Anxiety treatment is full of paradoxes. One of these paradoxes comes up when treating obsessive-compulsive disorder (OCD). The paradox is that with OCD you win by surrendering. This doesn't mean that you stop trying to fight and manage your OCD, it means that you stop trying to make things perfect, stop trying to figure things out, stop trying to analyze things to death. So, for example, you have just touched a doorknob and fear that you have gotten your hands covered with germs and that if you don't wash them immediately you will get sick and die and there's a good chance you will infect your family and they will all get sick and die as well. You have been here many times before and are familiar with this rather scary situation. In the past, you have learned that if you go and wash your hands carefully numerous times that you may achieve a temporary sense of safety from the risk posed by the germs you now think are on your hands. However, as you have learned about OCD you now realize that your attempts to achieve safety ultimately are futile and you are now trying to do things differently. You "surrender" the need to even attempt to be clean because you now recognize that this is part of the OCD, ignore the urges to once again go and carefully wash your hands and just go about your business as if there was no danger in the first place. While there is still a struggle for you in that you are now trying to resist the urge to wash your hands, so in that sense you aren't "surrendering" at all, but in another sense you are surrendering the need to be "certain" and you do this because you have come to understand the tricks and maneuvers this devious disorder has used in the past to get you to comply. You accept the uncertainty, surrender (i.e. let go of) any attempts to find safety.
Most people who suffer from OCD are, especially at first, unwilling to consider this idea of surrender. They mistakenly believe that their quest for certainty will lead to a positive outcome. It is often only after repeated attempts to achieve this mythical state of certainty that people eventually become willing to consider trying something different. Part of OCD's deviousness is that it continues to convince people that if you just try a little harder, try it one more time, wash just that one more time, check that door lock just one more time, etc. then relief will come and you will never have to wash or check again. Of course, this is a false promise but it is seductive and difficult to ignore. I have sometimes used the analogy of a mirage which looks so very appealing in the distance but which when pursued keeps receding further and further away. This is especially reinforced because when you do wash your hands, check that lock, etc. There is an immediate sense of relief but if you pay careful attention you will see that this relief is fleeting and is soon replaced by doubt and dread once again. Nonetheless, that immediate relief following doing the compulsion is seductive and gets people caught in a compulsive repetitive cycle. It is only once that cycle is recognized, and that the futility of doing the compulsions over and over again is finally accepted and recognized is the person willing to surrender their attempts to achieve certainty and that is when true recovery starts to happen.
Robert W. McLellarn, PhD
