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Areas › Worry and anxiety › Obsessions and compulsions
The whole point of shrinking the steps is to find one that moves. When nothing moves at any size, staying in the same weekly arrangement out of loyalty is not kindness to anybody. Day programmes and residential care are more hours of the same work with more support around them, and walking in having chosen it is a very different thing from being sent.
Obsessive thoughts and compulsions respond well to a specific kind of therapy. What is here is for understanding them, not for treating them by yourself.
Seek help with steadfastness and prayer (Quran 2:45). The verse concedes in the same breath that this is hard, so needing more help than you have is treated as ordinary.
البقرة
وَٱسۡتَعِينُواْ بِٱلصَّبۡرِ وَٱلصَّلَوٰةِۚ وَإِنَّهَا لَكَبِيرَةٌ إِلَّا عَلَى ٱلۡخَٰشِعِينَ
Seek help with steadfastness and prayer- though this is hard indeed for anyone but the humble
Qur’an 2:45read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
A review of the field notes that even with the best treatments available a substantial share of adults with obsessive-compulsive disorder do not reach remission, which is one reason alternative and digitally delivered therapies keep being developed. Stalling is common and it is not a personal failing. The review describes the state of the field and does not compare levels of care against each other.
Castle D, Feusner J, Laposa JM, Richter PMA, Hossain R, Lusicic A, Drummond LM. (2023). Psychotherapies and digital interventions for OCD in adults: What do we know, what do we need still to explore?. Comprehensive psychiatry doi
Strength of evidence: one line of research. A single study, or a theoretical account.
More support across more hours gives a piece of work that has stalled somewhere to go.
Offer choices rather than instructions. With a problem that runs on control, being told what to do gives that control somewhere to dig in.
Try not to talk the worry through in detail, even with someone kind. Going over the specifics feels like sorting it out, and it is closer to watering it.
Fears of doing something terrible, of hurting an animal or a person, are not treated by moving closer to the act. Nobody should be walking you up a ladder towards the thing you are terrified of doing.