Barry EIchenbaum, Psy.D.
Displaying irrelevance: A powerful tool to manage OCD
Intolerance of uncertainty is one of the core features of OCD. Instead of running away from the warning alerts caused by uncertainty, mentally embracing uncertainty, while uncomfortable, is the key to managing your OCD in the long term (see more here). When you accept that no amount of control or certainty can ensure that a fear won’t come true, you are actually displaying a degree of irrelevance to your intrusive thoughts. By telling your brain that you are willing to move on with life despite the intrusive thoughts, you are showing your brain that you are not treating this thought as threatening. You may still feel like the thought is threatening, but what's important is that you are mentally responding as if it was not threatening. If you continuously respond with this show of irrelevance, you can gradually rewire your brain so that it will cease labeling these thoughts as threats. That means you will likely notice the volume and frequency of those deafening OCD alerts decreasing over time.
While your mental acceptance of uncertainty displays some irrelevance to those threatening thoughts, it will probably not be enough to successfully treat your OCD. To do that, you’ll need to take your display of irrelevance to the next level, connecting this irrelevance to your actions. Why is this important? Lets take the following example. Imagine a mother who experiences loving and affectionate feelings to her newborn daughter. However, she also experiences unwanted, intrusive, images of her violently attacking her daughter. While these images seem totally incongruous to those tender feelings, she worries that experiencing those images is evidence that she could act on them. As a result, she starts to experience anxiety whenever she comes near the baby. She begins to spend less and less time with the baby so that she can avoid these anxious feelings. While doing this reduces her anxiety, she now experiences shame, guilt, and sadness for avoiding her baby.
This mother is experiencing a classic case of harm OCD, and is in desperate need of help! What can she do? Learning to treat these images as irrelevant to her life can be the key to managing these difficult emotions. This irrelevance needs to start in the mind. This mother would first need to accept that no matter how many precautions she takes, she can never be completely certain that she wouldn’t harm her daughter. Honest acceptance of this reality is an important and difficult first step in displaying irrelevance to these images. After all, if she took these images seriously, she would never be willing to accept the uncertainty. Once she is willing to try and practice mental acceptance, she needs to make sure that this acceptance is also shown by her actions. Lets say she mentally accepts the uncertainty, but avoids handling a knife when she is in the vicinity of her newborn. In this case, her brain tells her that handling a knife would invoke the uncertainty of whether she would take the knife and harm her daughter. By avoiding knives, she is giving relevance to these thoughts. So is she really accepting uncertainty? Not exactly. Her actions indicate that despite what she tells herself, she does not accept uncertainty, and that she is still treating these images as relevant.
So both our thoughts and actions need to display irrelevance towards intrusive thoughts. You got to walk the walk, not just talk the talk. This is exactly where exposure and response prevention (ERP) therapy, the gold standard treatment for OCD, comes into play. In ERP, a person engages in behaviors to expose themselves to the source of their uncertainty; actions that display irrelevance to their intrusive thoughts. In our example, the mother would deliberately make an effort to handle knives while she is in the vicinity of her baby. She would also have to try hard to resist the urge to return them right away or seek reassurance that she wouldn't act on these thoughts. ERP here can be an effective treatment because if the mother truly assigned relevance to the thoughts of uncertainty regarding hurting her baby, she would never willingly decide to handle a knife next to her. So handling the knife is a powerful behavioral show of irrelevance to these thoughts. When combined with the irrelevance displayed by a mental acceptance of uncertainty, you have unleashed a powerful tool to effectively manage your OCD.