OCD

Jeff Bell is a nationally recognized author, speaker, and radio news anchor. His first book, Rewind, Replay, Repeat: A Memoir of OCD, was published in 2007 and quickly established Bell as a leading voice in the mental health community. In this interview he talks about his new book: When in Doubt, Make Belief.

You describe this book as “an OCD-inspired approach to living with uncertainty.” What do you mean by OCD-inspired?

As I recount in my first book (“Rewind, Replay, Repeat”), I spent years battling severe obsessive compulsive disorder (OCD), learning firsthand what the extremes of uncertainty can do to one’s life — in my case, leading me to endless cycles of “checking,” washing, and other debilitating compulsions. I experienced what it’s like to be utterly consumed by doubt and fear, unable to trust even my own physical senses. Because I was fortunate enough to get treatment, I also learned what it takes to confront this so-called “doubting disease.”

Title: When in Doubt, Make Belief
Author: Jeff Bell
Publisher: New World
ISBN: 978-1-57731-670-1
Available from: Amazon.com.

When I went public with my story in early 2007, I was amazed by just how many non-OCD sufferers could relate to my challenges; and the more I traveled the country talking about severe doubt, the more I solidified two conclusions: first, that the lessons I’ve learned from living with chronic uncertainty apply not only to battling obsessions and compulsions, but also to dealing with everyday doubts and worries; and second, that the principles of applied belief that served as guiding beacons through my own darkest years can also offer a way out of the shadows of all kinds of doubt.

So, are you suggesting that everyone has a touch of OCD?

No, not at all. OCD is biochemical brain disorder with very specific diagnostic criteria and mechanics. The challenges its intrusive and disturbing thoughts present typically far exceed those of everyday doubts and worries. That said, I have come to find that there are many critical parallels between OCD and what I call fear-based doubt, specifically when it comes to the counterproductive ways in which we tend to the address the discomfort of both. Because of these parallels, I’ve discovered that OCD offers a powerful laboratory for understanding the mechanics of applied belief. And, if those of us who are biologically predisposed to doubt can train ourselves to believe beyond the flawed processing of our cross-wired brains, I’m convinced that anyone can.

Isn’t doubt often a good thing that serves us well?

Absolutely. That’s why it’s so important to understand the differences between the two distinct forms of doubt that we all battle: doubt based on intellect, and doubt based on fear.

Intellect-based doubt is what we might call “healthy” doubt. It stems from our innate inquisitiveness, human curiosity, and natural inclination to challenge the apparent. It is based on reason, logic, and rational deduction, and it definitely serves us well. It’s this form of doubt that prompts us, for example, to avoid crossing a busy street when we’re not sure whether we can make it to the other side before the flashing “don’t walk” light changes.

Fear-based doubt, on the other hand, is uncertainty based not on reason, logic, and rational deduction, but rather on emotional, black-and-white, and catastrophic thinking. This form of doubt tends to be especially consuming, and when we’re stuck in it, we often lose perspective. We might, for example, decide that we should never cross a street (even with the light), because we once heard about a freak accident in which a pedestrian was killed while crossing a street legally, and we’ve become consumed by a “what-if” question such as What if I too am hit while crossing the street?

How can we know which kind of doubt is driving our decision-making?

Ah, that is often a very difficult question to answer, especially given that the very same fear-based doubt that can distort our thinking is also quite adept at masquerading as intellect-based doubt. Over the years, I have learned to ask five questions that, together, serve as a helpful starting point for deciding what’s driving any particular doubt:

1. Does this doubt evoke far more anxiety than either curiosity or prudent caution?
2. Does this doubt pose a series of increasingly distressing “what if” questions?
3. Does this doubt rely on logic-defying and/or black-and-white assumptions?
4. Does this doubt prompt a strong urge to act — or avoid acting — in a fashion others might perceive as excessive, in order to reduce the anxiety it creates?
5. Would you be embarrassed or frightened to explain your “what if” questions to a police officer or work supervisor?

If you answer Yes to these five questions, chances are pretty good that your vantage point is somewhere within what I call The Shadow of Doubt.

Speaking of this Shadow of Doubt, you warn that within it there are six trapdoors. Can you explain?

I use the “Shadow of Doubt” as a metaphor for that distorted state of mind we find ourselves in when fear-based doubt begins consuming us. When we are stuck in Doubt, we often take futile actions in hopes of ridding ourselves of the discomfort of doubt. These actions are much like trapdoors, or apparent escape routes that only take us deeper into the darkness, and there are six of them:

1. Checking: physically searching for verification that some feared consequence did not, or will not, happen.
2. Reassurance-seeking; asking for the assurances of others that some feared consequence did not, or will not, happen.
3. Ruminating: mentally replaying events, conversations, and other events in search of verification that some feared consequence did not, or will not, happen.
4. Protecting: performing rituals (such as repeating patterns) and acting in unproductive ways for the sole purpose of warding off feared consequences.
5. Fixing: performing rituals (often relating to symmetry) for the sole purpose of making things “feel” right.
6. Avoiding: deliberately avoiding events that trigger anxiety.

While these trapdoors include many common OCD compulsions, they also cover the counter-productive actions people without OCD take in response to their fear-based doubts. Take, for example, a man who just returned from a job interview. His fear-based doubt might suggest to him that perhaps he blew a particular interview question. That doubt is uncomfortable, so he tries to get rid of it, replaying the conversation in his head (ruminating) or perhaps checking his answering machine again and again to see if the prospective employer has called. These actions might not be as potentially debilitating as OCD compulsions, but they’re certainly counter-productive.

So, if trapdoors only leave you further stuck in this Shadow, what is the way out?

In my experience, the answer is a process I call “making belief,” and I’ve come to see it as ten specific strategies for willfully choosing to believe beyond my fear-based doubts — about myself, about others, and about life, itself. Together, these strategies offer Ten Steps Out . . . When Stuck in Doubt.

And these strategies are consistent with those you learned through your OCD treatment?

Yes, I believe that they are. At the very heart of cognitive behavior treatment for OCD is the concept of learning to sit with the discomfort of uncertainty. Through a process known as exposure/response-prevention (ERP), therapists help OCD sufferers learn to confront their “what if” thoughts and willfully choose not to act on their urges to perform compulsions solely aimed at reducing the discomfort of those thoughts. In so doing, people with OCD habituate themselves to this discomfort and benefit greatly from the desensitization. Non-OCD sufferers, I have found, can do the very same thing by exercising their free will in avoiding trapdoors. This concept is hardly a new one; Buddhists, for example, have been practicing embracing uncertainty for thousands of years. And all of the great religious/spiritual traditions offer wonderful insights into this approach, as well.

If the process is so straight-forward, why do so many of us remain stuck in Doubt?

The short answer is that, despite its simplicity, this approach requires enormous motivation.

You often describe having learned that particular lesson the hard way.

Right. I learned the basics of ERP early on in my treatment process. Problem was, I wasn’t committed to doing the hard work of standing up to my doubt bully (as I call the imaginary source of my OCD and fear-based doubts). I wasn’t committed to this notion of making belief. And because of my lack of commitment, I floundered through many years of my therapy.

How did you ultimately turn things around?

Out of necessity, really, I developed a motivational tool I’ve come to call the Greater Good Perspective Shift — a means of shifting my decision making from fear-and-doubt-based to purpose-and-service-based. In shifting my perspective, I was able to stand up to my bully again and again.

Can you give us an example?

Sure. Let’s say I’m at a bookstore, about to give a talk about OCD. Because my doubt bully likes to taunt me with “what if” questions surrounding my potential to harm other people, “he” might pose the question: What if you’re unknowingly carrying some horrific virus that you might then spread to the people who have shown up for your talk? The bully tells me I should go to the restroom and scrub my hands, and suggests that this is the “good” choice because it will reduce my anxiety about harming others. By contrast, he says the “bad” choice would be to go straight to the speaking area and risk contaminating the people who are there. The bully’s motivators of fear and doubt would have me choose the so-called “good” choice, and therefore scrub my hands.

Over the years, I have learned that, when stuck in Doubt, my bully’s arguments as to why a particular choice is “good” are very compelling; after all, they offer me temporary relief! So I find that I need to leave that choice on the table, so to speak. But what if I can reframe the bully’s “bad” choice in such a way that it can literally trump his “good” choice. This newly-reframed choice — a Greater Good choice — must be bigger than the issue at hand; and to this end, I have found, it must be of service to others and/or enhance my own sense of purpose.

Returning to my bookstore example, if I reframe my bully’s “bad” choice as a Greater Good choice, I must consider the Greater Good of not washing my hands. In this case, I can make the argument that foregoing the washing will allow me to be of service to the people who have shown up for my talk (by being available to them, instead of being stuck at the sink!); and, by standing up to my bully, I can enhance my own sense of purpose as a mental health advocate. By shifting my decision-making in this fashion, I am able to fight the compulsive urge to fall through the trapdoor of “protecting” and instead go give my talk.

In my experience, these Greater Good motivators of purpose and service will trump fear and doubt every time . . . IF given the opportunity.

In the final section of this book, you offer what you call profiles of belief in action. How did you choose the people you interviewed for these profiles and what did you learn from them?

My goal from the beginning of this book project was to offer readers the most practical information and examples that I could — not just from the OCD world, but also from all walks of life. I decided to conclude the book by showcasing several individuals I’ve run across over the years who have demonstrated remarkable abilities to navigate the uncertainty in their lives. In the end, I wound up interviewing five such people, including former White House Chief of Staff (and current CIA Director) Leon Panetta and actress/advocate Patty Duke. I believe that, together, their stories offer a wonderful glimpse at the very principles of applied belief about which I write.