Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (14 page)

Anna sees “sort of a Zen aspect” to coming to a mindful awareness about OCD. “If you truly accept OCD, it’s a very profound acceptance and it really requires a certain mind control.” Anticipation helps her. She knows, “It’s not easy to remain unruffled when terror is shooting through my body.” But she has learned that “the body can do crazy things. It’s something that I have to live with, even though I really hate it. That’s my life. I’m
now well acquainted with OCD’s tricks, and I don’t fall for them as I once did.”

When first told that she had a brain disorder, Anna reacted with mixed feelings. “Though it was hard to feel good about having such a brain defect, I felt enormously glad to find that the disease wasn’t me.” She could begin to rebuild her shattered self-esteem. Now happily married and a mother, she’s able to look back and say, “Though lack of character was not what got me into OCD, quite a bit of character and stamina, combined with a well-considered approach (the Four Steps) would be absolutely essential to get me out of it.”

JILL

Jill, a real estate agent in her mid-40s, has been battling a contamination obsession for twenty-five years. It started when, as a bride of 18, she went to the funeral of her husband’s best friend, who’d been killed in a car accident. Looking at the body in its open casket, she was suddenly seized by the feeling that things she came in contact with were contaminated. She would clean her house over and over, in a way that made no sense. Dirty dishes could be piled in the sink, but Jill would ignore them while relentlessly scrubbing the walls, floors, and ceiling—which were perfectly clean—with Lysol or rubbing alcohol. Sometimes, she remembers, “My lungs would hurt from inhaling the fumes.”

Jill could never explain how, or why, an object might become “contaminated.” And she knew it was crazy to spend her days scrubbing. “You’re sitting there thinking, ‘Hey, other people are out there enjoying themselves and doing things, and you’re in here cleaning this imaginary contamination!’” Still, she couldn’t stop. It was easier to clean and thus force those awful feelings from her mind for a little while.

For an entire year, she left her house only to buy groceries, and even then she could go to only one store, which she had decided was still “clean.” Her obsession started with one store being contaminated, or one neighborhood. “It grew to where I’d
contaminated whole towns and states and I had to leave, I had to move. We moved an awful lot because of my sickness.” In some way she can’t explain, “I contaminated my parents, my sister, and my brothers and couldn’t see them for sixteen years.” If one of them chanced to call her, the telephone would then be contaminated, and she would have to “alcohol” her whole apartment (Jill uses that word as a verb). She’d even have to wash the cat and take the vacuum cleaner apart, pole by pole, and pour alcohol into it. If it was Christmastime, she’d have to take all the ornaments from the tree and submerge them in big pans of alcohol. She might feel an imaginary blob crawling up her arm from the hand in which she’d held the telephone and would have to shower five times to get rid of it. About the same time, Jill began to associate any official document with contamination, a throwback, she figures, to the stress of her divorce many years earlier. If she got a traffic ticket, for example, she would have to come home and “alcohol” the house and shower. She couldn’t bear to touch the registration certificate in her car or visit a government building.

Jill and her two teenage daughters were living in North Carolina at the time, but her OCD was getting worse and the rainy weather further depressed her, so she decided to drive to Florida, to see if she could find a noncontaminated place to live. She’d left the girls with friends temporarily and, anxious to make sure they were all right, she stopped regularly along the way south to telephone them. Because she had discovered that the girls had lied to her about places they had been and things they had done—to avoid the silly rituals they’d have been required to perform if they had told the truth—they had now become “contaminated,” so this was tricky. Jill always chose to make those phone calls from big hotels that she knew would have health clubs. She developed a routine for avoiding “contamination” when calling her daughters: She’d head for the health club, put her clothes in a locker, wrap herself in a clean towel, and go to a pay phone in the lobby. She laughs, “A lot of businessmen would come by and stare at me. I was hoping nobody would notice that I didn’t have
a bathing suit under that towel.” After talking to her girls, she’d wash the phone with soap and water, take at least four showers, wash her hair, and dress. In this way, she avoided contaminating her clothing and herself and would not be forced to toss out all the possessions piled in her car.

Jill still has urges to shower excessively, but for the most part she has overcome her contamination fears and the fears about death associated with them. The first hurdle in behavior therapy was “just accepting OCD, not making myself feel bad that I have it.” Occasionally, she gives in to an intense urge to wash or clean. That’s when her anxiety level is so high that she reasons, “Sure, I might be OCD-free if I don’t do the compulsion, but I might have a heart attack if I keep putting myself through all this stress. So now I try to be a little bit easy on myself and, if I feel really good, I’ll tackle something a little harder. If I’m not feeling really good, I’ll try to do a little something, anything.”

If she lets her OCD have its way, she has learned, “It’s kind of like you give it more credibility. It becomes a habit, and you keep on doing it and it becomes worse and worse.” Her compromise might be one shower instead of five. “Just take those little baby steps,” she advises—with the Four Steps as the helping hand.

“So much in my life has changed by just being able to Relabel this thing,” Jill says. “If you give in to it, it snowballs. It starts out with one person contaminated, then ten people, then ten stores, then the whole state.” Often, for Jill, Relabeling is enough. She takes a deep breath, relaxes, and the intrusive urge goes away. “If you face it right away, Relabel it as OCD right away, it’s not going to get to the point where it’s going to take hours of your day to deal with it.”

Before she started self-directed therapy, Jill was on medication. But, she says, “medication was just like a cold tablet. It helped take the edge off, but it didn’t really make it better,” as behavior therapy has. “If I’d known the Four-Step technique years ago, I would have saved myself a lot of aggravation, a lot of time, and a lot of heartache.”

KEY POINTS TO REMEMBER

• Step 2 is the Reattribute step.

• Reattribute means answering the questions “Why do these thoughts and urges keep bothering me? Why don’t they go away?” The answer is, because of a medical condition called OCD.

• OCD is related to a biochemical imbalance in the brain that results in a malfunction of the brain’s gearshift: The brain gets “stuck in gear.”

• Because the brain is stuck in gear, its “error-detection circuit” keeps firing inappropriately. This causes very uncomfortable feelings.

• Changing your behavioral responses to the uncomfortable feelings and shifting to useful and constructive behaviors will, over time, make the broken gearshift come unstuck.

• As the brain starts to shift gears properly, the uncomfortable feelings begin to fade and become easier to control.

3

Step 3: Refocus

“Wishing
Won’t
Make It So”

Step 1. Relabel

Step 2. Reattribute

Step 3. REFOCUS

Step 4. Revalue

S
tep 3:
Refocus
tells you what to do when you are trying to overcome those urges to do the compulsive behaviors. It instructs you to “work around” those nagging, troublesome thoughts by Refocusing your attention on some useful, constructive, enjoyable activity, such as gardening or playing a computer game. The key to the Refocus step is to
do another behavior
. When you do, you are repairing the broken gearshift in your brain. Your brain starts shifting more smoothly to other behaviors. The more you practice the Refocus step, the easier it becomes. That’s because your brain is beginning to function more efficiently.

I like to tell the story of the chameleon and his therapist to illustrate the futility of trying to think away the nagging symptoms of obsessive-compulsive disorder. The therapist tells the hapless chameleon, “Listen, you’ve got to calm down. The more you worry about changing color, the less progress you’ll make. Now, why don’t you put yourself on the green background again?”

With the OCD patient, the problem is exactly the same. The more you worry about trying to drive some foolish and bothersome idea from your mind, the less chance you’ll succeed. Eventually, you’ll just give up. OCD will win. A key principle in self-directed cognitive behavioral therapy for OCD is this:
It’s not how you feel, it’s what you do that counts
.

And perhaps the most critical thing you must do during an OCD attack is to Refocus on another activity. What do I mean? Here’s one way to look at it: Refocusing is like learning a martial art. Your opponent, OCD, is very strong, stronger than the power of your mind to make it go away. But you have one clear advantage: OCD tends to be very stupid. The closest OCD comes to being clever is the fiendish way it puts doubts in your mind. Now, if you stand right in front of this stupid but powerful opponent, it will knock you right over. Therefore, you have to take advantage of its stupidity. You have to step aside, put the OCD thought aside, and work around it by putting your mind in another place and doing another behavior, one that is more pleasant and functional.

This is Refocusing. You Refocus on another behavior. It can be a physical activity, such as taking a walk, doing needlepoint, shooting a few baskets. Early in therapy, physical activity seems to be especially helpful. But the important thing to remember is that whatever activity you choose,
it must be something you enjoy doing
. You may listen to music, cook, knit, play a computer game, or water your geraniums. The object is to pursue the activity for at least fifteen minutes—instead of acting out some silly ritual in response to an obsessive thought that has come from your brain. This is the fifteen-minute rule.

Now, fifteen minutes is only a guideline. At first, five minutes may be the limit to your staying power. The important thing is that for at least a few minutes, you will not be sitting and dwelling self-destructively on the bothersome thoughts and urges that have invaded your
mind, and you will not be acting on those thoughts and urges. Instead, you will be consciously Relabeling those senseless thoughts as OCD and Reattributing them to a wiring problem in your brain. Relabeling and Reattributing help you get “centered” and ready to bring your mind away from OCD and back to reality. Now you’re ready to work around those thoughts by Refocusing your attention on another, more wholesome, behavior.

The one-line summary of Refocusing is:
Do another behavior
. When you do, you’ll learn that the OCD urges change and tend to diminish over time when they’re not acted on. (It’s also true that medication tends to make the OCD fade more quickly while you’re following the fifteen-minute rule; see Chapter Nine.)

ONE STEP AT A TIME

Don’t just plunge in and try, through some kind of frenetic, nonstop activity, to dismiss all the bothersome thoughts at once. (Let’s not forget good old Professor Gallagher and his poor patient with the fear of snakes, heights, and the dark in Chapter One.) Rather, you take things gradually; slow and steady wins the race. You can’t do everything at once. Let’s say you have an obsession about contamination and that dreaded thought comes up again: “I have to wash my hands.” First, you
Relabel
and call it what it is—an obsession. Then you
Reattribute
and place the blame squarely where it belongs. You remind yourself, “It’s not me—it’s the OCD.” Then you
Refocus:
You walk away from the sink without washing your hands and do something worthwhile that makes you happy. You do not attempt to make the OCD go away through some kind of magical understanding of what it is and what it means. That’s a fruitless struggle. You will only become demoralized, literally beaten down internally.

By Refocusing and changing to another behavior, you shift those sticky gears in your brain and resist the urge in an intelligent way. When you do so, the urge slowly begins to lessen because you’re working to change the chemistry of your brain. When you pay the urge no attention, it starts to go away. When you shift behavioral gears, you improve how your brain works. This is what our research at UCLA has shown.