Obsessions Are Not The Real Problem
Obsessions are repetitive and unwanted thoughts that are intrusive and unrelenting. Due to a glitch in the brain’s neuro-circuitry, these particular thoughts are beyond the conscious control of the individual. Sufferers of Obsessive-Compulsive Disorder (OCD) know all too well the torment of these perverse and strange thoughts, which can accompany violent or graphic images. For them, it is a prison sentence of solitary confinement, inescapable, and seemingly deserved. There are many who fear losing their minds, while struggling to make sense of ideas foreign to their values and beliefs.
In my work with children and adults who suffer OCD, it is often assumed by the client that getting better means getting rid of obnoxious, intrusive thoughts. Relief means the elimination of obsessions. Although this is a noble goal, it is probably unattainable. In fact, obsessions are not the real problem for clients. Emotional recovery actually occurs as clients learn how to change the meaning given to their obsessions, while reappraising their true value. This article will briefly examine that process, as it pertains to work in psychotherapy.
Cognitive Behavioral Therapy (CBT) in combination with Exposure and Ritual Prevention (ERP) is an effective treatment modality for OCD. Through CBT, clients learn to recognize errors in their thinking. Clients are educated concerning how to correct those errors, which eventually produces healthier emotional states and coping behaviors. The process includes learning to recognize the difference between realistic and unrealistic appraisals of self, others, and the world around us.
ERP is a means for directly testing hypotheses regarding the assumed danger of an obsessive thought. Clients are guided through a series of graduated exposure exercises. Clients confront the situation, thought, or object that instigates fear without escaping. The goal is to realize there is no danger, which tends to extinguish compulsive behavior. Exposures range from 30 to 60 minutes.
Emotional re-education begins with a careful discernment of the neuro-biological causes of OCD. It is important for clients to understand that OCD is not due to a defect in character, weakness of the will, or some deep-seated, unresolved early life trauma. Life circumstances are nevermore than a contributing factor. Clients learn early on that a glitch in the brain’s circuitry is behind those odd thoughts.
Obsessions are False Messages
I always show my clients pictures of PET scan imagery that reveal the inner workings of the brain, pointing to the neurological causes of their obsessions. Borrowing from Dr. Jeffrey Schwartz, and his book Brain Lock, clients learn to RELABEL their obsessions as false messages caused by a “short circuit” in the brain. The relief of knowing this truth often eliminates for many clients long held, unrealistic appraisals of the self, such as, “I must be a bad (or weak) person for having those thoughts.”
A helpful metaphor I use to describe intrusive obsessions is to liken them to pop-up ads we often encounter while surfing the Web. Just like pop-up ads, obsessions are not under our control; they are always unwanted, and always annoying. Just as importantly, though, is for clients to realize that getting better emotionally does not depend on eliminating obsessions, which, in fact, is unnecessary, even perhaps, unattainable.
Obsessions can wax and wane over time, depending on several factors, including the individual’s stress load and physical health. Since OCD is a chronic condition, it is difficult to predict whether obsessions can ever disappear entirely. Some clients have told me their intrusive thoughts vanished almost overnight, only to reappear in a different form a few years later. It is nearly certain that those prickly thoughts will come back. If eliminating obsessions were the expressed goal of therapy, there would be little hope of relief for any sufferer of OCD.
What can we do? I teach my clients to recognize the following: obsessions alone are not enough to disturb the sufferer emotionally; there must be a consequent negative appraisal of the obsession, which actually produces the anxiety and depression felt by the person. This also provokes compulsive behavior. It looks like this:
- A father graphically imagines stabbing his son to death obsessively.
- He consequently tells himself (negative appraisal), “This must be what child murderers think. I’m an evil and corrupt man!”
- He consequently feels horrifying anxiety and depression, prays compulsively for God’s forgiveness, and avoids his son.
Once my clients are convinced that their OCD is a brain glitch, it becomes easier to attack the negative self-talk with corrective self-talk. Mind you, this is not easy to do. It often takes great practice, which includes managing pathological doubt (e.g. “Well, there’s always a chance I could murder my son, even if by accident.”). One cannot be passive with OCD: it takes consistent, deliberate, conscious effort to attack the problem. What is the problem? Negative appraisal. This is what produces emotional disturbance.
When the father in our example realizes his imagined thoughts arise via faulty neuro-circuitry, he is ready to take the next step, which is challenging the accuracy of his assumptions. This is where CBT is most helpful. A skillful therapist will guide the client to ask several reality driven questions, such as, “Where is the evidence that you are an evil and corrupt man?” Because this father finds his obsession to be morally repugnant, he will be asked to consider if it is likely that a serial killer feels any moral outrage for wanting to stab a child to death. The answer is obviously, “No.” Serial killers enjoy obsessing about their victims. In contrast, all OCD sufferers regard their obsessions as ego-alien, i.e. against their value system.
Additionally, this man can be challenged to consider and test the hypothesis that all human beings are capable of having disturbing thoughts, even murderous thoughts, which hardly makes one a murderer at all. This dad can ask trusted friends and relatives to verify the truthfulness of this premise. He will discover that we all have bad thoughts on occasion. The significant difference being that OCD sufferers obsess about their negative thoughts, the rest of us really do not. Once again, this is related back to the OCD brain glitch.
Borrowing from our example above, the corrected appraisal can take this form:
- A father graphically imagines stabbing his son to death obsessively.
- He consequently tells himself (corrected appraisal), “This is an OCD thought due to a glitch in my brain circuitry. It’s also an involuntary thought. I didn’t produce it and this thought is not me. Like anyone else, I can have a bad thought. Just because I think it doesn’t make me evil. I’ve spent enough time considering the issue.”
- He consequently feels healthy concern and relief.
Behaviorally, the father in our example would be encouraged to act on something right now that adds value to his life. Since all OCD obsessions are “junk mail of the brain”, they do not deserve copious amounts of our energy. This dad can deliberately spend time playing with his son, for example, not only as an ERP exercise, but also to neutralize the compulsive praying. It is likely that in less than fifteen minutes, his anxiety will reset to zero. Nothing terrible happens and this father learns to appreciate the value of loving a joyful son.
Finally, the fuel for OCD is anxiety. Cut off the fuel source and obsessions are likely to decrease dramatically. When clients change the meaning they give to their obsessions through reappraisal or thought correction, anxiety is lessened. When they commit to neutralizing their compulsions consistently, clients engage the “brain trick” head on, further robbing OCD of the anxiety it needs to fuel future obsessions. The bottom line is obsessions are not the real problem at all; it is the meaning we give to them that makes all the difference with coping emotionally.501 STATE ROAD 13 • SAINT JOHNS, FLORIDA 32259 PHONE: 904-410-6324 • FAX: 855-823-3434