“I have always been fascinated by the law of reversed effort. Sometimes I call it the ‘backwards law.’ When you try to stay on the surface of the water, you sink; but when you try to sink you float. When you hold your breath you lose it.” – Alan Watts
Are you bothered by intrusive thoughts that won’t go away?
Do you perform repetitive behaviors or mental acts to rid yourself of the discomfort caused by your intrusive thoughts? Do you feel overwhelmed by simple everyday tasks?
If you answered yes to the above questions you may be among the millions of people who suffer from obsessive-compulsive disorder (OCD).
You have a sense that what you are doing is probably unnecessary, but those thoughts and behaviors seem to be the only way to end your suffering in the moment. And sometimes you do get a feeling of temporary relief, which is why you keep trying to get things right, but the relief never lasts. The more you give in, the worse it seems to get.
OCD treatment in Denver can help you to take control of compulsive behaviors that may be hindering your day-to-day life.
There is a way out!
Evidence-based OCD therapy does exist. Once considered practically untreatable, OCD treatment and therapy was revolutionized in the late 20th century by the development of helpful medications and a type of behavior therapy called exposure and response prevention (ERP). Building on the success of these behavioral concepts by adding a cognitive component, Dr. Jeffery Schwartz developed an easy to follow four step method in his popular book called Brain Lock. Behavior therapy, whether in the traditional ERP format or in Schwartz’s format, has been shown to be very effective in treating OCD.
While many people decide to take medications to help them manage their OCD, there are also many people who are able to overcome their symptoms utilizing behavior therapy without medications. Whether or not you decide to take medications may depend on how successful you are with your therapy efforts. Also worth noting, is that therapy and medications are not mutually exclusive, so doing both therapy and medications might be what you ultimately decide to do.
How does exposure and response prevention (ERP) work for OCD?
ERP is meant to challenge and ultimately break apart the connections you have made between your anxiety, your obsessions, and your compulsions. As the name suggests, this type of treatment is accomplished by a serious of tasks—often with the support of a therapist—which gradually expose you the things you are most anxious about while helping you to refrain from responding in your old compulsive ways until your anxiety goes down. ERP, while uncomfortable, has proven to be an effective form of treatment for OCD. A helpful book on ERP is Stop Obsessing! by Edna Foa and Reid Wilson.
Habituation is one of the key principles of ERP. Habituation refers to the natural tendency of our bodies and minds to become accustomed to things through repeated, prolonged contact; think of adjusting to hot or cold water after a few minutes or not noticing the sound of a ticking clock in your room. Habituation also occurs in situations that trigger anxiety, and by having the courage and wisdom to tolerate the anxiety you feel in these moments without engaging in avoidance or compulsions to lesson the immediate distress, you find that the anxiety fades and you can focus on the things you enjoy about your life without the nagging urgency to engage in OCD thoughts and behaviors. Many clients tell me that they experience success with this concept, once understood, within minutes of resisting an OCD urge!
Extinction is another key principle of ERP. Extinction is what happens when a behavior no longer brings pleasure or reduces discomfort, such as no longer getting paid to perform your job or eating ice cream with no flavor. Assuming we work to get paid and eat ice cream because it tastes good, if these reinforcers are no longer there, we have less reason to continue doing these things. Of course, things such as work and diet have more nuances than just money (perhaps we get a sense of meaning from our work) and how good something tastes (maybe we are eating for nutrition over taste), but you get the point. When we stop engaging in compulsive rituals that are meant to reduce our anxiety, and our anxiety goes down on it’s own, we see the prior acts and thoughts for the problematic, unhelpful and annoying things that they are and they become extinguished as things that no longer give us the (fleeting moments of) relief they did in our prior OCD desperation!
The Four Steps
Dr Jeffrey Schwartz’s four step method of OCD treatment is something that can help you start managing your OCD immediately on your own or be combined with the classic ERP methods if you choose. His method builds on ERP by adding cognitive and mindfulness components with the support of neuroscience. The basic principle behind his program is that if you can develop a more accurate understanding of what your OCD thoughts and urges are and bring a mindful awareness to your choices about what you do and think about, you can actually change the way your brain works and thus better manage the anxiety you feel when the problematic feelings come up, allowing for more productive behaviors and ways of being. He states in Brain Lock:
“We learn that even persistent, intrusive feelings are transient and impermanent and will recede if not acted on. And, of course, we always remember that these feelings tend to intensify and overwhelm us when we give in to them. We must learn to recognize the urge for what it is—and to resist it.”
The Four Steps have worked for many of my clients. Give them a try! They are:
- Relabel. This is an acknowledgement that the discomfort you are feeling is a symptom of OCD and that you don’t have to listen to what it says you should do. Schwartz suggests the mantra: “It’s not me—it’s my OCD.” The goal, he tells us, is to control your responses to the thoughts and urges, not to control the thoughts and urges themselves. And it begins with relabeling them as unhelpful and unimportant, and reminding yourself of the false promises they make to you that attending to them will give you peace!
- Reattribute. This step builds on the Relabel step by recognizing in more detail that the urge you feel is caused by a false alarm of sorts in your brain. The goal of this step is to acknowledge that the intensity of the feelings and thoughts you are having relates to a biochemical imbalance in the brain. The good news, he points out, is that scientific research has found that resisting obsessions and compulsions actually changes the biochemistry that is causing the OCD symptoms! Another interesting point he makes in Brain Lock is that “many people come to understand that part of the urge is related to an emotional need to avoid intimate interpersonal relationships and unwanted personal responsibilities.” I know that last point may seem a little hard to swallow, but if you reflect on it for a moment, you may find some truth in it.
- Refocus. Schwartz calls this the “no pain, no gain” step! The purpose of this step is to work around the thoughts and urges by shifting your attention towards a more wholesome behavior for ideally at least fifteen minutes (the longer the better). This time delay allows for the urge to fade while you get on with your life in the way that you would like. And it works! Once you get good at putting this step in practice you will sometimes experience relief within minutes. This is an empowering feeling and is something you will be motivated to get better at once you first experience success!
- Revalue. The goal of this step is to ultimately devalue the OCD feeling. Even though it starts out by overwhelming you, by following these four steps, you are able to put it in its place as not something worth your time and energy. While you can’t make the thoughts and urges go away, you also don’t need to dwell on them. You have better things to do!
What you may gain from your struggles with OCD:
No doubt, dealing with OCD is not ideal and not fun. However, there are some really great things you have the opportunity to come away with by learning to manage your OCD. Some include:
- Letting go of the need to be perfect
- Developing increased self-control over impulsive behavior
- Experiencing a deeper sense of self-esteem
- Becoming more efficient with work
- Enhancing your ability to make conscious choices
- Making peace with life’s uncertainties
- Connecting better with others
- Learning how to truly relax
If you’re looking to learn more about and treat your OCD and live near Denver, Cherry Creek, Glendale or Virginia Village, reach out to my practice today. I’ve been helping people manage their OCD in the Denver area for years, and would be honored to be able to help you. Call 720-630-1373 today and schedule your appointment. OCD doesn’t need to continue to torture you!