OCD, Anxiety and the COVID-19 Crisis

The treatment of Obsessive-Compulsive and Related Disorders and Anxiety Disorders probably sit among the mental health conditions that are a focal point of my clinical practice. The disorders in these diagnostic categories are probably not unfamiliar to anyone reading this, but in the unprecedented times in which we find ourselves (amidst the COVID-19 pandemic) we are invited as clinicians from different sectors to think differently about what we already know and to be prepared to advise our clients accordingly.

OCD, specifically, is a neuropsychiatric condition marked by distressing and intrusive thoughts, impulses, or images (obsessions) and/or behaviours or mental rituals (compulsions) that are performed repeatedly in an effort to reduce the feelings of distress associated with the obsessions. We know that the time taken up by intrusive thoughts and compulsions is excessive and impairs the functioning of the individual and their family.

Some common symptom domains have been identified among individuals with OCD, including contamination obsessions with washing and cleaning compulsions; preoccupation with symmetry, ordering, arranging, repeating, and counting compulsions; hoarding; harm (aggressive) obsessions and checking; and religious or sexually themed obsessions and accompanying compulsions. Evidence-based treatment usually involves Cognitive-Behavioural Therapy with a specific focus on Exposure and Response Prevention (CBT-ERP for short).  

Amidst the COVID-19 crisis, it is particularly hard for those with OCD or Anxiety to know how to continue their facing and fighting of OCD symptoms (through ERP) while still maintaining well-communicated safety measures. For those struggling – how do we cope with the heightened uncertainty of the times? While these are tough hurdles to navigate, I found the following tips for clients to be the most helpful:

1. Give yourself permission to follow the guidelines. The exposure should be in keeping with the guidelines and trying not to do more than the guidelines because OCD will tell you it knows better (the authority is the CDC not OCD).  

2. In a time such as this, the goal ought not to be making the anxiety go away completely (because there is indeed a threat present). However, we need to exercise a kindness to ourselves (self-compassion) that allow us to take care of us in every way possible (physically, mentally, emotionally, spiritually – write down each of these domains and then what you need to feel a sense of personal congruence in each area. You do not need to get there all at once, but it gives you something to keep working on and a standard against which to track how you’re going and growing). Slow down and recognise what’s happening for you in the moment. Allow or accept the fact that some anxiety is okay – make it okay and don’t get into a fight with it/wrestle with it. Investigate / Be curious – maybe I don’t know everything, don’t be too definitive or strict with how you think things are. Nurture and take care of you, do things that help you to still enjoy your daily life.  

3. Making plans to travel, to see family members who are far away, to return to work, to send children back to school, all are really challenging decisions which can provoke a great deal of anxiety at this time. Set a deadline, a time when you will make a decision on these things, don’t labour on it longer than you need to. Use reliable sources to make the decisions about future travel/returning to work or school. Try not to ruminate or ask for reassurance (e.g., should I go or should I not go/will I get sick or not get sick), try to remain as present as possible.

4. Checking the news – it is very tempting to check the news often especially because of the fast-changing environment (figure out a frequency that works for you, NOT OCD or Anxiety), this atmosphere will increase the checking and reassurance seeking normally associated with some forms of OCD and Anxiety.  

Be well, Stay safe and Stay supported.