Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (34 page)

Using the Reattribute step will also help you to avoid performing rituals in a vain attempt to “get the right feeling” (for example, a sense of “evenness” or a sense of completion). Knowing that the urge to get that “right feeling” is caused by a biochemical imbalance in the brain, you can learn to ignore the urge and move on. Remember, “It’s not me—it’s my OCD.” By refusing to listen to the urge or to act on it, you will actually change your brain and make the feeling
lessen. If you take the urge at face value and act on it, you may get momentary relief, but within a very short time the urge will just get more intense. This is perhaps the most important lesson that people with OCD must learn. It will help you avoid being the “sucker” and taking the false bait of OCD every time.

The Relabel and Reattribute steps are usually performed together to bring about a deeper understanding of what is really happening when an OCD thought or urge causes you such intense pain. You Relabel it, call it what it is—an obsession or a compulsion. Use mindful awareness to get beyond a superficial understanding of OCD and to gain the more profound understanding that the thoughts and urges are nothing more than fallout from a medical condition.

STEP 3: REFOCUS

The Refocus step is where the real work is done. In the beginning, you may think of it as the “no pain, no gain” step. Mental exercise is like a physical workout. In Refocusing, you have work to do: You must shift the gears yourself.
With effort and focused mindfulness, you are going to do what the caudate nucleus normally does easily and automatically
, which is to let you know when to switch to another behavior. Think of a surgeon scrubbing his hands before surgery: The surgeon doesn’t need to wait for a timer to go off to know when it’s time to stop scrubbing. After a while, the behavior is simply automatic. After a while he gets a “feel” for when he’s scrubbed enough. But people with OCD can’t get the feeling that something is done once it’s done. The automatic pilot is broken. Fortunately, doing the Four Steps can usually fix it.

In Refocusing, the idea is to work around the OCD thoughts and urges by shifting attention to something else, if only for a few minutes. Early on, you may choose some specific behavior to replace compulsive washing or checking. Any constructive, pleasant behavior will do. Hobbies are particularly good. For example, you may decide to take a walk, exercise, listen to music, read, play a computer game, knit, or shoot a basketball.

When the thought comes, you first Relabel it as an obsessive thought or a compulsive urge and then Reattribute it to the fact that
you have OCD—a medical problem. Then Refocus your attention to this other behavior that you have chosen. Start the process of Refocusing by refusing to take the obsessive-compulsive symptoms at face value. Say to yourself, “I’m experiencing a symptom of OCD. I need to do another behavior.”

You must train yourself in a new method of responding to the thoughts and urges, redirecting your attention to something other than the OCD symptoms. The goal of treatment is to stop responding to the OCD symptoms while acknowledging that, for the short term, these uncomfortable feelings will continue to bother you. You begin to “work around” them by doing another behavior. You learn that even though the OCD feeling is there, it doesn’t have to control what you do. You make the decision about what you’re going to do, rather than respond to OCD thoughts and urges as a robot would. By Refocusing, you reclaim your decision-making power. Those biochemical glitches in your brain are no longer running the show.

The Fifteen-Minute Rule

Refocusing isn’t easy. It would be dishonest to say that dismissing the thoughts and urges and moving on does not take significant effort and even tolerance of some pain. But only by learning to resist OCD symptoms can you change the brain and, in time, decrease the pain. To help you manage this task, we have developed the fifteen-minute rule. The idea is to delay your response to an obsessive thought or to your urge to perform a compulsive behavior by letting some time elapse—preferably at least fifteen minutes—before you even consider acting on the urge or thought. In the beginning or whenever the urges are very intense, you may need to set a shorter waiting time, say five minutes, as your goal. But the principle is always the same: Never perform the compulsion without some time delay. Remember,
this is not a passive waiting period
. It is a time to perform actively the Relabeling, Reattributing, and Refocusing steps. You should have mindful awareness that you are Relabeling those uncomfortable feelings as OCD and Reattributing them to a biochemical imbalance in the brain. These feelings are caused by OCD; they are not what they seem to be. They are faulty messages coming from the brain.

Then you must
do another behavior—
any pleasant, constructive
behavior will do. After the set period has lapsed, reassess the urge. Ask yourself if there’s been any change in intensity and make note of any change. Even the smallest decrease may give you the courage to wait longer. You will be learning that the longer you wait, the more the urge will change. The goal will always be fifteen minutes or more. As you keep practicing, the same amount of effort will result in a greater decrease in intensity. So, in general, the more you practice the fifteen-minute rule, the easier it gets. Before long, you may make it twenty minutes or thirty minutes or more.

It’s What You
Do
That Counts

It is vitally important to Refocus attention away from the urge or thought and onto any other reasonable task or activity. Don’t wait for the thought or feeling to go away. Don’t expect it to go away right away. And, by all means,
don’t do what your OCD is telling you to do
. Rather, engage in any constructive activity of your choosing. You’ll see that instigating a time delay between the onset of the urge and even considering acting on it will make the urge fade and change. What is more important, even if the urge changes hardly at all, as sometimes happens, you learn that you can have some control over your response to this faulty message from the brain.

This application of mindful awareness and the Impartial Spectator will be empowering to you, especially after years of feeling at the mercy of a bizarre and seemingly inexplicable force. The long-range goal of the Refocus step is, of course, never again to perform a compulsive behavior in response to an OCD thought or urge. But the intermediate goal is to impose a time delay before performing any compulsion. You’re learning not to allow OCD feelings to determine what you do.

Sometimes the urge will be too strong, and you will perform the compulsion. This is not an invitation to beat yourself up. Keep in mind: As you do the Four Steps and your behavior changes, your thoughts and feelings will also change. If you give in and perform a compulsion after a time delay and an attempt to Refocus, make a special effort to continue to Relabel the behavior and to acknowledge that this time the OCD overwhelmed you. Remind yourself, “I’m not washing my hands because they are dirty, but because of
my OCD. The OCD won this round, but next time I’ll wait longer.” In this way, even performing a compulsive behavior can contain an element of behavior therapy. This is very important to realize: Relabeling a compulsive behavior
as
a compulsive behavior is a form of behavior therapy and is
much
better than doing a compulsion without making a clear mental note about what it is.

A tip for those who are fighting checking behaviors—checking locks, stoves, and other appliances: If your problem is, say, checking the door lock, try to lock the door with extra attention and mindful awareness the first time. This way, you’ll have a good mental picture to refer to when the compulsive urge arises. Anticipating that the urge to check is going to arise in you, you should lock the door the first time in a slow and deliberate manner, making mental notes, such as “The door is now locked. I can see that the door is locked.” You want a clear mental image of that locked door, so when the urge to check the door seizes you, you will be able to Relabel it immediately and say, “That’s an obsessive idea. It is OCD.” You will Reattribute the intensity and intrusiveness of the urge to check again to your OCD. You will remember, “It’s not me—it’s just my brain.”

You will Refocus and begin to “work around” the OCD urges by doing another behavior, with a ready mental picture of having locked that door because you did it so carefully and attentively the first time. You can use that knowledge to help you Refocus actively on doing another behavior, even as you Relabel and Reattribute the urge to check that has arisen, as you anticipated it would.

Keeping a Journal

It is important to keep a behavior-therapy journal as a record of your successful Refocusing efforts. It need not be anything fancy. The idea is simply to have a written record to remind you of your successes in self-directed behavior therapy. The journal is important because you can refer back to it to see which behaviors most helped you to Refocus. But—and this is equally important—it helps you to build confidence as you see your list of achievements grow. In the heat of battle against a compulsive urge, it isn’t always easy to remember which behavior to Refocus on. Keeping a journal will help you to shift gears when the going gets tough, when the obsess
sive thought or compulsive urge heats up, and will train your mind to remember what has worked in the past. As your list of successes gets longer, it will be inspirational.

Record only your successes. There is no need to record your failures. You have to learn to give yourself a pat on the back. This is something people with OCD need to learn to do more of. Make sure to give yourself encouragement by consciously acknowledging your successful use of Refocusing behaviors as a job well done. Reinforce that success by recording it in your behavior-therapy journal and giving yourself a little reward, even if it’s only to tell yourself how terrific you are for working so hard to help yourself. Many people find that even something as simple as jotting down one Refocusing behavior a day, and calling it the “Play of the day,” contributes significantly to their self-esteem.

STEP 4: REVALUE

The goal of the first three steps is to use your knowledge of OCD as a medical condition caused by a biochemical imbalance in the brain to help you clarify that this feeling is not what it appears to be and to refuse to take the thoughts and urges at face value, to avoid performing compulsive rituals, and to Refocus on constructive behaviors. You can think of the Relabel and Reattribute steps as a team effort, working together with the Refocusing step. The combined effect of these three steps is much greater than the sum of their individual parts. The process of Relabeling and Reattributing intensifies the learning that takes place during the hard work of Refocusing. As a result, you begin to Revalue those thoughts and urges that, before behavior therapy, would invariably lead you to perform compulsive behaviors. After adequate training in the first three steps, you are able in time to place a much lower value on the OCD thoughts and urges.

We have used the concept of the “Impartial Spectator,” developed by 18th-century philosopher Adam Smith, to help you understand more clearly what you are actually achieving while performing the Four Steps of cognitive biobehavioral therapy. Smith described the Impartial Spectator as being like a person inside us who we carry around at all times, a person aware of all our feelings, states, and cir
cumstances. Once we make the effort to strengthen the Impartial Spectator’s perspective, we can call up our own Impartial Spectator at any time and literally watch ourselves in action. In other words, we can witness our own actions and feelings as someone not involved would, as a disinterested observer. As Smith described it, “We suppose ourselves the spectators of our own behavior.” He understood that keeping the perspective of the Impartial Spectator clearly in mind, which is essentially the same as using mindful awareness, is hard work, especially under painful circumstances, and requires the “utmost and most fatiguing exertions.” The hard work of which, he wrote seems closely related to the intense efforts you must make in performing the Four Steps.

People with OCD must work hard to manage the biologically induced urges that intrude into conscious awareness. You must strive to maintain awareness of the Impartial Spectator, the observing power within that gives you the capacity to fend off pathological urges until they begin to fade. You must use your knowledge that OCD symptoms are just meaningless signals, false messages from the brain, so you can Refocus and shift gears. You must gather your mental resources, always keeping in mind, “It’s not me—it’s my OCD. It’s not me—it’s just my brain.” Although in the short run, you can’t change your feelings, you
can
change your behavior. By changing your behavior, you find that your feelings also change in time. The tug-of-war comes down to this: Who’s in charge here, you or OCD? Even when the OCD overwhelms you, and you give in and perform the compulsion, you must realize that it’s just OCD and vow to fight harder the next time.

With compulsive behaviors, simply observing the fifteen-minute rule with consistency and Refocusing on another behavior will usually cause the Revalue step to kick in, which means realizing that the feeling is not worth paying attention to and not taking it at face value, remembering that it’s OCD and that it is caused by a medical problem. The result is that you place a much lower value on—devalue—the OCD feeling. For obsessive thoughts, you must try to enhance this process by Revaluing in an even more active way. Two substeps—the two A’s—aid you in Step 2: Reattribute: Anticipate and Accept. When you use these two A’s, you are doing Active
Revaluing. Anticipate means “be prepared,” know the feeling is coming, so be ready for it; don’t be taken by surprise. Accept means don’t waste energy beating yourself up because you have these bad feelings. You know what’s causing them and that you have to work around them. Whatever the content of your obsession—whether it is violent or sexual or is manifested in one of dozens of other ways—you know that it can occur hundreds of times a day. You want to stop reacting each time as though it were a new thought, something unexpected. Refuse to let it shock you; refuse to let it get you down on yourself. By anticipating your particular obsessive thought, you can recognize it the instant it occurs and Relabel it immediately. You will simultaneously, and actively, Revalue it. When the obsession occurs, you will be prepared. You will know, “That’s just my stupid obsession. It has no meaning. That’s just my brain. There’s no need to pay attention to it.” Remember: You can’t make the thought go away, but neither do you need to pay attention to it. You can learn to go on to the next behavior. There is no need to dwell on the thought. Move ahead. This is where the second A—Accept—comes in. Think of the screaming car alarm that disturbs and distracts you. Don’t dwell on it. Don’t say, “I can’t do another thing until that blankety-blank car alarm shuts off.” Simply try to ignore it and get on with things.