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Treating Sensorimotor OCD (AKA Somatic OCD)

Sensorimotor OCD (also known as Somatically Focused 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.  Before reading any further, I recommend you check out Awareness, Attention, Distraction, and Rumination, because distinguishing between awareness and attention is the crux of the solution to Sensorimotor.

Someone with Sensorimotor OCD typically engages in three different mental processes that perpetuate the problem:

  1. Trying not to notice the sensation (trying to push it out of awareness)
  2. Checking/monitoring whether they are noticing the sensation (directing attention)
  3. Trying to figure out how to stop noticing the sensation (analyzing)

Let’s take these one at a time:

Trying not to notice the sensation

Trying to not to notice something means trying to push it out of your awareness.  As discussed in AAD&R, this doesn’t work.  You can’t push something out of your awareness, and trying to do so backfires, because in the process of trying to keep something out of awareness, you are directing attention towards it, which keeps it in awareness.

Trouble distinguishing between awareness and attention is at the center of Sensorimotor OCD, and the following two resources are intended to help with this:

Checking/monitoring whether they are noticing the sensation

Checking and monitoring involve directing attention toward the sensation.  Needless to say, directing attention toward something is not a good strategy for someone who is trying to stop noticing it.  Fortunately, as discussed in AAD&R, directing attention is controllable.

Trying to figure out how to stop noticing the sensation

The person with Sensorimotor is constantly trying to figure out how to stop noticing the sensation and how to navigate life with this problem — in other words, analyzing (what I refer to as rumination proper).  This constant analysis and planning keeps them thinking about the sensation all the time.  Fortunately, analytical thinking is also controllable.  For help with this part of the problem, check out How to Stop Ruminating.

In light of the above, here’s what you have to do to escape Sensorimotor:

  • Stop checking/monitoring.  In other words, stop directing attention toward the sensation.
  • Stop constantly trying to figure out how to solve the problem. In other words, stop analyzing.

BUT!

  • Don’t try to prevent the sensation from entering your awareness, and when it does enter, don’t try to push it out.

Here are some additional things to keep in mind:

  • Even though awareness, attention, and analysis are technically separate phenomena, they don’t initially feel separate to someone with Sensorimotor OCD, because as soon as they become aware of the sensation, they immediately start directing attention towards it, and trying to figure out how to stop noticing it.  It takes practice to distinguish among these phenomena, and to allow something to enter awareness without engaging with it in any way.
  • While it is crucial to understand the conceptual distinction between awareness and attention, in practice it is not always possible to distinguish between them precisely.  For example, when someone notices something, where is exactly is the line between awareness and attention? Trying to thread the needle between these phenomena too exactly just leads to directing additional attention toward one’s mental activity, which is obviously counterproductive.  It is therefore essential to hold the distinction between awareness and attention lightly and to allow the boundary between them to sometimes be blurry.
  • Learning to allow something to remain in awareness without directing attention towards it can take practice, and therefore time, so it is necessary to be patient and allow this to be a process. When it comes to rumination proper, I believe that stricter is better; but when it comes to differentiating between awareness and attention, I believe a lighter touch is necessary.
  • 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 the sensation enters their awareness again.  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.  As you learn that you can become aware of the sensation without getting stuck, awareness of the sensation will become progressively less threatening, which will make it easier not to engage with the sensation at all, which will make you progressively less aware of it, and less aware of when you’re aware of it. Eventually you won’t notice that you’ve noticed it.
    • The fact that the sensation has entered your awareness again is cause for celebration.  Hear me out: If the sensation has entered your awareness again, that means it must have left, which means you successfully disengaged from it.  Congratulations!  Now do the same thing again.

Does Exposure Have a Role to Play?

As stated above, the key to this treatment is Response Prevention.  There are only two types of exposures I use with Sensorimotor:

  1. Doing anything avoided.
  2. Setting reminders of the sensation, in order to practice not engaging with the sensation even when it comes into awareness.  This exposure also underscores that awareness of the sensation is not the problem and does not need to be avoided.

Notably, sustaining attention to the sensation on purpose (which is unfortunately the most common intervention that therapists try) is not an effective exposure.  In fact, it is just asking the patient to do a compulsion (directing attention toward the sensation) on purpose. Mindfulness is also not an effective intervention because it does not distinguish between awareness and attention.

Summary

Sensorimotor is actually simple to treat.  The key is distinguishing between awareness and attention.  If you stop fighting against the mental processes you can’t control, and start fighting against the ones you can, you’ll be feeling better soon.

Please note that this article is for your information only and does not constitute clinical advice or establish a patient-psychologist relationship.