Anxiety and OCD treatment is a paradox. You must become more anxious before you can become less anxious and you must become more anxious in the right way. The answer to anxiety is curiosity and compassion.
Mental illness is the only type of illness where you go to the doctor to get relief from a symptom and your doctor prescribes you more of that symptom. It doesn’t make sense. It’s reasonable for you to be confused and frustrated about your treatment plan and your treatment progress. Let’s talk more about this paradox.
You typically see a medical professional for structural disorders caused by pathology or injury. You need penicillin for an infection and a cast when you break your arm. Your eye doctor will prescribe you glasses as your eye sight declines; your dentist will give you a root canal for a decaying tooth. You are vulnerable to the effectiveness of your doctor, because something is wrong and someone else needs to fix it.
Mental health treatment involves some important differences.
The first difference is that the experience of anxiety is not a structural problem caused by pathology. You don’t have an infection that we can treat with medication. In fact, medication that completely sedates your capacity for anxiety would be problematic for you, because it would also sedate all your other feelings. (As an aside: The appropriate role of medication for anxiety and OCD is to decrease your sensitization enough to give you the chance to slow down and turn towards your own experience. If you are so overwhelmed by your symptoms that you don’t have the psychological resources to try something different, medication can support you and give you more access to your innate psychological resources.)
The second difference is that the experience of anxiety is not a structural issue caused by an injury. You didn’t break your leg or your tooth. There might be an traumatic injury (such as a car accident, chronic lack of emotional attunement in childhood, or a terrifying panic attack) in your past, but talking about that narrative doesn’t fix the distress you have about it the way a root canal fixes a tooth.
The third difference is that I cannot fix the way your anxiety operates the way a physician sets a broken bone. What maintains suffering long after trauma or bewilderment occurs is the way you respond to it. The role that I play is to help you observe the subtly of that response pattern and motivate you with curiosity, compassion, and humor to try something different.
What I have in common with other medical professionals is my thinking about blame. A good physician doesn’t blame you for vomiting when you have the flu; I don’t believe that how you respond to anxiety is your fault. In fact, the way you responded and continue to respond was and is your best option in that moment. For instance, if it was actually unsafe for you to be vulnerable about your feelings with your parents while you were growing up, it’s completely reasonable for your system to feel uneasy and anxious when you try to be vulnerable with new people now. What used to be a threat is no longer a threat. It takes a lot of self-awareness and self-compassion to shift the way your mind and brain reacts to something that still seems like a threat. If, in the present moment, despite intellectual awareness of the patterns that maintain your anxiety, you still have trouble doing something different, I assume there is a stuck point we haven’t discovered yet.
What this means for mental health treatment is that we have to work together to intentionally create circumstances that trigger your anxiety or OCD with an attitude of curiosity and compassion, so that we can observe what’s happening and figure out the stuck points. We need to give you opportunity and practice feeling something uncomfortable, deciding whether it is a threat to you, and then proceeding with confidence in your decision.
I want you to expose yourself to anxiety to learn how to love yourself, not to make it go away.
Exposure to anxiety without this understanding and without curiosity or compassion is just torture. It’s just more of what you’re already experiencing and it isn’t therapeutic. You aren’t doing something wrong if you can’t do something different when faced with some of your triggers. It just means that the mechanisms that maintain that response, whether cognitive or behavioral, are too sticky for you. We need more curiosity about what’s keeping you stuck and we need more patience and compassion while you’re practicing.
Clinical perfectionism says “there is a right way of doing things and I must always be acting the right way.” Emotional perfectionism says, “there is a right way of feeling and I must always be feeling the right way.” When emotional perfectionism shows up about treatment, it says, “there is a right way to get better and I must always be thinking, feeling, and acting in the right way to get better.”
Here’s the paradox: there is a right way. The right way to approach exposure to anxiety is with curiosity, compassion, and patience. Trying to be perfectly curious and compassionate is the opposite of curiosity and compassion. No wonder you feel frustrated or trapped!
Getting back to the basics of developing a curious and compassionate attitude, your path is through observing what’s happening.
Emotional perfectionism is:
- Urgent (“I must relate to this effectively right now!”)
- Critical (“I know what to do. Why can’t I do it?!?”)
- Comparative (“Other people don’t have this problem or are better at relating to it. What’s wrong with me?”)
- Compulsive (“What do I feel? What am I thinking? What I feel now? Oh no, where did that thought come from? What does that mean? Am I better? Will I get better? Is that surrender? Oh no, why do I have that feeling now? What does that mean? Am I better? Will I get better?”)
A curious and compassionate attitude towards recovery is:
- Patient (“Some triggers are harder than others for me. I’m going to focus on my next step and take pride in my process.”)
- Compassionate (“Even though I intellectually know what to do, practicing it is really challenging. I’m very uncomfortable and it is really courageous to stay with this experience.”)
- Self-respectful (“Other people may have a different process than I do, but I choose to own my own process.)
- Curious (“I’m noticing some sensations showing up. Let me describe them to myself. I’m noticing some thoughts too. Interesting. Is the content signaling anything to me or are my thoughts just sticky noise that showed up because I’m sensitized? Do I have any feelings now? Interesting. Maybe I have more than one feeling. Interesting…”)
If your belief is that you will be better when you no longer experience anxiety or OCD, then checking whether you are experiencing anxiety and OCD is reasonable. Hopefully this explanation has helped you understand why recovery is about how you relate to your experience, not whether anxiety and OCD show up.
If you must check, check on your attitude. Is your self-talk patient, compassionate, self-respectful, and curious?
If not, we’ll be curious about that together. You are an anxiety patient until you no longer need help being patient with your anxiety.