Slow Down, Consider Your Options and Make a Choice
Let me introduce you to one of my clients that I will call Sally. Sally has had OCD for the better part of 30 years and her fears centered around “contamination” from her immediate family. When her compulsions first began over 30 years ago she recalls being concerned about being contaminated by germs. However, when asked why she still avoids touching her family members today she is unable to give a good reason other than she feels “uncomfortable”. I find that many of my OCD clients are so accustomed to doing their compulsions that it has become like a bad habit and they often are unable to give a good reason why they do the compulsion. The moment they feel an anxiety spike following being exposed to what they’re afraid of, they immediately launch into doing their compulsion without giving much thought to what they are doing and why they are doing it in the first place. It has just become the way they always do things. Some clients, like Sally, have even forgotten the original reason they started doing the compulsion in the first place.
Other clients may have a good idea of why they are doing the compulsion but don’t stop to evaluate if their “reason” for doing the compulsion is a valid one. Another client, Jim, also has contamination fears, but his “contamination” revolves around being exposed to psychedelic drugs. He will avoid wearing a jacket because somebody he met a few years ago who he thinks may have been around psychedelic drugs touched the jacket and thus the jacket is now “contaminated” with psychedelic drugs. Of course, when he stops to think about it, the actual risk of that jacket having drugs on them is virtually zero, but in the moment Jim chooses to avoid touching the jacket nonetheless.
In either of the above cases it seems appropriate for both Sally and Jim to have a way of being more aware of what they’re doing, notice how the OCD is tricking/seducing them into doing the compulsion, and how easily and quickly they resort the compulsion without really considering other options. To help clients become more aware (mindful) of what they are doing and why they are doing it, I have come up with the acronym SOBER, which stands for:
Stop, Observe, Be aware, Expand and Respond.
Stop What cues can you notice that OCD has entered the room?
Most clients can recognize when their OCD has popped up.
Take a moment to notice what’s happening. Observe What is going on?
What are you thinking?
What are you feeling?
Be aware Notice what your mind is telling you.
Be aware of what the OCD wants you to do.
Be aware of what “tricks” your OCD is using to get you to comply and do the
compulsion.
Expand Consider other options besides what your OCD is telling you.
Connect with what you value.
Connect with what you want your life to be about.
What choice will move your life in the direction you want it to go?
Where do you want your life to be in a month, 6 months, 5 years?
Respond Choose what you want to do.
What choice will move your life in the direction you want it to go?
Don’t just automatically react, make an informed thoughtful choice.
Using this type of process is, of course, much easier said than done and it will take much practice (and ultimately courage) to use it, but it at least provides a framework to slow down, consider options and make a deliberate choice. I think it was Victor Frankl who said (and I paraphrase) between the stimulus and response there is a gap and in that gap lies your freedom.
Robert W. McLellarn, PhD 
Anxiety and Panic Treatment Center, LLC
