The refrigerator door stood open, as Peter hesitated. He handed me the chicken, then snatched it back and put it into the refrigerator, while handing me the fish. Then it was the leftover rice in the pot with an abrupt switch to the leftover rice in the tupperware box. He finally handed me something he wouldn’t even eat after I microwaved it, but instead ran into the family room. He turned on the TV, then quickly positioned a chair facing the corner, back to the TV. He ran down the hall to his little brother Luke’s room, and returned with one of the boxes Luke stores Pokemon cards in (cards emptied out), and started tapping and turning it. I firmly took the box out of Peter’s hands and hid it under the sofa.
“Peter, slow down! What’s going on?”
Peter’s eyes burned as he reached for the box and gasped, “Bok, bok!” (for “box, box”)
“Ok, calm down. Take a deep breath. That’s it. Come on, tell me what’s going on. So what happened there at the refrigerator? Can you write about it?” As Peter started squeezing my hands, I said, “You will get that box. But first let’s put some brakes on this. Remember, when you have an intense OCD, what does Dr. Gwen tell us we can do to delay it?”
Peter typed, “I can harness this sled dog. I can let myself have the box if I finish.”
I told him that was a great idea. If only he would write down his thoughts about what was going on at the refrigerator, then with the chair, then with the hand squeezing. Knowing he loves poetry, after he finished that, I gave him the challenge of putting it into verse, and adding rhymes. After he completed each stanza, I asked him to rate his OCD intensity as higher, same, or lower. I kept hoping he would say “lower” as writing bided time for us. Unfortunately, he kept saying “Same.” I tried to make the best of it, “Hey, you see, it’s not getting worse!” Here are Peter’s first three stanzas (English sonnet form abab, cdcd, efef).
Give me chicken, no let’s not.
Give me fish, no, another mistake.
First the rice in the box, not it’s the rice in the pot.
OCD picks the one thing I hate.
The chair in the corner is where I must sit,
Facing away so I can’t see the TV.
It doesn’t make sense, not even a bit.
No matter, OCD’s punishing me.
I’m squeezing your hand to wring out my pain.
Give me the box you put under.
I’m taking deep breaths but still going insane.
OCD rips and tears me asunder.
Finally after the third stanza, I asked Peter to rate his OCD. He typed,
“The box compulsion is surprisingly better,
As I delayed it while writing this letter.”
(That couplet completed the 14 lines of an English sonnet.)
“Wow, Peter!” I exclaimed, look at that! See how strong your creativity is!
Peter typed, “Strong enough to resist a 5/5 compulsion.” All lit up, he said with a big smile and gesture, “Bok, peez!”
“At this point, you have definitely earned that box several times over. But I want to know what you, Peter Tran, upper brain, really want to do now. Because OCD has been bossing you around all night and made you pick something you didn’t like out of the refrigerator and sit in a punishing corner. Wouldn’t you just love to slug OCD back one more time? Why not eat a piece of delicious piece of pizza first for dinner, and then get the box?”
I held my breath. I truly was totally prepared to let Peter take the box from under the sofa. Instead, he did something remarkable. He stood up and slowly walked to the kitchen. At one point he stopped, and started to turn back, but I positioned myself between his body and the sofa. Smilingly I encouraged him, “You are doing great, Peter.”
Peter turned abruptly back to the kitchen and headed through the door.
I’m sharing this story because I want to encourage you kids suffering from OCD and you parents trying to help your children deal with it. It may not be possible to completely change the wiring glitch that causes OCD, but you can build up the attention shifting and compulsion inhibition skills required to achieve a long enough delay for the compulsion wave to wane, and the frontal lobe engagement to move that broken record on a different track. Use deep breathing and the hope of eventually getting to do the compulsion to create some relief from anxiety. Help your child to recognize that it’s the intrusive thoughts of OCD, not his own, that are making him feel he needs to do something that doesn’t make sense. Distract him, help him shift attention away by engaging the upper brain/frontal lobes into an exercise you know he likes (In this case, I know Peter loves to write). Support him to initiate a strategy like delay that you’ve talked about together beforehand, and to self-monitor his state of being so he can watch the intensity of the compulsion fall and be encouraged by his own success. Doing something creative is especially powerful and rewarding because the child can create his own ending to the story; if he pretends to be successful, chances are greater he will become successful by being able to process what’s happening and envision a positive ending. Be transparent in your coaching, and tell your child what you are doing and thinking so that he can understand, want to cooperate with, and imitate it. It’s a goal for him to learn how to talk to himself in the same way. Most importantly, signpost his accomplishment. Be the banner bearer of his success. As Dr. Gwen tells us, the one thing that equips your child best to combat intrusive thoughts is the realization that “I can do this. I do have a choice.” That self concept and self esteem is built through accomplishment. So whatever progress your child makes, whatever small step in the right direction he is able to accomplish, even a baby step, proclaim it and rejoice! Developing emotional regulation is a slow process, but with each victory, another inhibitory or attention shifting synapse is born.