Cognitive Therapy and Obsessive-compulsive Disorder
For many people, obsessive-compulsive disorder responds well to a combination of antidepressant medication and cognitive therapy. Most people with OCD appear to be predisposed to the symptoms. Usually you can find other extended family members who share a similar pattern of ritualistic behavior. Therapeutic treatment involves the following process: relabeling, reattribution, relaxation techniques and refocusing strategies.
Relabeling and reattribution techniques are designed to assist in objectifying the disorder and realizing that people are more than their obsessions. For example, I teach people to internally respond by saying, “A part of my brain works in ways that make me repeat things continuously. This is merely my disorder speaking; I am more than my disorder.” This way of perceiving one’s obsessive features helps people to detach the nature of their problem from their sense of self.
Relaxation techniques may involve exercise, music, message, meditation and vacationing in a soothing environment. These strategies slow down the sympathetic nervous system minimizing anxiety and making it easier for people with OCD to manage their thoughts and behavior. One’s level of anxiety is directly related to the impact of compulsive behavior.
Refocusing techniques refers to assisting patients to shift from obsessional thinking and behavior to other more self-rewarding activities. A change in activities lessens the impact of the OCD thinking and behavior. For example, a child may have a ritualistic pattern of continuously changing the television remote control in a certain order. A therapeutic goal might be to get the child to leave his obsession by getting up and leaving the room, possibly departing the house for a brief walk. I have people track the intensity of their anxiety during the time that they are away from their ritualistic behavior. When removed from an obsessional behavior, anxiety initially becomes worse and then dissipates in strength over time. Once the child returns to the obsessional pattern after voluntarily leaving it, it usually has decreased in its impact and intensity. The child may say, “I was able to keep from repeating the pattern continuously. I only did it twice!” Reinforcement and encouragement are important for people attempting to minimize obsessive patterns.
Those who experience OCD are typically anxious about their symptoms and fight to get rid of them. It is essential that those who suffer from OCD learn to accept their symptoms rather than struggle with them. Acceptance of any form of anxiety helps one to minimize the symptoms. For example, one might say, “Here come those “crazy feelings” again. They sure are annoying but they won’t hurt me. If I learn to “let them be” they will eventually dissipate in their effect on me.”
It is important for those who experience OCD to share their problem with a close friend or therapist. Expressing one’s feelings about the pattern may help in dealing with any feelings of shame or embarrassment. For the OCD sufferer, it is significant to remember that most people experience features of the disorder. All behavioral problems lie on a continuum. Struggling with OCD is no exception. When we share our problems with others, we realize that we are not alone in our difficulties. It takes courage to admit that we are less than perfect and to allow ourselves to share our humanity with others. When we learn to quit fighting with our imperfections, the issue eventually seems less troublesome.
James P Krehbiel
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