Anxiety and OCD Therapy

When fear begins to organize life

Anxiety becomes a problem not only because of the intensity of the emotion, but when life begins to be organized around trying to prevent it. Places, relationships, decisions, and everyday activities gradually become restricted. A great deal of time may be devoted to checking, thinking, reassurance, analysis, or the search for certainty, while short-term relief reinforces the sense that there is no other way to cope.

In OCD, too, the thought itself is not necessarily the central problem. Intrusive thoughts, disturbing images, and doubts occur in many people. Distress grows when a great deal of energy is directed toward solving them, neutralizing them, checking, performing a ritual, seeking reassurance, or reaching a certainty that is not possible.

The cycle that maintains anxiety

Anxiety, panic attacks, and OCD may look different, but they are often maintained by similar processes: avoidance, hypervigilance, attempts to control bodily sensations, emotions, and thoughts, safety behaviours, compulsions, and the search for certainty.

These actions make sense in one respect: they are intended to reduce a sense of risk and distress. The problem is that they do not allow new learning to take place.

A person who avoids travelling, conversations, crowded places, meeting people, a racing heart, or a disturbing thought has no opportunity to discover whether they can cope and continue to act without avoiding or neutralizing. Fear therefore remains immobilizing, and life becomes more limited.

OCD is not only about visible rituals

Sometimes compulsions are clear: washing, checking, repeating an action, or arranging. In other cases, most compulsions take place internally as mental rituals: replaying conversations, repeatedly checking memory, arguing internally, praying or repeating a reassuring phrase, trying to determine whether a feeling is genuine, searching for signs, or asking other people for confirmation.

The content may concern contamination, harm, responsibility, religion, morality, sexuality, relationships, or personal identity. Therapy does not focus on judging the content of the thought, but on understanding how the person responds to it and the cost of that response.

What does the therapeutic work involve?

At the beginning, we will develop a picture of the cycle: which triggers evoke fear, what is being avoided, how the body and attention respond, what is done to obtain relief, and what happens over time. The aim is to identify the particular processes that maintain the difficulty for you.

Therapy may include gradual exposure to situations, thoughts, or bodily sensations that have come to be avoided, exposure and response prevention (ERP) for OCD, behavioural experiments, work with worry and rumination, practice in attending and relating more flexibly to thoughts, and learning to act in the presence of fear and uncertainty.

In panic, we may also work directly with bodily sensations and the fear of the sensations themselves.

I draw on cognitive behavioural approaches and ACT, together with tools from mindfulness practice and attention to the body.

When working with OCD, exposure and response prevention (ERP) is used as appropriate.

Anxiety, worry, and overthinking

Distress sometimes appears as persistent worry, rumination, or repeated analysis of the past and future. Thinking feels like an attempt to solve the problem, but in practice it may distance the person from action, intensify self-criticism, and leave them caught in the same questions.

In such cases, we will distinguish between thinking that leads to a practical step and abstract, repetitive thinking. We can then use methods designed to change the style of thinking, reduce rumination, and return attention to action and to life itself.

What can change?

Change may mean that fear takes up less time and space, that avoidance, compulsions, mental rituals, and checking decrease, and that it becomes possible to return to relationships, activities, and parts of life that had been pushed aside.

The aim is not only immediate anxiety reduction or fewer symptoms, but greater flexibility and an increased capacity for values-based action in the presence of fear and uncertainty.