Your whole life you were one way and now you appear to be another. This statement represents one of OCD’s cruelest, and frankly, laziest efforts to dominate your attention. Once it gets you to sign the contract, that you will commit to being unhappy so long as you are this way now and not the other way as before, you remain its slave. Hyperawareness or sensorimotor obsessions are characterized by an excessive concern that your attention to some otherwise forgettable or involuntary bodily process will become totally and permanently conscious. In other words, we do a lot without thinking about it, so thinking about it feels uncomfortable. Here are some examples of common experiences people with hyperawareness obsessions struggle with:

  • Blinking
  • Swallowing
  • Breathing
  • Heartbeat
  • Hunger levels
  • Bladder or bowel pressure
  • Itches or minor pains
  • Hair touching forehead, ears or neck
  • Positioning of body parts (i.e. where the arms are in relation to the rest of the body, where the tongue rests in the mouth)
  • Items in the field of vision (e.g. the nose, eye floaters)
  • White noise (e.g. the hum of a refrigerator)
  • The very presence of thinking taking place

Like any obsession, there is a fair amount of cross-over into other obsessions. Hyperawareness of the position of or sensations in the groin, for example, are a common issue for those with obsessive fears related to sexual issues. Hyperawareness of sensations in the hands, as another example, can be triggers for obsessive fears of harming self or others. The focus of this blog is primarily on the obsessive concern with the awareness itself.

What Are You Actually Afraid of?

In some cases it may appear that you are simply over-sensitive or have a low tolerance for specific discomforts, but in this form of OCD the problem is that the mind has become overly attached to a specific target and simply stuck there. Efforts to detach the mind from its target seem to have the opposite effect. Why this? You may wonder. In most cases, OCD gets you stuck on unwanted thoughts that are inherently disturbing (e.g. about illness or unwanted sexual or violent thoughts). People who suffer with those types of obsessions don’t want to be stuck there either, but with a sense of purpose. Who would anyone want to think such terrible things? What makes hyperawareness obsessions all the more frustrating is that the person experiencing the obsession is not only stuck, but feels stuck as if with no sense of purpose. Why am I thinking about my breathing instead of just breathing without thinking about it? However, it is not really the case that hyperawareness obsessions have no underlying fears. The seemingly innocuous obsession with unwanted awareness is just the surface of often much darker concerns. Some related obsessive thoughts include:

  • I will be permanently distracted by these thoughts
  • I will never feel what it felt like to experience this automatically, without conscious attention
  • I will be depressed forever because this thought will dominate my attention during meaningful experiences (e.g. my wedding and memories thereof will be ruined by my focusing on my blinking)
  • I will embarrass myself socially because I can’t pay attention to anything but these thoughts
  • I will have a mental breakdown, a panic attack, or become psychotic because of constantly thinking about this

More Compulsions Than You’d Think

People with these types of obsessions often assume that they are not doing compulsions because the experience is mostly one of lamenting the intrusive thoughts. I wish I wasn’t thinking about this! But actually many compulsions drive these types of obsessions and being able to identify and esist or interfere with them is key to overcoming this issue. Here are a few examples:

  • Mental checking to see if awareness is still present
  • Mental or physical checking to see if the sensation feels “normal”
  • Repeating the activities (e.g. blinking, swallowing, checking, etc.) a specific number of times or in a ritualistic way to give oneself permission to stop thinking about it
  • Relying heavily on distraction to avoid having the thoughts
  • Reassurance seeking that the awareness will go away or that it’s normal to be aware
  • Mentally reviewing how it must have felt before hyperawareness set in
  • Avoidance of environments or circumstances where awareness might become more pronounced
  • Mental rituals (e.g. chants, affirmations, neutralizing statements, etc.) to neutralize the fear of being permanently aware

Cognitive Therapy and Hyperawareness

At the core of these types of obsessions is the problem of over-protecting the present moment. It is what it is, but you’re concerned about ruining it. The idea is that if I am thinking about an involuntary or inconsequential process, then by definition I probably should be thinking about something else. Thinking about the last time I blinked or the next time that I will is the same as squandering attention that could have been placed somewhere more fulfilling or useful (anywhere). Cognitive therapy asks that you take these thoughts and challenge their assumptions. For example “I should not be aware of this” can be challenged as “I can’t control what’s on my mind and I don’t need more rules”.

Though “should” thoughts take center stage with hyperawarenesss, other common cognitive distortions can be recognized as well. Catastrophizing, for example, can come in the form of “If I don’t stop thinking about this my life will be destroyed”. Magnifying (relating to the thoughts or feelings like they’re a bigger concern than they are) also plays a serious role. Here, a thought like “Oh, no, I’m thinking about my breathing” can be challenged as “Right, so I think about my breathing. Breathing happens.”

Efforts to bring the way you perceive the problem back to an objective viewpoint can help reduce the intensity with which you may feel you have to get rid of the problem. The problem is, after all, not the problem it appears to be. OCD will tell you that the problem is you can’t stop thinking about your awareness. But the actual problem is that you are trying to control your mind. Loosening this control effort opens you up to accept uncertainty and expose to your fear that the uncontrolled mind will contaminate your life.

Exposure and Response Prevention and Hyperawareness

Like exposure and response prevention (ERP) for other forms of OCD, much of it comes down to doing willingly what your mind is doing against your wishes (exposure) and then resisting the urge to flee from the resulting discomfort (response prevention). Compulsive efforts to stop thinking about the obsession only seem to teach the brain that there is something special or interesting about the subject. Instead ERP aims to change the relationship between you and the fact that this thinking is occurring in this way. ERP for hyperawareness obsessions may typically come in the following four forms:

  • setting up reminders to bring your attention to the target of your obsession on purpose

Like a lot of ERP, this may seem counterintuitive or redundant. After all, you’re already spending a lot of time frustratingly noticing the things you don’t want to notice. However, your experience is almost exclusively on the defensive. The thoughts are intruding and you are trying to keep your cool, trying to make it stop, trying to distract. Lots of trying. By purposely bringing the thought to mind, you take an assertive stance and that means you are approaching ERP from the angle of practicing the work, not trying to avoid it. If the fear is obsessing forever, then trying to obsess denies the OCD its power position. Learning to let go of resistance to the idea that you may obsess forever is the best way to get to the other side and discover that this experience, like all others, is also impermanent.

  • writing scripts describing the consequences of being permanently aware

Imaginal exposures can be very effective in treating OCD, particularly if the feared outcome is undiscoverable until death. You won’t know if your life has been totally annihilated by your obsession until your life is, well, over. So taking the mind on a fictional journey through a life consumed by your obsession can effectively generate the sense of uncertainty and the emotional terror that comes with it. In a script like this, you could describe what you think it would really be like if this state of hyperawareness was a permanent upgrade to your operating system. The purpose of this exercise is to generate the urge to do compulsions so you can learn to be in the presence of this urge and not give in to it. Through this practice, you also learn to accept uncertainty because you do not automatically get thrown by your uncomfortable feelings.

  • agreeing with thoughts about permanent awareness

Taking the software upgrade metaphor further, agreeing with your unwanted thoughts about awareness in the moment is also an excellent strategy for breaking down the resistance that keeps the obsession alive. The OCD may say “You’re thinking about swallowing again and it’s going to take over your life!” You say, “You bet. The old version of me was relatively unaware of when or why I swallowed and how it felt, but Me 2.0 is always aware.” This approach takes the ind out of OCD’s sails and leaves it with little else to threaten you.

  • Putting yourself in likely triggering situations

Instead of trying to get to a distracted place where you feel free of your hyperawareness triggers, you can expose yourself to environments where triggers are likely to come up. One way to do this may be to consider what things you have already been avoiding. For example, engaging in social behavior can be an exposure if you have hyperawareness obsessions about eye contact. Meditating, especially in a style that focuses on the breath, can be excellent ERP for obsessions about breathing.

Mindfulness and Hyperawareness

The whole purpose of mindfulness is to increase your awareness of what the mind is doing in the present moment, so it may seem counterintuitive to use mindfulness as a part of treatment for hyperawareness OCD. But this concern reveals the actual problem with hyperawareness obsessions. You are aware that the mind is attending to something, so in a sense you are being mindful there, but you are missing the opportunity to also be mindful of the resistance to that attention. Instead of noticing the resistance as simply another object of attention, you are identifying with the resistance, which is feeding the OCD. In other words, the wish that you not think about [insert target here] is also something to be mindful of. In meditation practice, you can learn to identify resistance as an object of attention and notice when you are trying not to think something when it would be more skillful to simply observe that thinking is present. When you let go of the drive to stop thinking about your awareness, you may feel discomfort, a sense that the walls are closing in or your time is running out somehow. This discomfort is a feeling and, thus, subject to the same rules as any other object of attention.

People with hyperawareness or sensorimotor obsessions may feel isolated from the rest of the OCD community. It is easy to make the mistake of thinking that it isn’t OCD because the compulsions are not so visible or the subject matter is not so content-focused. But once you understand how the mind has gotten stuck, you can learn to stop doing what makes sense instinctively (the mental equivalent of flailing about in quicksand) and do the mindfulness and CBT work that can help you get grounded again.

Jon Hershfield, MFT is a psychotherapist in private practice licensed in Maryland, Virginia, and California, and director of The OCD and Anxiety Center of Greater Baltimore.  Follow him on Twitter and Facebook