Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (18 page)

Dottie, who performed ridiculous rituals out of fear that something terrible was going to happen to her son’s eyes, was hospitalized for a year in the 1970s—but that did little to help her OCD. She now understands that she was largely to blame, even though the techniques we now have for treating OCD had not been developed at that time. She remembers that in the psychiatric hospital, “We had group therapy every day, but no one ever knew what was wrong with me. People would say, ‘Now, Dottie, it’s your turn. What do you want to tell us about yourself?’ Well, I liked to help everybody else, but I would never talk about me and, of course, that’s the worst thing.” One day she just ran screaming from the group session—“It was the only emotion I ever showed in that hospital.” Why hadn’t she been able to tell the others about her horrible, obsessive thoughts? “Because I thought if I talked about them, they might come true.” After four years of attending our program at UCLA, Dottie is off medication, is able to hold down a part-time job, and talks about how she hopes to use what she has learned to help others who have OCD. The ultimate in Refocusing—doing cognitive-biobehavioral therapy with others.

OCD AS AN APHRODISIAC?

Domingo, whose obsessions include his fear that he has razor blades on the tips of his fingers and is going to hurt his wife when he touches her, has a most interesting—one might say unique—take on how OCD has affected his sex life. Tall, dark, and wiry with a big smile, he is attractive to many women and had his fair share of girlfriends before he recently married. (The following interview took place before his marriage.)

During sex, Domingo explained, “It’s hard to concentrate because of my OCD. Half of me is with the woman. But the OCD thoughts keep coming, and I can’t concentrate and the time keeps going by.
I’m still with her, but my mind is somewhere else. So I keep from having an orgasm. Women find that’s a very good idea because it lasts forever. I just go on and on and on. They tell me I’m a rare species of man.” Just what kind of OCD thoughts does Domingo have during lovemaking? “It could be, ‘Did I close the front door?’ ‘Did I bring the stereo in from the car?’ ‘Did I feed the dog?” ’ Do his partners notice that his mind is not entirely on them? He grinned. “They say, ‘Are you with me?’ I say, ‘I’ll be with you in a second. Enjoy it.’ They understand.”

Although new obsessions tend to sneak into Domingo’s mind even as he conquers others, he figures that, as a payoff for his diligence in doing the Four Steps, he is halfway home in his fight against OCD. When one of the terrible thoughts intrudes, he notes, “I just take a deep breath and say, ‘I can do this. I have things to do. I can’t wait fifteen minutes every time I’m upset because I will see fifteen minutes lead to two hours. It’s one obsession after another. If I wait fifteen minutes, I will sit here and do nothing all day.” So he simply mentally eliminates the possibility that he will perform the compulsion at all and goes on with his business. At UCLA, we call this Active Revaluing.

Not everyone has willpower as strong as Domingo’s. But he is not the only person who has been able to use the Four Steps as a sort of launching pad for behavior therapy and then to learn over time that he no longer needs to perform them as though he were reciting a litany. With practice, people like Domingo can bypass the Relabeling and Reattributing steps, which they find kick in automatically, and move directly to Refocusing behaviors, as a result of having very rapidly Actively Revalued the intruding thought or urge as worthless, miserable OCD.

This, of course, is the ultimate goal.

KEY POINTS TO REMEMBER

• Step 3 is the Refocus step.

• Refocus means to change your behavioral responses to unwanted thoughts and urges and focus your attention on something useful and constructive. DO ANOTHER BEHAVIOR.

• This is the no pain, no gain step. You must be ACTIVE. You cannot be passive.

• Use the fifteen-minute rule: Work around your symptoms by doing something wholesome and enjoyable for at least fifteen minutes. After fifteen minutes, make mental notes of how your symptoms have changed and try to Refocus for another fifteen minutes.

• Use your Impartial Spectator. It will strengthen your mind.

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

4

Step 4: Revalue

“Lessons Learned from OCD”

Step 1. Relabel

Step 2. Reattribute

Step 3. Refocus

Step 4. REVALUE

S
tep 4:
Revalue
is a natural outcome of diligent practice of the first three steps—Relabel, Reattribute, and Refocus. With consistent practice, you will quickly come to realize that your obsessive thoughts and compulsive behaviors are
worthless distractions to be ignored.
With this insight, you will be able to Revalue and
devalue
the pathological urges and fend them off until they begin to fade. As your brain begins to work better, it will become easier to see the obsessions and compulsions for what they really are. Your brain will function in a much more normal, automatic way. As a result, the intensity of your symptoms will decrease.

People who suffer from obsessive-compulsive disorder (OCD) feel a pain so great that they reach deep into their souls to seek an answer to the question “Why me?” Too often, they wind up thinking, “What a terrible person I must be for having such ‘bad’ thoughts.”

If you do not actively Revalue these thoughts as nothing more than false messages coming from the brain—messages with no spiritual significance whatsoever—you will certainly become demoralized and filled with self-loathing. The key is to realize that the thought is happening
in spite
of your will, not
because
of it.

A religious person, for example, can examine a blasphemous obsessive thought and understand that it has nothing to do with having objectionable feelings about the Virgin Mary or Jesus Christ—and everything to do with a medical condition, OCD. With this knowledge, you should see this as an opportunity to reaffirm your faith through spiritual self-examination. The knowledge that the blasphemous thoughts are nothing more than the reflection of a disease—not a reflection of your spiritual purity or integrity—is key to developing the capacity to “work around” the obsessive, blasphemous thoughts.

The general principle that is embodied in the Revalue step is,
The more clearly you see what OCD symptoms really are, the more rapidly you can dismiss them as worthless garbage that is not worth paying attention to
. The practice of the first three steps gradually removes the fear and anxiety that OCD causes when its false messages are taken literally at “face value.” As you learn that OCD need not control your behaviors or thoughts, you come to devalue it and can begin simply to ignore it as nothing but a bothersome pest. In fact, the more consciously and
actively
you can come to Revalue it as mere foolish nonsense, the more quickly and smoothly you can perform the Relabel, Reattribute, and Refocus steps and the more steadily your brain’s “automatic transmission” function returns. Revaluing helps you shift the behavioral gears! Furthermore, as people come to understand their disease more clearly and use the Four Steps as their weapon to defeat this enemy they commonly gain a new ability to Revalue their lives and their feelings about themselves and others.

Lara put it this way: “Having OCD has made me a more intense,
sensitive, and compassionate human being. I have been humbled by my disorder. It has built character even while tearing at my soul, my heart, and my self-esteem. It has enabled me to fight harder, to strive for the good and the truth inside me. It has made me less critical and judgmental of others who suffer in their lives.”

“GOD LOVES ME”

Having been given the tools to fight back against OCD—knowing that it need never again take over their lives—people begin both to think of the time and opportunity they lost and to look to the future with a renewed zest for living. Often, they experience a spiritual awakening.

Joel, having largely overcome his hoarding and contamination compulsions, finds that for the first time in years “there is an intrinsic value in life itself. I never had the type of depression where I would want to kill myself, but life was just really drudgery.” Carla tells of her gratitude that her daughter—the daughter she obsessed that she might kill—is now a happy, healthy 6-year-old. Although Carla is devoutly religious, in her darkest moments she had questioned whether there was an Almighty power capable of forgiving her for having these awful thoughts. Now, she understands, “God loves me.” She has Revalued her life. No longer wallowing in her guilt and anger, she is “fired up,” determined to do something more meaningful than just working to pay her bills. She says, “I want my life to make a difference. I want to help others. Having OCD has pushed me to work a little harder. There are so many people out there with needs. I feel like my life has been spared, like I have this illness for a reason, that now I must make a difference.”

God can certainly tell the difference between what is in your heart and is real and what is just a false message coming from your brain. It is important never to forget that point. Cognitive-biobehavioral self-treatment presents a real opportunity to actively reaffirm your faith in God’s ability to know who you really are. It is only when you allow yourself to take the blasphemous OCD thoughts at face value—and to mistrust your deepest inner feelings about God’s capacity to tell what’s real and what’s not—that you develop a sense
of self-loathing. Lake all battles worth winning, in the end it’s a test of faith.

You must continually remind yourself, “This is not a blasphemous thought. This is an OCD symptom. I don’t believe it, and it is not a reflection of what I feel in my heart.”

Perusing a conservative religious magazine, Christopher—who suffered from recurring blasphemous thoughts—read an article stating that it was wrong to receive Communion in the hand, even though it is common practice today in the Roman Catholic church and one that he had followed since childhood. Because he is very conservative by nature, Christopher became frightened that he would offend God and, for a long time afterward, would take communion only directly in the mouth. He also obsessed that nearly everyone around him was unknowingly committing this terrible offense of receiving Communion in the hand. This obsession made him feel so miserable that he came to dread Sunday Mass and would start getting nervous on Friday or Saturday. Finally, he forced himself to take the risk of offending God by confronting the obsession and taking the Communion wafer in the hand. The first time he did so, he broke out in a sweat and his heart was pounding so hard he could hear it. But, of course, God did not punish him.

The symptoms of OCD frequently have a religious content or overtone in people of faith, and this fact is not always appreciated adequately. For instance, the fact that when Christopher first sought professional help for his disease, he was rudely questioned when he tentatively explained that he had considered that his symptoms might be a form of demonic possession should serve as a wake-up call to the psychiatric community. Too many psychiatrists today seem to have a blatant inability to empathize with the perfectly reasonable content of religious thoughts in the minds of some religiously observant people. Being an intelligent and insightful person, Christopher basically understood that he had a medical disease and that demonic influence had nothing to do with his terrible thoughts. He knew, through spiritual self-examination, that he was not under the influence of demonic powers and was confident that he was suffering from a neuropsychiatric condition. He had already considered and discarded the possibility of demonic influence
before he consulted a psychiatrist. The stressful nature of the initial interaction between Christopher and the psychiatrist who misunderstood him was probably more a reflection of the all-too-common ignorance and arrogance of psychiatrists than of anything that was going on inside Christopher as he tried to describe and explain his terrible pain.

ELUDING OCD’S TRAP

In the context of the Four Steps, Revaluing can be understood as an accentuation of the Relabel and Reattribute steps. By refusing to take their symptoms at face value, people with OCD come to think of their bothersome feelings and urges as, in one person’s words, “toxic waste from my brain.” Doing so enables them to work around the thought or urge so quickly that the Relabel/Reattribute steps become virtually automatic. They no longer have to shift gears manually, gear by gear, to change to another behavior. They now recognize the OCD thought or feeling for what it is almost the moment it occurs. Ongoing self-treatment results in a decrease in the intensity of symptoms, which, in turn, enhances Revaluation by lessening the effort required to dismiss the OCD symptoms as the worthless rubbish they are and to Refocus on a positive behavior.