I’m a cognitive behavioral (CBT) therapist providing exposure and response prevention therapy for people who have OCD, anxiety disorders and depression. I am passionate about helping adults and adolescents take back their lives from these disorders.
One of my favorite pieces of advice in Reid Wilson’s Afterword to Fred is “Don’t accept OCD’s invitation to transact. If you never pick up the message to start with, then you don’t have to work to set it down again.”
Reid’s advice is the essence of Shoulders Back and the “Man in the Park” technique I’ve written two posts about (the original and the Q&A). It is, as I describe in those posts, my favorite ERP technique because I’ve found it to be incredibly powerful.
But if you have trouble using Shoulders Back/Man in the Park because you keep transacting with your OCD in your mind, otherwise known as “mentally ritualizing” or what some call “pure-O,” then you’ll probably find this blog post of interest. It’s about an ERP technique that’s a bridge tool to help you develop the strength to do Shoulders Back/Man in the Park effectively.
If there’s one thing I am exceptionally good at, it’s mentally ritualizing. I’ve had OCD since I was about 5 or 6 years old, and part of my OCD’s Rule #1 was that no one could know about the monster in my head. I was not allowed to act like anything was wrong at any time, which means that I did not engage in much avoidance or in many detectable compulsions in all my decades of untreated OCD. Instead, I became skilled at pushing myself into situations my OCD found uncomfortable and then going over those situations in my head repeatedly—for hours, days, sometimes even years—to convince myself that I hadn’t done anything wrong.
Over time, I became exceptionally skilled at the art of mentally ritualizing. I would analyze, replay, recreate, justify, defend, convince—anything to make myself believe that I wasn’t in danger, anything to try to get rid of that anxiety. And I could do all these mental gymnastics while doing anything else: having a conversation, giving a presentation, writing a proposal, seeing a play, anything.
As I look back on what I used to do, it was very much like having a courtroom trial going on in my head. Say, for instance, that my OCD was telling me that when I stopped by my coworker Bill’s cube, I’d told him not how good his idea for the new marketing campaign was, but instead the fleeting thought that had run through my mind during our staff meeting that morning: that he talked too much and took credit for ideas that weren’t his.
Begin the mental courtroom proceedings (and please note, all of the scene you’re about to read could transpire in just a few seconds in my head):
How do you plead?
My attorney: Your honor, we’re here today to prove beyond a shadow of a doubt that my client, Shala Nicely, not only didn’t say those words to Bill, but she didn’t even think them, because to think such things would be horrendous, and my client is a good person.
Judge: Ms. Nicely, how do you plead?
Me: Not guilty, your honor.
Prosecutor, staring at me like I’m filth: How can you even say you didn’t have the thought? You’re thinking the thought right now! And I know that you said the words out loud, because didn’t you see the way Bill looked at you as you were leaving? Like he was crushed!
Prosecutor’s second chair, jumping up from her seat: Not only that! I saw Bill talking to Amy later, and they both looked at the accused as if she were a vile human being, which clearly means that Bill told Amy what Ms. Nicely said, and they were processing how horrible she really is.
My attorney: Objection! There is no evidence that’s what they were talking about. They could have been talking about anything!
Juror, meekly holding his hand up, looking at the prosecutor: Excuse me, but speaking of evidence, you mentioned in your opening argument that the accused has had other charges brought against her for having a horrible character, such as how she might have offended the VP last week in that meeting where she interrupted him.
Me: No, I didn’t interrupt him! And he likes me. He told me what a good job I did on that new campaign only this morning!
Judge, banging gavel: Order! Bailiff, I will ask you to remove the accused if she can’t restrain herself during these proceedings!
My attorney: This is all nonsense! My client is a good, decent human who never means to hurt anyone. No one could possibly hold this one little transgression against her, even if it really did happen, which I’m 97.3% sure it didn’t.
Prosecutor: Intentions don’t matter. Actions matter. And I’m 98.7% sure that she said out loud that Bill was a credit-stealing loudmouth. Can you believe it? Who says that kind of thing?!?!
……And on and on and on. The trial in my head would never adjourn, no matter what I was doing. There would only be occasional breaks to switch out the players for fresh lawyers, a new judge and jury whenever my OCD sensed I’d committed yet another felonious act that needed deliberation.
This never-ending courtroom in my head proved problematic when I started doing exposure therapy for OCD. Even though I worked diligently on stopping all my secretive physical rituals as I exposed myself to various obsessions, the courtroom drama would often continue, unabated. Which meant that in essence I was doing exposure and partial response prevention, since I was still doing mental rituals. Which also meant that my ERP exercises weren’t as effective as they could have been.
“May or may not”
As I discuss in Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life, I decided to do most of my exposure therapy on my own, so without the guidance of a weekly therapist, it took me a long time to figure out I was sabotaging myself by letting my head hold court. And once I’d identified this was an issue, I just couldn’t seem to stop the proceedings. I seemed to be stuck in the courtroom not only listening, but participating! My mental courtroom drama been going on for decades after all; it was what my mind was used to doing.
But eventually I decided just because I was stuck in the courtroom, it didn’t mean I had to listen to what was being said or participate in the proceedings.
This is where I came up with my “may or may not” statements, also known as “scripts” or “scripting.” When I did ERP, or when I just got triggered, I listened to the proceedings for a handful of seconds to hear what my OCD thought the charges against me were, and then I started saying “may or may not (MOMN)” statements out loud, aggressively and quickly. For instance:
“I MOMN have told Bill he was a credit stealing loud mouth. I MOMN be a horrible person. I MOMN have interrupted Steve in our meeting. Steve MOMN be lying to me when he said I did a good job on the campaign. Bill MOMN have told everyone that I said rude things to him. Everyone MOMN hate me. I MOMN lose my job and never be able to get another. I MOMN have ruined my career because of this one transgression, which MOMN have even happened. But I can handle being anxious and uncertain, and in fact, I want that, because that’s how I beat you OCD.”
Why scripting can be helpful
These scripts served two purposes:
Competing response: If I said them out loud, talking quickly with almost no space between words, then I could not hear or participate in the courtroom drama in my head. I would only stop scripting occasionally for a few seconds to listen to the trial to make sure my MOMN statements weren’t leaving anything out that my OCD was worried about. (Essentially, I was just making sure I was taking all the obsessions currently in my head into account). The scripts acted as a competing response to my mental rituals. If I was scripting out loud, it was almost impossible to hear or give “testimony” in the courtroom.
Be present with obsessions without ritualizing: They forced my OCD to be present with the obsession in a therapeutic (as opposed to compulsive) way and face the uncertainty of the situation, that maybe I did do whatever it thought I did and maybe I didn’t. That I would, in fact, never know. That OCD’s questions are, as always, unanswerable.
It would sometimes take 5 minutes, 15 minutes, 45+ minutes, sometimes even hours, before I could stop scripting and not hear the courtroom proceedings. My scripts generally resulted in a mistrial, because all sides would realize that there was no definitive evidence, that this was all about uncertainty and all parties were just going to have to live with that. Recognizing that I wasn’t participating anymore and that we were never going to find “the answer,” the judge, lawyers and jurors just packed up and went home.
Although scripting does have some shortcomings…
While there’s nothing wrong with scripting, as a tool it does have some shortcomings:
It often takes a long time to work. Like I mentioned above, I would often say my scripts out loud for the length of the nightly news before I could move on. That’s pretty time-consuming and exhausting.
Scripting does give some credence to OCD’s “content,” all the stuff it uses to scare you. You are, in fact, transacting with it, but you’re doing so in a way that’s not compulsive. With scripting, you are paying attention to OCD’s content in that you are listening to the stories OCD is spinning in order to repackage them as MOMN statements and them hurl them back at the OCD. But you are wallowing in content, and OCD is NOT about the content. It’s about the uncertainty of not knowing whether that or any content OCD throws at you is true.
However, for those of us who are mental ritualizers and who can’t figure out how to leave the courtroom, I would argue that doing scripting is an incredibly mindful way to deal with the situation. For us, what’s real in the present moment are those obsessions that the court is deliberating about. To do ERP effectively, we need to be present with those obsessions without engaging with them ritualistically, and scripting allows us to do that.
Remember: this is about general uncertainty
Also, sometimes scripting about particular types of content is really tough. “I MOMN be a pedophile” is one example. But the truth is, we ALL may or may not be pedophiles or murderers or about to lose our minds or have an undiagnosed disease that will eventually kill us. We just don’t spend any time thinking about any of that if we don’t have OCD about those topics. So if I find myself unable to leave a mental courtroom about topics like these, I’ll say, “I MOMN be a pedophile, just like everyone may or may not be. This is about general uncertainty, and I’m going to accept this uncertainty just like I accept all uncertainty.” Or, sometimes I will insert random, ridiculous uncertainties to one up and poke fun at the OCD and remind myself this is about general uncertainty, which I’m really good at handling: “Yes, OCD, I MOMN be a pedophile. My mom might be one, too. I might come from a family of them. And an asteroid MOMN fall through the ceiling at any moment. I’m working on accepting all of this uncertainty.” Because really, when’s the last time you worried about space junk hitting your house?
You are good at handling uncertainty, and we want worrying about being a child molester to fall into the same category as worries about meteors falling on your head.
I did scripting for several years before I finally developed Shoulders Back, and it was an important bridge tool for me that allowed me to identify the difference between obsessions (the “what if?” questions) and mental compulsions (trying to figure out the answer to those unanswerable “what ifs”). Saying scripts also gave me practice in directing my attention away from the courtroom drama and onto something else (my scripts), helping me develop the mental muscles to redirect away from compulsive mental activity and to use Shoulders Back effectively.
While I don’t use scripting much anymore, I found it quite helpful in the early part of my recovery and find it helpful today whenever I get conned into participating in the occasional courtroom drama in my head. But to the best of my ability, whenever I see that courtroom deliberations are about to begin, I try to use the most powerful of all my tools: I put my shoulders back, act as if I’m not on trial, and get up and leave the courtroom.
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My blogs are not a replacement for therapy, and I encourage all readers to find a competent ERP therapist. See the IOCDF treatment provider database for a provider near you.
Let’s say that you’re walking through a park. As you’re taking in the fine spring day, you notice a man in a grassy area to your left shouting. As your walk takes you closer to him, you realize that he seems to yelling about the end of the world, and how it’s going to happen tomorrow. You see as you get even closer that he has a stack of pamphlets, and he’s trying to shove them into the hands of unsuspecting passersby. You immediately veer away from him, not wanting to make eye contact with the end of the world spokesperson, in case he decides to try to shove a pamphlet at you. You leave the park, the doomsayer’s voice fading in the distance, and go on with your day, almost immediately forgetting that you even saw the person shouting about that tomorrow is supposedly the very last day for earth.
You’ve probably seen someone enthusiastically shouting about the end of the world in a public park or on a street corner or in a city square. And even if you spiritually or philosophically agree with some of what he’s saying, you try your best not to act interested or take a pamphlet, in case he were to direct some of his fiery tirade at you. You certainty don’t run home, grab your family together and say, “This is it! Tomorrow is the end! We have to gather everyone we love together so we can see them one more time before it’s all over!”
Why don’t you heed the crier’s warning? Because you don’t believe that tomorrow is the end of the world. You act as though what he is saying is completely irrelevant in your life, because it is.
This metaphor is one I use all the time with clients to explain how to most effectively handle OCD. Because OCD is the guy screaming about the end of the world in a park. And when you pay attention to OCD by doing mental or physical rituals, you are making eye contact or taking a pamphlet. Then OCD directs even more of its frightening monologue at you, because you’ve shown interest. You’ve acted like what it is saying is important, so you’d given it power and incentive to keep yelling.
But you have a choice about how you react. You could instead do exactly what you would do if you saw a guy yelling in the park: keep going, not acting as if what he is saying has any relevance for you. The guy in the park wants you to be frightened, worried, and take some sort of action because the end of the world is nigh. But you could choose to do the opposite of that: put your shoulders back (and doing so will actually make you feel more confident, as an added bonus) and confidently go on with your day. That’s why I call this technique Shoulders Back. It basically means that you hear what OCD is saying, but just like with the man yelling in the park, hearing it doesn’t change how you act. It’s just there and you go on with your day.
Shoulders Back is the most powerful strategy I’ve found to address intrusive thoughts, because it completely takes the wind out of OCD’s sails. It takes practice to master, and even then, you won’t always do it perfectly (which is good, since imperfection actually supports your recovery). But if you can become proficient at Shoulders Back, it can dramatically strengthen your recovery.
So how do you do keep walking and not make eye contact or take a pamphlet? I’ve found that it’s a matter of training your brain to pay attention to the present moment.
For instance, say my OCD tells me as I’m having dinner that I’ve offended my fried Kimberley with something I said. My OCD would then like me to start engaging with that content in my head, replaying the conversation, checking my memory of what Kimberley’s reaction was, rationalizing with myself about how what I said wasn’t meant to be offensive and surely she knew that, etc. But all that is not reality, not the present moment. What’s real is what’s in front of me: my dinner. So the moment I hear, “What if you offended Kimberley when you said that?” I… 1) put my shoulders back because that’s a physical action that conveys confidence to my body and brain (see “The Best TED Talks for People with OCD, Part 2” for how this works), which is the opposite of how OCD wants me to act and 2) choose to turn my attention to what I’m doing, which is eating dinner, without doing any compulsions.
I can use my five senses to help me pay attention to what matters in that moment: the smells of the food, how it tastes as I chew, how it feels to sit in the chair at the table, how cute my dog, Bella, looks as she’s begging for a taste of what I’m having, the ambient sounds of the house. Those things are actually in the present moment, and I’m directing my attention to them so that I do not engage with OCD in my head. Paying attention to what I was doing when OCD so rudely interrupted me is the equivalent of continuing to walk on by the man yelling in the park, acting as if what he’s saying isn’t relevant.
Now, what OCD is saying may feel relevant, and that’s OK. That’s just anxiety, and I can handle that. In fact, I welcome being anxious because that gives me practice beating OCD. But even though I’m anxious, I keep my attention trained on what I’m doing, eating my dinner. I do not in any way address what OCD is saying or have a conversation with it in my head or do any physical rituals. I am laser focused on what matters to me, which is eating dinner.
If I do not engage with the OCD, the OCD becomes quiet. Because I didn’t do a compulsion, I haven’t given it anything to work with, and most times, it just gives up, and I quickly forget about what it was worried about. And then something even better happens: the more that I practice Shoulders Back, the less OCD bothers me. It’s almost as if it begins to realize, “When I bother Shala, she doesn’t do anything to address my worries. So what’s the point of even bringing this stuff up?”
Sometimes, however, OCD is sneaky, and all of sudden I look down and realize it has stuffed a pamphlet into my hands. By this I mean that somehow I’ve engaged with its content by doing a mental or physical ritual. For instance, I might have accidentally argued with it in my head, “Kimberley wouldn’t be offended by that!” or I might have done a quick mental scan of how she looked when I said whatever it is OCD is worried about. And unfortunately, that’s all it takes. As soon as I have any sort of conversation with or reaction to OCD that validates its content, it knows it’s got me: “Yes, she responded! She thinks this matters!! Woo hoo!!!”
If I can course-correct quickly enough by putting my shoulders back and re-engaging with the task in front of me, I can sometimes recover from my mistake of engaging with OCD, and it will leave me alone. But many times, if I’ve had any sort of conversation with it or if I’ve done any sort of physical compulsion, it will continue to bother me. If we think about the man in the park metaphor, this makes sense. Most people ignore the guy in the park. If someone stops to listen, makes eye contact with him, and/or takes a pamphlet, he’s going to think, “Wow! A live one! No one is ever interested in what I’m saying, but this person is, so I’m going to really focus on convincing him. If he leaves, I might just follow him, because he’s shown some interest, and if I just keep giving him all the reasons the world is ending, he’ll be convinced, too! I’m not going to let him get away!”
OCD is a lot like that. If you show interest in what it says by doing mental or physical compulsions, it knows that this particular intrusive thought has potential. So it’s not going to give up easily. It’s going to keep running along beside you as you try to leave the park, hurling more intrusive thoughts your way, hoping you’ll take the bait and do some more rituals.
If this happens, and you find the OCD won’t leave you alone, the most important thing is to stop doing rituals. If you’re a mental ritualizer and you cannot direct your attention back to what you were doing because you’re now hooked in OCD’s content, this is when I use “may or may not” statements.
I will describe these more fully in a subsequent blog post, but in essence what I do is say “I may or may not have offended Kimberley” out loud over and over so that I cannot do mental rituals in my head and so I can be present with my obsession in a way that’s therapeutic (i.e. letting it be there without engaging with the thought compulsively in my head). In other words, if OCD is running along beside me like the man in the park, what if’ing me to death, unwilling to let me escape because I showed interest, that is what becomes the reality of my present moment. At this point I can’t do Shoulders Back easily because I’ve acted like what OCD said was important, which is the opposite of Shoulders Back. That made OCD get bigger and louder, and I want to be present with those loud thoughts in a way that shows my mind I can handle them without compulsively engaging with them. So this is when I’d use a “may or may not script.”
The difference between scripting and compulsively talking with OCD in your head is as follows:
Compulsive interaction with OCD in my head: “Kimberley wouldn’t be offended. She wouldn’t be mad at me. She knows I didn’t mean anything by what I said. I think this will all be fine. In fact, I should text her just to make sure she doesn’t seem mad at me” [now I’m finding excuses to do more rituals, this time ones that are physical]….
Therapeutic use of “May or may not (MOMN)”, said out loud to drown out any tendencies to talk with OCD in my head: “Kimberley MOMN be offended. She MOMN be mad at me. I’m accepting this uncertainty. I don’t have any control over her or anyone’s reactions to what I say, and she MOMN be offended. I’m not going to do anything to check with her about this. I can handle being anxious and I want to be anxious, because that’s how I continue to make my life my own, OCD.”
I will say these MOMN statements out loud for a short time, and once I feel that I’ve better accepted the uncertainty of the situation, I once again try Shoulders Back, going back to acting as if what OCD says doesn’t matter. If I’m still getting bombarded with intrusive thoughts, I’ll go back to MOMN and then try Shoulders Back again and continue repeating this cycle until OCD quiets down.
Having to use the MOMN statements is a lot of work, so I do the best I can to do Shoulders Back immediately any time I have an intrusive thought, directly my attention back to what I was doing and going on with my life.
Shoulders Back is not thought stopping
There is an old CBT technique called “thought stopping” that was used for OCD decades ago. The technique is that every time you have a “bad thought” you flip yourself with a rubber band and/or say “stop!” to stop the thought. The 2019 Spring issue of the IOCDF newsletter explains why this technique doesn’t work and how it can even make OCD worse, because suppressing thoughts can lead to ironic rebound, where you have even more of the intrusive thoughts after trying to repress them.
What I do with Shoulders Back is not thought stopping. The intrusive thought is welcome to be in my head, but I’m not going to compulsively engage with it. As I wrote about in my blog post “Why There’s No Cure for OCD“, OCD is not the presence of intrusive thoughts—it is, instead, the reaction to the intrusive thoughts, whether that reaction be physical or mental. What I am choosing to do with Shoulders Back is to not react compulsively either physically or in my head to my intrusive thoughts. I am stopping the conversation I could have with OCD in my head about its content. I’m stopping my compulsive reaction, not the intrusive thought. What tends to happen, however, when I don’t interact with the intrusive thought compulsively is that the intrusive thought goes away. But if I try to push the intrusive “what if?” thoughts away, that’s telling the OCD that they are too painful for me to deal with, that I am taking them seriously, and that will cause the intrusive thoughts to increase.
Shoulders Back is the most powerful tool in my arsenal because it is the essence of exposure therapy: acting as though OCD’s content is irrelevant. Let your actions show that you are giving your attention to what matters to you in your life, not to your OCD’s worries.
Do you have a questions about how to use Shoulders Back? If so, please fill out this form. I will be writing an FAQs about Shoulders Back based on your questions.
My blogs are not a replacement for therapy, and I encourage all readers to find a competent ERP therapist. See the IOCDF treatment provider database for a provider near you.
I wrote a 5-part series for my Beyond the Doubt Psychology Today blog called The Best TED Talks for People with OCD, plus an additional post related to Part 4 about how to feel more connected to others.
“I don’t have to chase extraordinary moments to find happiness – it’s right in front of me if I’m paying attention and practicing gratitude.” – Brené Brown
OCD Recovery Tip: Give thanks for your OCD? You bet! Every single trigger it provides you with is an opportunity to make yourself stronger and find happiness. Remind yourself of this again and again!
Are you feeling a little (or a lot) down? If so, sometimes making a gratitude list can help lift your spirits. It may seem like you would feel more grateful only if you were happier, but the opposite is actually true: gratitude can make you feel happier, as David Steindl-Rast discusses in one of our favorite TED Talks: Want to be happy? Be grateful.
“If you believe in yourself and have dedication and pride – and never quit, you’ll be a winner. The price of victory is high but so are the rewards.” – Paul Bryant
OCD Recovery Tip: Take pride in your OCD recovery work. As researchers have found (see below), that sense of pride can make all the difference!
Fostering gratitude, compassion, and an authentic sense of pride make you more likely to keep your New Year’s resolutions than trying to increase your self-control or willpower directly. Read “The Only Way to Keep Your Resolutions” by David DeSteno in The New York Times to learn more!
Paint by Sticker is a fun way to practice your mindfulness skills. You can do it while listening to music, an audiobook, the radio, etc… or you can try to be really mindful and just put the stickers on without doing anything else! You can also use it to mess with your OCD. Shala did the goldfish picture over the holidays last year and left one sticker out purposely so that the picture will never be finished. Drives her OCD nuts, but helps her strengthen her OCD recovery!
“Be brave and take risks. You don’t have to have it all figured out to move forward.”
– Roy T. Bennett
Key 2 OCD Recovery Tip: Our Doubt Bullies love to tell us that we’ll never tackle our OCD until we “have it all figured out.” Hmmm. That sounds like black-and-white thinking to us!
Appreciation: “Thank you for this great opportunity to practice doing ERP and beating you, OCD!”
Authenticity: “I am not my OCD’s doubts and fears.”
Abundance: the paradigm-shifting belief that the universe is friendly.
Key Two: Resolve to maintain a mindful perspective and remember the bigger picture, otherwise known as the Greater Good: how you can enhance your sense of purpose or be of service to others.
Key Three: Throw your shoulders back and do the exposure, acting on your Greater Good and recognizing that you want to move toward not away from anxiety.
Key Four: Surrender or let go of desired outcomes, a task especially challenging for those of us with monsters who throw fits when things don’t go their way. This is terrible! your monster will scream, immediately throwing the “bad” label on any outcome that doesn’t meet its criteria for certainty, comfort, and control. But what might your monster learn from the Chinese farmer parable?
A Chinese farmer and his son wake up to find their only horse is gone (seemingly bad), then arise the next day to find the horse has returned, bringing a herd of wild horses with it (seemingly good), only to have one of the new horses throw the son off his back the following day (seemingly bad), which then keeps the son from getting conscripted into the army the day after (seemingly good, but hey maybe not!).
The story poignantly illustrates the essence of the fourth key: that we can’t judge things as “good” or “bad” until much later, if even then.