Obsessive-Compulsive Disorder: When Your Brain Gets Stuck

Obsessive-Compulsive Disorder (OCD) can be distressing and debilitating - but it is also very treatable, with some hard work and determination. One helpful way to understand how OCD operates is through an analogy used by Dawn Huebner in the book, What to Do When Your Brain Gets Stuck. She compares the OCD brain to a malfunctioning junk sorter that’s meant to sort useful information from useless rubbish. In an optimally functioning brain, thoughts come in, are evaluated, and dismissed if they’re irrelevant, unimportant or just plain nonsense! But for someone with OCD, this “junk sorter” is broken. Instead of discarding the useless thoughts, it makes the person focus on them, attributing meaning to them, so we get stuck listening to “junk” thoughts, even when part of us knows they are not true. In fact, they are often the exact opposite of who we actually are.

Normalising Intrusive Thoughts

It’s important to note that everyone experiences intrusive or irrational thoughts from time to time. For example, most of us have some “magical thinking”:  touch wood and it’ll all be okay or salute a magpie and we’ll ward off bad luck. These behaviours are driven by a type of thinking that can be similar to OCD, where the person links their action with preventing something bad from happening, even though they know it’s not logical (magical thinking). These small rituals are relatively harmless, but they show how everyone’s brain can sometimes make connections that don’t make sense.

For individuals with OCD, however, these intrusive thoughts take on a much more distressing and repetitive quality. While people without OCD can brush off a thought about accidentally harming someone or leaving the door unlocked, those with OCD may feel intense anxiety or fear over these thoughts, leading them to perform rituals or compulsions in an attempt to neutralize the anxiety.

OCD is considered ego-dystonic because the intrusive thoughts or urges go against the individual's values and sense of self. This internal mismatch is what causes the intense distress associated with the disorder. People with OCD recognize that these thoughts are irrational and unwanted, but the anxiety comes from the meaning they attribute to them. The distress arises not from the thought itself, but from the fear that having the thought somehow reflects who they are.

The 3 R’s Approach: Seeing thoughts as just OCD, not me

One of the most effective strategies for managing OCD comes from Jeffrey Schwartz’s book, Brain Lock.  His 3 Rs approach helps individuals understand that these upsetting and distressing thoughts are not a reflection of their true desires or beliefs. OCD can cause people to doubt themselves, but Schwartz’s framework helps individuals to separate their identity from the obsessive thoughts.

Here’s an overview of the 3 Rs approach:

1. Relabel: Recognize that the unwanted thought or urge is an obsession. It’s important to label it as such: “This is just my OCD talking.”

2. Revalue: Understand that the obsession is being caused by OCD. The brain’s junk sorter is malfunctioning, sending out incorrect signals and getting us stuck believing that the thought is meaningful. By acknowledging this, individuals can begin to realize the thought doesn’t reflect their true self – and that it is, in fact, junk. The thoughts lose their power, and the individual begins to see them for what they are: just background noise that can be ignored.

3. Refocus: Once the thought is labelled and understood as a symptom of OCD, the person can shift their focus to something else—ideally something constructive or distracting that can break the cycle of compulsion.

This process helps individuals begin to recognise that these thoughts are not a reflection of their true values or desires. If the thoughts cause distress, that’s often a sign that they’re not aligned with what the person truly wants, they’re ego-dystonic. This can be a powerful realisation in the recovery process, helping to separate the person from their OCD thoughts.

Therapy and Treatment Options

OCD is a treatable condition, and therapy is often the first line of treatment. The most effective therapeutic intervention is Cognitive Behavioural Therapy (CBT), specifically a type called Exposure and Response Prevention (ERP). ERP involves gradually exposing the person to the feared thoughts or situations that trigger their obsessions while preventing them from engaging in the compulsions. For Pure O, where the person only has ego-dystonic thoughts, we use the 3Rs, helping individuals to accept their thoughts as “junk”. Over time, this reduces the anxiety associated with these thoughts and helps the individual realize that the feared outcome is unlikely or irrational.

For example, someone with OCD who fears contamination might touch a public doorknob and resist the urge to wash their hands. Initially, this exercise might trigger significant anxiety, but with repeated practice, the brain begins to realise that the feared consequences (e.g., getting sick) don’t happen, and the compulsive behaviour becomes unnecessary.

Therapy can also help individuals develop coping strategies for managing anxiety and stress, which often exacerbate OCD symptoms. Mindfulness techniques, relaxation exercises, and psychoeducation about OCD can all support recovery.

The Role of Medication

In some cases, medication may be necessary to help manage OCD symptoms, especially if they are severe or do not respond adequately to therapy alone. Selective Serotonin Reuptake Inhibitors (SSRIs), a class of antidepressants, are commonly prescribed for OCD. These medications can help regulate the brain’s serotonin levels, reducing the intensity of obsessions and compulsions.

Medication is typically most effective when used in combination with therapy. It can help reduce the frequency and intensity of the thoughts, allowing individuals to engage more fully in treatment. Medication doesn’t “cure” OCD, but many individuals find that a combination of both therapy and medication offers the best long-term management.

Recovery Is Possible

Living with OCD can be challenging, but it’s important to remember that it’s a manageable condition. Whether through therapy, medication, or a combination of both, individuals can regain control over their thoughts and reduce the impact of compulsions. If you or someone you know is struggling with OCD, therapy can help fix your junk sorter, even when your brain feels stuck.