You’re not sure you turned off the stove, so you go home to check. After you leave again, you’re still unsure. What if the house burned down? So you check again. And again. This is classic obsessive-compulsive behavior. Dread arising from intrusive thoughts (obsessions) leads to repetitive behavior (compulsions).
One of my patients washed his hands 100 times a day. He knew they were clean but he could not shake the feeling that they were dirty and scrubbed until his hands were cracked and raw.
Five million Americans suffer from obsessive-compulsive disorder (OCD), whose symptoms make daily life exceedingly difficult. Countless more have minor obsessions and compulsions they would like to get rid of.
Examples: Getting up at night to check and recheck a lock rereading the same passage to make sure you got every word having unspeakable thoughts of violence that you can’t get out of your mind.
We’ve made great strides in pinpointing the cause of the maddening symptoms and developing a therapy that really helps.
A glitch in the brain
OCD is caused by a biochemical imbalance in the caudate nucleus, a region of the brain whose function is to control another part of the brain called the orbital cortex.
Ordinarily, the orbital cortex serves as a sort of “error-detection system.” When the caudate nucleus malfunctions, the orbital cortex is left stuck in the “on” position. This “brain-lock” condition creates a “something-is-amiss” feeling that won’t go away.
To the rescue: My four-step program can control OCD within a matter of weeks.
Step 1: Re-label
Since obsessions and compulsions won’t go away of their own accord, your first step is to re-label them by making mental notes. If you feel compelled to count all the blue cars you pass on the highway, for example, tell yourself, “I don’t need to count the blue cars. I’m having a compulsive urge to do so.”
This inner dialogue brings you back to reality. By observing your brain neither giving in to the compulsion nor pretending it doesn’t exist you bolster your “Impartial Spectator.” That’s the innermost part of your personality and what will allow you to conquer OCD.
Step 2: Reattribute
The next step answers the question, “Why these terrifying thoughts won’t, urge and behaviors go away?” Reattribute these symptoms to their true cause a biochemical imbalance in the brain.
Think of OCD anxiety as a mental alarm system with a hair-trigger. The siren may wail incessantly, but that doesn’t mean you must pay attention to it.
Helpful: Silently reflect on the phrase, “It’s not me, it’s OCD.” Doing so stresses the distinction between your thoughts and fears and your real self. Once you learn to separate yourself from your urges and anxieties, you can choose not to act on them.
Step 3: Refocus
Each time your obsession or compulsion resurfaces, refocus your attention on a pleasurable, constructive activity taking a walk, gardening, doing needlepoint, listening to music and playing a computer game.
Your goal is to pursue the activity for at least 15 minutes. At first, however, you may be able to go no longer than five minutes.
The longer you refrain from acting on a compulsive urge, the weaker it becomes. Even if you ultimately give in, you still come out ahead. You’re learning to tolerate psychological discomfort and building up your power to say “no.” This is profoundly empowering
Step 4: Revalue
The more diligently you practice relabeling, reattributing and refocusing, the more fully you’ll recognize your obsessions and compulsions for what they are worthless distractions having no value whatsoever.
This process will gradually become automatic. Without even thinking, you’ll be able to devalue the thoughts and urges and fend them off until they fade.
Benefits of this method
Some people experience a profound sense of relief after using my four-step technique for only a single day. For most people, however, it takes about eight to 10 weeks.
Do not expect your urges to go away completely. Each incremental improvement you put off checking the lock for five minutes brings you closer to full control. Praise yourself for each step forward!
The four-step method is more than a behavioral technique it has physiological effects. Studies using positron emission tomography (PET) show that in individuals who practice the four-step method, brain function returns to normal.
What about medication?
Some recently developed drugs including the antidepressants fluoxetine (Prozac) and fluvoxamine (Luvox) and the antianxiety drug buspirone (BuSpar) greatly weaken the fear that makes OCD urges so hard to resist.
I think of these drugs as “training wheels” a useful aid when you’re just getting acquainted with the four-step method.
Once you master my program and your brain biology begins to change, you’ll be able to reduce the dosage or give up the drugs completely.
