Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (2 page)

By applying behavior therapy techniques, you can change how you respond to these thoughts and urges, and
you can physically change the way your brain works.
The use of these techniques actually makes the automatic transmission in the brain shift more smoothly, so that over time the intrusive urges decrease. One
patient at UCLA, Dottie, on being told that her problem was caused by a biochemical imbalance in her brain, immediately brightened and coined the catchphrase “
It’s not me—it’s my OCD.
” To most people with OCD, this realization alone comes as a great relief.

Washing, checking, and other OCD rituals consume hours of time each day and make the lives of people with OCD miserable. People with OCD may even fear they are going crazy—they know that their behavior is not normal. Indeed, the behavior is apt to be foreign to their personalities or self-image. Yet until they learn the Four-Step Self-Treatment Method, they are unable to stop themselves from responding to the brain’s false alarms.

WHAT ARE COMPULSIONS?

Compulsions
are the behaviors that people with OCD perform in a vain attempt to exorcise the fears and anxieties caused by their obsessions. Although a person with OCD usually recognizes that the urge to wash, check, or touch things or to repeat numbers is ridiculous and senseless, the feeling is so strong that
the untrained mind
becomes overwhelmed and the person with OCD gives in and performs the compulsive behavior. Unfortunately, performing the absurd behavior tends to set off a vicious cycle: It may bring momentary relief, but as more compulsive behaviors are performed, the obsessive thoughts and feelings become stronger, more demanding, and more tenacious. The afflicted person ends up with both an obsession and an often embarrassing compulsive ritual to go with it. It is not surprising that many people with OCD come to see themselves as doomed and may even have suicidal thoughts by the time they seek professional help. In addition, years of traditional psychotherapy may have served only to confuse them further.

A Checklist of Common OCD Symptoms

O
BSESSIONS

Obsessions about Dirt and Contamination

Unfounded fears of contracting a dreadful illness

Excessive concerns about dirt; germs (including the fear of spreading germs to others); and environmental contaminants, such as household cleaners

Feelings of revulsion about bodily waste and secretions

Obsessions about one’s body

Abnormal concerns about sticky substances or residues

Obsessive Need for Order or Symmetry

An overwhelming need to align objects “just so”

Abnormal concerns about the neatness of one’s personal appearance or one’s environment

Obsessions about Hoarding or Saving

Stashing away useless trash, such as old newspapers or items rescued from trash cans

The inability to discard anything because it “may be needed sometime,” a fear of losing something or discarding something by mistake

Obsessions with Sexual Content

Sexual thoughts that one views as inappropriate and unacceptable

Repetitive Rituals

Repeating routine activities for no logical reason

Repeating questions over and over

Rereading or rewriting words or phrases

Nonsensical Doubts

Unfounded fears that one has failed to do some routine task, such as paying the mortgage or signing a check

Religious Obsessions (Scrupulosity)

Troublesome blasphemous or sacrilegious thoughts

Excessive concerns about morality and right or wrong

Obsessions with Aggressive Content

The fear of having caused some terrible tragedy, such as a fatal fire

Repeated intruding images of violence

The fear of acting out a violent thought, such as stabbing or shooting someone

The irrational fear of having hurt someone, for example, the fear of having hit someone while driving

Superstitious Fears

The belief that certain numbers or colors are “lucky” or “unlucky”

C
OMPULSIONS

Cleaning and Washing Compulsions

Excessive, ritualized hand washing, showering, bathing, or tooth brushing The unshakable feeling that household items, such as dishes, are contaminated or cannot be washed enough to be “really clean”

Compulsions about Having Things “Just Right”

The need for symmetry and total order in one’s environment, for example, the need to line up canned goods in the pantry in alphabetical order, to hang clothes in exactly the same spot in the closet every day, or to wear certain clothes only on certain days

The need to keep doing something until one gets it “just right”

Hoarding or Collecting Compulsions

Minutely inspecting household trash in case some “valuable” item has been thrown out

Accumulating useless objects

Checking Compulsions

Repeatedly checking to see if a door is locked or an appliance is turned off

Checking to make certain one has not harmed someone, for example, driving around and around the block to see if anyone has been run over

Checking and rechecking for mistakes, such as when balancing a checkbook

Checking associated with bodily obsessions, such as repeatedly checking oneself for signs of a catastrophic disease

Other Compulsions

Pathological slowness in carrying out even the most routine activities

Blinking or staring rituals

Asking over and over for reassurance

Behaviors based on superstitious beliefs, such as fixed bedtime rituals to “ward off” evil or the need to avoid stepping on cracks in the sidewalk

A feeling of dread if some arbitrary act is not performed

The overpowering need to tell someone something or to ask someone something or to confess something

The need to touch, tap, or rub certain objects repeatedly

Counting compulsions: counting panes in windows or billboards along a highway, for example

Mental rituals, such as reciting silent prayers in an effort to make a bad thought go away

Excessive list making

THE FOUR STEPS

In recent years, there have been major advances in treating this condition. More than two decades of research by behavior therapists have documented the effectiveness of a technique called
exposure and response prevention
. The use of this technique involves systematic exposure to stimuli that bring on OCD symptoms, such as having a person with OCD touch a toilet seat or other objects that he or she fears are contaminated, and cause the person to have obsessions and compulsions. The therapist then enforces extended periods during which the person agrees not to respond with compulsive behaviors. These periods, in turn, cause tremendous amounts of anxiety that last an hour or more and call for a significant amount of assistance by a trained therapist. As the therapy progresses, the intensity of the anxiety decreases, and the person gains much better control over the OCD symptoms.

At UCLA School of Medicine, where we have been studying OCD for more than a decade, we have developed a simple self-directed cognitive-behavioral therapy to supplement and enhance this process. We call it the Four-Step Self-Treatment Method. It is a technique that does not require expensive professional therapy or the use of medications. By teaching people how to recognize the link between OCD symptoms and a biochemical imbalance in the brain, we were able to develop this method that very effectively treats persons with OCD solely with behavior therapy. In this book I will teach you how you can effectively become your own behavior therapist by practicing the Four Steps. This method can be used with or without a professional therapist. You will learn to fight off those urges and redirect your mind to other, more constructive behaviors.

For the first time ever for any psychiatric condition or any psychotherapy technique,
we have scientific evidence that cognitive-behavioral therapy alone actually causes chemical changes in the brains of people with OCD.
We have demonstrated that by changing your behavior, you can free yourself from Brain Lock, change your brain chemistry, and get relief from OCD’s terrible symptoms. The end result:
increased self-control and enhanced self-command, resulting in heightened self-esteem
. Knowledge, as they say, is power. There is a huge difference in the impact an obsessive thought or urge has on a trained mind compared to what it has on an untrained mind. Using the knowledge that you will gain by learning the Four Steps, you will not only have a powerful weapon in your battle against your unwanted thoughts and urges, but you will empower yourself in a much broader sense. You will take a big step toward strengthening your ability to attain your goals and improve the quality of your day-to-day life. You will develop a stronger, more stable, more insightful, calmer, and more powerful mind.

If people with OCD can do so, it is highly probable that those with a wide variety of other problems of different degrees of severity can, too. Other disorders include:

• uncontrolled eating or drinking
  
• nail biting
  
• hair pulling
  
• compulsive shopping and gambling
  
• substance abuse
  
• impulsive sexual behaviors
  
• excessive ruminating about relationships, self-image, and self-esteem
  

The Four Steps can be used to help you control almost any intrusive thought or behavior that you decide you want to change.

The Four-Step Self-Treatment Method is a way of organizing your mental and behavioral responses to your internal thought processes. Rather than just acting impulsively or reflexively, like a puppet, when unwanted thoughts or urges intrude, you can train yourself to respond in a goal-oriented manner and can refuse to be sidetracked by self-destructive thoughts and urges.

We call these steps the four R’s:

Step 1. RELABEL

Step 2. REATTRIBUTE

Step 3. REFOCUS

Step 4. REVALUE

In
Step 1: Relabel
, you call the intrusive thought or urge to do a troublesome compulsive behavior exactly what it is: an obsessive thought or a compulsive urge. In this step, you are learning to clearly recognize the reality of the situation and not be tricked by the unpleasant feelings OCD symptoms cause. You develop the ability to clearly see the difference between what’s OCD and what’s reality. Instead of saying, “I feel like I need to wash my hands again, even though I know it doesn’t make any sense,” you start saying, “I am having a compulsive urge. That compulsion is bothering me. That obsessive thought is hounding me.”

The question then arises, “
Why
does this keep bothering me?”

In
Step 2: Reattribute
, you answer that question. You say, “It keeps bothering me because I have a medical condition called OCD. I am having the symptoms of a medical problem. My obsessions and compulsions are related to a biochemical imbalance in my brain.” Once you realize this fact, you begin to ask yourself, “What can I do about it?”

In
Step 3: Refocus
, you turn your attention to more constructive behaviors. By refusing to take the obsessions and compulsions at face value—by keeping in mind that they are not what they say they are, that they are false messages—you can learn to ignore or to work around them by Refocusing your attention on another behavior and doing something useful and positive. This is what I call “
shifting gears
.” By performing an alternative, wholesome behavior, you can actually repair the gearbox in your brain. Once you learn how to Refocus in a consistent way, you will quickly come to the next step.

In
Step 4: Revalue
, you revalue those thoughts and urges when
they arise. You will learn to devalue unwanted obsessive thoughts and compulsive urges as soon as they intrude. You will come to see intrusive OCD symptoms as the useless garbage they really are.

The Four Steps work together. First, you
RELABEL:
You train yourself to identify what’s real and what isn’t and refuse to be misled by intrusive destructive thoughts and urges. Second, you
REATTRIBUTE:
You understand that those thoughts and urges are merely mental noise, false signals being sent from your brain. Third, you
REFOCUS:
You learn to respond to those false signals in a new and much more constructive way, working around the false signals by refocusing your attention on more constructive behavior to the best of your ability at that moment. This is where the hardest work is done and where the change in brain chemistry takes place. By expending the effort it takes to Refocus, you will actually be changing how your brain works in an extremely healthy and wholesome way. Finally, the real beauty of the Four-Step Method is seen in the
REVALUE
step, when the whole process becomes smooth and efficient, and the desire to act on unwanted thoughts and urges has been overcome to a significant degree. You will have learned to view those troublesome thoughts and urges as having little or no value and, therefore, your obsessions and compulsions will have much less impact on you. Things come together very quickly, resulting in an almost automatic response: “That’s just a senseless obsession. It’s a false message. I’m going to focus my attention on something else.” At this point, the automatic transmission in your brain begins to start working properly again.