Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (16 page)

In Refocusing, at first even a minute is progress. But several weeks down the line, you’ll have to push the edge of the envelope. This is fighter-pilot territory. You will no longer be able to cling to your mental timer that’s set for five minutes or ten minutes. You will have to make yourself increase your tolerance of your discomfort. It’s a perfectly good idea to promise yourself some treat—a theater ticket or a yogurt or an ice cream bar—if you manage to wait at least fifteen minutes before you act on some obsessive thought. Then you should record your success in your behavior-therapy journal. Many people come to see recording their successes as the biggest treat of
all. A woman in our therapy group who has battled body dysmorphic disorder, an OCD-related condition, for many years, finally made up her mind that she was no longer willing to live with the lights dimmed and the mirrors covered with newspapers to prevent herself from scratching and picking relentlessly to rid herself of imaginary skin flaws. For every fifteen minutes that passed that she resisted the urge to pick, she would give herself twenty-five cents for new clothes. It definitely helped.

When the going gets tough and the job of Refocusing taxes your willpower, keep in mind that there will be a payoff down the line. As time goes on, you will begin to get a lot more mileage out of diligently practicing the Four Steps. You will change the inner workings of your brain. By Refocusing, by working around your OCD—by accepting it for what it is, not for what it isn’t—you will come to understand that your whole life doesn’t depend on controlling those awful, intrusive feelings and that your world isn’t going to crumble because your OCD won’t go away.

DERAILING THOSE ANXIETIES

Performing an activity that requires your full attention is an excellent way to divert yourself from your OCD symptoms. This is what Howard Hughes was probably doing when he was piloting his airplane. Hughes thought nothing of flying a plane, but was gripped with fear at the thought of touching a doorknob that he imagined was contaminated. In his day, his friends were totally perplexed by his behavior, but if we analyze it in terms of what is now known about OCD, it’s really not difficult to understand. The doorknob gave him a morbid fear of death, but he did not associate his airplane with contamination, so he had no feelings of fear associated with flying. Flying was a form of behavior therapy for Hughes. At the controls of his airplane he Refocused away from his OCD onto an activity that required total concentration. In an airplane, the pilot is in control. For a person with OCD, the mundane action of touching a “dirty” doorknob may cause the dreaded thought that a disaster is imminent. In the short run, the feeling of fear is uncontrollable, probably because it, is caused by misfiring in the cingulate
gyrus. But it can be worked around and, in that way, can be controlled.

After a time, the Four Steps become almost automatic. Michael, who obsesses about his pants being too tight, says that the Four Steps gave him “the discipline that I needed. I learned to tell myself, ‘You do this today, and you’ll feel better tomorrow. Do this tomorrow, and you’ll feel better the next day.’ The Four Steps were a beginner’s guide. Now, it’s like I’m still doing the Four Steps, but without really thinking of the Four Steps. I think most people sort of improvise what works for them, but they’re still doing the basic method. You know, you don’t have to think, ‘Now I’ve gotta do the First Step…’ And you don’t have to think, ‘Okay, this is a biochemical problem.’ You just have it in your own mind exactly what it is you have. You don’t have to have a name for it. Basically, you just know that you have to do something else. You improvise, but you always try to improve. You’re always figuring out exercises that will help you help yourself.” This is good advice on intermediate-level behavior therapy.

Sometimes, Michael says, Refocusing is “sort of like pushing the thought out of my brain. I almost feel like something is hitting my brain and then leaving it. And that’s not like OCD feels at all. It sort of feels good.” He finds physical exercise very helpful in working around his OCD thoughts. “If I could play basketball twenty-four hours a day, I’d be great. I’d never feel bad.” When Michael’s anxiety level is low, his powers of concentration become very intense, and he is able to perform his stenographic job extremely well. “People say, ‘Oh, that’s good. You have a decent job and you’re able to do it, even with your OCD.’ But my comeback is—and I think this is good for me—that I don’t want to be doing this job; I want to be doing something I enjoy.” As his OCD continues to improve, he becomes more optimistic about getting a better job. For a long time, he could read very little because his OCD symptoms would intrude, causing him to read and reread every page, but now he is reading voraciously and learning new things—“I can read more books now in a month than I used to read in a year. With my behavior therapy, and getting more insight every day into what this OCD is all about, coming to grips with it, I hope I can have more job success.”

In his battle against OCD, Michael figures he’s about 70 percent of the way there. “You have to keep working. That’s the only way to get above 70 percent. I realize now that something in me, be it biochemical, genetic, whatever, will never allow me to be 100 percent. But I always want to work to get close to that. At the same time, I want to be realistic. It’s important to me not to have unreachable goals, but just to work and reach whatever it is that I can attain and to realize that my anxiety is not going to kill me.”

For Michael, coming faithfully to the weekly OCD therapy group at UCLA is like doing a homework assignment, part of his ongoing behavior therapy. In short, it is vigilance. He has, however, abandoned the idea he once had that his primary mission was to try to help others in the group who have not yet achieved his level of success. With the best intentions, he once brought to the group the exterminator’s business card that he’d carried around, reasoning it would be effective exposure therapy for others with a fear of pesticides. After all, it had worked for him. Instead, he recalls, “It made some people go nuts. I realize now that I can’t be Mother Teresa.”

There’s an important lesson to be learned from Michael’s experience as a “therapist.” Each person must fight the OCD battle on his or her own terms and at his or her own pace.

Jack, who conquered his hand-washing compulsion, remembers that I gave him a finger puzzle whereby the more you tug, the tighter it grips. You have to calm down, use your brain, and extricate your fingers. It’s the same when OCD grips you. You tend to panic and start to push and pull the wrong way. What you need to do is stay calm and use the Four Steps to unlock your brain. For Jack, staying calm took real perseverance. He admitted, “I had that kind of personality where I would prefer to have some big force come in and do everything for me. I used to have a drinking problem. Alcohol would make me a different person, and I wouldn’t have to face myself or make any effort to change. So it fit right in with my personality.” Before seeking treatment at UCLA, Jack was on drug therapy, suffering terrible side effects and making little progress in fighting his OCD. Looking back, he says his doctor acted “kind of like he was trying to knock a virus out of me.” When Jack would call the
doctor to say that the drugs were giving him explosive headaches, the doctor advised him, “Just hang in there. You don’t abandon ship if it develops a little leak.” Eventually, Jack realized that medicine just wasn’t going to do the job for him. He told himself, “This is it. It’s up to you now. You’ve got to change your behavior. You just can’t rely on chemicals to change your life.” Years earlier, Jack had developed an intolerance for alcohol.

Jack faced facts: “I was running out of options. I had to start relying on myself,” not on medication. “Winter was coming, and I couldn’t stand the thought of having dry, cracked hands again. Something had to be done. Until then, I had thought that even having my hands like this was better than having to endure the anxiety that would follow if I didn’t give in and wash them. But I began to wonder if it was worth it.

“I began trying not to give in to the thoughts that my hands were dirty and would spread contamination everywhere. Of course, I was anxious, at first, when I didn’t wash, but then I discovered that the longer you don’t give in and find out that nothing happens, the easier it gets the next time. You begin to have a history of incidents in which nothing really happens when you ignore the obsession. Being in the therapy group was helpful because it was hard to keep going to group and not show any progress. And once you made progress, you were encouraged to continue, so you wouldn’t let others in the group down.

“I found that when I ignored the unpleasant, intrusive thoughts, their intensity would decrease. It was when I started to pay attention to them that they would begin to bother me. I also tried to work at reducing the excessive checking that I would go through when I left my house or car. This was difficult because there are so many fears associated with what might happen to an unprotected dwelling or automobile. Of course, being clean and protecting your property are real concerns that everyone has. It’s just that, with OCD, you don’t know when to stop. Eventually, you have to walk away from your house or car after telling yourself that you did everything you reasonably could to make sure they were secured. When OCD gets really bad, you can stare at a locked door or see that a window is closed, but not get that reassuring feeling that they’re all right.
There comes a point when you have to assure yourself that everything is okay.”

As Jack began to make himself spend less time checking, he realized, “You don’t have absolute control over things. All you can do is your best—and then you have to decide when you’ve done enough. The amount of checking may go up or down, depending on the amount of stress that you’re going through, but you must not let it get out of control. You have to give yourself credit for every little improvement you make. As I learned in the group, the more you change your behavior, the more your thoughts will change.”

Sometimes Jack found it difficult to tell if what he was experiencing was really OCD. For example, one symptom common to people with OCD is hoarding useless objects. But at times, Jack had the reverse problem: He became obsessed with getting rid of things he felt he no longer needed. At first, getting rid of things gave him pleasure, but later the situation got out of hand and it became a major preoccupation. He didn’t know when to stop rearranging things and sorting through things. That’s when he decided it was probably an OCD symptom. He was right: If you think it’s OCD—it’s OCD! Reality doesn’t feel like OCD.

Jack was in the group for three years and continues to practice self-directed therapy. Today, he estimates, his symptoms have decreased 90 percent. He washes his hands only a “socially acceptable” number of times each day.

MEETING THE ENEMY HEAD-ON

Christopher, who had contamination obsessions, as well as terrible blasphemous thoughts, worked out a no-nonsense self-directed therapy technique. When his neighbors went on vacation, they would ask him to walk their dog. Now, for someone who is terrified of contamination, walking a “dirty” dog on a “dirty” street is a challenge. Christopher met it head-on: He would stop, pick up some dirt, and rub it on his hands and arms. That done, he would focus on walking the dog. When he returned home, he didn’t allow himself to wash the dirt off until he had to go to work or to bed. And he never devel
oped a washing compulsion! Since he was following the guidance of his Impartial Spectator, he had a clear view of reality.

Since Christopher works in a kitchen, he must wash his hands frequently. For a while, he said, “I developed this kind of quirky obsession that if I washed my hands several times, that would be developing a compulsion. And
that
was the obsession.” But this obsession didn’t prevent him from washing—again, self-directed behavior therapy. And since reality doesn’t mimic OCD feelings, he could always be confident that when he felt the need to wash, it wasn’t OCD. In this particular case, OCD would have made him
stop
washing. One of his tasks at the restaurant was to put tomato sauce on the pizzas. It was agonizingly hard for him to do because he had developed an obsession that the tomato sauce was actually blood. But he had no choice. This was something he had to do repeatedly every day. It was, in effect, constant exposure therapy. In time, Christopher overcame his thoughts about the sauce being blood and had no difficulty tending to the pizzas.

Amy, who had a morbid fear that if she picked up a pen or pencil she might write something obscene, recalls her moment of triumph over this obsession. On her birthday, the family went to an Italian restaurant for dinner. Amy panicked when the maitre d’ seated her party right next to the waiters’ station, where pens and pencils and pads were clearly visible. She wanted to flee, but she did not. She remembers, “I just consciously said, ‘I’m going to stick it out.’ I told myself, ‘This is not real. You’re not going to get up there and do anything. You’re going to sit here like a normal person. You’re not going to act on your fears.’” Having done so, she was able to Refocus on the birthday celebration and socialize with the rest of her family. She realized that by fighting back against the OCD, she was giving herself the best possible birthday present. Through self-directed cognitive biobehavioral therapy, Amy has become pretty comfortable with pens and pencils. It is interesting to note that when her typewriter broke down, she made a conscious decision not to have it repaired. She knew that by forcing herself to use pens and pencils, she would hasten her recovery.

Brian, who had the awful fear of battery acid, knew he needed professional help when his obsession reached the point where he
asked a physicist friend to figure out how long battery acid would cling to the tires of his car after he had driven through a spill. (For the record, his friend estimated that all traces of the acid would be gone in about four revolutions of those tires.) Now Brian is able to see his obsession as “totally bizarre.” But he still remembers the agony of those nights when he would follow the police and fire vehicles, cleaning up real or imaginary acid spills on the pavement. He shakes his head. “I would actually go out and clean public streets. That’s pretty damned bizarre. Somebody must have seen this idiot out there with buckets and baking soda.”