(Information for this essay comes from the following
sources: the book “The Brain That Changes Itself” by Dr. Norman Doige, M.D., the
website “ocduk.org/four-steps.”
Writer’s note: this essay is only my personal view. It is
not meant as therapy. I have no right offering therapy. I recommend that the
reader contact his/her doctor for therapy.
- Ken Munro)
* * * * * * * * * * * * *
* * * * * *
INTRODUCTION
Over the years, we feel the only way in bringing peace of
mind to our OCD situations is by acting out our rituals and compulsions and by
practising avoidance behaviours.
If we are to have any chance of recovery, we have to learn a
whole new discipline in managing/conquering our OCD. As the saying goes: “old
habits are hard to break.” It’s a lot of
work. It’s not easy. But it can be done.
We just have to be shown the way.
Secondly, I do not believe we are ever totally cured from our
OCD. But we can to learn to manage it. If we have been cured, my first reaction
is how sick was the individual originally?
Over the years, I have been taught several therapies. A lot
of information was thrown my way. Often confusing. With this essay, I’ve tried
to simply everything.
Here are 3 types of therapies that have helped me:
(1) cognitive behaviour therapy
(2) the concept that the brain is made of plastic or
"plasticity" and
(3) "Brain lock" therapy.
First, cognitive behaviour therapy or CBT.
COGNITIVE BEHAVIOUR
THERAPY
There are two parts to cognitive behaviour therapy:
Cognitive – the knowing part, the theory. The principle that
giving in to our compulsions makes matters worse.
By giving in to our OCD, we may “win the battle but not the
war.” We may get temporarily relief but the sources of our fears are still
present. Original fears must be confronted. And we become prone to new fears.
In the long run, giving in makes matters worse.
The behaviour part – the practice of confronting one’s
fears. And there are two parts to this known as “ERP” – “exposure” and
“response prevention.”
Simply put: exposure is facing our fears, the triggers that
cause our OCD and response prevention is NOT giving into our compulsions.
With CBT, we create a list of all our fears. We start with
the easiest and work up to the more difficult fears.
We don’t want fears that are too easy. But fears that are
challenging enough that won’t leave us devastated if we confront them. We start off with the weakest fear and work
up from there.
The intensity of the fears is measured by a scale: "S.U.D.S."
which stands for "subjective units of distress scale" or
"subjective units of disturbance scale." The greater the number, the greater
the distress.
The plan is to build up confidence with each fear, to become
accustomed to the fear so that the fear no longer holds terror in us. Once we
gain confidence, we can move on to the next challenging fear.
It’s been said that CBT works in most cases. Few fail if
they practice the principles.
Even if we gain confidence over our fears that once baffled
us, we must constantly continue to confront them when they arise. Or they will
control us as before.
CBT is difficult. I have been in CBT therapy groups where
people have dropped out.
CBT can be quite costly if we don’t have medical insurance.
The wait list to take CBT is quite long. I have taken it twice having to wait
over a year each time.
THE BRAIN and
PLASTICITY
There is a new therapy that I find very helpful and its
extension of CBT. It looks inside the brain and how certain parts of the brain
work as it pertains to OCD.
OCD is connected to part of our brain that acts like a
“sticky” gearshift. That is why we don’t respond to logic when it comes to our
fears.
According to the book “The Brain That Changes Itself” by
Canadian psychiatrist Dr. Norman Doige, M.D., the brain can heal itself. It is
made up of plastic.
Studies have shown from brain scans that when we have an OCD
attack, there are three parts of the brain that are involved - the “orbital
frontal cortex”, the “cingulate gyrus” and the “caudate nucleus”. They are
hyperactive in OCD sufferers.
The initial attack starts in the cortex which sends a signal
to the cingular gyrus which triggers the dreadful anxiety causing the physical
sensations we associate with dread.
Signals are, then, sent to the “caudate nucleus” or the
“automatic gearshift” allowing our thoughts to flow from one to the next.
Except in cases of OCD, where the caudate becomes extremely “sticky” and cannot
process the information. Probably one of the reasons we don’t respond to logic
and reasoning when it comes to our fears.
Because our OCD is caused by some faulty brain circuitry,
the brain can heal itself if we confront our fears.
More specifically, the more we give in to our compulsions,
they more we reinforce our fears, even though our fears are imaginative. We
make matters worse.
But by letting go, those old circuits die making room for
new circuits to grow. The brain can heal itself.
Or another way of looking at it: the more we give in to our
compulsions, the more we want to do it; the less we do it, the less we want to
do it.
But that principle is not easy for OCD sufferers. We do not
want to confront anxiety. And we feel the only way in bringing relief is by
acting out our compulsions.
But remember: we are being bluffed by sensations though
painful. Fears are based on our imagination.
BRAIN LOCK THEORY
Taking it one step further, Dr. Jeffery Swartz, author of
the book “Brain Lock” came up with a 4 step approach to managing one’s OCD.
(The title: “Brain Lock” comes from the idea that with OCD, the first two parts
of the brain are turned on and stay on as though locked in the “on position”
together.)
His idea is to “manually shift” the gearshift with his 4
step approach.
The steps are as follows:
Step 1: Relabel
Step 2: Reattribute
Step 3: Refocus
Step 4: Revalue
With step 1 and 2, when one of our fears hits us, it is not
an attack of germs or personal hygiene. But an attack of OCD.
In Step 3, we try to refocus on something positive. We try
to get our minds onto something more constructive. That is difficult for many
OCD sufferers. Our thoughts make us think inward. And many of us are loners.
The OCD doesn’t go right away due to faulty circuits in our
brains. But by refocusing, (step 3,) we grow new circuits and old circuits die.
This also triggers dopamine release which is very helpful.
Even with “Response Prevention” for a few minutes (not
giving in to the compulsion) can be grounds for growing new circuits.
In step 4, we realize that our fears were really nothing of
importance. We gain the confidence and start feeling normal.
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