Inhibitory Learning For OCD
When somebody is facing their fear, they repeat this process over and over again their body tends used to it. We’ve seen this in many different ways such as jumping into a really cool swimming pool. At the very beginning it is very cold but their body adapts and get used to it. We didn’t have to spend time convincing ourselves it was going to get better, it just happens. This can be seen when we are using exposure and response prevention. When you are exposing yourself to the upsetting fear it’s going to feel very difficult at the beginning. Overtime, you may face the same fear but notice that the anxiety level is a lot less. This is seen as the habituation model. That we essentially are doing exposures to reduce your anxiety by half or more. You’re getting used to it, you’ve taken the value away from it. When it comes to the habituation model, it’s all about this anxiety reduction in your body adapting just like the swimming pool. We will often use us as a measure of success if you were doing exposures correctly. If you’re anxiety is reducing this is a good thing.
There are definitely some drawbacks from using the habituation model. Anxiety is something that we want to take value away from as well. If we are focusing solely on anxiety and having us go up and down individuals can get stuck in paying attention to the anxiety and wondering if they are doing the exposure correctly or not. Let me start obsessing about the actual anxiety versus the actual fear. Many will start to question and wonder why they’re in anxiety is not reducing. Well evidence shows that the habituation model does work, individuals can you get stuck with these pitfalls often.
This is why there is another approach to exposure and response prevention called inhibitory learning. While this is still being researched there is evidence that shows that this helps reduce OCD symptoms as well. The difference is not the actual exposure you were doing but rather the way you were approaching it. With the inhibitory learning model you are teaching your brain more than reducing anxiety. Exposures are all about what can your brain learned from this experience. It doesn’t matter if your anxiety reduces or not. It might not even matter if you have anxiety while you’re doing the exposure. The whole mindset is all about your brain learning something new. So if I was facing a fear that really caused some anxiety, the way I approach is designed is to face the fear, expose yourself to it and RESPOND differently to the fear. You sole focus is what am I teaching my brain by every movement, words I’m saying, what I’m thinking, how I’m behaving.
If I avoid touching something because it’s contaminated, my brain learned that that thing is dangerous. If I touched it and acted like it wasn’t a big deal and didn’t do any compulsions, then my brain learns it’s not a big deal. You may learn time and time again that you faced your fear and NOTHING happened. That is what the brain is learning.
If you’re confused by the two, here is an easy way to remember:
The habitual model means your body is getting used to it and your anxiety is reducing.
Inhibitory learning model means your mindset is all about what your brain is learning from the exposure regardless of the anxiety felt.
Realistically, there isn’t the right choice comes to do an exposures. You do what you feel like is best for you. I have used both models together where I focus majority of my time making sure that the person knows that the brain is learning something. We use anxiety as a measure but ultimately it doesn’t matter if the anxiety reduces or not.
If your brain can learn that the fear that you have is not happening and it is it because you’re trying to control the situation what is the compulsions and to me that’s one of the best ways to do an exposure. Let things be. Stop controlling. It feels like an experiment, but the experiment is worth taking for your brain to learn something major. That you’ve never been a danger.
Habituation For OCD
Inhibitory Learning Exposures
How To Stop Ruminating with OCD
Rumination and OCD
This video is a long time coming. Let’s talk about rumination. Do you know what rumination is? I would say most, If not all individuals who struggle with OCD ruminate. The official definition of rumination is “the action of chewing the cud”……
Wait, that’s not it. How about this. “a deep or considered thought about something.” That’s better. We can all be in deep thought from time to time. It can whisk us away from the present moment. It can distract us from noticing the surroundings around us. Some have said that rumination is often considered to be a silent mental health issue. No one can see what’s going on except the person. They often don’t know the harm they may be causing themselves because of this rumination.
But why would thinking something very deeply be an issue? Well, it only tends to be an issue when it actually starts interfering in a person’s life. When it comes to anxiety, rumination is essentially a way for the individual to gain answers and problem solve whatever they’re feeling anxious about. It’s trying to problem solve the future. Trying to problem solve the “what if’s”.
If you think about yourself, are you ever able to actually come up with a good answer to the things you are ruminating about. I would guess the answer is no. Because we think we have a good answer, we react as if we have a good answer, we do behaviors assuming we have a good answer, and in the end it ends up being different than what you thought.
Rumination is a huge part of obsessive-compulsive disorder. Individuals who struggle with this often are looking for certainty. They want to know for sure what they are experiencing is true or not. If there really that type of person or not. If they would really do that thing or not. If that catastrophe in the future is going to happen or not. Rumination is thinking about all these things. Thinking about your specific topic or fear when it comes to your anxiety and OCD. Often rumination is just trying to figure out if what you are experiencing is OCD related or not. It’s problem-solving through what your brain says is a potential problem.
Here is an example: somebody you may experience contamination OCD may attach to door handle. Their brain has attached meaning to this. Here’s the rumination and what my sound like: “ I can’t believe you just touch the door handle. Do you have any people touch the door handle? What if somebody was sick that touched it? Do if you touched your face or no after you touch the door handle? No is probably okay to touch it. But if it’s not okay then I’ll get sick. I get Sick, then I won’t be able to go to work. If I can’t go to work, then how am I going to support my family. You know even though it’s probably fine, you should probably wash your hands just in case.
The person goes to wash their hands.
I know you washed your hands, did you know if you touched your pants afterwards? I know you trust your phone is a something you probably need to wash? How about you just change her clothes just in case. Well I know now you just kept yourself safe, but did you see that your child just touched the door handle. What things did they touch. Maybe need to go ask them, wash their hands change their clothes washed the door handle.
As you can see, this person is problem-solving they are doing just in case behaviors. There trying to think through it and prevent whatever the fear is from happening. Often I see rumination as very automatic. It will throw out these threats to you as quick as it can. If you go down this road and problem solve or think through the situation. You are doing a compulsion.
The compulsions are the things that are keeping you trapped. All your brain knows is that you may have saved yourself from whatever fear it says was going to come your way. It is a liar. You cannot think your way through your fear.
I say don’t engage with rumination. Do not give it any power whatsoever. This is a very tough task. But here are some tips you can use. Making sure you give your brain the same answer every single time it threatens you. It says you hit someone with your car are you thinking through this whole situation. Your answer is maybe I did maybe I didn’t. Some choose to agree with the threat to take the power away. They may say, sure I totally have someone of my car.
I can only imagine the OCD screaming you just gave it that answer, that you agreed with it. Are you sure you actually love your partner? Maybe I do maybe I don’t. Are you attracted to somebody of your same gender? Maybe I am maybe I’m not. Will I harm my child? Maybe I will maybe I won’t.
There is not a topic or theme you cannot use this phrase with. Everybody thinks their special and that their specific topic or fear does not apply. To help you not ruminate, it’s committing to not engage by giving it the same answer every single time. Even if it feels real, even if you feel like this one’s different.
Some choose have different catchphrases. That’s not my thing. Sure man totally. Thank you for your opinion.
These statements need to be followed up with not engaging in the compulsions. The individuals that do the compulsions are not really committed to the maybe maybe not’s that they are saying. Because you cannot say maybe maybe not, and then go wash your hands because you’re just not sure. Or avoid the knife because you’re just not sure. Or go back and check to make sure you did hit a pedestrian because you’re just not sure. Ask for reassurance again because you’re not sure. That is the whole point. You need to be unsure. Being unsure on purpose as a way to stop the rumination.
One of the first parts is recognizing that you’re even ruminating in the first place. You might think about what is my reasoning for thinking through this right now. Am I just genuinely curious, or do I feel this urge for this need to figure out this answer right now. If it’s the urge, you’re not gonna do it, you choose not do it. Is actually your choice. The thoughts will start coming in that’s the automatic part, but you engaging with them is completely your choice. Give yourself that power.
Did you know that I created a very specific course for OCD. It takes you through understanding yourself, the treatment and a way to maintain your progress. We talk about rumination, hierarchies, exposures, writing scripts so much more. There are over 41 videos in this thing. I’ll link it in the description. You can preview you it for free.
Do you ruminate? What do you ruminate about?
Overthinking and OCD
Nathan Peterson, LCSW
OCD can be tricky! I want to provide useful information for your OCD, anxiety, tics, tourette's, BFRBs, and many other anxiety related disorders.