Speaking TogetherObsessive-compulsive disorder is often accompanied by some cognitive distortions, which are basically inaccurate beliefs that usually make us feel badly about ourselves. One of the more common cognitive distortions that might occur with OCD is known as black-and-white (or polarized) thinking. When my son Dan was dealing with OCD but could still drive, this type of thinking was obvious. If he went 25 mph in a 35 mph zone and the driver behind him honked his horn, Dan was convinced he must be the worst driver in the world. Not a good driver who was going too slowly, but the worst driver ever. No gray, just black-and-white. Sometimes a humorous comment from me would make him see how ridiculous this thinking was, but more often than not, this is what he believed.

When I think of OCD and black-and-white thinking, the two really do make a perfect pair. One of the driving forces behind OCD is the need to know with absolute certainty that nothing bad is going to happen. What a perfect example of black-and-white thinking: Either I am 100% sure that I (and/or those I care about) am completely safe, or I am definitely in great danger. No gray, nothing in between.

But as we know, that’s not how the world works. We live in a world of gray. Dan is a really good driver who goes too slowly sometimes. We try to be safe, but accidents happen. Usually these accidents are no big deal, but sometimes they are. It’s unlikely, but they might even be catastrophic. Our world is uncertain.

Like plants in a greenhouse, OCD thrives on black-and-white thinking, and this cognitive distortion can even sabotage the treatment and recovery of the person with OCD. Exposure and response prevention (ERP) therapy, by its very nature, is slow and tedious and often fraught with setbacks. A person with OCD who thinks in black-and-white might conclude: “I’m a complete failure at ERP Therapy because I gave in to my compulsions today. What’s the use? I’m never going to get better. I shouldn’t even bother fighting.” Because of this tendency toward black-and-white thinking, it is important for those with OCD to understand the difference between a lapse and a relapse as they pursue treatment. This knowledge could significantly impact their long-term prognosis.

I believe that for Dan, just being made aware of black-and-white thinking and his tendency toward it was extremely helpful. That’s just one of the many reasons to connect with a therapist who is experienced in treating OCD. He or she can help you understand and address cognitive distortions (as well as get rid of them) through the use of Cognitive Behavioral Therapy. This understanding is an important component of therapy and recovery from OCD. Indeed, all of us, whether we have OCD or not, could likely benefit from being able to think in shades of gray. The world is not black-and-white and once we are able to accept this fact, we can move forward and not only accept, but embrace, the uncertainty in our lives.