OCD and Mental Checking
If you are faced with the challenge of Pure Obsessional OCD (also known as “Pure O”), then chances are you’ve completed your first round of obsessions and compulsions before you’ve even gotten out of bed each day. Before you open your eyes, the wheels in your OCD machine start turning, and a sort of science fiction scan of your brain begins searching for evidence of “it”. Whatever “it” is, “it” is sure to be in there somewhere.
Perhaps it takes a few moments, or maybe it takes no time at all for the OCD search engine to drum up some piece of the broken puzzle. But inevitably, you find what you are looking for. The obsession is still there, still unresolved, still malicious and unfair. The lump in your throat swells and the other physical symptoms of anxiety begin to surface. Something is wrong and the day has only just begun.
Immediately, your OCD brain begins to engage in a series of mental exercises pitting the unwanted thought against reality, trying to force them to match up or reveal themselves as permanently incongruent. Someway, somehow, you have to get that sense of closure to indicate that “it” is not you. Otherwise, you may never get out of bed.
This is “mental checking”, and it is a common feature of Pure Obsessional OCD. The scan feels like an automatic part of life, no different than the first yawn or stretch. It happens throughout the day, often without you really being conscious that you are doing it. When it is not automatic, it presents itself as necessary, like the annoying reminder message for your computer’s antivirus software. It is important to realize that mental checking is a compulsion. And despite its automatic presentation, it is subject to the same treatment mechanisms employed when challenging other OCD compulsions with Cognitive Behavioral Therapy (CBT).
In short, mental checking is a behavior. It is the act of looking for your OCD obsession with the presupposition that you will in some way be able to squash it and get relief. Furthermore, since we always find what we are looking for when what we are looking for is evidence to justify action, we feel we need to do something about the obsession. This follow-up compulsion is a form of mental ritual aimed at neutralizing the OCD thought. It may be playing an event over in your head to make sure it was handled appropriately (also known as retracing), or it may be repeating a series of “good” thoughts to outweigh the so-called “bad” ones. But the initial behavioral compulsion that puts this OCD cycle into motion is the mental checking, and it is among the more challenging behavioral compulsions to resist because it often appears to precede the unwanted thought.
For people with Pure Obsessional OCD, there are three opportunities to challenge mental checking, listed here in decreasing order of difficulty:
- preemptive resistance
- concurrent resistance
- retrospective resistance
Preemptive resistance may appear impossible until you are well into a course of Cognitive Behavioral Therapy (CBT). Preemptive resistance requires that you have an awareness of your OCD tendency to check. If you have developed this awareness, you are more able to see opportunities for mental checking before they happen, and to see them as opportunities to resist checking. If you have OCD, you may feel an urge to check when you become aware of the absence of your obsession. Use this urge as evidence that you should re-direct your focus, rather than seeking certainty that the obsession has been dealt with. In other words, the urge is your clue – it is your signal to resist doing the compulsion.
Somewhat more tangible an objective is concurrent resistance. If you have already begun mental checking, you are already down the path to digging up an otherwise dormant, unwanted thought. This is where you can jump in and say, “Wait! This is mental checking! This is OCD, and I don’t need to do this!” At that moment, the challenge you face is to pull yourself back to the present. What matters now is not whether your obsession has been dealt with. What matters now is interrupting and stopping the pointless mental compulsion.
Finally, retrospective resistance may at times be the only tool left in your OCD toolbox. You have already searched for and found the obsession. You have already tried some compulsive mental exercises in an effort to make the obsession go back to where it came from. But all is not lost. You can still use the power of mindfulness and clinical self-observation to fully acknowledge that this was mental checking. Take this opportunity to remember what it felt like to look for the obsession. Identify that urge, and acknowledge that it sent you down the path of grappling with the same old OCD junk. You might be surprised how effective this post-compulsion labeling is in helping you better develop the skills of concurrent and preemptive resistance.
We often find ourselves sending the wrong message to the OCD brain when we engage in compulsions. We feel fear and engage in a mental (or physical) behavior to flee from that fear. The brain remembers this as evidence that the behavior saved us from the fear. But a more effective message to send to our brains is that the behavior is pointless and so is the fear. (For more information on this process, see our previous post on Exposure Therapy for OCD and Anxiety.) So even if OCD may have won a skirmish on the mental field by pushing you into a bout of mental checking, you can still win the battle by reminding yourself that what happened was nothing more than a compulsion. Next time it won’t be so easy to fool you.
Now get out of bed.
•Jon Hershfield, MA, is a psychotherapist at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions. He can be contacted jon@ocdla.com.
5 Comments to OCD and Mental Checking
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The information and research here on OCD is of value and appreciated. This was one simple idea on OCD, that for some, might be of help. Art is way of quieting the mind, relieving it of obsessiveness, gaining self-esteem. When you can disappear 3 hours into an artwork, even if it is amateurish, it helps you to refocus and is balancing. For some, it can be an essential self help skill to learn. Turning off the television also is of necessity for some with OCD. TV and movies, can wind one up like a top, bring back memories that are better left dormant, and even the news can have this effect on some. Reading is better for the mind than watching TV or movies (movies, that is entertainment or action movies, as oppossed to documentaries, or educational movies), especially as a way of life, that is daily or weekly.
Hope this idea finds root or acceptance among those working with those with OCD. Thanks.
This article is helpful in identifying the steps needed to begin changing behavior. An equally interesting and effective approach, I have found, is outlined in William Glasser’s “choice theory”, where we begin to see our behaviors in a different light (”I choose to do it” over “I have to do it.”) When we begin to make the unintentional more intentional, it changes the way we think about our behavior. I tell OCD people to first think of times when circumstances dictate that they were unable to do the obsessional act they feel compelled to do (this shows them in fact that they don’t have to do it), and then as they become more aware of their behavior to intentionally do the act or thought even if it is not compelling. As our awareness of the thoughts and acts moves towards concurrent and preemtptive, we ask clients to decide whether they want to choose the tendency to check. The goals is not so much to stop the tendency but the change the way we view it. And as that view changes, the tendency, as I have seen it, begins to alter the way that client’s see their obsessions and compulsions–as choices rather than requirements. But it doesn’t work for everyone, so I am thankful to have the above information to help with this often troubling and difficult disorder.
Tom,
Thank you for your insightful comment. I agree with your connecting this approach with Glasser’s “Choice Theory”. There are often overlaps in between various psychological theories.
From a Cognitive Behavioral Therapy (CBT) perspective, “I choose to do it, but I don’t have to do it” is an example of cognitive restructuring. Our approach melds traditional CBT with mindfulness-based concepts found in Acceptance and Commitment Therapy (ACT) and other “third wave” treatment modalities.
Cool story, I did not thought this would be so great when I read the link!
I agree with Tom – the concept of choice has helped me quite a bit in battling my OCD and anxiety problems. I fully understand that I can’t control the world but when I emphasize my power over my own choices in life, I feel a little bit better about myself.