Helping Students With Obsessive Compulsive Disorder OCD
OCD, Obsessive-Compulsive Disorder, is characterized by obsessions- unwanted thoughts that repeat over and over and make you feel bad and anxious and compulsions- unwanted behaviors or actions you feel you have to do over and over again to stop bad things from happening or to get rid of the bad thoughts or feelings. OCD always demands more and needs more from you, consuming your time and comfort. These are some strategies to help students challenge their OCD thoughts and behaviors more effectively, but they also hold true for teens. These can be done alongside collaboration with a student’s therapist or psychiatrist. The gold standards of treatment for OCD is psychotherapy and medication, often a combination of the two, so talk with parents about signing a release for you to collaborate with a student’s provider when able.
The first step is to Identify the OCD Thought- which can be tricky, so that they can begin talking back to it. OCD thoughts are irrational and can trigger our fight-or-flight stress response when there is no actual threat occurring. They can convince us that maybe something bad will happen or that we should not feel content when things are going well. We feel we need to do something immediately and repeatedly to prevent the possibility of future catastrophes. OCD is like a system error in our brain that we need to learn to detect. Help students list their fears and habits and then circle the ones that may be OCD in disguise. Common examples can be the fear of dirt or germs, fear that they are being watched, poisoned, followed, they’re unknowingly doing something bad or will do something bad, or that they need to wash their hands, touch something, or follow a ritual or there will be danger for them or someone they love. When we get in a habit of naming that thought as OCD, we are giving ourselves the opportunity to challenge it. With kids, I often like to have them draw a non-threatening OCD creature or color block that they can visualize as their OCD to make it easier to comfortably talk back to it.
The next step is to Pick a Method that works best for them to talk back to their OCD thoughts. I’ll list a few, but I recommend picking one to use consistently at first to increase its effectiveness before rotating through more. If you find that one is not working for the student though, then they should try another method. The first method is to Delay. Delay giving into a compulsion by at least 5 minutes can impact OCD’s control over their anxiety response. It teaches them to better tolerate the discomfort of not listening to their OCD (so that uncomfortable stress response) and helps them to build their tolerance further each time. Delay is a great method to help them build better control over all of their reaction responses.
The next method is to Leave the Area where those thoughts are being triggered or where their compulsions want them to do a task. This is more difficult in a classroom setting, so there needs to be agreed upon removal areas, like the cozy corner, bathroom, etc. For example, a student can remove themselves from an area with sinks when their OCD wants them to wash their hands repeatedly, this may look like going immediately from the bathroom (after washing hands once) to the classroom so they aren’t tempted to go back into the bathroom as easily. Then they would utilize Power Skills to further delay while they’re in the classroom. The next method is to Change How Your OCD Wants You To Complete a Compulsion, meaning they don’t do it exactly how it wants them to or even better, they do the exact opposite of what their compulsion wants. So again for handwashing- you could wash your elbow instead or you can choose to draw something on your hand instead of washing it. That tactile stimulation can help ground them while they delay or refuse what their OCD actually wanted them to do. If they can’t change the compulsion they can try to Add a Funny Element to it so they can build more control over it and relieve some of the intensity surrounding the action. So that may look like washing their hands while singing a silly song, saying jokes out loud, or making silly faces in the mirror.
The last method is to Set a Limit for themselves. OCD always wants more, so washing your hands once or twice in that day won’t feel like enough- it will keep demanding more from you to feel safe. Setting a limit is saying to your OCD, “Ok, I will do it, but only 3 times today”. The goal is to keep building a tolerance to the physiological distress of challenging OCD. Consistent delaying and tolerating can eventually break the connection between hand washing and imaginary safety for the student.
Remember, OCD is tricky and it will try to move to another compulsion or set of obsessive thoughts. It can feel discouraging for students to begin a new battle with OCD, but each time they challenge it they can help keep it from continuing to build and grow. They can have better management of their OCD. Power Skill strategies like deep breathing, meditation, or progressive muscle relaxation can help to manage the distress from denying or delaying the OCD. The more access to reputable resources and supports, the better!
