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.
•The OCD Center of Los Angeles is a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related anxiety based conditions. In addition to individual therapy, the center offers six weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment. To contact the OCD Center of Los Angeles, click here.