The importance of mood in OCD

For a person affected by OCD, mood is often marked by heaviness and seriousness. Fortunately, positive engagement can bring more colour to the horizon and create positive changes in mood.

The importance of mood in OCD

This article explores the importance of mood in OCD, and vice versa. My hope is that the article gives the reader confidence that, as a person affected by OCD, it is possible to change your mood through positive forms of engagement.

OCD is a serious disorder, and at the same time it thrives, is maintained and is reinforced when a person is caught in a serious, heavy frame of mind. You can therefore make the conditions less favourable for OCD by engaging in a hobby or an entertaining activity that shifts thinking and mood away from heaviness.

Throughout the article, I will use the concept of positive engagement as an umbrella term for engaging either in a hobby or in an entertaining activity.

First, I introduce the mood scale and explore the relationship between mood and OCD. I then describe how creating positive engagement leads to positive changes in mood and can therefore improve quality of life. In connection with this, I offer advice on how this can be done. I then introduce the concept of flow and explain how this positive state creates motivation and a stronger sense of self. In the next part of the article, I explain the theoretical background for the relationship between actions (behaviour) and mood, illustrated through practical examples and figures. In the final part of the article, I offer a framework for understanding the background to our worrying thoughts and mood, and the general challenges involved in feeling joy, which has major consequences for people affected by OCD. Feeling low and having worrying thoughts is therefore not unique to people affected by OCD, but a phenomenon that is more normal than most people think.

Mood

If you try to visualise a vertical scale (or look at figure 1), where a serious, heavy mood is placed at the bottom and a mood marked by lightness is placed at the top, OCD is most comfortable and thrives at the bottom. When OCD takes hold, it tends to pull a dark cloud of heaviness over the person’s thinking and mood. It therefore creates a sense of seriousness and sadness, as well as dichotomous (black-and-white) thinking, which weighs the person affected by OCD down. This is also why you are more vulnerable in situations where your mood is strongly affected by heaviness and sadness. This might happen, for example, after a death in the family or after an argument with your manager. In these situations, OCD thoughts may arise more easily, even if the event has no direct connection with your OCD. In this way, mood can help both maintain and reinforce OCD thoughts and OCD-driven behaviours.

Positive engagement affects your mood positively

In the clinic, we often meet clients who have completely forgotten activities that once gave them great pleasure and joy. Try asking yourself what previously put you in a good mood. You can almost certainly think of one or more activities. You may also have had a hobby in the past where you could become absorbed and, for a while, forget time and place. Then ask yourself what it would take for you to engage in these activities or in your hobby again.

In addition to changing mood, engaging in an activity or hobby often has the side benefit of quieting OCD for a while.

Many people affected by OCD organise their lives so that they avoid situations that trigger their OCD. Over time, they restrict their own freedom of movement and mental freedom, and they let themselves be governed by their OCD and the heaviness that comes with it. As a result, many experience that they lose (and over time forget) interests and hobbies that once gave them great joy.

One central way to affect your mood in a positive direction, and thereby move up the mood scale, is to create positive changes in everyday life through engagement in activities that lift your mood. For some clients, it is about letting go of control in the here and now, for example by doing something silly, such as playing loud music and dancing. For others, it works better to engage in a hobby they can become absorbed in. This is about personal preferences and what feels meaningful to the individual. Some people find silly activities stupid and meaningless, while others find it freeing to let go of control and have a good laugh. Both forms of positive engagement have the effect of causing a change in mood and can also bring a person into a so-called flow state, where they forget time and place. As a result of this state, OCD is pushed out of awareness for a while.

The flow state

Flow is a mental state in which a person is completely absorbed in and engaged with the activity they are doing.

Achieving a state of flow can be a goal in itself, but it is not a criterion for quieting OCD. It should rather be understood as a side benefit of positive engagement.

The flow experience arises when the activity or hobby we are engaged in balances our skills and the challenges we face. If skills are lower than the challenge, this can result in worry and, at worst, an anxiety-like state. If skills are higher than the challenge, it can easily result in boredom and lack of motivation (see figure 2). You should therefore engage in a hobby or activity that creates this balance. If you find it difficult to judge this, it may be helpful to get support from your psychologist or from a person you are close to and feel safe with. Sometimes you need to try several different activities in order to find the right balance. Once the right activity or hobby has been found, you can act with deep but effortless engagement, which removes worries from consciousness. It is important to understand that we are able to bring ourselves into a state of flow, either on our own initiative or with help from another person. As mentioned earlier, it can be difficult to start activities yourself when you are right down at the bottom of the mood scale. It can therefore be helpful to make an agreement with a good friend or a family member to help start the activity. Once you have got going, your mood will quickly rise, and when you reach the flow state, you will be so absorbed in the activity that you forget time and place, thereby quieting OCD.

Another important point is that the state is strongly motivating. Once you reach it, you will be motivated to continue the positive engagement. The activity or hobby becomes a bright spot in everyday life and creates increased enjoyment of life. Finally, your sense of self may feel stronger when the flow state ends, partly because you experience a sense of control over your life and therefore also over OCD.

Why does positive engagement work?

At OCD Klinikken, we work from a cognitive behavioural paradigm.

Cognitive behavioural therapy emerged in the mid-1960s and is characterised by emphasising the importance of cognition (thinking) and behaviour (action) for emotional life and for psychological problems and symptoms.

The relationship between thought, feeling, body and behaviour is fundamental to cognitive behavioural therapy and can be illustrated in “the cognitive diamond” (see figure 3), because their mutual influence resembles the pattern of a diamond, just as they reflect (influence) each other.

To create changes in mood, you can work with changes in both cognition (thinking) and behaviour. To explain this, the following examples show how you can change mood, first through thinking and then through behaviour.

The example below illustrates how thoughts affect mood (see also figure 4):

In the example, we see how the thought “they do not like me” creates a negative chain reaction that affects mood. The mutual influence described here can be worked with by changing what you think about the situation, and the example could instead look like this:

For people with and without OCD, it is difficult to change thinking directly. It is also bound to go wrong if you tell people: “you just need to think differently”. Sometimes it can be more helpful to start with the part of the cognitive diamond that concerns behaviour (actions). In this way, changes in behaviour can lead to changes in thinking and mood (feelings).

Many people affected by OCD are trapped in an everyday life marked by routines and rituals that give them no joy, but which they feel an urge to perform in order to reduce the anxiety or discomfort connected with their OCD thoughts. This inevitably affects both thought life and emotional life and can help keep a person in a serious, heavy mood.

If you try to replace some of these routines and ritual actions with fun activities or a hobby, this can affect mood in a positive direction.

If we return to the example of the woman who is going to meet her friends and look at the behavioural part, we see that when the woman withdraws from the group, this reinforces the thought “they do not like me” (see figure 4).

Conversely, it has a positive effect on thinking when she instead walks over to her friends and discovers that they do, in fact, want to spend time with her (see figure 5). Again, thinking affects mood directly, but because behaviour affects and reinforces thinking, you could say that your actions affect mood indirectly (as a secondary outcome), which, as mentioned, you can use to quiet OCD.

Figures 6 and 7 illustrate the message of the article: through changes in behaviour, we can affect our mood, either as the primary outcome (figure 6) or as a secondary outcome (figure 7). By starting entertaining activities that are fun and silly, we affect mood directly, and the thoughts are quieted or reduced for a while. In this way, OCD thoughts are kept out of consciousness.

By becoming absorbed in a hobby, alternative thinking is created, which moves a person up the mood scale. People affected by OCD may typically have thoughts such as “my OCD has taken control of my life” or “if I constantly have to have these unpleasant intrusive thoughts in my head, life is not worth living”. Such thoughts show OCD’s power over the person affected by OCD and make it difficult to think positively at all. Engaging in a hobby can, as mentioned, break with this negative and dichotomous thinking, and alternative thoughts arise, such as “I am actually able to take control back” or “it is actually possible to quiet the unpleasant intrusive thoughts, so that life is worth living”. During the activity itself, OCD thoughts will be replaced by thoughts related to the hobby, which means that when we become occupied with and engaged in something else, the OCD process is quieted or reduced.

It is important to remember that both forms of positive engagement are effective and helpful, and that one form of engagement is not better than the other. Likewise, both are able to bring us into a state of flow. It is probably faster to reach a flow state through an entertaining activity, partly because these activities often do not exceed our skills, and partly because such activities are easily accessible and can therefore quickly make us forget time and place. On the other hand, the flow state is probably more genuine and motivating when it comes from becoming absorbed in a hobby.

Another important point is that both forms of positive engagement can quiet or reduce the OCD process because thinking changes or is interrupted.

It is therefore possible to change your mood and take control of your life. It is also worth noting that up to 95 % of the population experience intrusive unpleasant thoughts. The phenomenon is therefore in no way abnormal, which is why it is also interesting to understand the background to our worrying thoughts and therefore why it is so difficult to feel joy. In the final part of the article, I explain the background to this from an evolutionary psychological perspective.

Why is it so difficult to feel joy?

For people affected by OCD in particular, the feeling of joy is difficult both to achieve and to maintain, but in reality this is a common human phenomenon. To understand the background to this, we need to travel back in time and look towards evolution. The modern human mind, with its incredible ability to analyse, plan and communicate, has undergone a significant development over the last hundreds of thousands of years, since our species, Homo sapiens, first appeared on planet Earth. But our minds have not developed so that we can feel happy. Our minds have developed for the purpose of ensuring our survival. In evolutionary terms, it has paid off for our species to have heightened attention to potential dangers and to avoid them. The better our ancestors were at anticipating and avoiding dangers, the longer they survived, and the greater their chance of reproducing. Evolution has led us to where we are today, for better and worse. This means that the modern human mind is on guard and constantly assesses everything we encounter. Good or bad, safe or dangerous, harmful or helpful? But as we all know, the “dangers” we meet today are quite different. It is therefore no longer (at least not in our part of the world) dangerous predators that our minds warn us about, but rather rejection, unemployment, social situations or some other worry. Most people therefore spend enormous amounts of time worrying about something that often never happens at all.

Another aspect that has ensured the survival of the species has been the social aspect, that is, belonging to a group. Our minds have developed to make comparisons with others in the group in order to adapt to the group’s norms and ultimately avoid being rejected and excluded. This aspect troubles many people today, not least people affected by OCD. Thoughts such as “do I fit in”, “am I doing the right thing” or “am I as good as the others” are typical examples of how our minds warn us against rejection and compare us with the rest of society. This applies both to our immediate environment and to glamorous media images on television and social media. When we compare ourselves with these glossy images, we often feel inferior and disappointed with our lives.

Closing

Because of our evolutionary history, we humans have a tendency to worry. It is therefore normal for the feeling of joy to be difficult both to achieve and to maintain. This has major consequences for people affected by OCD, because OCD thrives, is maintained and is reinforced in a serious, heavy mood.

My hope is that the article has given the reader an understanding of - and confidence in - the fact that you can make an active effort yourself to change your mood through positive forms of engagement. The message is therefore that you can take control of your life by changing your behaviour, your thinking and therefore also your mood.