Treating Sensorimotor OCD (AKA Somatic OCD)

 

Sensorimotor OCD (also known as Somatic OCD) refers to cases in which people become hyperaware of their bodily sensations, such as their breathing, swallowing, or heartbeat.  While this might not sound so bad to someone who hasn’t experienced it, it can be profoundly distressing.

Like with Pure O, the key to treating Sensorimotor OCD isn’t in the Exposure, but rather in the Response Prevention.

Someone with Sensorimotor OCD typically engages in three different mental processes, all of which are compulsions that perpetuate the problem, and all of which are controllable:

  • Trying not to notice the sensation
  • Checking/monitoring whether they are noticing the sensation
  • Analyzing/trying to figure out how to stop noticing the sensation

The way out of Sensorimotor OCD is to:

  • Stop checking/monitoring
  • Stop analyzing/trying to figure out how to stop noticing the sensation
  • BUT! Not try to stop yourself from noticing

Checking/monitoring and analyzing/problem-solving are both controllable types of thinking.  In other words, if you try to stop doing them, you can stop.  For help learning how to stop, check out How to Stop Ruminating.

But noticing is not a controllable type of thinking.  You can’t stop yourself from noticing something, and if you try to stop, you’ll just end up thinking about it more.

In case you’re confused about the idea that you can’t control noticing but you can control monitoring, consider what it’s like when you see someone attractive:

Can you prevent yourself from noticing them?  No.

But can you prevent yourself from following them with your eyes?  Yes you can.

The same applies to bodily sensations: 

  • You can’t stop yourself from noticing them
  • But you can stop yourself from monitoring them and monitoring your awareness of them
  • Trying not to notice them will make you feel frustrated and will keep your attention on the sensations
  • But trying not to monitor them will allow your attention to eventually shift away from them
  • Similarly, refraining from analyzing/problem-solving will allow your attention to eventually shift away from them

 

Here are some additional things to keep in mind:

  • Even though noticing and ruminating are technically separate phenomena, they don’t initially feel separate to someone with Sensorimotor OCD, because as soon as they notice the sensation, they immediately launch into analyzing/trying to figure out how to stop noticing it.  It takes practice to see this separation, and to accept noticing without launching into analyzing/problem-solving.

 

  • Sometimes a person with Sensorimotor OCD is monitoring their body because they are afraid of missing a medical problem.  When this is the case, it’s important to identify and challenge this justification.  Does monitoring actually accomplish anything?  If it does, is there another way to accomplish the same goal without monitoring all the time?  Until a person lets go of this justification, they will not get better because they’re simultaneously trying to monitor and stop monitoring at the same time, and you can’t do both.

 

  • Many people who are in the process of working on their Sensorimotor OCD feel upset when their attention drifts back to the body sensation.  It’s important to remind them of a few things:
    • You’ve been thinking about this body sensation for a long time, so of course you’re not just going to forget about it, and of course it will come to mind from time to time.
    • The goal isn’t to stop this from happening, it’s to learn that you don’t have to get stuck when it does.  Once you learn this, noticing the sensation will be so non-threatening that you won’t notice that you’ve noticed it.
    • The fact that your attention wandered back to the sensation is cause for celebration.  Hear me out: If your attention has wandered back to the sensation, that means it must have wandered away from it first, which means you successfully disengaged from it.  Congratulations!  Now do the same thing again.

In summary:

Noticing is okay.  Noticing is not the issue.  Focus your efforts on refraining from monitoring and problem-solving.

If you stop fighting against the things you can’t control and start fighting against the things you can, you’ll be feeling much better very soon.