Hi! I apologize for the out of the blue ask, but you have posted about this kind of thing before so I hoped you might be able to help me. TLDR, my little brother has OCD and has just recently started (ERP) therapy about it, and I am looking for things to read so I can better help him with it.
One of my bro's main compulsions is reassurance-seeking and I'm one of his main people. I know that part of therapy is to start to resist that urge, but I don't have a clue where to help him set that balance - as someone who loves him and whose first response is always validation, I worry my instincts to just. Try to help him feel better might not be helpful for him. He and I talk about it, obviously, but he's at the beginning of his journey and doesn't always know the best balance either. Do you know of any resources available to the layperson that you'd trust to help me get started?
The trick to supporting someone with OCD is to shift from the mindset of “fixing a problem” and move towards the mindset of “feeling an emotion.” Reassurance seeking relies on the natural human instinct to comfort difficult feelings and welcome positive ones - we are naturally empathic, we share our joy and our relief. But sometimes someone needs to feel scared or sad or angry as a requisite necessity in order to feel better, the same way someone may need to feel some pain when removing an ingrown toenail in order for the problem to stop. If you stop before the toenail is extracted then the toenail will not stop growing, it will continue to grow and hurt more and more over time, and eventually cause even worse problems than simple physical pain.
In other words, we cannot use intellectual solutions to emotional problems.
When your loved ones with OCD share feelings of fear or sadness or even self-loathing related to OCD, it helps to encourage them to sit with the raw feeling rather than look for an intellectual solution. That means validating the feeling without taking action to resolve it, at least not immediately. This is SO challenging, especially for helpers, but the long-and-short of it is that if your brother asks for reassurance, ask if this feels related to OCD. If he says yes, then do not provide the reassurance, no matter what. Instead, provide support while he experiences the emotion. Some examples of intrusive thoughts and helpful responses can be:
Thought: What if someone bursts into my bathroom stall and hurts me? I need to check the lock a few more times to be sure I’m safe. (Primary emotion: fear)
Response: “Oh wow that would be so scary if that happened! I know I would feel really scared about it. I wonder if you can just sit with that fear for a moment before turning the lock. I’ll set a timer for three minutes. In the meantime, try and pee as fast as you can!”
Thought: “What if I accidentally hit someone with my car and didn’t know? I need to go back and check!”
Response: “Oh man, that would be rough. You could get in trouble if you did that. I’m glad you’re concerned enough for others to risk returning, but I’m not sure if it’s a good idea for you. Let’s drive forward a few more miles while you try and remember if you did that or not.”
In reality it is often very counter-intuitive, at least at first. We try and do the opposite of what the OCD tells us when it’s severe because even if it’s a common concern with a rational solution, rationality is not the name of the OCD game. Empathy is. If the OCD says to keep scrubbing your hands, then you have to stop, and stay stopped for as long as possible, even if it’s a valid concern. The rest is gonna be on a case-by-case basis. If you can, I’d recommend asking your brother if you can go to one of his sessions. If you can, I’d also recommend asking your brother to sign an ROI with his therapist to allow for a one-off phone call to discuss ideas between yourselves. In addition, I have some other ideas that can be helpful:
Ask them what their therapist recommends as long as wait times, coping tools, and mnemonics. I personally am a fan of the S.T.O.P. acronym for obsessions and compulsions:
Stop the compulsion cold-turkey
Trick the compulsion
Obstruct the compulsion
Postpone the compulsion
Any of these steps can obstruct a compulsive behavior long enough to let the fear pass on its own, which is the primary goal of OCD treatment. It’s not to rationally address the fear, often because the fear is, itself, rational. A person with intrusive thoughts about getting sick is going to feel stressed because it’s stressful to be sick and we know it. A person with intrusive thoughts about harming others is going to feel scared and sad because harming others is a scary and sad thing. The problem is with the intensity of the distress and the time consumed in the compensatory behavior. So finding ways to S.T.O.P. the OCD can be beneficial. Other ideas can include:
“Overcoming obsessive thoughts” is a book that has often been helpful for my patients with OCD.
Use of humor as a way to desensitize someone to their intrusive thoughts can be helpful too - I had a client once who said he was scared of accidentally calling others slurs and being seen as a bigot, and when he told his friends they started every phone call by addressing him with insults (i.e., “whuddup, dork!”) related to his identities so he could get used to hearing them. Use of repetition to desensitize oneself to intrusions can also be helpful - i.e., repeating certain phrases to oneself or others often to take away the sting of panic until it feels boring. I had a client with intrusions about going to hell, and so anytime they did something I’d say “oh, you’re so going to hell for that,” but like, I mean ANYTHING. Like, adjusting in their chair, looking at the wall while thinking, rolling their eyes at me for telling them they’re going to hell, etc.
This kind of desensitization can be done in a myriad of other ways, too. I once had a client with harming intrusions (i.e., intrusive thoughts about harming others) press a freshly-sharpened pencil into my hand for 15 minutes until they got bored. My supervisor at work had a client hold a machete to his throat for 10 minutes while they discussed the client’s favorite board game. I had a straight, cisgender, white male professor wear mismatching clothes and only do half a face of makeup for 6 sessions with a client who had intrusions about being laughed out of a room for “looking silly” and needing to check the mirror and with others at least 15 times before they could do anything so that client could be exposed to some of their more judgmental/self-critical thoughts by seeing someone else do the thing they were afraid of and not care.
The short answer to your question is, honestly, “it depends.” It depends on your brother, it depends on the intensity of the distress, and it depends on the circumstance. Things that work for some people would never work for others, and some things are just too untenable to even attempt. The fact you care and are attentive to it is a good sign, because the long answer is that your brother’s needs and your needs will change over time, but learning the basics to be ready for some stuff can still be helpful. I hope this response gave you some ideas, and I hope you know you are always free to reach out for support. My DMs are open, there are abundant online communities that can provide support and ideas for this, and your own family and friend group can be good resources as well. I hope all of this made sense because I’m sick rn and a little out of it.
Also, I wish you The Best of luck! I hope your brother knows and appreciates your curiosity and interest. And I hope you can continue to be curious about the lives of others and yourself.
And for the rest of you reading this: Be kind to others, be kind to yourselves, be gayer, and read more Terry Pratchett. I love y’all
