In theory, we know we should take care of ourselves. But in real life, stressors come fast, from all directions: work, life at home, bad news online, fears and regrets on those nights you toss and turn. Maybe other people have time to get 8 hours of sleep, you think. Not me!
And obsessive-compulsive disorder (OCD) makes it even harder. You feel you have to do things to feel okay when your thoughts and fears strike—constantly washing your hands, repeating a phrase to yourself, asking your partner if they’re mad at you, or re-reading the same article over and over.
OCD wants you to believe that compulsions like these are helpful. It convinces you that this is the way to stay safe, feel better, or even take care of your loved ones. But soon after you’ve done whatever you need to feel in control, your obsessions return, and the cycle starts again.
Why OCD makes self-care harder (and more important)
On top of that, OCD is a stealthy enemy, notes Taylor Newendorp MA, LCP, an OCD specialist. It can hijack self-care routines. “What can initially look like healthy constructive self-care runs the risk of becoming a compulsive ritual,” he says. And that can make your OCD worse.
So, if you’ve decided to take your life back from OCD, you might think you should focus on mental health treatment, and worry about your day-to-day habits after you get better.
But Newendorp says that’s a mistake, as well—the two need to go together. Yes, therapy is essential to living well with OCD, but no therapist can do the work alone. You need to do your part, and this includes taking care of yourself.
“When people are not getting decent sleep, they’re not eating as well as they might otherwise, when they’re not getting some physical activity, when they’re not engaging and enjoyable activities, it’s simply harder to have the mental and physical energy to effectively do therapy,” he says.
Beating OCD means taking care of yourself using strategies that help you stay well, that you can stick to, and that you don’t allow to turn into compulsions, Newendorp says.
The best self-care strategies for OCD
Here are the strategies that experts recommend, because research has shown that they work.
1. Exercise
Aerobic exercise, like jogging, swimming, or cycling, helps reduce stress, improve mood, and some research suggests it decreases OCD symptoms. (In one study, for example, people who regularly exercised got much more relief from symptoms than a control group.) Many experts recommend at least 30 minutes of moderate exercise a day. Of course, Newendorp notes, that’s an average, and individual needs vary.
2. Sleep
Sleep deprivation can worsen OCD symptoms. And many people with OCD find that their symptoms get worse when they’re alone, all is quiet and the challenges of the day aren’t around, Newendorp notes.
“That’s when, all of a sudden, a person might experience a flood of intrusive, unwanted thoughts and images, and get overcome with anxiety,” he says. “And then there’s the added anxiety of, ‘oh, no, this is the time I’m supposed to be resting and sleeping, and it’s not happening.'”
You can’t always ensure that you’ll sleep when you want to sleep, but you can at least make sure that you’re doing all you can to protect yourself from sleep deprivation. Try to go to bed and wake up around the same time, as much as possible, and avoid bedtime habits that keep you up at night. Using a phone or other screen device, for instance, sends you information that stimulates your mind, and the screen light signals your brain that it’s not the right time to fall asleep.
3. Healthy eating
Food is important. That means it gives OCD lots of footholds to get in your mind. OCD might tell you that you have to avoid whole categories of food because they might be dangerous or contaminated, or ask over and over about whether that lettuce was washed well. Or you might feel you can only eat “the right” foods, or that you have to eat in a certain way to avoid choking or vomiting.
If OCD has led to disordered eating, a good first step is an appointment with a doctor to check for your habit’s effects on your health. Your doctor may refer you to a nutritionist, who can give you accurate information about nutrition and eating habits. If OCD has deeply affected your eating, you should get treatment with a therapist who is trained to handle OCD in particular. Effective, research-backed therapy can help you improve your eating patterns, which in turn will help you do the work of therapy more effectively.
4. Connecting with others
Friends, family and other loved ones are a powerful buffer against stress and mental health struggles. If you’re feeling isolated, consider joining a club or group with people who share your interests.
This one can be particularly challenging for people with OCD, Newendorp says. “A lot of people with OCD want to feel close to family and friends. But as a result of the OCD, they find themselves isolating and withdrawing from those really important relationships. Intrusive thoughts can attach themselves to the people they love and care about the most. So they don’t want to feel that anxiety and discomfort around other people, and over time it feels easier and safer just to be withdrawn.”
That makes it all the more important to make that effort to “do the opposite of what OCD is telling you to do,” Newendorp says. “We know that ongoing avoidance, isolation, and withdrawal will further increase anxiety and usually lead to depression as well.”
We know that ongoing avoidance, isolation, and withdrawal will further increase anxiety and usually lead to depression as well.
5. Doing things you enjoy
It’s all too easy for busy people to put tasks and worries ahead of the things we enjoy doing. But those pastimes and hobbies—making music, walking in the park, playing games or whatever you love to spend time on—are good for your health.
One study, for example, found that people who did more “enjoyable activities” had lower blood pressure, lower levels of the stress hormone cortisol, and less depression and low mood. Not surprisingly, they also told the researchers they felt better than did people who did fewer of these activities.
Doing things you love can ease the mental health struggles that interfere with overcoming OCD, writes psychologist Jonathan Abramowitz. “We have found that a few weeks of challenging negative thinking styles and engaging in pleasurable activities helps many depressed people with OCD to feel more confident and ready to address their obsessions and compulsions.”
6. Practicing mindfulness
Mindfulness involves paying attention to the present moment without trying to control or judge what you are experiencing. Studies show mindfulness-based interventions can reduce OCD symptoms. If it’s hard to manage alone, you could try a meditation class. If you get very upset about your “bad” thoughts, a mindfulness app, teacher or group class can help you learn to drop the habit of classifying thoughts into “good” and “bad” in the first place. After all, your thoughts are just thoughts. What matters is how you respond to them.
7. Relax!
Calming yourself down and getting into a peaceful frame of mind are skills. They can be learned. Deep breathing, progressive muscle relaxation, and guided imagery can calm your body and mind. Just learning to take really deep breaths (so-called “abdominal breathing” or “belly breathing”) can reduce your stress.
8. Limit your chemical crutches.
Some people with OCD report getting short-term relief from their symptoms via caffeine, alcohol or cannabis. But unfortunately, this short-term relief is exactly what makes behaviors like these compulsive, meaning that they actually make your symptoms worse over time. One study found that cannabis can increase anxiety in OCD sufferers who aren’t used to it. And when people use alcohol to ease their OCD symptoms, they experience a “rebound,” where symptoms get worse after the alcohol wears off.
Many, many people with OCD do this. One study found that nearly one in four people with OCD had a substance use disorder. Others put that figure at closer to two in five.
For all mood-altering substances, it’s vital to remember the difference between a little temporary relief and any kind of real improvement. There’s no evidence that using any of these will create any lasting change. And with all three, there is a risk of use turning into a compulsive behavior.
When a drink, cigarette, or gummy becomes something you feel you have to have, then you’re becoming dependent in an unhealthy way, and you’re making your symptoms worse in the long run.
Keeping OCD away from your self care
Whatever you do to stay healthy and happy, it’s important to keep your self-care routine out of OCD’s clutches. The disorder is very sneaky, and even well-intentioned routines can be compulsive if you’re not careful.
“An example would be exercise,” he says. “We often hear that people should get at least like 30 minutes of physical activity a day. But it would be easy to slip into a ritualistic pattern where you tell yourself, 30 minutes isn’t enough, it has to be three hours. Before long, they get stuck doing the same routine in the same order, every single day, and get really anxious if they deviate from the ritual. It crosses the line into being an unhealthy behavioral pattern, and ultimately makes them feel worse, instead of better.”
A good way to guard against this is to remain flexible with your self-care routines, and change them up now and then.
“Especially for someone living with OCD, it’s important to purposefully mix it up. Go to the gym sometimes in the morning, and sometimes in the afternoon. Try new things in your workout. Avoid having a rigid routine. Over time, that helps you experience what we call cognitive flexibility,” Newendorp says. “And that actually helps you better manage your obsessions—getting away from this idea that things absolutely have to be a certain way.”
Self care isn’t enough. OCD requires specialized treatment
Self-care is essential for therapy, but it’s not a replacement. To really get your life back, you need to reduce the time and energy OCD consumes. Treatment is the only way to do that—but it has to be guided by a therapist who has specialized training in OCD, and who knows how to use methods that actually work.
That’s because training for most general therapists doesn’t include much information about OCD’s unique challenges. And some of the practices untrained therapists use can actually make OCD worse. For example, a therapist may seek to validate your feelings and make you comfortable with them. This is great for many mental health conditions, but for people with OCD, this often ends up feeding compulsive reassurance-seeking and reinforcing the OCD cycle.
The most proven, evidence-based approach that works for OCD is exposure and response prevention (ERP) therapy. In ERP, your therapist will guide you as you gradually expose yourself to things that trigger your OCD, and learn to sit with the discomfort and anxiety you feel—without using compulsions for a sense of quick relief. For example, if you’re afraid you might hurt someone with a knife, you might start by holding a plastic knife for a few moments. As time passes, you get better and better at dealing with uncertainty and other uncomfortable feelings.
A lot of ERP, says Newendorp, “is just doing the opposite of what the OCD is saying. If OCD is saying, ‘I have to stay away from others out of contamination fears’—then you have to act the opposite way. And the more you purposely engage with others, even while experiencing obsessions and discomfort, learning you can tolerate it, the more you see that those things you were afraid of simply don’t come true, and you learn to live with the little bit of uncertainty you have.”
How treatment and self care work together
Getting evidence-based treatment, from a professional trained in OCD, is essential to living well with OCD. It is the path to getting your life back. And that treatment will reinforce good self-care habits, while those habits reinforce the effects of treatment. It’s a win-win that needs both components to succeed.
As ERP therapy progresses, symptoms become less frequent and less intense (this often happens in about two months, though of course each individual is different). At that point, most patients enter into “maintenance” mode, where their appointments are less frequent, but they still check in to make sure they’re continuing to do well.
“Effective self-care is all about supporting and maintaining your gains from treatment,” Newendorp says. “And the number one thing we recommend when you’re going into maintenance is ongoing self-care. We know there’s a strong correlation between heightened stress and an increase in OCD symptoms. So it’s important to continue working on day-to-day stress management to keep the OCD at bay. That’s what prevents a spike in symptoms if some sort of stressful event occurs in their life.”
Effective self-care is all about supporting and maintaining your gains from treatment.
In the end, effective therapy and self-care go hand-in-hand, each one making the other effective as you regain your life.