Coping Skills & Strategies for OCD
So, what kind of things help you to help yourself? Any and all of the following:
Learning All You Can About OCD
The first step in self-help for OCD is understanding your disorder. You already have an advantage, of course: This is your life. And that means you understand OCD in a way that no article, no research, and no mental health professional can.
But OCD is tricky, like a devil on your shoulder whispering “What if?” into your ear instead of sweet nothings. You know you shouldn’t listen and you try to tune it out but OCD is nothing if not persistent. And that makes understanding it, truly understanding it, essential to healing.
Unfortunately, this can prove elusive. If OCD weren’t already terrible enough, misinformation about it is everywhere. Hollywood, laypeople declaring that they’re “so OCD” because they check their teeth for lipstick or organize their glove compartment, stores selling products that trivialize it – we’re surrounded by misrepresentation.
And all this means you have to be careful what basket you put your eggs in. For instance, reading a blog written by someone who “loves their ‘OCD’ because it keeps them so organized” is not likely to expose you to accurate information. Instead, consider gathering knowledge, book recommendations, and resources from the following websites:
Regardless of the website you visit, there are a few things to keep in mind. For starters, although many sufferers experience similar thoughts and similar rituals, the disorder is very individualized and one person’s story might not be yours. Along these lines, what works for someone else might not necessarily work for you. This is especially true in relation to medication, which seems to have a strong genetic influence.
Sometimes, the information regarding OCD appears hyper-focused on the subtypes that are more stereotypical, such as contamination and germs, order and organization, and symmetry. This might feel dismissive to people who have a less common subtype, particularly if their subtype is one that elicits very potent shame (as is prevalent in Harm OCD and Pedophilia OCD).
Thus, for anyone whose flavor is one of the lesser known types of OCD, it’s beneficial to explore resources that speak directly about that subtype. This helps you feel less alone while offering usable resources on how to do things like parent when you’re afraid you’ll strangle your child.
Removing Stress from Your Life
Ha ha ha! That’s a good one! Okay, removing stress might be a little bit of hyperbole. The truth is, it’s probably impossible to remove stress from your life entirely (even if it feels like your day-to-day stress is somewhat controlled, here’s a global pandemic to unsettle you). However, limiting stress in any capacity that you can is vital to controlling OCD because of stress’s ability to stoke the flames.
Many people with OCD, perhaps most, experience an increase in symptoms whenever their underlying stress worsens. This is true whether or not that underlying stress has to do with OCD specifically. Pressure at work, a visit from your mother-in-law, or moving from one city to the next can all affect OCD dramatically.
For this reason, anything you can do to help control stress levels will benefit your mental illness. But engaging in a stress-reduction regiment won’t do much for you if you start the day before your mother-in-law actually sets foot inside your house (and questions your choice in decor). Instead, controlling stress requires daily (or near daily) dedication to the following:
Working Out: Exercising is helpful at managing stress, OCD, and general anxiety. For one thing, breaking a sweat produces endorphins, which are “feel good” chemicals that improve mood. Exercise helps you sleep longer and more soundly, too (more on the importance of that below). Working out every day may also motivate you to adopt other healthy habits.
Naturally, it’s not easy or else we’d all do it. With full-time jobs, kids, and day-to-day responsibilities, it can be hard to find the time to work out. A few things can help sidestep the challenge, including exercising first thing in the morning before other matters pop up and get in the way, exercising with a friend (who will help hold you accountable), telling others about your workout plan (this is something else that may hold you accountable), and buying a treadmill or elliptical to use at home (for many, it’s much easier, faster, and convenient to work out in their den rather than a gym).
Another way to stick to an exercise routine is to do something you enjoy. If you absolutely hate running and you decide to take up jogging, you might skip it any chance you get. Instead, try something that isn’t as strenuous such as walking or hiking. Some people find that combining exercise with socialization (joining a soccer team, for example) provides even more encouragement for them to see it through.
Engaging in Relaxation Techniques: If you’re like most people with crippling anxiety, hearing someone tell you to relax probably elicits rage and a face-punching reflex. But there is some merit to the suggestion as anything you can do to relax will help OCD symptoms.
Similar to working out, relaxation techniques are best adopted as a daily practice for strongest effect. Some of the things worth trying include:
- Breathing exercises
- Mindfulness (this may be along the lines of meditation but it can also involve mindful eating or a mindful walk around the block)
- Activities that you personally find relaxing, such as walking, dancing, or taking a scenic drive
Mindfulness, in particular, appears to offer people (with or without OCD) a potent benefit. According to research, regular practice can do the following:
- Boost frontal brain activity, which boosts the capacity for rational thought and emotional awareness
- Reduce activity of the amygdala, the part of the brain that looks for threats and activates the fight or flight response (this ability of mindfulness is potentially very beneficial to people with OCD since OCD sufferers tend to have an amygdala that is hyperactive)
- Enhance social neural circuitry and improve relationships and emotional nourishing by increasing levels of bonding hormones and improving ability to perceive the emotions of others
- Develop new neurons in the hippocampus, which stores memories and influences overall cognitive functioning
- Increase activation in the anterior subdivision of the cingulate cortex (another area of the brain implicated in OCD), resulting in better regulation and attention
- Increase activation of the insula (the gut instinct portion of the brain), which helps people become more attuned to themselves
While mindfulness sounds great, it’s not always easy to do. You have to make time and commit. But, even then, you may sit down to meditate, only to find that you can’t stop thinking about when you need to pick the kids up from swimming practice or whether or not the proposal you just set a client had any typos. If this sounds familiar, you might benefit from guided meditations. These are available on several apps, including:
- Insight Timer
- The Mindfulness App
Some people find it easier to practice mindfulness if they combine it with yoga. In that case, there’s an app for that! Consider the following:
- Yoga Studio
- Asana Rebel
- Down Dog
- Daily Yoga
Letting go of Toxic Relationships: It’s always easier said than done to leave a toxic relationship, particularly when it involves someone you truly care about. But, unfortunately, toxic relationships can feed stress, more so when you live with someone toxic or you’re married to them.
None of this suggests that relationships should be all butterflies and unicorns in order to be healthy. Relationships, on the whole, are hard and take lots of work. Still, there’s a difference between a difficult relationship and a toxic one. In regard to the latter, some of the signs that it’s time to let go, include:
- The relationship constantly feels bad
- Your minor mistakes are used against you all the time
- You feel that you have no voice or you’re told that your opinion doesn’t matter
- You feel like the negatives outweigh the positives
- You have to make all the effort and all the compromise
- Your partner has a history of lying, cheating, or abuse
Laughing: We’ve all heard that laughter is the best medicine. While you probably shouldn’t toss your antibiotics in the trash in favor of giggling the next time you have an ear infection, there is some truth to the adage.
According to the Mayo Clinic, laughing does wonderful things inside the body, including:
- Increases oxygen: Laughing requires you to breathe more, which not only stimulates the body’s organs and muscles, but it releases endorphins (similar to working out).
- Activates then calms your stress response: Laughing, most dramatically when it’s heavy laughter, revs up your stress response and then calms it down. This helps you feel relaxed.
- Releases tension: Laughter, in some ways, is like a massage for your soul. It stimulates your circulatory system, resulting in less physical and emotional symptoms of stress.
- Improves immunity: Laughter enhances immunity a few ways. First of all, it releases neuropeptides (proteins produced by neurons that modulate synaptic transmission) that fight stress and disease. Second of all, laughter counteracts negative emotions, which can cause chemical reactions that suppress immune function.
- Offers pain relief: Laughter helps the body release its own natural painkillers.
- Improves mood and personal satisfaction: Laughter improves connections with others (not to mention yourself) and lightens mood, making everyday stress as well as more serious stress easier to handle.
Getting Adequate Sleep: Most of us know that we need to get enough sleep each night (ideally between 7-9 hours for adults). But Mr. Sandman is a bit more anal-retentive than that and requires consistency too. In short, getting enough sleep isn’t enough; you should also strive to go to bed around the same time and get up at the same time each day (including weekends, sadly). This stabilizes your internal clock and keeps your circadian rhythm rhythmic.
In people with OCD and other anxiety disorders, this is crucial because lack of sleep tends to increase the release of cortisol (the stress hormone). Many people with OCD find that their intrusive thoughts are worse on days when they’re tired and their compulsions are harder to refrain from.
Eating Well: We know that eating well benefits our physical health by doing things like controlling weight and blood pressure but it affects mental wellness too. Depending on food choice, what you eat can hurt you or help you.
Certain foods are more likely to increase stress levels, including:
- White flour
- Processed food
- Artificial sweeteners
- Milk that include antibiotics or growth hormones
On the other hand, there are plenty of foods that act as allies. The stereotypical fruits, vegetables, and whole grains are helpful, but those with OCD uniquely benefit from foods that are known to increase serotonin. These include:
- Sweet potatoes
- Nuts and seeds
Yogurt that is high in probiotics or supplemented with them (especially lactobacillus rhamnosus) may be helpful in decreasing OCD symptoms as well. This is due to the gut/brain connection.
Considering Supplements (With Caution)
It’s easy to take supplements and other over the counter medications without thinking much about their side effects. But you should always consider supplements only with caution and speak to your doctor before taking any. This is most important if you have problems with your heart, lungs, or blood pressure or if you are taking prescribed medications. Some supplements counteract negatively with the common meds used in OCD. For instance, St. John’s Wort should be avoided by anyone taking SSRIs as combining the two can increase serotonin too drastically, leading to serotonin syndrome.
However, when caution is applied, supplements may prove beneficial in controlling OCD symptoms. While there isn’t one magic pill that seems to work across the board, there are several that appear to have some benefit and it’s possible that they may work for you as well.
Some of the supplements worth considering include:
Vitamin D: The goal of a vitamin D supplement is not so much to increase your levels but to prevent them from getting too low (something extremely common with around 50% of adults worldwide deficient). The reason this is so important to people with OCD is that low levels are linked to several psychiatric conditions (OCD included).
You don’t necessarily need to swallow a pill to avoid a deficiency. You can also increase levels by eating mushrooms, fish and other seafood, and fortified foods. Or simply go out and have some fun in the sun. UV rays are one of the easiest ways to up your levels but only if you’re not wearing sunscreen. To get the benefits of vitamin D while avoiding the dangers of skin cancer, it’s recommended that fair-skinned people spend about 20 minutes outside SPF-free before reaching for the Coppertone. People with darker skin may need to spend a little more time outside to increase their levels (40 minutes or so) but, because their skin is less susceptible to damage from UV rays, they often can do this safely.
Glycine: Glycine is an amino acid that lessens OCD symptoms because it has an agonist effect on NMDA receptors. In studies, it’s been found beneficial but at large doses that might cause nausea in some people. Alternatively, you may benefit from a glycine-rich diet that includes meat, fish, dairy, and beans.
N-Acetyl Cysteine: NAC has gotten a lot of press when used for OCD, with its tendency for tolerance aiding its case. NAC is converted to cysteine in the liver, which is believed to inhibit the release of glutamate (something people with OCD may already have too much of). NAC has grown so popular in the OCD world that some doctors even prescribe it over other medications. But it’s not without controversy. For example, with a quick Google search you can find articles that talk about how NAC treats cancer and how it causes cancer (ah, the internet!).
Part of the deviation is due to the fact that research has been conducted largely on mice, which don’t always translate to people. In other words, if something causes cancer in a mouse that doesn’t necessarily mean it has the potential to cause cancer in humans (especially if the cancer it causes is one that is very common in mice (such as lymphoma, mammary, or lung)).
The other part of the confusion may lie in the fact that NAC is an antioxidant. Historically, it’s been believed that antioxidants prevent cancer from starting in the first place by fighting against oxidative stress and protecting cells. While this is still the theory of thought, when cancer or precancer already exists, some now hypothesize that antioxidants may offer the dangerous cells the same kind of protection, ultimately increasing the risk of either a precancerous condition evolving into cancer or a pre-existing cancer spreading.
This uncertainty is, of course, hard to deal with, especially if you suffer from Health Anxiety OCD. But it’s important to know the science before jumping into a supplement. This gives you the ability to compare the good with the bad and decide if the benefits outweigh the risks.
St. John’s Wort: St. John’s Wort is popular among people with OCD, other anxiety disorders, and depression because of its ability to increase serotonin. As previously mentioned, it may be contraindicated with certain medications for this very reason. The research surrounding the effectiveness of this herb has proven inconclusive and, so far, science doesn’t have any proof that it works against OCD. But, anecdotally, some people have experienced benefits. In that regard, the research is irrelevant: If it works for you, it works for you.
Milk Thistle: Milk thistle acts as a sedative and antidepressant (as well as an antioxidant and anti-inflammatory). It’s believed to increase serotonin and mirror the effects of a monoamine oxidase inhibitor.
Milk thistle is rumored to interact with all kinds of medications but Drugs.com only lists four interactions (three moderate: Deferiprone, Raloxifene, Simeprevir, one minor: Indinavir). Check with your doctor to be sure.
Valerian Root: This root was once used as a perfume in the pre-Calvin Klein days of the 1500s. Now, it’s used to regulate GABA receptors, helping reduce anxiety. Studies have found that it is more effective for OCD than placebo and it tends to kick in quickly.
It has a reputation for causing liver damage, though studies suggest that this is far more likely to happen when it’s combined with other herbs, such as skullcap or black cohosh.
Curcumin: When taken for a long period of time (35 days or more) curcumin appears to decrease compulsive behavior in rats. It increases dopamine levels, which is likely the reason compulsions go down. As an added bonus, curcumin is well known for its anticancer effects.
Borage: Borage is a plant traditionally from Persia (modern day Iran) that offers sedative effects along the lines of Valium as well as antidepressant effects. It has been proven to decrease symptoms of anxiety (specifically OCD) when taken daily for at least six weeks. In one study, participants didn’t notice any change until four weeks in.
Resveratrol: Resveratrol is a compound often marketed as the Fountain of Youth in a bottle. It is believed to possess anti-aging effects because it blocks stress. You’ll find resveratrol in red wine as well as grape juice (especially the grape juice made with Concord grapes) but you can also take it via supplement.
It’s not exactly understood how resveratrol blocks stress but researchers believe it influences corticosterone (the stress hormone that moderates how you react to stress), offering neuroprotection in the process. Too much of this hormone can make OCD and other anxiety disorders worse.
Does Cannabis help OCD?
Cannabis has been all the rage for the last few years, as state after state moves toward recreational legalization. But does it work for OCD?
Marijuana might not be particularly helpful for OCD because the THC it contains is well known for causing anxiety (something sufferers are already stocked up full on). Hemp, on the other hand, is different.
Unlike marijuana, hemp doesn’t contain any THC (technically, it may contain up to .03% but certainly not enough to cause any psychoactive effects). Instead, it only contains CBD (a non-psychoactive cannabinoid). And this makes CBD oil and supplements attractive options.
But do they work?
Maybe. Evidence suggests that the endocannabinoid system does play a role in OCD. This is a system we all have, one that is made up of endocannabinoids (neurotransmitters), receptors, enzymes, and naturally occurring cannabinoids that regulate many tasks of the nervous system, including sleep, mood, pain, hunger, immunity, and anxiety.
Exactly what this means for OCD is yet to be determined and requires more research before conclusions are drawn. Even so, many people with all types of anxiety swear by CBD and it’s possible that it will prove helpful for you as well.
Taking Medications as Prescribed
OCD medication doesn’t work for everyone, with about 2 out of 3 people finding that it’s beneficial to some degree. If you’re having difficulty finding a med that works for you, talk to your doctor about a genetic study.
A quick saliva test can reveal what kind of metabolizer you are, something dictated by your genes. You’ll fall into one of the follow categories:
- Poor metabolizer: Your body breaks down medication slower than normal, increasing the levels in the blood and the potency of side effects.
- Intermediate metabolizer: Your body breaks down medication slower than normal but not as slow as those who are poor metabolizers.
- Extensive metabolizer: Your body breaks down medication at the normal rate, increasing the likelihood that the medication will work as intended.
- Ultra-rapid metabolizer: Your body breaks down medication faster than normal, decreasing effectiveness. In OCD, off-label medications may be most beneficial for this group (which makes up about 5-8% of the population). If the medicine has certain metabolites, ultra-rapid metabolizers may even have an enhanced response.
Most people are extensive metabolizers, which is why medications are designed to work for this classification. If you fall under a different category, side effects may be stronger than expected or the medication may be less effective than expected. Knowing your classification can avoid a lot of trial and error.
Regardless of the type of medication you’re on, it’s important to take it as prescribed, not to mix it with other medications (or with alcohol) unless you speak to your doctor first, and to refrain from stopping medication cold turkey. Sudden stoppage for those on antidepressants can cause antidepressant discontinuation syndrome. This condition manifests as flu-like symptoms, nausea, sensory changes, loss of balance, shock-like sensations in the brain, insomnia, and anxiety. The syndrome is usually mild to moderate, though some people experience symptoms so severe that they return to taking antidepressants.
Practicing ERPs and also Self-Compassion
The most challenging part of OCD treatment is completing ERPs, exercises that are extraordinarily difficult to successfully finish 100% of the time. Books, resources, and apps can help you along the way, offering tricks, tips, and encouragement (apps may be of particular use in this regard). The key to ERPs lies in the willingness to keep doing them. They do get easier the more your practice, but the only way to see this firsthand is to practice, practice, practice.
Something else that is highly important is self-compassion. Self-compassion, in layman terms, is simply the ability to give yourself a break. There are several ways to practice it, including:
- Treat yourself the same way you would a friend
- Find tolerance and patience for your own flaws
- View your flaws as human and remind yourself that no one is perfect
- Remind yourself that everyone makes mistakes and you’re allowed to make them too
- Refrain from judging yourself too quickly
- Practice mindfulness
- Put things into perspective
- Ask yourself if you would judge a stranger for doing the same thing you’re doing (For example, if you’re sitting in a window seat on an airplane and you need to go to the bathroom, you may feel like you’re being annoying by asking the two people next to you to get up. But, if roles were reversed and you were in the aisle seat, chances are you wouldn’t think anything of it when the person sitting at the window needed you to get up for three seconds so they could use the restroom.)
Joining Support Groups
Some people find OCD support groups very helpful, whether they’re conducted online or in person. While many attend for general OCD support, others might find that it’s more helpful to go to support groups that focus on their particular subtype of OCD (this may be most important for people who suffer from the more taboo flavors of OCD).
Regardless of the type of group you choose, there are a handful of things to watch out for, including:
- Groups with a judgmental member or members (support groups should make you feel better, not worse)
- Groups that discourage medication as a rule
- Groups that promise to cure you
- Groups that focus only on alternative therapies while disregarding cognitive behavioral therapy and exposure response and prevention
- Groups that attempts to sell you something
- Groups that charge high fees (while many groups charge some sort of fee, it tends to be nominal or small and not high enough to suggest that the people running it are profiting in a way that takes advantage of those who are struggling)
Advocating for Yourself
OCD is extraordinarily misunderstood (as previously mentioned) but this misunderstanding is not limited to the general population; those in the medical and therapy worlds greatly misunderstood it too. Many therapists who treat OCD don’t have the qualifications to do so (they lack specialized training in it).
For people who suffer from the lesser known types of OCD or those that may be ignorantly perceived as dangerous (such as Harm OCD, Pedophilia OCD, or Self-Harm OCD), going to a therapist who is treating outside of their qualifications can be very risky. Even if it doesn’t leave you traumatized, it’s likely to make you worse (especially if the therapist attempts to help you “control” your thoughts or suggests you put a rubber band on your wrist and snap it any time an intrusive thought pops into your head).
It’s always recommended that you go to therapists who specialize in OCD and who have completed OCD-specific training. Don’t be afraid to advocate for yourself in this department. If the therapist is making you worse or making it clear that they’re conducting therapy well outside their wheelhouse, go somewhere else. There are lots of excellent OCD therapists out there; it’s up to you to find them.
However, when you do find someone who specializes in OCD, there is no guarantee that you’ll gel with them. The connection between therapist and client is highly important; it’s the catalyst to successful treatment. They may be the expert in OCD but you’re the expert in yourself. Thus, if you find someone you feel doesn’t get you, go find someone who does.
Celebrating Small Improvements
It’s not always easy to celebrate small improvements when you feel as if you’re constantly squirming and writhing in OCD’s grasp. But noticing tiny steps is vital to healing. For one thing, it allows you to practice self-compassion (as mentioned above). More importantly, noticing small improvements empowers you to notice progress. When you realize what you’re doing is working, you commit to continue doing it. Remember: Big improvements are just a bunch of small ones, all added up.