Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (19 page)

Here’s a reasonable way to conceptualize this:

• Self-treatment with the Four Steps leads to changes in the brain, which result in diminished fear and a lessening of the intensity of symptoms.
  
• This tends to enhance Revaluation of the symptoms because it makes it easier to see them for what they really are, which, in turn, intensifies the Relabel, Reattribute, and Refocus steps and leads to further changes in the brain. Thus, a therapeutic, self-enabling feed-forward pattern is established.
  
• During the Refocus step, it is likely that the actual chemistry of the brain is changed, which causes the urge to diminish, making it easier to Revalue.
  
• Revaluation results in easier Relabeling and Reattributing and leads to more Refocusing, which causes further changes in the brain and an even greater decrease in symptoms, which leads to more Revaluing, and so on.
  

The end result is usually a clear decrease in the intensity of symptoms and a marked improvement in controlling behavioral responses to the thoughts and urges that may remain.

We know that the traditional behavior therapy technique of having the anxiety-besieged patient just passively “ride it out” for an hour or so, waiting for the anxiety to subside, after exposure to a stimulus that causes intense OCD urges, is not a readily achievable self-treatment method for those who suffer from OCD. What people with OCD can more readily do is modify the traditional behavior therapy technique by practicing self-directed response prevention, using the Four Steps for gradually increasing periods. This means telling yourself, “It’s all right—it’s just OCD” (Relabeling); then Reattributing it to a brain glitch; Refocusing on a constructive, enjoyable behavior, rather than washing your hands or checking the lock—and finally, Revaluing the meaning of those thoughts or urges.

In Revaluing, you realize that your obsessive thoughts and compulsive urges are not important, that you can deal with them. You are, in essence,
devaluing
those silly thoughts. By trying to wait for at least fifteen minutes and then working to gradually increase the length of the time delay even more, you are giving yourself space to work around the OCD thoughts. And fifteen minutes of doing focused self-directed behavioral therapy with the Four Steps gets you a lot further toward genuinely getting past the OCD urge than fifteen minutes of unfocused waiting it out. A powerful mind—which you will develop by practicing the Four Steps—will be increasingly able to make note of even subtle positive changes in the OCD symptoms and to understand the profound implications of those changes. And what are those profound implications? Namely, that you’re changing how your brain works by changing your behavior, and you’re getting back control of your life. A powerful mind is a mind that can take note of subtle changes and understand the implications of them.

Anna, the philosophy student with the irrational fears that her boyfriend was unfaithful, says that her recovery depended, in part, on being able to look at OCD thoughts and urges in a new light. “Once I learned to identify my OCD symptoms as OCD, rather than as ‘important’ content-laden thoughts that had to be deciphered for their deep meaning, I was partially freed from OCD. As the process of Relabeling became automatic and I learned how counterproductive it was to act on urges and dwell on obsessions, it became easier to ignore the tricks that OCD was always playing on me.” She finds it helpful to personify OCD “as someone clever and devious who tries to ensnare me.” Since Anna’s disturbing, intrusive thoughts are by nature unsolvable—“How does one ever know for sure that one’s lover is faithful in action and in thought?”—her OCD obsessions are impossible for her to think her way out of and are extremely painful. But, she says, “Now that I’ve seen OCD’s tricks many times and learned how to think and work around OCD, I no longer get suckered into obsessing or acting compulsively, as I did before.” Practicing the Four Steps has brought her not only relief from OCD suffering but “a greater sense of self-mastery and confidence to tackle almost any problem.”

A BATTLE OF WILLS

Because obsessions follow you around and you cannot walk away from them as you can from a stove or a door, it is harder to work around them. As one person put it, “You can’t leave your brain.” Obsessions cannot always be refuted by logic. A plane may crash after a person ignores the inner voice that’s warning, “Do this compulsion or else….” The fact that there is no connection between the plane crash and the person’s failure to do the compulsion may not be metaphysically provable. However, we know for certain that the person who continually does compulsive behaviors based on an obsessive fear of a plane crash (or an earthquake or another calamity) will live a life of hell.

I suggest that you Actively Revalue the obsessions with the help of two substeps of the Relabel and Reattribute steps: the two A’s
—Anticipate
and
Accept
. The first A reminds you to anticipate that
obsessive thoughts will occur hundreds of times a day and not to be surprised by them, even if they are violent and extremely upsetting. It is an amazing fact of OCD that people can have the same obsessive thought a thousand times a day and still be startled and upset by it every time—if they don’t make the effort to consciously anticipate it. By Anticipating your particular obsessive thoughts, you will recognize them as soon as they arise and Relabel them right off. In this way, you will be simultaneously Revaluing them. You will learn to go onto the next thought or behavior even though the obsessive thought is still there. As you do so, the second A, Accept, will come into play. When you Accept that your problem is a treatable medical condition, you do not allow yourself to get down on yourself, to criticize your inner motives. You don’t want that OCD thought to be there, but you Accept that
it exists despite yourself—not because of yourself
. Patients with obsessions tend to ruminate, to ponder, “What’s going to happen if I actually do that inappropriate behavior? If I punch someone or sexually attack someone?” They visualize themselves being carted off to prison in handcuffs as everyone shouts, “See, he did it! He did it!” So it is very important to Actively Revalue obsessions, rather than let the Revalue step take its course, as it tends to do when you deal with compulsions. And, of course, the answer to the invariable question, “How do I know I won’t do it?” is always, “Because I don’t really want to! Its only an obsession, a false message from my brain. It can’t take over my will.”

Lara, who is overwhelmed by violent thoughts about knives, was confronted by a psychologist friend: “How do you know you’re not going to act on them? Certainly, Charles Manson was obsessional. Jeffrey Dahmer was obsessional.” But Lara now understands, “They were also psychopaths; they had no guilt. For me, there’s guilt, there’s depression, there’s a feeling of ‘I don’t want the consequences.’” What’s more, it’s extremely doubtful that these two evil men were really obsessional in any true OCD sense. They weren’t getting false messages from their brains; they were ruminating about evil things they
wanted
to do. Lara and I have talked about this difference. She has told me, “I won’t do it because I don’t want to do it. I don’t want to hurt anybody. I could never do that.” She is right.

EASY TO SAY—HARD TO DO

As a medical professional, it is very humbling for me to watch people struggle to overcome their obsessions and compulsions. Many times, people with OCD have told me, “It’s easy to say. It’s hard to do.” Believe me, I do understand how hard it is, and I never say “Just do it” in some glib, offhand way. It’s a hard job, a tough assignment, but the rewards are great. Furthermore, it’s a battle that can’t be avoided because OCD gives no peace; any peace from it must be earned!

The ultimate goal, of course, is for the anxieties to disappear forever. At UCLA, we have found that using
progressive
time delays that gradually increase to fifteen minutes or longer, breaking the task into manageable bits, reassessing the situation while you are still anxious, and noting changes in your response make this goal more attainable. Of course, you can always try to put a series of time delays together to lengthen the time span. Always practice the Four Steps during the time-delay periods. Recording in a journal the activities you do during the Refocusing and Revaluing steps, as achievements you want to keep track of, strongly reinforces this process. As you note each decrease in your anxieties and urges and record which activities cause the anxiety to decrease, these signs of progress will strengthen your resolve to persevere at the hard work of doing the Four Steps. As a result, you will view each little improvement as a victory, rather than see your inability to totally overcome your anxieties the first or second or third time as a demoralizing sign of failure. You will see that you are actively helping yourself, being your own therapist.

One of the ironies of OCD is that it enables some people to function at a very high level because their attention to detail is so great. Years of practicing OCD rituals appear to create skills that increase their powers of observation and memory in ways that can be highly adaptive. Unfortunately, however, people with OCD also tell us that they can’t help but wonder how much they might have accomplished had they not spent so much time dealing with their obsessions and compulsions.

Michael, who obsesses that his pants are shrinking, stated flat out,
“My OCD has killed my success. I’m intelligent and I used to have so much potential in so many different ways, but it really killed me. I wake up in the morning and drive a 1983 Dodge Colt to this stenographic job that I don’t want to be doing. The OCD is what did that. I hate my OCD because it hasn’t allowed me to do what I want to do.”

In an effort to understand better how it has affected his life, Michael reads a great deal about mental illness and its causes. He seeks answers to why he developed OCD. He wonders, “Was it more than biochemical that I was this sad eight-year-old kid in school? Or was OCD the result of emotional factors, as well as other corrupting elements, such as genetics? I want to know how I got to the point where I am today and how I can maybe someday reach the point where I want to be. It’s an incredible mystery, and one that I want to keep studying on my own. I think that’s a part of the recovery process.” Some days, he says, he would like to “take a knife and stick it in my head and cut out the sick part of my brain.” He wakes up tired and asks himself, “Why aren’t I doing more?” (Many people with OCD report that they have interrupted sleep patterns that cause them to be constantly fatigued. If these interrupted sleep patterns are chronic, the possibility that the OCD is being complicated by depression must be seriously considered.) There was a time, Michael says, when he would wake up feeling “like I’d run a marathon in my sleep.” Medication—as an adjunct to behavior therapy—helped him to sleep more soundly and to function more effectively on the job, probably by treating a depression at the same time it was treating the OCD.

LOSING AN “OLD FRIEND”

When people successfully Revalue their OCD symptoms and take back control of their lives, it is not uncommon for them to go through a period of grieving the “loss” of OCD. As his obsessive urges became less and less frequent, Jeremy (whose anxieties included his fear that alcohol had somehow contaminated his food) recalls, “I felt an emptiness in my life that I had never felt before. For years, OCD had run, and been, my life. I thought about it more
than anything else. Now it was, for the most part, gone. So the emptiness was real. I actually mourned my OCD. This feeling lasted until I started filling the emptiness with positive actions. Positive thoughts and feelings followed. Dining is no longer torture. When I realized that OCD was bullshit noise, I realized I could enjoy my meals. I haven’t ruminated about my food obsession for more than two years.” Jeremy has also overcome his fear of using a public toilet and most of his other anxieties. He says, “It feels great.”

Other people with OCD may use their medical condition as a convenient way to excuse their shortcomings or to rationalize behaviors that are essentially self-destructive. Psychiatrists generally refer to these excuses as the “secondary gains” of having OCD. Barbara (who obsessed about Mr. Coffee) was a temporary worker with an Ivy League honors degree. She reflected, “Although it’s hard to admit, I can take jobs beneath my capabilities and blame it on my OCD. It also enables me not to take risks. Of course, these are self-esteem issues, not OCD issues. I have to watch that because I can’t use OCD as an excuse my entire life.” Barbara readily acknowledges that she always takes these lesser jobs “not necessarily because of the OCD, but because I lack some belief that I can do the job. So I do stuff that I could do with my hands tied behind my back. Certainly, I don’t need a college education for it.” But Barbara has always had a self-esteem problem that she believes has nothing to do with her OCD. Alcoholism is rife in her family, and, at one time, she drank to excess and indulged in sprees of compulsive overeating to cope with the stresses of living with an alcoholic father.

She says, “I know I’m smart, I’m competent—and at the same time I don’t think I’m good enough. It’s the same as with OCD. I know the doors are locked, I know the stove is turned off. At the same time, I don’t believe it. On paper, I look great, but I undermine myself completely. Not long ago, I was offered a great job. I signed the contract and then I got out of it. I used anxiety as an excuse. I told them I was too anxious and, of course, they just flipped out. It was very unprofessional of me. And I know I’ll probably never get another job in that field.” It’s worth noting, however, that as her work with the Four Steps has improved her OCD, her level of comfort with responsibility has also increased.

Self-esteem has also been an issue for Carla. When you have OCD, Carla says, your self-esteem is so low that you tend to direct your anger inward, even when it is not justified. “Maybe if someone said something to you that was negative, or something negative happened to you that day, instead of dealing with the issue—and only the issue—you internalize it. Anxiety is a part of it. You have a tendency to take the anger and say, ‘Okay, why didn’t I do such-and-such differently, why did I say that to someone, why didn’t I say this?’ It’s like with OCD, you second-guess yourself all the time instead of considering that the problem might have nothing to do with you.” It may well be that OCD can contribute to bad habits in your thinking pattern. Practicing the Four Steps can help solve both problems.