Introduction

Obsessive-compulsive disorder (OCD) is a type of mental health disorder where a person experiences intrusive thoughts, urges, or images. For example:

  • Needing things to be placed in a certain way
  • Doubts about whether certain objects (e.g., doors, stoves) are still open
  • Immoral or aggressive thoughts
  • Worries that something is contaminated

These obsessive thoughts tend to increase anxiety, which then leads to compulsions that are meant to reduce distress – at least in the short-term. Some common compulsions include:

  • Doing something until they feel just right
  • Washing hands frequently or for a long period of time
  • Thinking a more positive thought to replace the negative thought
  • Checking something over and over again to make sure that it is locked or off

The reason why obsessions lead to anxiety and compulsion is how we interpret the thought. Most folks have weird thoughts from time to time, but they are able to brush it off and just say “Oh, that was weird” and get on with their day.

However, folks with OCD tend to place special significance into the thought. For example, they worry that having a negative thought (for example, “my friend sucks”) might mean that something bad will happen to that person. Therefore, they feel compelled to “neutralize” the thought.

Exposure and Response Prevention Therapy

One very common psychological treatment for OCD is exposure and response prevention therapy. The idea behind the therapy is to “expose” ourselves to the obsessive thoughts and urges but not follow through with the compulsion. For example, you might touch something dirty but then refrain from washing your hands.

By tolerating the distress of not immediately going for the compulsion, we learn to sit the with the distress. Over time, we recognize that nothing bad happens and the distress reduces. It is important to do these types of exposures repeatedly and for long enough to see a drop in distress.

SMART Goal Setting for OCD

Of course, sitting with our distress is easier said than done. However, there might be ways to use SMART goals to make these goals more achievable and realistic.

SMART Goals stand for:

  • Specific – What exactly am I doing?
  • Measurable – How do I know whether this is working?
  • Achievable – Is it within my capacity (at least right now) for me to accomplish it?
  • Relevant – Does this actually work on my problem?
  • Time Bound – When do I have to finish this by?

The use of SMART goals allows us to work on OCD symptoms based on what you are struggling with and start at a place where you feel confident succeeding. SMART Goals can also be used in many different psychological disorders, such as depression, anxiety, and sleep. SMART Goals can be particular helpful for certain obsessions. Some examples below.

SMART Goals for Feelings of Contamination

Typically, the compulsions associated with contamination is to wash hands, take showers, or make sure that there is no ‘cross-contamination’ happening when a person touches something they perceive as ‘dirty’ with something they perceive as ‘clean’.

To slowly work on these OCD-related symptom using exposure and response prevention, we can play around with duration or frequency to build up our tolerance. For example, a few possible SMART goals include:

  • Washing hands for 30 seconds instead of 2 minutes
  • Waiting for a period of time before washing or taking a shower (e.g., 5 minutes)
  • Reducing shower time by half of usual time
  • Reducing how much soap you are using when washing hands to only one pump
  • Touching clean clothes with dirty hands and tolerating the distress for 5 minutes

As you feel more comfortable, you can up the stakes. For example, washing for a shorter duration, fewer times, or waiting for a longer period of time before taking a shower. For cross-contamination, you can touch something clean after touching something dirty without following the need to clean it afterwards.  

Tackling ‘Not Just Right’ Feelings

Some folks feel compelled the need to do or think something until it feels ‘just right.’ For example, needing to place items down in a way that feels right. Another example might be being compelled to touch something with both hands so that there is a feeling of completeness. The same SMART goal setting can be used in this case:

  • Placing objects in a ‘not right’ way and then sitting with the distress  
  • Engaging in one behaviour (e.g., moving to one side) without ‘evening it out’
  • Intentionally putting things in odd or even numbers – whichever is more uncomfortable

By staying with the distress of feeling ‘not just right’ longer and doing this multiple times throughout our day, we will gradually see reductions in our distress.

SMART Goals for Checking Behaviours

For checking behaviours, SMART goals can mean reducing how long and or how much time you are spending checking:

  • Checking the stove only once and then going to sleep
  • Spending 1 minute engaging in checking behaviours before leaving the house
  • Keeping the tap slightly on before going on a 30-minute walk

At this point, you are probably an expert of SMART goals, so I won’t belabour the point.

Behavioural Experiments for Scary Predictions

For some intrusive thoughts, it is harder to develop a specific SMART goal. For example, some folks have a type of magical thinking that if they say or do something, then something bad could happen. A person might think: “If I think a bad thought about a person, something terrible will happen to them.”

In this case, we might slowly experiment with these hypotheses and see what happens when we let the bad feelings stay. These are called behavioural experiments.

Similar to SMART goal principles, you can start with something low stakes. For example, you could start by imagining something bad happening to a coworkers or acquaintance (and then observe if anything indeed went wrong). You can even start with me! I won’t mind. You can email me afterwards to see if I’m still okay.

Changing our Morally-Related OCD Thoughts

Some folks get very distressed from thoughts or images like hurting people or seeing people injured. This causes a lot of distress and doubt about themselves and who they are: “Maybe I really am a bad person.”

Using cognitive strategies can help change the way we think. For example, people with moral OCD have thoughts about hurting someone which they feel very terribly for. One common strategy I find helpful is to notice that the fact that you distressed about this thought is probably good evidence why you’re not a bad person. Would a truly terrible person care if they had these thoughts? Probably not.

Another helpful strategy is to make the distinction between having a thought and engaging in it. You’ve likely had the thought, but you have probably never done anything with them. So intention is important.

Using a full thought record can be helpful to tackle these negative beliefs of “I’m a bad person” or “Thinking something is just as bad as doing something.”

Hopefully, this post was helpful to start working on a few OCD symptoms!

Best wishes,

P