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The OCD Cycle

Caring Carol says that children who suffer from OCD often find it difficult to choose what they want do. This is why they do compulsions. Compulsions reduce anxiety for a little while and so children do compulsions again because it's hard to live with anxiety. They think this is the solution but unfortunately it isn't because it keeps OCD going in a circle. Children also think compulsions will stop bad things happening; or to feel right. But this doesn't work because children need to repeat the compulsions. This page helps you learn not to do compulsions which can help you do what you want instead of what OCD wants. 

Let's find out how Caring Carol teaches children how to break the OCD cycle!

Let’s go around the circle to see exactly what happens during each stage

To help you understand the OCD cycle, simply follow the stages on the purple arrows on the OCD cycle diagram above. Start from the top and work your way around as you read the sections below. 

Notice the first part on the OCD cycle is Obsessive Thought.

Obsessive thought

Obsessive thoughts are also called intrusive or unwanted thoughts; and also obsessions. These are worrying thoughts that make children and grown-ups feel fearful about harm coming to themselves or someone they know. Or they may be about keeping things perfect, to feel right, or being fearful of losing things.  Nobody can help their obsessive thoughts, they just happen. 

Now let's look at the next part, which is Anxiety

Anxiety 

Obsessions cause anxiety which is like the feeling you get in your tummy when you go to the dentist or when you think something makes you scared. 

Not let's look at Compulsive Behaviour


Compulsive behaviour


Anxiety is so horrible that children do compulsive behaviours to reduce this kind of distress. Compulsive behaviours also known as rituals or compulsions might be checking, straightening things, hand-washing, tapping, counting, ruminating, avoiding or escaping, or something else. It might also be saying a certain phrase or prayer under your breath to cancel out an unwanted thought or image. You might also swap bad images for good ones. Or you might keep things because it makes you feel anxious to part with them. 

And now let's look at the last part, which is Temporary Relief


Temporary relief


Doing compulsions gives you temporary relief.This means that the anxiety goes away for a little while but then it comes back because the obsession bothers you again. When anxiety gets really high you get the urge to do more compulsions to get temporary relief again.


So now you can see how OCD goes around like a circle


 Obsessive thoughts, anxiety, compulsive behaviours and temporary relief happen over and over again because each part of the OCD cycle feeds the other parts. 

Learning to break the OCD cycle helps children get better, but this is hard work, so to help you along Caring Carol invites you to read her 3-step doubting challenge (below) - here you will see that making your own decisions, even when you're doubtful or feeling very anxious, can help you break the OCD cycle. Just remember that anxiety can only reach so high before it comes down all by itself, and it can never harm you, it just feels very horrible.

 The 3-Step Doubting Challenge



Children with OCD often find it difficult making decisions


Because children with OCD often find it difficult making decisions, they can get the urge to do what OCD wants instead. This can be very scary because some children believe that if they don’t do what their OCD wants it will make a threat that something bad will happen; or they think that they'll never ever feel "just right" about something or that they might lose something, get germs and fall ill, or feel dirty forever, or something else.

Caring Carol says there is no proof to show that OCD threats can make bad things happen. If OCD could make bad things happen it would be like magic, but magic is just a trick!

Unfortunately, children still get doubts about making decisions which is why Caring Carol wrote the 3-step Doubting Challenge. 


Let's take a look! 


YOU DECIDE

First, a decision can be anything, like choosing what you want to wear, what you want to eat, whether to go out, whether to straighten something or not, whether to hug your mom or someone else, or whether to wash your hands one more time. Or it might be deciding whether to cancel out a thought with a certain phrase or swap a good image in your mind for a good one. It could be deciding whether to pray for safety, or to ask someone to repeat saying something until what they say "feels right", or it might be about making a choice about whether to avoid or escape something, or to keep one of your things or not, like sweet wrappers. The list is endless isn't it. 



Caring Carol says you can learn to challenge what OCD tells you to do by making your own decisions. For example, if your choice is to wear your blue jumper, then the idea is to resist putting on your black one, which is what OCD might be telling you to do. 

Once you've made your choice, whatever it might be, you've taken a very brave step, so well done! 

Now let's skip to step 2… 


LET YOUR DISTRESS HAPPEN

doubt often creeps in once you’ve made your choice. You may continue to worry that something bad could happen and wonder if it would be better to change your mind and do what OCD wants instead. If you do what OCD wants instead this will be a compulsion. But your job is to resist doing the compulsion, so remember to bear with the anxiety whilst keeping to your decision. You might think you'll panic forever about not "feeling right" or that you'll never get over "losing something" or get really fearful that a bad thing might happen to someone you care about (or whatever it is that causes you distress). But if you stay with your choice and resist giving into what OCD wants you will find that you won't panic forever about what it is that makes you anxious. Doubts can make you feel very distressed, but the best thing to do when challenging a doubt is to stick with your choice while letting your distress happen.



Now let's jump to step 3… 



RESIST THE COMPULSION 

Holding on to your choice shows great courage, and it gives you the chance to recognise that the fear about something bad happening if you don't do a compulsion is based on feelings and guesses, not facts. It also gives you the chance to learn that you can manage really well when you get the "it doesn't feel right" sensation. Or when you think you'll never get over losing something, or whatever it is that causes you distress you will see that this isn't the case and that you can cope after all. 

Even though you know this, you may still feel the urge to do a compulsion so stay strong and read below "what to do when you're faced with doubts".


WHAT TO DO WHEN YOU'RE FACED WITH DOUBTS

When you're faced with doubts continue to hold on to your choice. You can break this down by resisting doing a compulsion first for 15 minutes, even 10 or five minutes. Then build on the time you started with. When you do this and practice it you learn to recognise that anxiety usually goes away all by itself, usually after about 15-30 minutes, and no longer than an hour. If it's a little bit longer, don't worry, it will come down, and you will be okay. This is when you start to realise that OCD threats do not come true. This is also when you learn to cope with uncertainty. What happens next is that all your fears start to weaken. When this happens, OCD doesn't bother you so much anymore, and so making your own choices become easier and easier! 


Doing the 3-step Challenge is very courageous! When you've done it once, you can do it again, and every time you do it, you keep on beating OCD!


You're a star!


Image result for thumbs up


CARING CAROL'S YOU DECIDE TIP 

Caring Carol says that as you begin to challenge and defeat OCD, remember her important message below!

"Every minute you resist doing a compulsion means you are in control. For every minute you are in control, you are beating OCD. Control means being in charge of what you do instead of OCD being in charge of what you do."

 Now let's learn about cognitive behavioural therapy

 Cognitive means thinking, reasoning, remembering, or learning. The word behavioural means the way someone behaves or responds to their thoughts and feelings. The word therapy means someone like Caring Carol helps you change how you think about your unwanted thoughts, and when these change for the better your feelings change for the better too. When you can think and feel better you feel confident. When you feel confident it helps you resist compulsions and instead you do the behaviours you want to do and not what OCD wants. When you resist compulsions and do what you want you do what is called exposure response prevention. Let's see what this means in the section below.

Exposure Response Prevention

When you start to resist compulsions you learn to challenge your OCD fears by first making a list of what these are. You then do exposure response prevention, or ERP for short. The word exposure means  agreeing to confront the fears on your list one by one. You would usually do this with a therapist like Caring Carol or a family member. The words response prevention means you make a big effort not to respond as you normally would with a compulsion but to resist this instead. You know all about resisting compulsions don't you! :) 

Dulling your fear

Doing ERP begins to dull your fear. Dulling your fear means becoming desensitised or habituated to the triggers and obsessions that cause you the fear. Let's say catching germs from a toilet door and becoming ill is your fear. When doing ERP in small steps, your fears and doubts about catching germs weaken. This helps you to take risks, which helps you live with uncertainty. 

What does becoming habituated mean? Read the message in the column opposite this one! 

For example, if you wash your hands 5 times after touching a toilet door, your new response will be to wash them 4 times, then 3 and so on until the urge to repeat the behaviour loses its strength and you begin to wash appropriately. 

Becoming habituated is like getting into a cold swimming pool. When you've been in the pool for a few minutes it doesn't feel so cold anymore. The same happens with anxiety. The more you resist compulsions you become habituated to your fear-related obsession. Isn't this clever! :) 

Remember, when you think differently about your unwanted thoughts, your behaviours and responses change for the better. So if Johnny touches a toilet door, he could think "I can either accept there is a very small risk of catching germs and becoming ill; or worry about my fear forever." He would then do his ERP by using the handwashing steps above. One tip is to also delay asking for reassurance about whether everything will be okay, because the more you ask, the more you'll need to ask. This is because reassurance seeking is a compulsion and makes the obsession worse. Delaying asking shows you can learn to live without reassurance and weakens the obsession. 

  Caring Carol's 3-minute ERP egg timer technique

 

 You can use a 3-minute timer to help you time and monitor your ERP sessions. So if your first exposure time is for 9 minutes you would turn the timer over 3 times and then note the time down in a diary. The aim is to reach 1 hour or longer without doing any compulsions. You can get bigger sand timers with more sand when you are ready for longer exposures, and they come in lovely colours too. These are not only a clever way to note down your exposure times, they are also calming when you watch the sand fall to the bottom.


Distress levels

When your distress becomes manageable, which is around 3/10 or less, you don't usually need to do ERP for your feared situation any longer. However, each day you are still encouraged to do the things you've learned. The good thing is it gets easier the more you practice!

 Distress thermometer 

To measure your anxiety level you can draw a thermometer, like the one opposite. 

Each day, you put a tick beside the number that indicates your distress level. You can then copy this into your diary to help you monitor your progress. Don't worry if things don't go the way you want them to, just keep trying and you'll get there eventually!

 Anxiety Thermometer Handout for

 Question Section 

Let's see how well you can remember what you've just learned!

 Caring Carol says please ask your grown-up to help you find the answers! 

  1. Can you name the four things on the OCD cycle?
  2. What happens to the OCD cycle when compulsions are resisted?
  3. Does anxiety come down all by itself? How long does it usually take?
  4. What can a sand timer and a distress thermometer help you to do?
  5. Please design a postcard and copy on it Caring Carol's You Decide tip. 
Caring Carol says WELL DONE on coming to the end of your third lesson!


 
 Thumbs Up!

Here is an extra question: Think of getting into a cold swimming bath. What happens after a few minutes and how can you compare this with OCD?

And now for your final lesson...

It's time to go to the next page for your fourth and final lesson to help you learn about other problems that can occur with OCD. Just click on the link below... see you there!

ocd-tourettes-adhd-depression.php

Parents and caregivers: 

The goal highlighted on this page is to help children feel confident that they are capable of making their own choices and to believe that their decisions are okay. This learning page further reinforces the importance that thought-action fusion isn't connected and as a result encourages your child to trust facts based on probability rather than feelings or guesses. Since doubts versus certainty play a big part in OCD, it's important that this problem is addressed as soon as it's recognised to guard against OCD becoming further entrenched. Also highlighted in this lesson is the recognition that with continued exposure children learn that they can manage their anxiety which further helps them habituate to their fears. ERP logs and a diary is effective because it helps children monitor their weekly progress and working on setbacks. 

Copyright © 2013 Carol Edwards. Updated 2016.  

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