When you first start obsessing about your relationship, you don’t immediately recognize your ROCD like you would recognize a headache. By the time you do and discover you have ROCD, a lot of time is likely to have elapsed. In that time, you might end up developing many compulsive rituals, both physical and mental. Some of them may have become so internalized that you may not even look upon them as compulsive rituals but just as quirks.
This leads to many rituals remaining unnoticed and under the radar. When you seek treatment, you may not mention these rituals because you may not be aware of them yourself. For example, you may have stopped meeting one particular friend socially because you may think her relationship is better than yours and you don’t want to be triggered. You may not consider this as an important point to mention during therapy. However, it is an important aspect which keeps your ROCD strong and hence needs resolution.
Additionally, whatever rituals you develop are likely to have core fears that need to be identified as well. Most times, you may not even realize that there are core fears getting you to do the rituals. For example, you may fear an abusive relationship in future similar to a news article you read and hence may want to make sure your partner is perfect. Your fear of the abuse and the pain may be stronger than getting into the wrong relationship. You may not even mention the fear of pain during therapy but it needs resolution for you to feel better.
So, when you start the recovery process, there are three stages that you might have to go through with each compulsion before you learn to handle them.
Awareness: In this stage, you begin to gain knowledge about and understand all your compulsive rituals. Avoidance of meeting people who remind you of your fears is a compulsion. If this is not identified, it may remain unresolved. In the second example, you are explained that the fear of pain and abuse needs resolution too and not just the fear of being in the wrong relationship. If you don’t understand the core fear, you may keep working on the fear of being in the wrong relationship and struggle to deal with it when it doesn’t seem to seem to make you feel better. The fear of the pain and abuse may appear through some other compulsive ritual and the cycle may keep repeating. Knowledge and understanding will help you identify what and how much needs to be dealt with. Along with it, the knowledge of how to handle the obsessions is also important.
Recall: Awareness is not always sufficient, particularly in ROCD. Even with the knowledge and understanding of what needs to be handled and how, you may not be able to. When it is time to face the fear, that is when you are triggered, the obsession may be bad and the thought may seem real. You may not be able to remember what you know and have understood. So, you may not remember that avoiding social contact is incorrect, and that you need to risk the pain if you are to get over your ROCD. But with repeated reminders and with the strengthening of your mindfulness muscle, you may finally begin to remember. Thus, the second stage in recovery is remembering the knowledge gained in the triggered state.
Action: When you gain knowledge and understanding, and begin to remember that the rituals are not to be performed when you are triggered, the third stage, which is action, becomes possible. In this stage you decide to either perform your rituals or stay away from them. Even though you may have gained knowledge and understanding, and even though you may remember what you are supposed to do, taking action to stop ritualistic behavior is not going to be easy. But with repeated reminders and with better acceptance of the need to not do the compulsions, you may begin to take action.
When you are triggered and want to cancel a social engagement with that friend, you may remember that it is unhelpful and despite what your ROCD asks you to do you choose to meet the friend. Similarly, when you wonder if your relationship is right, you may remember that you are supposed to risk future pain and continue to be anchored in the relationship right now, despite the fear. When you continue to do the difficult things, you are taking action.
Thus, in the beginning, you may not even be aware of where you are going wrong. With knowledge and understanding you become more aware. When you are triggered, with sufficient effort and mindfulness you may begin to remember more often not to act upon your compulsive urges. With practice and acceptance of the futility of doing the compulsions, you may begin to take action to resist the urges.
In the beginning, maybe out of the ten times you are likely to get triggered, you may recognize the pre-trigger signs only once. Out of the ten times you are triggered and get the urge to do your compulsions, you may mindfully remember only once to not do your compulsions. And out of the ten times you remember not to act upon your urges compulsively, you may accept the situation and succeed in not doing your compulsions only once. But slowly, with repeated practice, and with your MMA super vision getting stronger, the number of times you recognize, remember and resist the urges will increase and you will begin to inch your way towards recovery.
In the next chapter, we shall understand the difference between plain response prevention and ERP.