Understanding why people with OCD do what they do, and why other people get involved: supporting people with OCD and loved ones to move from safety-seeking behaviours to approach-supporting behaviours

Abstract

Abstract The distress inherent in obsessive compulsive disorder (OCD) can often lead to partners, family members and friends becoming entangled with the OCD in terms of being drawn into performing certain behaviours to try and reduce the distress of their loved one. In the past this has often been referred to somewhat pejoratively as collusion, or more neutrally as accommodation. In this paper we emphasise that this is usually a natural human response to seeing a loved one in distress and wanting to help. This paper provides detailed clinical guidance on how to understand this involvement and how to include others in the treatment of OCD along with practical tips and hints around potential blocks that may require troubleshooting. It also details the relatively recently introduced concept of approach-supporting behaviours, and provides guidance on how to distinguish these from safety-seeking behaviours. The ‘special case’ of reassurance seeking is also discussed. Key learning aims (1) To illustrate the importance of understanding the person’s OCD beliefs ‘from the inside’ including the internal logic that leads to specific behaviours. (2) To understand the ways that key individuals in the lives of people with OCD can become entangled with the OCD (through the best of intentions) and to provide practical clinical guidance for CBT therapists around how to engage and work with these individuals in the lives of people with OCD. (3) To explain and delineate the idea of approach-supporting behaviours, distinguishing these from safety-seeking behaviours. (4) To distinguish the interpersonal component of reassurance from the neutralisation component and provide guidance on how we can help family members to replace reassurance with something that is equally or more supportive whilst not maintaining the OCD.