hyperawareness Anxiety

The underlying theme behind hyperawareness obsessions is I am consciously aware of something benign that no one overtly thinks about, and I want to stop being aware of it, but I can’t. One way in which you may be looking at the nature of these obsessions is almost as too much mindfulness. In other words, it’s an obsession with mindfulness, with attention to the present moment. However, it’s the resistance to this awareness that actually pulls you away from the experience of the present moment, and it’s thus not “mindfulness gone wild.” It’s just OCD attacking from another angle. Mindful acceptance must include acceptance of any discomfort that comes with awareness of the present moment. Instead of pulling away from the experience of awareness, mindfulness asks you to stay with it, whatever thoughts, feelings, or sensations may tag along.

Somatic obsessions (sometimes called sensorimotor or somatoform obsessions) deal with the intrusive sense of awareness of involuntary bodily processes, typically involving but not limited to: • Awareness of breathing • Awareness of blinking • Awareness of swallowing • Awareness of body positioning (for example, where your arms are in relation to the rest of your body) • Awareness of physical sensations that are benign or of unknown origin (for example, itching, warmth, heartbeat, and so on) • Awareness of ringing in the ears • Awareness of eye “floaters”

Some additional common triggers in the category of hyperawareness include concern with: • Awareness of benign sounds (for example, birds, wind chimes, traffic noises) • Awareness of remembering songs (getting songs stuck in your head, sometimes called “earworms”) • Awareness of memories of specific images (sometimes benign, sometimes disturbing, but in either case involving a sense of being stuck with them) • Awareness of your own thinking process, that you have a mind, that thinking is happening at a level that feels burdensome

What types of things do you find yourself hyperaware of that may cause you discomfort? The primary obsessions associated with hyperawareness are: • I will never go back to doing these things involuntarily, and will therefore do them in a stilted or strange way. • My awareness of this thing will become so burdensome that I won’t be able to function, and will become depressed or go insane.

What types of fears come up for you when you struggle to accept your awareness of these types of triggers?

The primary compulsions associated with hyperawareness obsessions typically involve: • Mental checking for the trigger (breath, swallowing, and so on) • Mental review of the voluntary or involuntary nature of the trigger • Mental review of the significance of the awareness • Reassurance seeking (particularly from treatment providers) to confirm that this is not the sign of a severe mental illness, and that it will go away in a specific amount of time • Avoidance of situations that might trigger the obsession (for example, avoiding parks due to bird noises, avoiding social interactions where hyperawareness may be upsetting)

What compulsions do you think you may be engaging in to resist accepting your hyperawareness trigger? Acceptance Tools for Hyperawareness OCD Perhaps more so here than in any other kind of OCD, mindfulness is the key way to alleviate hyperawareness obsessions. The greatest exposure for this type of obsession is acceptance. It’s as if the OCD has opened a window to a view where you were previously unaware there was a window or a view. Resisting what you are seeing in this window and resisting the presence of the window only makes it bigger and more anxiety producing. This doesn’t mean resigning yourself to thinking about your obsession for all time. To the contrary, the act of thinking or analyzing is counter to the experience of accepting thoughts as they come and go.

The problem inherent in these obsessions is not simply noticing the presence of the obsession. It’s noticing the noticing and then resisting that experience. Acceptance in this form of OCD asks that we do exactly that, let go of fighting the noticing of the noticing. This means observing disturbing thoughts like I may never swallow without thinking about it again, I’ll always find my thought process burdensome, or I’ll always be bothered by this sound.

Hyperawareness of Thinking vs. Hearing Your Thoughts When OCD attacks your very awareness, it can be terribly frightening. The only way to describe your experience is that you are “hearing” your thoughts or that they are “too loud.” An untrained therapist may confuse this with auditory hallucinations and suggest a schizophrenia diagnosis. This couldn’t be further from the truth. Hyperawareness of your thoughts is not the same thing as hearing voices. In auditory hallucinations, there’s measurable activity in the auditory portion of the brain. The voices are heard in the same way that you hear sounds from the outside. Awareness of your inner voice is not the same thing as recording your thoughts into an audio-recording device and listening to them (in the way that some imaginal exposure is done). Although the experience may feel like the sound of your voice, the presence of intrusive thoughts must never be confused with the presence of auditory hallucinations. The short version is you’re not crazy. You just have a brighter light shining on the idea that you are thinking than someone without OCD might have.

Practice: What thoughts, feelings, physical sensations, or other internal data do you believe you will need to mindfully accept as you alleviate your hyperawareness OCD?

Meditation Tips for Hyperawareness OCD Meditation in the moment, and in specific meditative practice, may play a significant role in treating your hyperawareness obsession, even if you have an obsession with awareness of your breathing. In any form of meditation, you are working on strengthening the mental muscle that allows you to disengage from thinking and return to the present experience of the breath (or the stairs, the food, or whatever present thing is your anchor in the meditation session). When you focus on your breath, you may notice thoughts about whether you are attending to the present or overattending. Take note of that thought. Acknowledge that your mind has taken the act of meditation and shifted it to a performance review. Practice willingness to have that experience, and bring yourself back to the breath even if that seems like playing into the OCD. I’m thinking about my breathing. I can accept that this thinking is happening and disengage from being an active participant in it. Even now I am participating by identifying it, but it’s okay for me to be imperfect in this moment. Let me just take my time and let go of any problem solving I’m able to let go of in this moment. What if the thinking never stops? That’s another thought. I can have that thought, not mind having it for now, and return to the breath.

Assessment Tools for Hyperawareness OCD The primary distorted thought in this form of OCD is that the experience of awareness is intolerable, that it won’t end, and that it will eventually destroy the enjoyment of life itself.

As such, the primary cognitive distortions are typically magnification of the thought, catastrophizing about an intolerable future, and “should” or “must” statements about what you believe you are supposed to be aware of or unaware of. Remember that cognitive restructuring is a backup tool, a device for you to use to aid in your struggle to disengage from compulsions and return to the present. Too much emphasis on cognitive restructuring as your primary approach to treatment can easily become a tool for more mental ritualizing, so use it sparingly.

What cognitive distortions are at play in your hyperawareness OCD? Practice: Try doing some automatic thought records on situations that trigger your hyperawareness OCD. See the following sample automatic thought record.

Sample Automatic Thought Record

Trigger What set you off? ////// Started thinking about my blinking.

Automatic Thought What is the OCD saying? //////// I’m not blinking normally, because I’m thinking about it. So I must decide if I should blink more or less than I’m currently blinking to avoid looking odd.

Challenge What is an alternative to the distorted thinking? ////////// It’s not important how or when I blink, and I have no way of knowing if other people perceive it as normal or abnormal. I blink when I blink, and I have to accept that it sometimes makes me feel uncomfortable. It’s only a problem to be aware of my blinking if I choose to respond to it as a problem.

Action Tools for Hyperawareness OCD You may feel frustrated that you don’t see yourself as doing compulsions, and the wrong treatment provider may confirm this fear if he or she is unfamiliar with mental rituals in OCD. But if you are responding to your thoughts, feelings, and sensations as if they aren’t supposed to be there, then you are acting on a compulsion.

In Vivo ERP for Hyperawareness OCD In vivo ERP for hyperawareness means eliminating avoidance of triggers, and instead going out of your way to purposefully think the thoughts instead of flee from them. As in other forms of OCD, there are several strategies, particularly avoidance and mental review, that involve compulsively resisting your awareness of an unwanted thought. You may have come to believe that the unwanted thought is inescapable because something like breathing, blinking, or thinking is essentially normal, whereas you may see thoughts of violence or fear of contamination as being somehow different. But the obsession here is not with the blinking, swallowing, and so on. It’s with the fear that your awareness will keep you from experiencing joy or will make you descend into madness. So in essence, it’s a fear of mind contamination. As such, anything you do to cleanse your mind of this fear should be viewed as a compulsion. So exposure therapy means purposefully putting yourself in situations where you may be especially hyperaware, and then resisting the mental review or avoidant impulses that follow.

For hyperawareness of thinking, try to engage in social interactions that may require some additional mental processing, such as ordering food from a menu. As you look at the menu, tell yourself that you have no idea what you will order, and try to hold on to the idea that there’s too much information in front of you. Wait for the server to arrive, and then randomly pick an item at the last minute, risking being completely wrong.

For hyperawareness of breathing, purposefully meditate on your breath. When you begin to notice that you are noticing your breath more than you would like, tell yourself that this is absolutely terrible and will result in insanity. Note, this is a completely different process from actual mindful meditation, in which you would notice the thought about your breathing, acknowledge that it’s okay for it to be there, and then let the thought flow through you without judgment. The purpose of this exposure form of meditation is to generate and habituate to the anxiety that comes with your fear.

For hyperawareness of swallowing or blinking, you may practice swallowing while telling yourself you are doing it wrong. Doing this in public may heighten the anxiety.

Imaginal ERP for Hyperawareness OCD It might be a good idea to start with an acceptance script for hyperawareness, something you can check in with once a day to point you in the right direction (see the “Acceptance Scripts” section in chapter 3). The key to your acceptance script should involve identifying specifically what your obsession is. Remember, it’s not just the words— the content of your intrusive thought—but what you think having never-ending awareness of that content would do to you. Once you have identified the obsession, acknowledge the things you do to reassure yourself, or to try to make the obsession go away. Take a look at some of the mental compulsions you may be engaging in, or any other way in which you resist the presence of these thoughts.

The key to a good imaginal ERP script about hyperawareness is identifying what you are really afraid of. Try to answer the following questions:

What will you be thinking about forever? What makes this never-ending awareness intolerable or unacceptable? How is it different from what “normal” people experience? If the obsession continues for a very long time, what will be your strategy for addressing it? If this strategy fails, what will happen to your mental stability when you discover that this obsession will never go away? What are a few things that would happen before you would no longer be able to function in society? How do the people you care about deal with this? How will you end up?

It’s absolutely fine if you don’t feel ready to take this particular journey right now. If you’ve been struggling with this obsession, you’ve probably been spending a lot of effort trying not to go to the dark place where these questions have upsetting answers. Work on eliminating reassurance-seeking behaviors and avoidance first. Continue to read about and practice mindfulness skills. When you are ready to make more direct contact with your fear, you’ll know. You’ve been through a lot.. you made a huge step in taking back control of your life. Don’t be discouraged if you found the suggestions for mindful acceptance, cognitive therapy, or exposure therapy too challenging just now. If you are working with a therapist, let this person know that you need to be guided through this process at a pace that you can tolerate. If you are going through this workbook on your own, then be your own therapist here, and reflect back to yourself that this is hard; there’s no race to beat this disorder, and no prize for suffering the most. Take a break and come back when you’re ready to sit with the inherent discomfort of fighting OCD this way. If you aren’t doing the practices but are just reading this book to build the strength to take the next step, that’s absolutely fine. Know your enemy. Attack when the battle strategy is clear.

Maladaptive Coping Strategies Mindfulness is the art of embracing things as they are. It’s changing yourself by accepting yourself. It’s a living paradox. To be mindful is to be open to reality as it is. But reality involves pain, intrusive thoughts, fear, and doubt. For you, reality involves having OCD. What this means is that states of unreality are the opposite of mindfulness. At certain doses, alcohol, other drugs, and pornography all have the appeal of escape to unreality. This doesn’t mean that they are all bad at all doses or for all people. But if the process is one of avoidance, then it’s counterindicative to treating your OCD. Sometimes the things we do to feel better, to escape reality when it’s uncomfortable, become sources of discomfort and stress themselves. Tempting as they may be, these moments of silence you can achieve by forcing massive doses of unreality on your mind only embolden the OCD. The escape sends the very clear message that the present reality is not tolerable. So while you may enjoy the high you get from whatever source of unreality you choose, the OCD will wait for your return and will remind you of why you left.

Still, not all escape is bad or destructive. Sometimes, temporarily leaving can be a shift to a positive, adaptive place, and returning can bring about a healthier perspective. A vacation or a strenuous workout can also be a form of walking away from stress. And not all escape has to be particularly meaningful either. Escaping into your favorite TV show or video game for a bit can be a healthy, positive reward for staying in reality all day. It may be necessary for you to assess, perhaps with the help of a loved one or a treatment provider, what forms of escape are adaptive and what forms are destructive. If you are struggling with an addiction of any kind, it’s important to get help and treat that alongside (if not before) working on your OCD. While one may exacerbate the other, addiction is its own beast and often requires its own treatment strategies.

A Lapse Is Not a Relapse

You don’t start over from square one every time you act on a compulsion. Success in managing your OCD is largely measured by the decrease in frequency and significance of compulsive behaviors. If you’ve managed to resist double-checking the stove for a week and then one morning you decided to go back and check a second or third time, this doesn’t render that week of progress obsolete. If you’ve resisted seeking reassurance from your partner about your obsessive thoughts for two weeks and then one day you find the words, “Can I just ask you one thing?” spilling from your lips, this is not an indication of your failure to beat OCD.

Fill out an automatic thought record to challenge distorted thinking that might be going on regarding setbacks. For example, imagine that you have been working on resisting the urge to compulsively check to see if you left the stove on. Then, a life stressor shows up, and your ability to tolerate discomfort feels compromised. You know you need to be strong and resist, but you just don’t have the strength today, so you end up going back to an old, familiar way of doing things.

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