Anxiety Sensitivity is the Missing Piece for OCD Treatment

By Jeremy Shuman, Psy.D.

The second week in October is OCD Awareness week.  This two-part blog series from Dr. Jeremy Shuman is intended to help folks recognize OCD in all its forms and understand what it takes to disrupt the obsessive-compulsive process.

OCD leads people to fear possible future catastrophes, but OCD does not improve by pointing out the likelihood of those catastrophes.  Imagine this: you are in a car with a person driving away from their home, and they are experiencing self-doubt about whether or not they turned off their bedroom light. They tell you that they fear the house may burn down if they don’t return to make sure the light is off.  They then explain to you that they are turning around to check their bedroom light. You might be tempted to ask them, “Does leaving a light on really matter?  Will anything bad happen if a light is left on all day?  Has anyone’s house burnt down and the insurance company refused to pay because they left their light on while they were at work?”  That individual may be able to answer that they recognize that their fears are ridiculous, but they need to turn the car around anyway. This is an example of how OCD cannot be lessened by pointing out the unlikelihood of the feared catastrophe.

No one likes to feel bad.  Pain can be a sign of injury.  Persistent negative emotions can be a sign of a mental health condition.  We are told to see a doctor if we experience unexpected discomfort.  We talk to a therapist if emotional pain is hard to cope with alone.  We are told that we should be happy.  That we should be grateful.  Calm.  Confident.  Optimistic.  Driven by purpose.  We are told that if one of these is lacking, then we need to get back on track.  Isn’t that a nice thought?  That with some soul searching and support we can invariably land on certainty about what we want and plan a path to feel like we are working toward achieving it.  But none of this is promised.

Distress is a part of life.  In a life well lived, we will face difficult situations and personal failures.  We accept risk into our lives without the promise of pleasure as the reward, and sometimes that gamble leaves us with aversive consequences to our own well-intentioned actions.  And we want to push it away because no one likes to feel bad.  We falsely expect that if we have “coped” then distressing emotions should be mild and transient.  This leads to distress intolerance, and a specific example of this is anxiety sensitivity.

Anxiety sensitivity is when dislike of the emotion of fear leads folks to catastrophize the experience of fear.  Interpreting fear as dangerous or even simply as a signal that there must be something to do in response can be a prime driver of OCD.  Where a safety behavior may be functional at first—think increased handwashing for a nurse just starting a career at a hospital—OCD removes the function from the ritual.  The ritual eventually needs to be performed out of intolerance for the feeling that comes with obsession.  This is why no amount of reasoning with OCD will convince someone experiencing obsession that they don’t need to do their related compulsions.  Insights about feared future outcomes become irrelevant when folks can’t tolerate the distress in the here and now and would do anything to escape.

Therapy for OCD has to tackle anxiety sensitivity.  Tolerating the physical sensations and cognitive experience of anxiety can be part of a treatment plan for OCD.  This is done through exposure therapy and if needed, a technique called interoceptive exposure.  Whereas many providers know about anxiety sensitivity with regard to panic attacks, some may miss the importance of this piece in conceptualizing and treating OCD.  This work can be difficult as a client, but it is also so incredibly rewarding to see identity shift toward beliefs of resilience and mastery over anxiety.

The Center for Mindfulness & CBT has many providers who specialize in treating OCD. If you or a loved one is interested in gaining therapeutic support, fill in this form to be connected with a provider.