Mental Fitness is like Physical Fitness
Originally, I was planning on making this week’s blog post an overview about Exposure Responsive Prevention (ERP) as part of my continued series on “Fundamentals of OCD Recovery” - but I was struck by some inspiration on my morning run and decided it would be more timely to write about this topic instead. That is, the idea that when it comes to OCD recovery, training your mental health and fitness is basically the same as training your physical health and fitness.
What do I mean by that? Let me explain. I think that most people, even those who aren’t necessarily gym-goers or athletes, can fundamentally understand the basics of training and improving your physical fitness. People go to the gym and lift weights, and if you do this consistently, you gradually build up the amount of weight that you can lift. Or with running - people start out running and can barely make it half a mile before being out of breath. But if they follow a training plan and run consistently, they might be able to run a full marathon (26.2 miles) in a year or two! It’s very easy and intuitive to understand how you can improve your physical health and fitness - all it boils down to is consistent training and quality workouts.
So, how does this tie back to mental health, and more importantly, OCD recovery? A common theme that I see with OCD sufferers (and something which I experienced myself, going through recovery) is that they are afraid to improve their mental fitness. They are used to, and comfortable with, doing the compulsions, ruminations, and being afraid of their intrusive thoughts. All of this is only strengthening OCD’s hold on you and degrading your mental health - it’s basically the equivalent of letting your brain sit on the couch all day eating nachos. What you need to be doing instead is improving your mental fitness through ERP exercises - refusing to do compulsions, refusing to ruminate on your obsessions or trying to figure out “what if” scenarios, and refusing to let feelings of anxiety/uncertainty/fear/etc… control your life.
When it comes to OCD recovery, the mindset you should adopt is to be excited about triggers and exposures, and see them as opportunities to build your mental health! Don’t think of them as things to be afraid of, or try to avoid them - instead, actively seek them out! Be excited and curious to explore these triggers and view them as “mental workouts” to build your capacity to accept thoughts, feelings, and uncertainty. A professional NFL player doesn’t try to skimp on his workouts, because he knows they are fundamental to his improvement. Sure, the workout may be hard, and it may make him sweat a lot, but at the end of the session it improves his physical fitness and capabilities. He gets excited to do these workouts, because he knows that even though he may struggle with the workout, it will be a net benefit to him for doing it!
The same must be true for anyone suffering from OCD who wants to recover. Don’t avoid triggers or indulge in compulsions, because this doesn’t help you at all. Instead, actively seek these triggers out and approach them as a workout - how long can you refuse doing compulsions? How many things can you achieve in your day (cooking, writing an important report at work, doing the groceries, making your bed) despite feeling anxious? How long can you avoid ruminating on your obsessions? Don’t be afraid of feeling anxious or fearful - instead, welcome those feelings as signs that your “mental workout” is having the intended effect. Trying to avoid feelings of anxiety or fear during ERP is like trying to avoid sweat during a tough physical workout (one of my favorite quotes from Mark Freeman, which I’ve paraphrased here). I’ve had many OCD sufferers tell me that they can’t handle ERP, because it makes them too anxious or fearful - but that’s the whole point! If we can’t build up our tolerance to handling these thoughts and feelings, we will never improve our mental health and fitness and will continue to be OCD’s slave.
So now that we’ve emphasized the importance of doing ERP, and that we should adopt a mindset of treating each exposure/trigger as a chance to improve our mental health rather than being terrified of these triggers, it begs the question: how do we go about becoming mental health athletes? Here are some recommendations based on my own experiences in recovery:
Tracking your Compulsions
An earlier blog post I wrote explained how, during my own recovery process, I tracked the amount of compulsions I did each day. The full details can be read in that post, but at a high level: this ensures accountability and also provides a benchmark to measure yourself by. If you did 50 compulsions in one week, your goal for the next week should be to get that down to 40 or less. And then if you get down to 40 that week, then the next week you should target 30 compulsions or less. Obviously, the only way you can reduce the amount of compulsions is by actively refusing them and accepting any residual feelings of doubt or anxiety - which is the core principle of ERP. And this exercise requires you to be brutally honest with yourself. If you check the door because you’re afraid it’s unlocked - mark that down as a compulsion. If you think of a terrible thought and immediately try to convince yourself that you would never act on that thought - mark it down as a compulsion. If you actively avoid a person or situation because you know it’s triggering to you - mark it down as a compulsion. Tracking your compulsions and having data is extremely powerful for recovery because it gives you a target to aim for each week and enforces accountability, but only if you are honest with yourself about it. Purposefully not counting compulsions in order to make your “progress” look better is only hurting yourself, much like an athlete who purposefully avoids a workout. I’d also recommend that when doing this approach, you track and aggregate your compulsion counts on a weekly basis rather than daily. We all have daily fluctuations and some days are better than others, so using a weekly count will be more helpful for the purposes of giving yourself a target to shoot for the next week.
Don’t judge Progress by how you’re feeling…
I think it’s quite common for people who are just beginning ERP to have doubts about the process, especially when their feelings of anxiety (quite naturally) spike as a result of cutting out compulsions. They then begin to have doubts: I must not be doing ERP correctly because I feel anxious! I feel so bad when I cut out compulsions, it must mean my OCD is different and can’t be recovered from. I hate this feeling of anxiety, I can’t do anything or enjoy life while I feel like this!
The problem is we are allowing our feelings (of anxiety, or fear, or doubt, or whatever) to control our actions and outlook. Why is it a “bad” thing to feel anxious? Is it stopping you from cleaning your house, or going on a date, or playing your favorite video game? Going back to the analogy of physical workouts - it’s only natural to sweat and experience muscle soreness if we do a tough workout. That’s not a bad thing! Being afraid to get sweaty or to experience soreness during a physical workout is like being afraid of handling anxious thoughts and feelings while practicing ERP. Instead, we can learn to welcome these feelings, because it means we are growing and building our capacity to handle these sensations. You can only lift heavier weights or run faster if you do hard workouts that push your limits, and the same goes with mental health: you can gradually train your brain to learn to accept and even welcome these feelings of anxiety during ERP, because it means you are getting stronger and improving your ability to refuse OCD compulsions!
… instead, base your Progress on Tangible Accomplishments!
When going through ERP and actively refusing compulsions, it is quite common to feel heightened feelings of anxiety and distress (of course! You’re cutting out OCD’s only source of relief! So it’s natural to feel some feelings of withdrawal). However, telling someone suffering from OCD that they “have to suck it up and deal with these terrible feelings” is not exactly helpful. While it is true that the key to OCD recovery is learning to accept intrusive thoughts and feelings of anxiety without trying to chase them away, I also understand (having gone through the process myself) that spending weeks and months feeling miserable is not exactly how most people want to spend their lives. Instead, what helps is to switch your focus to tangible accomplishments - what did you achieve in spite of feeling anxious? What were you able to do today (no matter how big or small) even if you felt like crap?
Did you do less compulsions than yesterday?
Did you face a big trigger or exposure and manage to prevent ruminating on it?
Did you workout, cook breakfast, change your bed, watch TV, spend time with your loved ones, etc… despite feeling anxious?
Mark them all down as accomplishments! And at the end of each day, make a practice of reviewing the things you achieved and practice gratitude that you were able to do these things, no matter how you may be feeling or what fear that OCD is trying to get you to ruminate on. Putting the focus on tangible accomplishments really helps you learn that you can still live your life and do valued actions, no matter how anxious or fearful you may feel. In turn, as you practice this consistently, you teach your brain that you can accept these intrusive thoughts and fears without needing to act on them - because you can still live your life fully without doing compulsions!
To wrap up today’s blog post, I want to re-emphasize and stress the fact that in order to recover from OCD, you must practice ERP and approach your ERP exercises with the mindset of being a mental health athlete - how many triggers can you face today and still refuse compulsions? How many thoughts and fears can you think of in your brain and avoid ruminating on them? How many things can you do today even while feeling anxious? Improving your mental health and fitness is just like training your physical health and fitness - through structured practice and discipline, you can improve your brain’s capacity to refuse OCD compulsions and accept intrusive thoughts and feelings. In turn, as you become a stronger and fitter mental health athlete, it gets easier and easier to refuse OCD compulsions until you eventually recover - but the key thing is, this takes work. Lots of sweaty, difficult, uncomfortable work! In order to recover from OCD, you have to accept and welcome the fact that there will be lots of hard workouts every single day for you to practice and improve upon. Instead of being afraid of triggers and intrusive thoughts, get excited by them! Welcome them as opportunities to improve your mental fitness and capacity, like a lifter welcomes the idea of lifting progressively heavier weights because he knows it will make him stronger in the long run!
No professional athlete got to where they were by skipping workouts and avoiding sweat. So why would OCD recovery be any different?
Eric