Doubt and guilt are considered the hallmarks of OCD. Doubts can arise about every situation, topic, event, or person and these doubts are often futile in resolving. Guilt can also play a major role in OCD. You may feel personally responsible for things that had nothing to do with you and constantly find yourself thinking, “If only….” Remind yourself that you are responsible for yourself, and you generally do the best you can. Especially after a relapse, you may feel many negative emotions. Don’t ignore the emotions, but don’t dwell on the feelings either, as they can contribute to OCD. If you find yourself feeling doubtful (“Did I do everything I could? Am I really sane? Will I become a criminal? Can I really get to the other side of OCD?”), address these feelings. Say to yourself, “I have doubts about this situation. Is this coming from me or from OCD?” The same is true for guilt. You may experience a period of time with no OCD triggers, then suddenly experience obsessions once again.  After the obsessions re-emerge, you may feel a need to complete compulsive behaviors, and this is considered a lapse. A relapse, however, involves absolute or rigid thinking following the re-emergence of obsessions, such as, “All my therapy is wasted, I must now engage my obsessions and compulsions.” This type of rigid thinking is associated with a relapse. For example, a person with contamination fears may be triggered by using a dirty public restroom and begin washing compulsions as a result of the distress. This is a lapse. Anticipate what situations will trigger lapses or setbacks into obsessive thoughts or fears. If you know you will experience heightened distress (like you will be around many people and may begin to have a contamination fear), plan for intrusive thoughts. Recognize that the thoughts are a result of the stress and a part of OCD. Having intrusive thoughts is not a failure. Say to yourself, “I know this is a stressful situation, and that obsessive thoughts or fears may happen. Even if they do, it does not mean that I am failing.” After you’ve identified a lapse, assess what made you lapse and how you can prevent future lapses. You may feel triggered at a number of situations, yet having a plan to deal with these triggers is most important. Think about what worked during treatment and try that on your own. When triggered, expose yourself to the fear, stop yourself from engaging in rituals, get through the anxiety, and repeat the process. Say to yourself, “This is stressful, but I know I can handle this. This fear exposure can help me work past my anxieties and not need to perform a ritual.” Remind yourself that nobody is perfect and to not set too high a bar for yourself. You may forget medication here or there, or begin to give into obsessive thinking. Instead of beating yourself up or putting yourself down for getting off track, refocus your efforts to start again.  There’s no need to guilt or shame yourself. Forgive yourself and get back on track. If you have a rigid approach to treatment and success, it can backfire. Recognize that obsessions won’t go entirely away and you may experience triggers and fears.

Summary:
Address feelings of doubt and guilt. Understand the difference between a lapse and a relapse. Plan for lapses. Manage lapses. Expect recovery to be imperfect.