The OCD Cycle

We live in a society where we do not like to be uncomfortable, and we have difficulty tolerating distress. Anxiety is a word that has a lot of negative connotations, and because of this, we go into problem solving mode and try to quickly find solutions. For some people, the danger signal gets attached to everyday neutral things that are generally innocuous, such as people, social situations, doorknobs, dogs, physical sensations, or emotions. The actions we take when anxiety is present are called safety behaviors, or within the context of OCD, compulsions. These actions are meant to decrease our distress, which they do, but only temporarily. Some common safety behaviors are avoidance, reassurance seeking, researching, substance use, washing, counting, etc. Since these behaviors actually work in lowering anxiety, they continue to be used in a repetitious manner, causing the individual to get trapped in this cycle and preventing them from learning that the fear was unfounded or tolerable. Ironically, these safety behaviors and compulsions actually maintain the fear in the long run and simultaneously prevent growth and learning, which can severely limit an individual’s life. The thought, situation, emotion, or body sensation that creates the anxiety might be different within each presentation of OCD, but the cycle that maintains it is exactly the same. Please see our previous blog entry – Understanding the Cycle of Anxiety – for further information.

What is Sensorimotor OCD?

Sensorimotor OCD, formerly known as Somatically-Focused OCD, occurs when people become hyper-aware of their bodily sensations, body functions, and/or the internal sounds of thinking itself. This results in individuals hyper-focusing on the sensation, checking and monitoring whether or not they are noticing the sensation and then analyzing the sensation. This obsession on bodily sensations creates an increased amount of worry and uncertainty.

Common Obsessions with Sensorimotor OCD

Obsessions may include any thought that the individual experiences about body sensations or processes including, but not limited to:

• Breathing
• Blinking
• Swallowing/salivation
• Movement of the mouth and/or tongue during speech
• Pulse/heartbeat
• Eye contact
• Visual distractions or floaters in the eyes
• Awareness of specific body parts
• Bladder or bowel pressure
• Skin tingling or itching
• Joints popping or creaking
• Sensitivity to the internal sound or mechanisms of thinking

These thoughts can create a high level of anxiety for the individual and make them feel a need to abide by rules and rituals to reduce them and/or regulate the sensations. Individuals can become fearful that the sensations will not return to their previous state or that they will be unending and never out of awareness. The need for compulsions increases as attempts to distract themselves from these sensations repeatedly fail.

Common Compulsions with Sensorimotor OCD

Compulsions are defined as any intentional thought or behavior done in an effort to neutralize or reduce the distress caused by an individual’s anxiety. In this case, these can include:

• Cognitive avoidance/distraction – trying to not notice, distract from the sensations, or push the sensations out of awareness
• Overthinking/rumination – continuously thinking and trying to figure out the problem
• Checking/monitoring – physically or mentally monitoring, seeking reassurance, and over-researching the bodily sensation

Treatment of Sensorimotor OCD

The most evidence-based treatment for Sensorimotor OCD is Cognitive Behavior Therapy (CBT), Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT). Unlike many other forms of OCD, the key to treating this form of OCD within ERP is not in the exposure, but rather is the response prevention. The aim is to decrease the person’s reactivity to bodily sensations. Since individuals with Sensorimotor OCD are overly aware of these sensations, the goal becomes to be aware of the sensation but not pay it any more attention than it needs or warrants. It becomes very easy to fixate and ruminate on these sensations, which only increases an individual’s anxiety as it sharpens the focus on the sensation about which they are distressed. Teaching individuals to understand the difference between attention and awareness can be challenging at first, but this will be an essential aspect of ERP treatment. Over time, individuals will become aware that they can allow sensations, and even welcome them to be present. There is no need to try to control the sensations. They come to accept their body’s “noise” and will learn to respond to their awareness of bodily sensations with a casual focus without relying on distraction. Just because a trigger provokes anxious preoccupation, does not necessarily mean that there is anything amiss. In the majority of cases, it is the reaction to the sensation, rather than the sensation itself that is problematic.

Within CBT, individuals are encouraged to challenge and restructure their thoughts or distortions, looking for evidence against their thoughts and fears. Individuals might be excessively monitoring their body because they are afraid of missing a medical problem. They can explore if excessively monitoring their body is actually allowing them to identify/prevent medical problems They will also challenge and explore their anxious justifications for their behaviors by participating in cognitive reframing and redirecting.

Within ACT, individuals are introduced to the concepts of mindfulness and acceptance, helping them to be present with body sensations without trying to change them, criticize them, judge them, or overrespond to them. They can learn that they do not need to get stuck with these sensations, but that over time, awareness of the sensations will become less threatening. Individuals can learn to become aware of various bodily sensations via a mindful body scan that enables them to practice shifting their attention from one area of the body to the next without getting stuck and hyper-focusing on any one particular sensation/part of the body. Outside of therapy, individuals with Sensorimotor OCD can also benefit from medication.

Need help or support?

If you or a loved one are struggling with OCD or any other mental health need, know that you are not alone. If you are a parent/caregiver and are seeking additional information about these diagnoses or how you can best support your child, our office provides parent training with the SPACE program. Please see our November 2021 Newsletter for more information on SPACE. For these or any other mental health concerns, please contact the OCD and Anxiety Center at (630) 522-3124 or email info@theocdandanxietycenter.com.

We have offices located in Oak Brook and Orland Park and offer telehealth services available in Illinois, Indiana, and Iowa. At the OCD and Anxiety Center, we can provide treatment both in the office and at off-site locations (your home, mall, school, etc.). We will work closely with you to create an individualized treatment plan and discuss the frequency of visits, having the ability to meet with you once a week or more if needed. We look forward to hearing from you!

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Jacqueline Jones is a licensed clinical social worker at The OCD & Anxiety Center in Oak Brook, IL and Orland Park, IL. She specializes in treating all forms of OCD and anxiety in children, teens, and adults. She provides Exposure and Response Prevention Therapy and is comfortable working in and outside the office, wherever anxiety happens.