The Circle of OCD
A ritual seen in obsessive compulsive disorder is goal-directed but has no rational justification. For example, daily activities such as washing oneself once has an appropriate end-point – that is, to feel clean. However, going to excessive lengths in washing oneself to feel cleansed will never be satisfied, meaning the end-point can never be reached. Similarly, checking once that the doors and windows are closed before going to bed has a purpose, which is that the house has been made secure. Yet, checking repeatedly to “prevent” harm only serves to relieve anxiety in the short term, hence the repetition; thus, the end-point will never be arrived at.
All obsessions are fear related. It’s this fear that drives corresponding rituals to “correct” the problem even though in the long term they are of no use. Obsessions might relate to harm, sexual, symmetry, cleanliness, somatic, moral or other; and resultant behaviours include reassurance, double checking, confessing, cleansing, praying, and so on.
The uncertainty of what has, is or will occur creates a resistance to rational persuasion, hence re-occurring doubts and repeated responses to remedy the problem, albeit unsuccessfully. Basically, no amount of checking, reassurance or other repeated behaviour ever takes away that grain of doubt. This is why living with uncertainty is encouraged because certainty can never be guaranteed.
COGNITIVE THERAPY WITH EXPOSURE RESPONSE PREVENTION
The way to break the circle of OCD is with cognitive behavioural therapy (CBT) with exposure response prevention (ERP). The first (CBT) helps to correct errors in thinking. When these change so do feelings and thus behavioual outcomes are generally more favourable. Likewise when a unhelpful behaviour changes, healthier thoughts and feelings follow. Thinking errors are when you assume your feelings are evidence of a fact – e.g., “I feel anxious, therefore the situation must be dangerous”; or “I feel guilty, so I must have done something wrong”; or “I felt a groinal response, therefore I must be gay, a paedophile (or other)”. These thinking errors are linked to faulty beliefs such as catastrophising and overimportance of thoughts. By encouraging the resistance of pursuing purposeless goals, the second (ERP) is able to help OCD sufferers build distress tolerance. In other words a person agrees to face their fears (obsessions) in grades steps with the purpose of resisting giving into all compulsions related to their obsessions for the duration of their exposure time. ERP is the gold standard treatment intervention known to actively alter brain chemistry to reduce obsessional behaviours.
Whilst medication is not an active replacement for working on rational goal-directed behaviours it is often required in moderate-severe cases to allow for cognitive improvement, and in which a person is then more able to become actively involved in ERP. Selective Serotonin Reuptake Inhibitors (SSRIs) such as Sertraline (Zoloft) are the usual prescribed medications for OCD and are known to passively alter brain chemistry to reduce obsessions, usually by up to 60%. Just to note: an old class of tricyclic antidepressants – commonly Clomipramine (Anafranil) which works well for OCD – might be prescribed if a person cannot take to a SSRI. Other times, atypical anti-psychotics such as Aripiprazole, sold under the brand name Abilify, are prescribed for reducing obsessive-compulsive symptoms.
Now have a go at answering the questions below. The first five correct answers out of the bag will receive a copy of my Basic OCD Study Course and a personal invitation to join my OCD Study Group (on Facebook). If you’ve already joined my OCD Study Group, you are welcome to invite a person of your choice.
- What drives a person to pursue goal-directed behaviours that have no rational justification?
- What makes a person resistant to rational persuasion?
- It can be seen that rituals do not change the course of events; yet, persistent checking, washing or other ritual never takes away what?
- Thinking errors are when you assume your feelings are evidence of a fact – e.g., “I feel anxious, therefore the situation must be dangerous.” True/False?
- Thinking errors are linked to faulty beliefs such as catastrophising and overimportance of thoughts. True/False?
- Why is living with uncertainty encouraged?
- Name two daily activities that (a) have an appropriate end-point such as handwashing before dinner, locking the door after leaving the house etc.; and (b) note on a rational level whether these behaviours need to be done once or without prolonged duration, or done repeatedly?
- A ritual is carried out to (a) stop the obsession (b) relieve anxiety in the short term or (c) to rationally prevent harm?
- Which therapy helps to actively alter brain chemistry to reduce obsessive-compulsive behaviours?
- Which treatment intervention is able to passively alter brain chemistry to reduce obsessions by up to 60%?
HOW TO SEND YOUR ANSWERS
Please paste your answers in the message box on my contact me page
Closing Date: 14th April 2018
Winners revealed on this page on or before 21st April 2018
Special note: this quiz will run each month. So if you don’t find your name in the winners’ list on this page, you can try again!
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Congratulations! Luis Ortiz, David Baker, M.J.W., Tanya North and L. Wilson