But…but…what if a tornado hits during an earthquake?

We all have obsessions. As unpleasant as they may be, they do serve a protective function. It seems even a squirrel looks more than once when crossing a street! Double-checking and triple-checking is a way of eliminating errors caused by distraction or absentmindedness. But how far can we go with this? For a person with Obsessive-Compulsive Disorder (OCD) it can be debilitating.

As our worry about something increases, so does our need to control outcomes. For example, the more we worry about health the more we do things like consult doctors, check internet websites, exercise, watch what we eat, etc. It’s all good. Anxiety makes us careful but it also restricts us. It is the price to pay for protection. But where are we supposed to draw the line?

At some point, protection diminishes and restriction becomes severe. Washing your hands will reduce the spread of disease, but washing your hands a hundred times per day will screw up your ability to function normally. Ironically, it will also end up causing cracks in the skin that will likely increase your risk of infection.

The problem here is a little thing called doubt. There are no guarantees (except death and taxes of course). Doubt exists in just about everything. This lack of certainty, when combined with anxiety, causes a tendency to obsess.

The interesting thing is that we all handle uncertainty differently. Some people are able to see things in relative terms while others are more black and white. They see things in absolutes. To them something is either safe or not. There is no such thing as ‘pretty safe.’ These types of thinkers are more prone to obsessional problems because they do not distinguish much between possible and probable. It is possible that in the next few minutes you will have a heart attack, you will be caught in an earthquake, and an airplane will hit your building. Anything is possible even if highly improbable.

The fertile imagination of the anxious person makes these ‘possibilities’ more and more real…and more and more scary. They then start to avoid these possibilities thus justifying (and increasing) their fears.

This is why we treat OCD at two levels, cognitive and behavioural. First we help a person realize that how they handle doubt is feeding their problems. We encourage them to think more critically and to trust their perceptions and their logic when dealing with uncertainty. At a behavioural level we encourage people not to act on their exaggerated fears so as to learn that anxiety dissipates naturally even if they do not do anything about it.

Here is something I published a couple of months ago on the issue of probable versus possible.

Possibly probable
(Source: Probablement possible. Journal Métro, June 4, 2013)

I can’t help but hesitate before buying a pair of shoes. Will they stretch and become more confortable? Can I find better ones? Am I spending too much? It seems I can’t make a purchase without some second thoughts.

Doubt; it’s one of those human emotions that seem to cause us nothing but misery. It imposes itself on all decisions, and the bigger the decision, the bigger the doubt.

Doubt the good
Despite the anxiety it causes, doubt is our ally. It makes us careful. Second-guessing protects human beings from acting without thinking. Impulsive acts, whether they involve spending money or crossing a street, can often lead to serious consequences. Doubt is an asset that keeps us safe. Unfortunately, as they say, too much of a good thing…

Illness of doubt
Too much doubt makes us overly anxious, and when extreme it can cause Obsessive-Compulsive Disorder (OCD). While we all have our obsessions and rituals, in the case of people suffering from OCD, doubt controls their lives. Doubt makes them check locks for hours and wash their hands hundreds of times. People with OCD are highly intelligent. They know these things don’t make sense. But doubt pushes them to double and triple check…just in case.

Possible or probable
Doubt plays with our minds and affects our ability to distinguish between possible and probable. Almost anything is possible, but that doesn’t make it probable. It is possible that in the next five minutes a plane will crash into the building you are in. But this event is highly unlikely. I don’t think any of you should go stand outside and keep an eye on the sky.

Acting on the probable
Giving in to doubt is like scratching a mosquito bite. It produces temporary relief but it only makes us itchier. The best way to deal with doubt is to not act on it. Logic and the need to function normally should be the only determinants of behaviour. For example, there is a possibility of death each time we get in a car but if we want to function normally we will drive regardless. By not acting on the doubt, its voice weakens. Eventually we feel quite safe driving even though the actual probabilities haven’t changed. The possible now feels improbable.

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Voici la version Française:

Probablement possible

J’hésite toujours avant d’acheter des chaussures. S’étireront-elles pour devenir plus confortables? Puis-je en trouver de plus belles? Sont-elles trop chères? On dirait que je ne peux pas faire un achat sans y penser à deux fois.

Le doute : une émotion qui ne semble être rien d’autre qu’un supplice. Il s’impose dans la prise de toute décision, et plus la décision est importante, plus grand est le doute.

Douter des bonnes choses
Malgré l’anxiété qu’il engendre, le doute est un allié. Il nous rend prudents. Reconsidérer les choses empêche d’agir sans réfléchir. Les gestes impulsifs, que ce soit de dépenser de l’argent ou de traverser une rue, peuvent avoir des conséquences graves. Le doute est un gage de sécurité. Mais il ne faut pas abuser des bonnes choses…

Le doute maladif
Le doute excessif rend anxieux et, poussé à l’extrême, il peut mener au trouble obsessif-compulsif (TOC). Même si nous avons tous nos obsessions et nos rituels, les gens qui souffrent de TOC voient leur vie contrôlée par le doute. Il les pousse à vérifier pendant des heures si la porte est verrouillée, ou à se laver les mains des centaines de fois. Ces gens sont très intelligents. Ils savent que ces choses n’ont pas de sens. Mais le doute les pousse à vérifier encore et encore… juste au cas.

Possible ou probable
Le doute affecte notre capacité à distinguer le possible du probable. Presque tout est possible, ce qui ne le rend pas probable. Il est possible que dans cinq minutes, un avion s’écrase sur l’immeuble où vous êtes. Mais la probabilité est mince. Je ne pense pas que vous devriez sortir pour aller scruter le ciel.

Agir en fonction des probabilités
Se laisser aller au doute, c’est comme gratter une piqûre de moustique : « ça soulage sur le coup, mais après, ça pique encore plus. » Il vaut mieux s’en abstenir. La logique et la nécessité de fonctionner normalement devraient être les seuls facteurs qui déterminent notre comportement. Par exemple, il existe une possibilité de trouver la mort chaque fois que nous prenons la route, mais si nous voulons fonctionner normalement, nous conduirons tout de même. En ne réagissant pas au doute, nous l’atténuons. Et nous finissons par nous sentir en sécurité au volant, même si les probabilités n’ont pas changé. Finalement, le possible semble devenu improbable.

Tagged as CBT, doubt, OCD.

Posted in Anxiety, Mental health, Stress.

Posted on 30 Jul 2013