental fitness, and OCD recovery, is the exact same as physical fitness. We need to approach exposures as opportunities to get stronger and fitter mentally. Don’t be afraid of intrusive thoughts or “bad” feelings - welcome them! Be excited that you get to experience them! Because it means you get to practice your ERP/ACT skills and develop your mental fitness and become stronger! And it may be tough at first to refuse compulsions, or to accept feelings of anxiety, but the more you practice and use your ERP/ACT skills, the easier it becomes. And then you can work on handling even tougher obsessions and triggers as you become stronger mentally. As I wrote about in this blog post, we should strive to be mental health and fitness athletes! We should be grateful to experience feelings of anxiety, or intrusive thoughts, because they are ways for us to practice our skills and get stronger. We shouldn’t avoid the tough mental workouts, we should run towards them with open arms!
So all of that being said - going back to the original question: “do you still get intrusive thoughts or anxiety?” Of course. Everyone does. Studies show that even “normal people” have weird, intrusive thoughts, but they are able to disregard them as inconsequential. OCD recovery means learning to accept these thoughts and treating them like clouds in the sky - you can observe their presence, but you don’t have to spend time judging them as “good” or “bad” or trying to chase them away, no more than you’d try to make the clouds disappear. And do I still get anxiety? Yes. I believe that feelings (happiness, sadness, anxiety, fear, etc…) are a fundamental part of the human experience. You shouldn’t seek to avoid negative feelings, but learn to accept them, and realize that even if you feel uncertain or scared, these feelings ultimately can’t stop you from living your life. I may feel anxious about a project at work, but ultimately those feelings of anxiety can’t stop me from doing things I value and living my life.
I’ll give a personal example. This week, I had a big uncertainty pop up. I won’t go into details, but when that uncertainty appeared in my life, here’s how I responded:
I stayed mindful and present - I didn’t immediately jump to try and “figure out” the uncertainty or reassure myself that it wouldn’t happen. Instead, I asked myself: does this particular doubt actually prevent me from living my life, right now? Is trying to “reassure myself” or chase certainty a valuable use of my time and energy? The answers were No and No, so I stayed engaged on the present moment and the task I was working on.
Later, I recognized that I still had some feelings of anxiety from the uncertainty that was hovering in the back of my mind. Instead of being upset about feeling anxious, or trying to solve the uncertainty to provide reassurance, I observed my feelings with detachment. Why am I feeling this? Where am I feeling this? Do these feelings really matter? Are they reflective of how I am actually doing, in this present moment? And again, I accepted the sense of anxiety by recognizing that it wasn’t preventing me from actually getting on with my life and doing things I valued.
Finally, as I reflected back on my experience, I realized that - as strange as it may sound - I was happy with experiencing those feelings of anxiety and uncertainty. It had been quite awhile since I’ve really felt anxious about anything, so this was actually a breath of fresh air - it was something new for me to experience, and an opportunity to sharpen up my ERP/ACT skills. I recognized that I was able to grow and become mentally stronger - and I was thankful for the opportunity to do so. Instead of being upset by the experience, I was happy that I had the chance to build up my mental fitness even more!
So I hope that personal example helps illustrate that even though I am “recovered from OCD,” I still get occasional uncertainties and feelings of anxiety, stress, and doubt. So does everyone! It’s a totally natural part of the human experience and we shouldn’t “judge” ourselves for having and experiencing these things. As one of my favorite OCD specialists Mark Freeman likes to say: “You are not a rock!” Rocks don’t have feelings, but humans do, and that’s great! We can learn to accept all sorts of uncertainties, thoughts, and feelings, but still recognize that we can live our lives and do things that we value. OCD recovery is all about realizing that these things do not control your actions or define who you are.
I’ll go even further and suggest that OCD recovery is not a “state” - it is a mindset. Just like a weight lifter who is always trying to lift heavier things, or an academic who is always trying to learn more, there will never be a moment where you think: “I am complete. I no longer need to lift weights/gain more knowledge/etc…” Instead, you should always be hungry to improve and get stronger - and that is the same with OCD recovery. There will never be a point where you are 100% cured and can “stop” doing the techniques you learn in ERP/ACT (mindfulness, acceptance, etc…) Instead, you will gradually come to understand that these are fundamental skills that can help in all facets of your life, and practicing them regularly will develop your mental health and fitness so that you are well equipped to handle any difficult thing that life throws at you (whether it’s OCD thoughts, losing your job, dealing with the death of a close friend or family member, etc…)
So when people ask me: “Are you recovered from OCD?” I can answer: “YES!” It doesn’t mean I never get intrusive or weird thoughts. It doesn’t mean I never feel anxious or uncertain about big decisions in life. It doesn’t mean I am immune to the feelings and experiences that all humans have. What it does mean is that I have the knowledge, skills, and mindset to handle whatever life throws at me - OCD or otherwise. That’s the key point I want to emphasize in today’s blog post, because I feel like so many OCD sufferers are stuck on this idea that OCD recovery means never experiencing intrusive thoughts, or never getting anxious, or there will suddenly be a moment in time where the switch “flips” and they are 100% cured. That is the wrong mindset and will only get you stuck with OCD. Instead - focus on achieving the recovery mindset and seeking out opportunities to build your mental health and fitness skills. That is what will set you free from OCD.
I hope today’s blog post helps. As always, if you have any questions or feedback, I’m always happy to discuss further. Wherever you may be reading this, I hope you have a great weekend and know that you deserve to live a happy and fulfilling life free from OCD, and you CAN achieve that!
Eric