Regulation, Not Control

I started a new OCD journal today – new by necessity: my previous one ran out of pages – and so what better time to revisit my first OCD journal and our good friend Dr. No? I know what you’re thinking: “We get it, Steve. Dr. No. Bad. We get it!” I’m sure you do – and you’ll be happy to know that I’m going to keep writing about Dr. No till I’ve reached the end of our sessions. There’s still an awful lot of material to cover between now and them. Here’s the latest!

Journal: write down the thought, what I do (i.e., positive thought), etc. (recurrence, etc)

Making a journal’s not the worst idea. But the mention of “positive thought” might well be: it hints at thought replacement, which is a compulsion and which, as we’ve seen, Dr. No made integral to his version of OCD therapy.


What? Is this an oblique Sleater-Kinney reference? “Perfect hexagon of the honeycomb/And you soothe your soul with the shapes you know”? Probably not. Carrying on.

permission/right to take ownership of feeling

This is good. No, really: this is an important step to effectively managing OCD. But if you’ve been paying attention then you’ll know Dr. No’s about to pick up a couple red flags and wave them over his head. Let’s see here…


Red flag #1! Big, fat compulsion alert! At the top of the page there’s another note that reads: “REGULATION (NOT CONTROL).” Except…regulation’s a form of control. It’s a wolf in sheep’s clothing. And it’s a compulsion.

using thought as self-punishment?guilt -> anxiety; actions a result of belief system & guilt

Red flag #2! Big, fat psychoanalysis alert!

worry-thought: ack., let it float away; assoc. of ideas (exposure to a thought diminishes its intensity)

Big, fat irony alert! That last bit – “exposure to a thought diminishes its intensity” – actually crystallizes exposure with response prevention, or ERP, or the only evidence-based treatment for OCD, or the same thing Dr. No said we “might” do. Remember, it’s what he referred to as “exposure with response promotion,” a concept that seems diametrically opposed to “response prevention.” Am I being pedantic? Regardless, there’s lots more where this came from. We’re really only just getting started!


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