What is an OCD backdoor spike?
An OCD backdoor spike is when a person with OCD starts to feel better with less stress and anxiety and fewer intrusive thoughts and doubts, and then begins to “obsess” that they are not worried about thoughts in their head and almost fears starting to feel better. As OCDLA notes, they worry they are not anxious enough!
This spike tends to occur when the person has successfully learned to manage their OCD symptoms. I have witnessed this quite a few times in my private practice, and it follows the same theme of the client starting to worry or obsess as there is nothing to worry or obsess about.
I shall tell you what I say to my clients; if anything, this is a good sign and not to be feared, as it is a clear indication of recovery; but your brain has yet to catch up that you are doing okay.
In my experience of providing therapy to people with OCD, I see this backdoor spike occur in one of two ways.
At the end of treatment, the person begins to obsess that they are getting better.
Previously extinguished compulsion comes back. For example, someone goes to send an email but feels the need to compulsively check for errors after they have completed many tasks without the need to check for mistakes repeatedly.
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Causes of backdoor spikes
Neural pathways in your brain.
When you had OCD, each time you had an obsession and you immediately carried out a compulsion, you were inadvertently teaching your brain a new neural pathway.
It’s like a learning curve, where you lay down a set of instructions for your brain so it can carry the task out automatically. For example, if your OCD focused on germs, you probably washed each time you touched something. The more you did this, the stronger the neural pathway became in your brain; touching something means I must immediately wash.
Even though you might have completed therapy and can touch something without ritualising (washing), the neural pathway will still be there. It could cause a backdoor spike where you feel anxious and want to wash.
However, the more you resist this compulsion, the old neural pathway will lose its strength, and a new helpful path will form.
How to deal with a backdoor spike if it happens
Step 1: Recognise that you’re experiencing a backdoor spike
To manage a backdoor spike, the best course of action is to continue doing the exposure and response prevention (ERP) exercises you have been doing. This includes refraining from engaging in rituals or compulsions and instead focusing on leaving the intrusive thoughts and feelings uncertain. The goal is to learn to respond differently to the threat and not give in to the fear or worry associated with it. You can learn to manage the backdoor spike with continued practice and stay recovered.
Step 2: Accept that your anxiety spikes will happen
Even if you thought that you had moved past fear or worry, it is possible that it could resurface unexpectedly. Please don’t be hard on yourself for experiencing this setback; understand that it is a normal part of recovery.
Step 3: Breathe and Ground Yourself
When you feel overwhelmed and anxious, try taking slow and conscious breaths to help regulate your breathing rate. This will help to calm your mind and body. Additionally, try to ground yourself by focusing on the sensations of the environment around you.
Step 4: Create a Plan for Dealing with Anxiety
It’s essential to create a plan for dealing with anxiety spikes when they happen. This might include talking to a friend or therapist, taking a break from the situation, or using distraction techniques such as watching a favourite show or playing a game on your phone. Having a “rescue plan” is also beneficial if you need to leave a situation quickly.
Backdoor spikes are common and a good sign that all your hard work is paying off and you are starting to recover. Understanding what is happening and why will help you manage and get through this spike. Remember, it’s just a blip and part of your recovery.