Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (10 page)

• When you change your behavior, you change your brain.

• The
key to success
is to strengthen your Impartial Spectator, your ability to stand outside yourself and observe your actions with mindful awareness.

2

Step 2: Reattribute

“Unlocking Your Brain”

Step 1. Relabel

Step 2. REATTRIBUTE

Step 3. Refocus

Step 4. Revalue

S
tep 2:
Reattribute
answers the questions,
“Why don’t these bothersome thoughts, urges, and behaviors go away?” “Why do they keep bothering me?” “What should I attribute them to?”

The answer is that they persist because they are symptoms of obsessive-compulsive disorder (OCD), a condition that has been scientifically demonstrated to be related to a biochemical imbalance in the brain that causes your brain to misfire. There is now strong scientific evidence that in OCD a part of your brain that works much like a gearshift in a car is not working properly. Therefore,
your brain gets “stuck in gear.”
As a result, it’s hard for you to shift behaviors. Your goal in the Reattribute step is to realize that the sticky thoughts and urges are due to your balky brain. (See Figure 1 on Introduction.)

At UCLA, we use self-directed behavior therapy to enhance the mind’s own power to actually change the chemistry in the brain. That’s what you accomplish when you get around those intrusive thoughts that get stuck in your brain and won’t go away. Our tools are the Four Steps—Relabel, Reattribute, Refocus, Revalue. In time, with persistence, they will enable you to tame that hyperactive unruly
orbital cortex. No neurosurgery is needed. You can do it with your mind.

When I talk about self-directed behavior therapy, I mean an active response to OCD symptoms in which you recognize this intruder for what it is and you fight back, using the Four Steps to shift those sticky gears in your brain.

In Step 1: Relabel, you learned the importance of calling an obsession an obsession, a compulsion a compulsion. But Relabeling alone does not make those painful thoughts and urges go away. You wonder, “Why the hell does this thing keep bothering me?” It keeps bothering you because you have a glitch in your brain—the sticky automatic transmission that you learned about in the Introduction.

Now it’s time to bring into play Step 2: Reattribute. You have already identified your problem as OCD. In Reattribute, you learn to place a lot of the blame squarely on your brain: This is my brain sending me a false message. I have a medical condition in which my brain does not adequately filter my thoughts and experiences, and I react inappropriately to things that I know make no sense. But if I change the way I react to the false message, I can make my brain work better, which will improve the bad thoughts and feelings.

“IT’S NOT ME—IT’S MY BRAIN”

Because these thoughts and urges make your life unbearable, you must devise active, positive strategies for working around them. You need to adapt, to keep telling yourself, “It’s not me—it’s just my brain.”

I would never tell a person with Parkinson’s disease, “Stop that tremor! Don’t move until you stop that tremor.” That person cannot wish the shakes away, just as the person with OCD cannot wish away the false messages that the brain is bombarding him or her with. Both have a medical condition to which they must adjust. (It is interesting to note that both Parkinson’s disease and OCD are caused by disturbances in a brain structure called the striatum.) It’s futile and counterproductive for the person with Parkinson’s disease to decide, “Oh, I’m no damn good. I can’t move as fast as everybody else,” and it is equally counterproductive for a person with OCD to give in, to
say, “This thing’s too monstrous, too powerful. I can’t fight it, so I’ll do as it tells me.”

Earlier, I introduced the concept of the Impartial Spectator, or mindful awareness. Using the Impartial Spectator, you can distance yourself from your OCD, create a gap or safety zone between your will—your wholly internal spirit—and your unwanted, intrusive urges. Rather than respond to urges in an unthinking, mechanical fashion, you present yourself with alternatives.
Early in therapy, it’s good to think of some alternative behaviors to have ready when the pain of OCD seizes you
. Any pleasant and constructive activities will do. Hobbies are especially good.

The Reattribute step intensifies the mindful-awareness process. Once you realize this thing is OCD, the next step is to gain a deep understanding of why it’s so bothersome and why it won’t go away. We now know beyond a reasonable doubt that it doesn’t go away because it’s due to a medical condition, a biochemical imbalance in the brain. By Reattributing the pain to this medical condition, you strengthen your certainty that it is not your will, not you, and that it won’t take over your spirit. You are still intact and able to make conscious, considered decisions in response to your pain.

FALSE ALARM!

A woman in my weekly OCD therapy group said it so well: “Behavior therapy breaks the lie of what the anxiety is saying.” In other words, the intensity and pervasiveness of these thoughts or urges is not a personal weakness or a psychological problem. It is simply a false alarm caused by a short circuit in the brain. Thinking of this analogy should help you understand the proper response to these urges: In the middle of the night, a car alarm goes off. It wakes you, and you become agitated and annoyed. But only a fool would lie in bed tossing and turning, trying to will that alarm to cease. It won’t. In all probability, it is responding to a short circuit that has caused a false message. So the sensible person tries to ignore the alarm, think about something else, and go back to sleep. When OCD sends a false message to your brain, you can’t make it go away, but you don’t have to act on it. First, you Relabel it; then you Reattribute it. You
tell yourself, “I will not do this. I do not want to do this. It’s not me—it’s just OCD.”

In combating compulsions, we have had success using the fifteen-minute rule: When you are overtaken by the urge to perform a compulsion, you try to wait fifteen minutes. But this is not just passive waiting. It’s a waiting period during which you actively keep telling yourself, “These are not real thoughts. These are faulty messages from my brain.” If, within fifteen minutes, the urge begins to fade—and it frequently does—you begin to see that you have a sense of control over your OCD. You are no longer a passive victim.

It is pointless to sit and ruminate about how dreadful your life is going to be if you act on a fearsome, violent, obsessive thought. You are not going to do it. Why not? Because the real you doesn’t want to do it. Think of heavy smokers who have to quit for their health’s sake: They may never be free from the urge to smoke a cigarette, but they can stop smoking by changing their behavior in response to that urge to smoke. Over time, the urge to smoke fades.

Remember: OCD is not some hidden wish fulfillment. It is simply a broken machine.
OCD may mimic the feeling of reality, but reality never mimics the feeling of OCD
. This fact leads to a very important principle: If it feels like it
might
be OCD, it
is
OCD! If it were reality, it wouldn’t feel like it even might be OCD.

THIS IS WAR

The Relabel and Reattribute steps are often done together because they reinforce one another; that is, mindful awareness (the Impartial Spectator) and a cognitive understanding that this is a blip of misinformation coming from the brain are working together. These techniques are the foundation for building a powerful defense system against this enemy, OCD. You may want to think of it as creating a platform on which to stand to observe the ridiculous nature of OCD and from which to plot your counterattack. No matter how uncomfortable the feelings, when you stand on that platform, you’re in charge. Truth is on your side.

There was a time when Barbara, who obsessed about checking things and locking things (Remember Mr. Coffee?) would come
home from work each day so stressed out from her obsessive thoughts—Had she hit someone while driving? Had she put a business contract in the wrong envelope? Had that letter she dropped in the mailbox really gone down?—that she would have to go right to bed. But she wouldn’t let herself go to sleep “because that brought the next day’s OCD on that much sooner. I would lie in bed like a convalescent and just decompress. My life was getting through the day and then recovering from it. And dreading the next day.”

Today, ten years after the onset of OCD and six years after starting self-directed behavior therapy, Barbara is able to say that her few remaining OCD rituals are “just a minor nuisance, like having to floss my teeth every day.”

After four years of suffering, she felt she was losing the fight. Several things had conspired to contribute to her sense of defeat. Once, while out of town for a weekend, she was overcome by the fear that she had failed to lock her apartment door although, of course, she had locked it. So Barbara called her landlady, told her the door was not locked, and asked her to lock it. Naturally, she didn’t say she wasn’t
sure
she had locked it—“I didn’t want her to think I was bizarre or unstable.” The inevitable happened. The landlady
unlocked
the door. When Barbara returned home to find the door unlocked, she realized, “I can’t even enlist people unwittingly to help me because I end up sabotaging myself.” For the first time, she felt truly defeated.

About that time, her mnemonic (memory) devices were losing their novelty. At first, Barbara could say, “Okay, I’m locking the door now. I’m wearing a blue shirt. It’s Tuesday.” Then when she got to work, she could tell herself, “Okay. Blue shirt. Tuesday. The door must be locked.” But that technique no longer worked. Her brain had begun to tell her, “Aha! Maybe you also wore a blue shirt on
Monday
.”

It was at this point that she succumbed one day to hiding the coffee machine and the iron in her book bag and taking them to work. She was mortified. “I had self-esteem problems connected with the OCD and what I was doing professionally [she was a perennial underachiever]. I didn’t also need for it to be found out that I had an iron in my purse.”

Once she learned that she had a biochemical disorder of the brain—and that she could help herself through therapy—she began to improve. Looking back, Barbara says, “Your brain can get into such bad things. You say, ‘Is the stove off? Is the stove off?’ And then you get to the point of saying, ‘Well, what’s
off
? When I turn the knob up to the off position, how do I know that’s really the off position?’”

When her OCD was at its worst, she couldn’t escape it even on vacation. She’d check other people’s stoves. If she didn’t, her brain was telling her, some terrible catastrophe was going to take place.

By using mindful awareness whenever she checks something, Barbara can now ignore her OCD urges, knowing she has turned off the stove or locked the door. She tells herself, “It is the disease that is making me feel uncertain. And while I feel the stove is not off, I have checked it mindfully and should now walk away.” Her OCD is no longer severely disruptive. It is, rather, “a presence in my life as real and insistent in its own way as a fussing infant.” She knows what to do when her toddler cries. She also knows what to do when her OCD kicks up a fuss.

Incidentally, Barbara became pregnant while in therapy and credits her pregnancy with accelerating her healing process. Stress, we know, exacerbates OCD symptoms. When Barbara became pregnant, her priorities changed. “I no longer cared so much about my job as I cared about remaining stress-free through the pregnancy. I just decided, ‘Well, if a letter goes out riddled with mistakes, who cares?’ I knew I wasn’t going back to that job. And then the OCD symptoms would be greatly lessened.” What’s more, her number of mistakes did not increase.

Anyone who has OCD will tell you that refusing to give in to urges or compulsions is hard to do.
Painful
is the word I hear most frequently.

Dottie, who performed all manner of bizarre rituals out of an unfounded fear that something terrible was going to happen to her son’s eyes, describes not giving in to doing the behaviors as “like losing an old friend. I always say OCD is like a friendly enemy. It’s something you want to get rid of, but it’s also like a part of you that you don’t want to give up.” It’s easier to take comfort in doing the
ritual than to fight off the feeling. And sometimes we can use compulsions to avoid someone or something we don’t want to deal with. But, as we now know, that is a prescription for lifelong pain.

One person with OCD described so well what happens to those who don’t resist: “Bad habits make a groove in your brain.” And those horrible, intrusive thoughts get stuck right in that groove.