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When a family member sees someone they love suffering, naturally, they want to help. This is human nature. But with obsessive-compulsive disorder (OCD), the support we give is often counterproductive.
If you are providing support in the form of accommodations, you probably do not realize that you are feeding OCD’s monster and aiding in maintaining the OCD cycle.
So what are accommodations anyway?
They are behaviors by loved ones that attempt to reduce or alleviate anxiety or distress that one is currently having.
Common accommodations include:
- Providing reassurance. For example: telling your loved one that they will be fine or what they fear happening will not or did not happen.
- Waiting for a loved one to complete their compulsions, which may make you late to events or doing things together.
- Engaging in compulsions for a loved one such as checking locks at night or buying excessive cleaning supplies.
- Aiding a loved one’s avoidance behaviors by agreeing to let them stay home from school or not doing something because it’s uncomfortable.
Why do we care about accommodations? Because they:
- Maintain the OCD cycle:
obsessive thought, image, sensation, or feeling > anxiety > compulsive behavior/avoidance > temporary relief. Cycle repeats. - Limit opportunities for exposures (E of Exposure and Response Prevention therapy-gold standard treatment for OCD).
- Reduce motivation.
- Interfer with learning gained from interacting with feared stimuli.
If you have provided accommodations to a loved one you are not alone. Statistics, and my own clinical experience, show us that up to 97% of individuals with OCD have someone they know accommodating in some fashion.
You’re probably wondering, now what?
To begin, if your loved one is not in therapy, they should consider seeing a trained OCD therapist who specializes in Exposure & Response Prevention (ERP).
Next, you will need to create an accommodation reduction plan. This is a collaborative process and should be done with the person with OCD, their therapist (if they have one), and anyone providing accommodations. Begin by creating an accommodation list together and include all support you provide concerning safety behaviors, compulsions, and avoidance.
Then, with your loved one, rate each of those from 0 -10, from least anxiety provoking to most anxiety provoking if they were to be removed. This is called the subjective units of distress scale (SUDS) with rating 0 = no anxiety to 10 = extreme anxiety. Begin removing any accommodations that fall between 0-5. When you remove accommodations, be prepared for your loved one’s anxiety to go up initially, which is why it’s best to start with SUDS 0-5. In time, you can work towards the higher rating items.
There should be no surprises. Always let your loved one know what’s going to be removed, when it’s going to be removed, and why it’s going to be removed. Be prepared to remind them.
Always plan for the worst. You’re loved one may get angry, cry or beg for your help. It’s important to stick to the plan and be consistent.
You will want to have a planned script to say when this occurs. The script should externalize OCD/anxiety (the two often go hand and hand), validate what your loved one is experiencing, label OCD/anxiety, and encourage your loved one to stick with it (act as a cheerleader or coach for them).
Here are some examples:
I know this is really frustrating and difficult for you. Validating one’s feelings.
OCD wants me to tell you that you will be okay. We agreed I wouldn’t do that. Externalizing OCD.
I am not answering any of OCD/anxiety’s questions. Labeling.
You got this, stick with it! Cheerleading/Coaching.
Remember, supporters need support too! When things get tough, have a plan for yourself. You may need to walk away, take a bath, or go for a hike. Think of what grounds you and do this during difficult times to avoid burnout/supporter’s fatigue.
My clients have found it helpful to change their mindset from ‘in-the-moment thinking’ to ‘forward thinking’. Knowing what you are doing may take time and it will get better.
And remember, giving does not always equal caring, sometimes you have to take something away to show you care.
