In an assessment session, one of the things I will explore with a client is what they’ve already tried to address the problem that is bringing them into therapy. Sometimes the things that they’ve tried have helped a bit, but likely only partially. Sometimes they haven’t really helped at all but the person has continued to rely on them for lack of any other solutions. And sometimes the things they are doing in an effort to alleviate their difficulty is unfortunately making it worse. 

Sometimes solutions work in the short term but not in the long term. Or maybe they did work at one point in the past, but continuing to apply that same solution now isn’t having the same effect any more.

This idea of the solution as part of what is maintaining the problem is one that applies across many different mental health issues from health anxiety to bulimia, to agoraphobia and obsessive-compulsive disorder. The common theme is that the solutions are generally trying to reduce the distress that the person is experiencing. 

For people with death and existential anxiety, common solutions used to try to reduce their distress include things like avoiding stimuli that might trigger this distress. For example avoiding conversations, books, movies or news stories about death or avoiding walking past places like graveyards. Other common solutions include keeping really busy in an attempt to distract oneself from uncomfortable thoughts and feelings. And for people troubled by existential questions, ruminating on the ideas and trying to problem solve or reason one’s way to an answer is the attempted solution. This may be accompanied by hours spent researching on the internet for answers or ‘proof’.  

The reason these solutions are difficult to stop doing is that they are often partially effective. Even if only fleetingly, any alleviation of the distress is reinforcing and so one can become seduced into the idea that, if they just keep applying their solution, eventually things will get better. This process is typical for people with OCD and obsessions about contamination, where the compulsion of handwashing can temporarily reduce the anxiety. But the relief is short lived, the cycle is repeated and ultimately this ends up fuelling the obsession and the anxiety. 

The process is similar for a person with existential OCD. They attempt to reason their way to an answer to their existential questions. Every now and again they may hit on an idea that seems like it might be a satisfactory answer and lead them to the certainty they crave. (This rumination is essentially a mental compulsion and the equivalent of the handwashing for the person with contamination OCD.) However because these questions are ultimately unanswerable, eventually the doubt and uncertainty creeps back in, and the cycle is perpetuated.   

For some people this ruminative process may be a part of their journey and necessary as they work their way through and out the other side of their anxiety. For people where there is a lot of avoidance however, and therefore a really significant impact on a person’s day to day life, I think this is more difficult to do. 

So for some people they get to a point where they are seeking support because whatever they’ve been doing up until this point hasn’t really been working and has just been keeping them trapped in a vicious cycle. This often means that a different approach is required from what they have perhaps tried in the past. Sometimes a radically different approach.

This approach is ultimately about, rather than trying to get rid of the thoughts and the feelings and directly reduce the distress, learning to have a different relationship with it. This approach is underpinned by ideas that are thousands of years old and stem from Buddhist psychology and other spiritual philosophies, and are now conceptualised in modern Acceptance and Commitment Therapy. This approach talks of ‘dropping the control agenda’ and ‘dropping the struggle’ with the feelings. Though this approach does not attempt to reduce the difficult thoughts and feelings, directly, there is lots of evidence that changing the relationship with them will reduce the impact and thereby also the distress.

Understandably the person hopes that the distress will reduce eventually, and very often this is the case. But directly trying to reduce it through the various solutions the person has been applying hasn’t been working and so we do the opposite. We stop struggling and flogging these worn-out solutions. We make space for the thoughts and feelings, turning towards them rather than away from them. And in so doing, we find that this reduces their power. This then frees us up to focus on what’s really important – using our precious time to do the things that matter and are important to us. In other words, living our lives in line with our values.