This page briefly describes a behavioral self-treatment program that can be used for dealing with compulsive and obsessive thoughts, urges and behavior. This approach has been shown effective in numerous studies conducted during the past twenty years for the treatment of obsessive-compulsive disorder (OCD), compulsive overeating, substance abuse, and pathological gambling. It is also thought to be helpful for compulsive sexual urges and behavior. Recent research by Schwartz and others at UCLA has demonstrated that this self-treatment program can also alter the neurochemical brain processes that seem to be associated with compulsions and obsessions. See also the page on this WEB site that deals more generally with Anxiety and the Treatment of Anxiety Disorders.
STEP 1: RELABEL
The first step is to learn to recognize your obsessive thoughts and compulsive urges as symptoms of a disorder. To do so, it is important to increase your mindful awareness of this pathological process at work. Some have referred to this awareness as the "Impartial Spectator" or the "Observing Ego", which is the capacity that resides in each of us to observe our behavior and recognize what is "real" as distinct from what is not real, or just a symptom. The capacity to distinguish between real needs and pathological symptoms allows us to fend off pathological urges until they begin to recede and fade. The goal of Step 1 is to learn to RELABEL intrusive thoughts and urges as obsessions and compulsions, and to relabel these assertively. It will serve you to refer to these urges in these terms - use the labels "obsession" and "compulsion". Train yourself to say, "I don't need or want to do this behavior; I'm merely having a thought that I need to do this." You must learn to recognize these intrusive, obsessive thoughts and urges as the symptoms of a disorder, and as such distinguish these from desires that are healthy for you to satisfy, and behaviors that will enable you to feel better over the long term. You must come to recognize these intrusive, obsessive thoughts and urges as symptoms that help keep the disorder in place. You might consider the urges you experience as similar to the irrational thoughts of the compulsive handwasher who believes that he must constantly wash his hands to be free of harmful germs and bacteria.
STEP 2: REATTRIBUTE
The essence of this step is to REATTRIBUTE your obsessive thoughts and urges to a disorder that involves the sending of false messages from your brain. It is important to not take your thoughts and urges at face value, and to remind yourself that "this is not me; this is my disorder at work." Research has demonstrated that individuals who develop obsessive-compulsive urges and behavior also tend to have certain brain areas (the caudate nucleus and associated frontal lobe structures) that are chronically overstimulated, which contributes to the intensity and urgency of obsessive-compulsive thoughts and urges. It is important to be aware of this underlying physiological process and to realize that it is impossible to make the thoughts and urges go away immediately. The important thing to realize is that you don't need to act on the urges. You don't need to listen to them. Don't take them at face value. They are false messages from the brain that are part of a disorder. The most effective thing you can do is to put the thoughts and urges aside and go on to another behavior. Do something else; trying to make the thoughts and urges go away will only create more stress, which serves to make the thoughts and urges more intense. The point is to not engage with the thoughts by either acting on them or trying to make them go away, but simply RELABEL and REATTRIBUTE them as symptoms of a disorder. Then move on to other things, as described in Step 3.
STEP 3: REFOCUS
This step involves taking action to refocus your attention to another subject. This ordinarily is the automatic work of the brain - specifically the caudate nucleus - but because the caudate nucleus is not functioning properly, this shifting of focus is something that you must do "manually". In REFOCUSING, the idea is to work around the intrusive thoughts and urges by shifting attention to something else, if only for a few minutes. This may involve making and following through with plans for the remainder of the day. It should lead to an activity that will absorb your attention, and that you will find satisfying and enjoyable. Hobbies can be particularly good. For example, you may choose to take a walk, exercise, listen to music, read, play a computer game, or practice a sport that you enjoy. The goal of treatment is to stop responding to the obsessive thoughts and urges, while acknowledging that, for the present, these uncomfortable feelings and urges will continue to bother you. You begin to "work around" them by doing another behavior. You learn that, even though the thoughts and urges are present, they do not have to control your behavior. You make the decision about what you're going to do, rather than responding to thoughts as a robot responds to commands. By REFOCUSING, you reclaim your decision-making power, and as a result the dysfunctional biochemical reverberations of the brain no longer dictate what you do.
It is important to acknowledge that REFOCUSING is frequently not easy. It can take significant effort and even require tolerance of some very painful feelings. Therefore, it is important to observe the "Fifteen Minute Rule", which basically states that you will not act on an obsessive-compulsive thought or impulse without allowing at least 15 minutes to pass. During this 15 minutes you should work on RELABELING, REATTRIBUTING and REFOCUSING. In time, as you practice this, the process will become easier and will lead to greater reductions in the intensity of the compulsive thoughts and urges. Sometimes, however, the thoughts and urges will be too strong and you may find yourself performing the compulsion. This is not a time to berate yourself for succumbing to the obsessive-compulsive behavior. Simply acknowledge that your compulsion and disorder "won this round", and that your practice will make it more manageable the next time. It is also helpful to keep a JOURNAL of your successful REFOCUSING efforts. This will help to remind you of your successes and to identify which behaviors are most helpful to the process of refocusing. Also, as your list of successes gets longer, it will become inspirational and will be a place you can turn when the thoughts and urges "heat up." Record only your successes. There is no need to record your failures. You will be assisted by learning to give yourself a pat on the back, which is often difficult for people who experience compulsions and obsessions.
STEP 4: REVALUE
The Revaluing step comes into play after much practice of the first 3 steps. After you have had experience with relabeling, reattributing and refocusing - identifying your compulsive thoughts and urges as part of a pathological process - you will begin to REVALUE - actually put much less value on - the feelings that go along with this process. This is further assisted by two substeps to STEP 2: REATTRIBUTION: these are ANTICIPATE and ACCEPT. Anticipate means that you are prepared for the thoughts and urges to recur; you are not surprised by them, and you do not spend energy beating yourself up because you have them. You know what causes them and you work around them. You refuse to let these symptoms shock you, and you refuse to let them become a source of negativity about yourself. Obsessive thoughts and urges may occur hundreds of times each day. There is no need to dwell on them. This is where the second substep, ACCEPT, comes into play. Simply anticipate and accept that you have these thoughts and urges, and do your best to get on with other things. REFOCUSING is like a martial art, and a little like meditation. An obsessive thought or a compulsive urge is very strong, but also quite stupid. If you stand right in front of it and take the full brunt of its power, trying to drive it from your mind, it will defeat you repeatedly. Once you learn to step aside, acknowledging the thoughts as you work around them, you will find it progressively easier to move on to the next thing. You are learning to keep your wits about you in the face of a powerful opponent, an opponent that will also wither and die from your unwillingness to imbue it with attention and energy. Eventually, by taking charge of your actions, you will take charge of your mind and ultimately take charge of your life.
No comments:
Post a Comment