OCD and Driving
Obsessive-Compulsive Disorder (OCD) can manifest in myriad ways, including being focused around the act of during. At Kairos Wellness Collective, we treat individuals who are limited by fears or compulsions related to driving, which might reduce their ability to earn a living, transport family, or even leave the home. These are just some of the ways that OCD can interfere with driving:
Fear of Harming Others: Individuals may experience intrusive thoughts or fears of causing harm to pedestrians, other drivers, or passengers while driving. They might fear accidentally hitting someone or being responsible for a car accident.
Fear of Causing Accidents: People with driving-related OCD may have excessive worries about causing or being involved in car accidents. They may engage in safety-related compulsions to prevent accidents, such as repeatedly checking their mirrors or brakes.
Contamination Obsessions: Some individuals may have contamination obsessions related to driving, fearing that the steering wheel, car controls, or other surfaces inside the vehicle are contaminated. This can lead to cleaning or washing compulsions before or after driving. For others, the car is a “clean” space like their bedroom, and they feel like parts of the car can get contaminated (including morally contaminated) by an item or a person.
Checking Compulsions: Checking rituals are common among individuals with driving-related OCD. They may repeatedly check if the car is locked, the lights are off, or if they have parked correctly. This can lead to significant delays before starting or completing a drive.
Avoidance of Certain Routes or Conditions: Individuals with driving-related OCD may avoid specific routes, intersections, or driving in certain weather conditions due to fears or intrusive thoughts.
Excessive Reassurance-Seeking: People with driving-related OCD may seek reassurance from others repeatedly, asking for confirmation that they are driving safely or that they did not cause harm while driving.
Mental Rituals: Some individuals engage in mental rituals, such as counting, repeating mantras, or praying, while driving to reduce anxiety or prevent perceived negative outcomes.
Intrusive Images: People with driving-related OCD may experience distressing and intrusive mental images of accidents or harming others while driving. These may feel so real to some, that they feel compelled to go back and check on the route to make sure they didn’t hurt anyone.
It's essential to recognize that these obsessions and compulsions can significantly interfere with an individual's ability to drive safely and can lead to significant distress and impairment in daily life. If you or someone you know is struggling with driving-related OCD, seeking help from a mental health professional experienced in treating OCD is crucial. Cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) is a highly effective treatment for OCD and can help individuals develop healthier coping strategies and reduce the impact of OCD on their driving and overall well-being.
ERP involves exposing individuals to their obsessions (in this case, driving-related fears) and preventing the usual compulsive responses. The goal of ERP is to reduce anxiety and distress and help individuals develop healthier coping strategies. Here are the steps involved in treating OCD driving through Exposure Response Prevention:
Assessment: A thorough assessment is conducted to identify the specific driving-related fears, obsessions, and associated compulsions. The therapist and individual work together to create a hierarchy of driving-related situations ranked by the level of anxiety they provoke.
Exposure: The individual is gradually exposed to the driving-related situations from the hierarchy, starting with less anxiety-provoking situations and gradually progressing to more challenging ones. Exposure can involve imagining the situation, looking at pictures or videos related to driving, or engaging in real-life driving tasks.
Preventing Compulsions: During exposure, the individual is instructed to refrain from engaging in their usual compulsive behaviors, such as checking, seeking reassurance, or avoiding certain routes or conditions. This is often the most challenging part of ERP, as it requires facing the anxiety triggered by the obsession without resorting to compulsions.
Staying in the Situation: The individual is encouraged to stay in the feared situation until their anxiety naturally decreases. The therapist helps the person recognize that the anxiety will decrease over time, even without engaging in compulsions. The client may be supported in creating a loop tape on their phones, which creates a catalog of their worst fears around driving, and therefore lean into the fear.
Repeating Exposures: Exposure exercises are repeated regularly, allowing the individual to habituate to the anxiety and develop greater tolerance for the distressing thoughts and feelings associated with driving-related OCD.
Homework Assignments: The individual is given homework assignments to practice exposure exercises independently between therapy sessions. This helps reinforce the learning and generalization of coping skills to real-life driving situations.
Support and Guidance: Throughout the ERP process, the therapist provides support, encouragement, and guidance, helping the individual cope with their anxiety and develop effective strategies for managing driving-related OCD.
ERP for driving-related OCD is a gradual and systematic process, and the pace of exposure is tailored to the individual's comfort level. The ultimate goal is to reduce anxiety and improve driving confidence, enabling the person to resume driving without the overwhelming burden of OCD symptoms. At Kairos, we even have a coach that does driving exposures with the client, known as “en vivo” exposures, which can be more effective than homework or imaginal.
It's essential to work with a qualified mental health professional, such as a therapist experienced in treating OCD, for effective ERP. ERP is part of a comprehensive treatment plan for OCD, and it may be combined with other therapeutic approaches and, if necessary, medication to optimize the individual's recovery.
Please contact Kairos Wellness today if you or your loved one may be affected by driving OCD.
