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 threading the needle 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
  2. Checking/monitoring whether they are noticing the sensation
  3. Analyzing/trying to figure out how to stop noticing the sensation

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 entails directing attention toward it, which backfires and keeps it in your awareness.

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.

Analyzing/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, ruminating).  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 analyzing/trying to figure out how to solve the problem. In other words, stop ruminating.

BUT!

  • Don’t try to stop yourself from noticing.  In other words, when the sensation enters your awareness, don’t try to push it out.

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 distinction, 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.

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 is brought 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.

Summary

Sensorimotor is actually extremely simple to treat.  The key is threading the needle 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 much better very soon.

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