(Part five in a continuing series by the Cognitive Behavior Therapy Center of Southern California’s OCD experts)
We’ve previously written (see OCD Treatment Tip #1: Why Checking Doesn’t Bring Us Certainty) about the function and the peril of CHECKING in Obsessive Compulsive Disorder (OCD) but we feel that it’s also important to discuss a form of checking that people often miss because it’s “invisible”, yet very powerful in its negative effects on the person struggling with OCD.
We’ve looked at a variety of checking behaviors in earlier posts. We’ve described how “Lily” in an earlier post would spend minutes to hours checking and rechecking the burners on her stove before leaving the house or before going to bed at night. This grueling ritual repeated infinitum would reduce Lily to tears and deepen her doubt as to whether or not her burners were actually securely turned off. We described how the repeated checking, though an attempt to gain certainty about a certain thing or action, actually leads to less certainty and to more anxiety as the OCD doubts grow and grow with rechecking.
Most checking is a clear and overt action. For example, walking over to the stove and repeatedly looking to see if there is a flame burning at the burners or repeatedly locking and unlocking and locking again the bolt on the front door. These are clear observable actions that involve the body in the checking ritual.
However, there are other individuals with OCD fears whose checking behavior is completely mental and, thus, invisible to others. This member of the compulsive checking “family” is mental reviewing.
“Samantha” was extremely concerned with the possibility of hitting and injuring someone with her car while driving. In, in driving through an intersection or making a turn and seeing a pedestrian at the side of the road, Samantha would check in her rear view mirror repeatedly to see if she had hit somebody and left them lying injured in the road. When this mirror checking didn’t extinguish her doubts, Samantha would often turn her car around and drive back to the intersection to “make sure” that she hadn’t hit anyone. Too often, on the drive back to the intersection, something else would trigger her worry. For example, she might see a mother and her child waiting to cross the street. She would now wonder, “Did I just run over that child?” She would now have TWO incidents to worry about. As we have seen, the checking behavior, designed to increase one’s sense of security, often backfires and, paradoxically, further inflames the doubt and anxiety.
Over the course of her treatment here at the CBT Center, Samantha worked hard to face her fears by driving without doing the mirror-checks and the drive backs. She improved rapidly until her progress mysteriously plateaued and then ground to a halt. Closer examination of what Samantha was doing revealed that though she had eliminated the compulsive mirror-checking and was no longer driving back to the ‘scenes of the crime”, she was compulsively reviewing the trigger episodes in her mind later when she had left the car
When the doubts weren’t allayed by the mirror-checking, Samantha would, upon arriving at her apartment, sit quietly for an extended period of time and “replay the video” in her mind of her trip through the intersection, trying to convince herself that nothing disastrous had happened. She would review her memory of driving through the intersections, trying to remember if she had hit someone. She would play and replay this “movie,” trying to achieve certainty that nothing catastrophic had happened. The reviewing might take upwards of an hour and be exhausting for her.
Mental reviewing interferes with our ability to feel the difference between memory and imagination
Even though we might not have hit someone in actual fact, we CAN imagine hitting someone, and this ability leads us into greater trouble when we mentally review. How do we tell the difference between an actual MEMORY of hitting someone and IMAGINING that we have hit someone? Ordinarily, we can tell them apart because those two mental representations FEEL different from each other. We know the difference between an actual memory and something that we imagine because they internally feel different from each other. But as we repeatedly review the “video” we begin to rub off the feelings attached to both memories and imagined events, until we become less and less certain about which is which. That attempt to gain certainty backfires with mental reviewing just as it does with the other forms of checking. Our doubts increase with the repeated checking. The reviewing fans the doubts and drives up our anxiety as we more and more lose touch with our actual experience. Once Samantha and her therapist could see what was going on and Samantha began to eliminate her mental reviewing, her progress continued and she drove with more and more confidence and ease.
Mental reviewing, though internal and invisible to others, is still a compulsive behavior and needs to be eliminated in order to make progress with your OCD.
All of our therapists at the Cognitive Behavior Therapy Center of SoCal are experts in the evaluation and treatment of Obsessive Compulsive Disorder.
Contact us if you have any questions or to schedule an initial evaluation and learn how we can help you with your OCD.
Author Dr. Rodney Boone is the Founder and Director of CBT SoCal, has taught as a former member of the faculty in UCLA’s Department of Psychiatry, and practices in Glendale and Torrance, CA.