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Why OCD Treatment Can Fail

"Six Degrees of Kevin Bacon" to the rescue.

Key points

  • Conventional OCD treatment may fail to address the emotional core of OCD.
  • The emotional core of OCD is a heightened existential sensitivity: a fear of death, loss, and chaos.
  • A mindful approach can transform your OCD into an unexpected ally and superpower.
 RumorFix/Wikimedia Commons/Creative Commons Attribution 3.0 Unported license
Source: RumorFix/Wikimedia Commons/Creative Commons Attribution 3.0 Unported license

You'd think it was because people with obsessive-compulsive disorder (OCD) refuse to do exposure and response prevention (ERP) that they fail treatment. Between one-quarter and one-half of people with OCD decline ERP even though it reduces symptoms 60 to 80 percent. But many OCD sufferers feel misunderstood because current OCD treatments fail to see them. They miss the emotional core of OCD: the "Kevin Bacon" found in six degrees or fewer.

Remember that old game you used to play as a kid? One person picks an actor—say, Julie Andrews. She was in the movie "Enchanted" with Amy Adams, who, in turn, was in "Night at the Museum 2" with Ben Stiller. Stiller was in "Meet the Parents" with Robert De Niro, who was also with Kevin Bacon in the movie "Sleepers." Just a few steps—here only four—and you're back to Kevin Bacon himself.

The core of OCD—our "Kevin Bacon"—is the fear of death and loss. Uniting a wide variety of OCD presentations—health obsessions, relationship insecurities, contamination fears, checking concerns—is a fundamental anxiety about the loss of our most precious gift: life and the relationships that sustain life itself. This is the root note formed by the triad of chaos, powerlessness, and fear that morphs into OCD.

OCD as Existential Sensitivity

Individuals with OCD are sensitive to this like the oxygen in the air and are keenly aware of when any issues arise to possibly threaten it and their sense of well-being in the world. They have a heightened existential awareness, one that, without help, leaves them feeling internally like Edvard Munch's famous figure in the painting of "The Scream."

Many can track back their main preoccupations of OCD to this "Kevin Bacon" and, yet, nearly all OCD treatments fail to acknowledge the profound empathy and sensitivity behind it; nor do they see it as a potential strength. Instead, they label it distorted noise that's better tuned out.

Tuning Into the Music Under the Noise

I agree with cognitive-behaviorism (CBT) and acceptance-commitment therapy (ACT) that OCD plays back with lots of distortion. But there's lots of interesting emotional music there if you listen closer and turn down the volume. I've worked with clients whose OCD anxieties were brought on by actual brushes with death, whose concerns about the health of their significant others echoed legitimate early fears of losing an unhealthy parent, and myriad other fears that conjure up legitimate existential anxieties.

Companioning the Emotional Core of OCD

OCD develops and flares up because of this profound sensitivity that goes untended and misunderstood. The good news is that it's quite easy to bring down OCD's fears by witnessing and clarifying them, rather than relegating them to just thoughts, veritable tics of the mind to be managed rather than lovingly integrated into one's story. This is the emotional core—the "Kevin Bacon"—so easily missed by many OCD treatments today.

How to Find Your "Kevin Bacon"

About a month or two into the COVID-19 lockdown, I woke up one morning with a haunting obsession. I could feel a toothache just beginning, and, all of a sudden, I worried: What if I need to go to the dentist and they’re all closed down? What if I have to suffer with a toothache for weeks and months on end? What if I luck out with an appointment and I catch COVID-19 and spread it to my family? The more my mind spiraled, the more the toothache felt even more real.

  • Step 1: Don't Let Your Thoughts Scare You and Throw You Off Track

This is the way OCD catches you. It sets up a problem that is there but it throws you off the trail. It’s just like being 15 minutes into a "Law and Order" episode when you think you’ve got the case solved, but it’s really just a dead end.

Unfortunately, most people with OCD will keep pursuing the wrong lead over and over because there’s a hope beyond hope that it will finally yield its secret. Ironically, the message is not too far away, but it is definitely somewhere else. The toothache really wasn’t my problem.

  • Step 2: Check the Periphery for Your "Kevin Bacon" Concerns

It wasn’t an unreasonable or outlandish concern. Living just north of New York City, we were close to the epicenter of the outbreak, and, on the news, we’d see numbers climbing every day. Worse yet, we’d see and read stories about perfectly healthy adults in their prime mysteriously felled by this as-yet-unknown invader.

In the past, I would have let this obsessional spiral take me over and would have investigated every possible doubt and fear until I was so far down the rabbit hole, I wouldn’t know up from down. But, with my new understanding of OCD, I remembered to play "Six Degrees of Kevin Bacon" to track the fear of loss, death, and chaos operating silently underground.

  • Step 3: Source Your Feelings

Slowly, I questioned myself. Is there something else you are feeling scared about right now? Is there something you aren’t allowing yourself to feel? And then it hit me! I was trying to feel OK and calm for the sake of my 2-year-old son and to keep optimistic that this dystopian nightmare would be over soon. Another side of me was terrified that lockdown would go on for weeks, months, or even years. Here was the "Kevin Bacon" of chaos.

I also remembered a moment playing with my son, pretending to visit the bagel store and go to the grocery in our imagination since we couldn’t in real life. Here was the "Kevin Bacon" of loss I couldn't quite articulate. I was afraid of him losing his precious innocence because of this profound existential reality, and I didn’t want to admit it to myself.

Ironically, by digging down and tapping into that pipeline of feeling—finding that "Kevin Bacon" not even six degrees away—all of a sudden the obsession lost its hold. By getting to the underlying feelings that that obsession was signaling, I was able to decode its message and reconnect more fully with the layers of my experience.

  • Step 4: Make Yourself and Your OCD Mindful Again

Instead of seeing OCD as a nuisance, I thanked it for alerting me to subtleties of my experience that I had tried to push aside. Surprising as it may seem, this more mindful approach to OCD, seeing it as a helpful friend and messenger, not just an enemy and demon, is part of what has been so missing in conventional OCD treatments.

The good news is when we find our "Kevin Bacon," like I did with my toothache obsession, we get the fuller message and the emotional clearing that helps us get back to creative flow. Once you make this link, you’ll find your OCD a powerful ally and an unexpected superpower. Even better, you'll start succeeding at your OCD treatment where it has failed you, and not the other way around!

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