Progress Report On
“Acting Normal”

(and other secrets to becoming normal)

The following audio link is a clip from a recent session with a client who – since she is unidentified – wanted to share her success with others who struggle with OCD or other forms of intrusive worry. She has struggled with OCD since childhood and has been in therapy several times in her life, including use of various medications. She has had periods of significant remission of symptoms but acknowledges she has never been entirely free of compulsive behaviors.

Listen to her story:

 

She is an example of the fact that unless one becomes completely free of compulsions, one is prone to complete return of all compulsions and intrusive thoughts. It is consistent with all addictions – all or nothing at all. Partial abstinence will likely result in return of loss of control of thoughts and behavior. It’s not likely an addicted cigarette smoker can switch to smoking 1 cigarette a day long term. Same for any addictive behavior. So this audio clip describes the various techniques she has been utilizing to resist surrender to the irrational compulsive urges. These techniques and strategies include:

Acting normal 

 She will model a normal person she knows and act, look and sound the way they would in a trigger situation. In this case she thought of how her boyfriend would respond and responded similarly. She also thinks of how some normal friends, and her sister, handle situations and works to act like them.

Preplanning behavior

Preplanning what to pack for a trip. We decided she should use this technique because her OCD triggers fearful associations with different clothing items when she’s in the process of deciding what to bring while she is packing. She only experiences the illogical fearful thoughts about different items of clothing in the process of simultaneous decision-making and packing. It involves use of  cool-headed “Step 2”  logical thinking ahead of time as to what makes sense to bring and bringing those preselected items. She will also draw from others ideas as to what would be a logical clothing choice for her needs on a particular trip. 

Preplanning behavior along with Acting normal 

Preplanning how to exit through a door or passageway ahead of time. Often when she is exiting, her OCD triggers an irrational need to walk back in and out in a ritualized pattern – sometimes needing to repeat the ritual until it “feels right”. The strategy involves her preplanning her exit behavior: walk through the doorway like a normal person to resist the OCD rituals – performing Step 3 by replacing an irrational behavior with a normal behavior.

Labeling (Step 1) 

Including paradoxical labeling – meaning reverse labeling i.e. labeling her irrational urge as the opposite of what it is. In this case she has found it can be very powerful to tell herself “I don’t have OCD” in response to her sudden urge to ritualize exiting through a door. She similarly labels herself as “normal” which helps induce a consistent mindset and more normal behavior. 

Addiction model 

All or nothing mindset about her OCD urges – assisted by her experience with lifelong OCD. She has had periods of significant reduction to minimal levels of obsessions and irrational urges, but has never been completely absent of cooperating with some of her urges. She has experienced a number of times that she was prone to complete regression since she was never completely “abstinent”. This time she is making significant progress in resisting all compulsions to ensure long-term recovery. She is more serious about it this time so not inclined to give herself permission to just “cheat a little”.