Like I’ve mentioned previously, I am currently attending group for my OCD. We meet weekly to discuss our progress, successes, and setbacks. I enjoy listening to and getting to interact with others who also have obsessive compulsive disorder, hearing what works for them and listening to the advice and counsel from the doctors to myself and everyone else.

Initially, I was feeling a bit overwhelmed and there was one day when I dreaded going to group because I don’t know, I was afraid of being asked to do something I didn’t think I could handle? I didn’t want to be judged? But I keep going, and I keep learning, and now I look forward to my weekly check in’s.

One thing that one of the doctors either said or implied with the questioning that sometimes happens in the group that stuck with me is “What is the fear?” 

What is the Fear?

Sometimes the obsessions are so intense but they don’t really tell us what the “fear” is—just that there is fear, that “something” terrible will happen if a compulsion is not done. But when you start asking the obsession, as it were, what that fear actually is, it becomes clear that it is often a straw man—the fear either is far fetched, illogical, or there isn’t really a significant fear at all.

I think that’s why the psychologists keep asking us “what is the fear?” They will sometimes hound us with question after question when we say we felt the need to do the compulsion: “Why?” “But why?” “What did you think would happen if you did or didn’t do XYZ?”

Maybe this isn’t making sense without a concrete example. So let’s just go through one of my “obsessions” or anxieties. 

Situation: Hand washing after going to the bathroom

Obsession says: You got water or a soap spray on your upper arm. You are not clean there now. You need to be clean.

Compulsion wanted: You need to rewash that part of your arm and rinse.

Common reality: I don’t want to retouch the soap pump because I touched that when my hands were dirty. I use a tissue to pump soap either on to the arm or another piece of tissue and wash that part of my arm (or watch or whatever got “dirty” from the hand washing water or soap).

Why do it?: Well, so often I “hear” the obsession and compulsion and think, “well, that’s not so hard. I’m here and just want to get out of the bathroom. I’ll just do it quickly and get on with my day.” I don’t want to stand at the sink analyzing everything for five or ten minutes.

But why? What is the fear, really? I often don’t pause in the midst of the anxiety and ask myself that question. Later, maybe, but not usually right then.

So what would be the fear? Oh, that somehow the water or soap fleck had “dirt” or pee or whatever else from my bathroom trip in it and would then be on my arm. If I didn’t wash it off, I could theoretically get my clothes dirty or something I touch dirty. If it’s my clothes, then when I wash my clothes next, other clothes and the laundry machine would get contaminated.

Sometimes just having to go through the entire story highlights the ridiculousness of it all. But sometimes the OCD is so vivid and strong that the story seems plausible. It could happen.

Maybe, Maybe Not

In group, we try to remind each other that “it could happen” isn’t really a good reason to give into compulsions. One person used the phrase “Maybe, maybe not” and many of us have adapted that— for the example here, “maybe I’ll get my clothes contaminated with harmful bacteria and contaminate all of my clothes and ruin our laundry machine and therefore everything I ever wash from now on will be dirty and could cause myself and others to become ill. Or maybe not.”

The uncertainty, of course, is what fuels the performance of the compulsion. The thought, “why should I put myself through that agony of not knowing and wondering when I could just do a quick wash and prevent all of that?” is strong motivation to do that compulsion and be done with the worry (or so the OCD tells us).

Because, for real, the uncertainty is awful for someone with OCD. A “normal” person without OCD would probably think, “What in the world? Why are you even worried about that? I’ve never even thought of that. Of course nothing bad will happen.”

But that is what makes that person “normal” or a non-sufferer of OCD. It doesn’t mean my reality or that of any other person living with OCD isn’t valid or extremely terrifying.

Not So Easy

Exposure response prevention is hard. Asking “what is the fear?” can illuminate that the fear isn’t really severe or likely to happen, yes, but it doesn’t always eliminate the distress that comes with restricting a compulsion. Logic doesn’t always pacify the OCD because OCD isn’t logical. But hopefully that’s where the cognitive part of cognitive behavior therapy will come in at some point—trying to restructure and change how these thoughts are perceived and accepted.

We’ve also talked in group about how thoughts are just that—thoughts. The thoughts and ideas we have aren’t necessarily real or valid, even if they seem to be. We can’t always trust our judgment when we have OCD or trust that our assessment of what is “fearful” or “terrible” is actually anything different than what a normal person would do 99% of the time.

Asking “what is the fear?” can help us eliminate some foolish or unnecessary compulsions, just as it can also make us see that our views and beliefs are out of whack. That issue, though, is one that takes more time to root out and change.

Have you ever stopped to ask “What is the fear?” in the midst of an OCD episode? What did you do or change as a result?