In the past 20 years, behavioral therapy has shown great effectiveness in the treatment of obsessive-compulsive disorder. Among them, [exposure] and [reaction prevention] are very effective behavioral therapy technologies for the treatment of obsessive-compulsive disorder.
In the traditional process of psychotherapy, patients, under the guidance of a professional therapist, learn to expose themselves to stimuli that aggravate obsessive-compulsive ideas and impulses, and then do not respond in a compulsive way.
For example, a person who is irrationally and compulsorily worried about being contaminated by soil may be instructed to take some dirty things with his hands and cannot wash his hands for at least 3 hours afterwards.
However, such an approach is dangerous and is by no means suitable for patients to try it on their own.
Later, foreign scholars made some improvements to this method, so that patients can complete it independently without the presence and supervision of therapists.
The basic principle of self-treatment is that by understanding whether one’s obsessive-compulsive ideas and impulses are what or not, one realizes the fear and anxiety brought about by limiting corresponding thoughts and impulses. After being able to manage one’s own fears, patients can control their behavioral responses much more effectively.
The specific treatment strategy has four basic steps:
- Step 1: Reaffirmation Step 2: Reattribution Step 3: Refocus Step 4: Reevaluation
The patient’s goal is to practice these steps every day, of which the first three steps are especially important when starting treatment.
This technology can be applied in daily life to manage patients’ [response mode] to obsessive-compulsive disorder. Its essence lies in [self-treatment].
It should be emphasized that before [self-treatment], please see a psychiatrist to confirm that you do suffer from obsessive-compulsive disorder.
Step 1: Reconfirm
The key first step is to learn to recognize obsessive-compulsive concepts and impulses.
Specifically, we need to try our best to obtain a deep understanding, that is, [this very annoying feeling at the moment is the feeling of forcing thinking or forcing impulse].
STEP 1 Focus on Awareness
To do this, it is very important to strengthen [focus awareness], that is to say, we need to realize that these invasive thoughts and impulses are symptoms of the disease.
The requirement of [concentration awareness] is to consciously identify obsessive-compulsive concepts and behaviors and to [psychologically mark] them through some practices.
For example, we can train ourselves to say [I don’t think my hands are dirty, I have a compulsive idea that I always feel my hands are dirty], or [I don’t think I have the need to wash my hands. I have a compulsive impulse to force my hands to wash].
This method is also applicable to other compulsive concepts and impulses, including checking doors and electrical appliances, suspecting that you have cancer, and unnecessary counting.
At this stage, we must learn to see through the truth of these invasive obsessive-compulsive concepts and compulsive impulses-they are obsessive-compulsive disorder.
2. [Let them disappear]?
It is also important to bear in mind that just reconfirming these thoughts is impulsive and will not let them go.
In fact, the worst thing we can do is [try to make them disappear].
This will not work, because these thoughts and impulses are already deeply [written] in the brain, which is beyond our control.
What we can control is the response to those compulsive behaviors. Try not to wash your hands, not to check, not to think over and over again… It is difficult, but it is worth trying.
3. Identify new goals
The process of confronting obsessive-compulsive disorder may take us at least a few weeks or months and requires patience and sustained and constant efforts.
Attempts to let these ideas and behaviors go within a few seconds or minutes can only lead to frustration, depression and tension.
In behavioral therapy, the most important thing is to learn the fact that all our reactions to thoughts and impulses are actually under our control, no matter how strong or annoying they are.
Remember, our goal is to control our [reactions] to these thoughts and impulses, not to control [ideas] and [impulses] themselves.
The following is the practice time!
- When I can’t help but want to check whether the doors and windows are relevant, I have to train myself to say…? When I can’t help but want to check if the gas valve is closed, I have to train myself to say…? When I feel that my hands are not clean enough and I can’t help but want to wash them several times, I have to train myself to say…? When I feel that I have some kind of disease and want to go to the hospital for another examination, I have to train myself to say…? When I can’t help but want to count the floor tiles in front of me, I have to train myself to say…?
What again?
Return to the above, find it, remember it, and then come back to finish this exercise.
Let’s keep practicing this exercise in our daily life. Don’t worry, the changes brought about by this exercise need to go through a process.
Step 2: Reattribution
The goal of this step is to learn to reattribute the intensity of obsessive-compulsive disorder thoughts or impulses to their real cause-a mental disease triggered by the biochemical imbalance of the brain.
Admitting this is the first step towards a deeper understanding of [these symptoms are actually an illusion], after which you can no longer be fooled by their appearances.
1. What is the problem with obsessive-compulsive disorder?
Deep in the brain, there is a structure called the caudate nucleus. Scientists now believe that there is something wrong with the caudate nucleus of obsessive-compulsive disorder patients.
We can think of the caudate nucleus as an information processing center or filtering station, which processes all kinds of very complicated information produced by the frontal lobe in the anterior part of the brain, and the frontal lobe region is probably the part used to perform thinking, planning and understanding functions.
The caudate nucleus and the structure called the putamen next to it form the striatum. They, like automatic transmission devices in automobiles, receive information from the part of the brain that controls body movements, body sensations, and thoughts and plans involved in movements and sensations, ensuring that the body can smoothly transition from one behavior to another.
2. What’s problem with the sick striatum?
When a person decides to do an action, intrusive actions and misleading feelings will be automatically filtered, so that the actions we originally wanted to do can be completed quickly and effectively.
After this action is completed, the striatum will switch to the next action, just like the gear conversion of a variable speed car.
On a normal day, we can easily and quickly make many behavioral changes, which are smooth and easy, and usually do not require thinking.
However, in patients with obsessive-compulsive disorder, the failure of caudate nucleus causes it and putamen to fail to function normally, which leads to problems in effective filtering of temporary information and conversion of thinking and actions.
As a result of this failure, the anterior part of the brain becomes overactive and energy consumption increases accordingly.
It’s like our wheels are stuck in the ditch. We press the engine hard and try to turn the wheels, but as long as there is no help from the trailer, the car cannot get out of the ditch.
Obsessive-compulsive disorder patients consume too much energy in the area of the frontal lobe called the orbital frontal cortex. This area contains the error monitoring circuit. It will realize that we are [stuck in the groove], so it works hard to correct the errors.
How does self-treatment correct the problem?
Self-directed behavioral therapy, like a trailer, enables us to objectively repair the damaged [gearshift] in the brain, namely the caudate nucleus, while realizing the [gearshift] behavior and getting rid of that groove.
The most effective thing we can do to improve the brain is to learn to put aside those [thoughts] and [feelings] and start the next behavior.
This is what we mean by [shifting gears]: doing another thing.
We can use the two steps of reconfirmation and reattribution at the same time to understand more clearly [what happened to what] when forced thinking and impulse tortured us severely:
- Let’s reconfirm it first and call it as it is-[obsessive-compulsive concept] and [obsessive-compulsive impulse]; Then, we use [concentration awareness] technology to take the [meaning] of the superficial symptoms of obsessive-compulsive disorder to a deeper level-these thoughts and impulses are just side effects of a disease, it is just because our brain has a problem and cannot smoothly [shift gears].
At this time, we can make decisions for ourselves and do another thing.
Step 3: Refocus
At this stage, we have really entered the [curative] stage.
Without hard work, there will be no harvest. This step of practice may make people feel [difficult] at the beginning.
1. Is what a [refocus] technology?
Let’s first understand the concept of [refocus]: bypass compulsive thinking and impulse by shifting our attention to other things, even if it is only for a few minutes.
At first, we can choose some specific behaviors instead of forced hand washing or examination. Any constructive and pleasant behaviors can be used. Hobbies are especially helpful, such as walking, fitness, listening to music, reading, playing computer games, knitting or playing basketball.
The goal of this stage of treatment is to stop responding to obsessive-compulsive symptoms and realize that these discomfort will continue to plague us in the short term.
Generally speaking, we need to bypass obsessive-compulsive ideas and impulses by diverting our attention to other behaviors. Once we learn this trick, even if obsessive-compulsive symptoms still exist, what we actually want to do will no longer be controlled by it.
In this way, we can decide for ourselves what actions we will take, instead of bowing to compulsive ideas and impulses like robots.
In short, [refocusing] technology can restore the power of [self-selection].
Specifically, we can achieve our goal through exercises such as [15-minute rule] [keeping a behavior diary].
2. The 15-minute rule
It is not easy to refocus. Only by learning to resist obsessive-compulsive disorder symptoms can we change our brains and gradually relieve the pain.
In order to help everyone achieve their goals, scholars have designed the [15-minute rule]: when being instructed by compulsive impulses or thoughts to carry out compulsive acts, delay the response time-preferably at least 15 minutes.
At the beginning, or when the impulse is very strong, we can set a short time as the target, such as 5 minutes.
However, the principle remains unchanged: coercion must never be committed without delay.
Remember: This is not a [passive waiting] time.
During this period of time, you can actively complete the previously learned steps of reconfirmation, reattribution and refocus.
We need to keep the goal [to limit the time to at least 15 minutes]. Keep practicing, and our efforts to the same extent will make the compulsive impulse weaken more and more.
In addition, the longer the waiting time, the greater the magnitude of impulse change.
Generally speaking, the more we practice the 15-minute rule, the easier it will be to stick to it. Soon, we can stick to it for 20 minutes, 30 minutes or even longer.
STEP 3 Keep a Behavior Diary
Keeping a diary of behavioral therapy can enable people to have a written record to remind themselves of their success in self-directed behavioral therapy.
The importance of diaries is that we can review them again in the future to find out which behaviors can most effectively help us refocus.
Similarly, when we see a longer list of achievements, our self-confidence will certainly increase.
So, how to keep a diary of behavioral therapy?
You can try to write according to the following example.
In addition to recording successful experiences in the diary of behavioral therapy, you should also strengthen it by giving yourself some small rewards, even if you just tell yourself that “you are great because you are trying hard to help yourself”.
There is no need to record the failure experience when the confrontation time is less than expected, because what we need in the diary is the accumulated self-confidence.
4. Action is the most important thing
It is extremely important to shift attention from impulse or thinking and refocus on other reasonable behaviors or activities.
The long-term goal of refocusing is [to never use compulsive behavior to respond to compulsive thinking or impulse again], but the medium-term goal is [to establish a delay in time before any compulsive behavior is implemented].
Sometimes, compulsive impulses come too ferociously, forcing us to surrender. Even so, we need not blame ourselves too much.
Remember: while implementing the four-step rule and changing your behavior, our thinking and feelings will also change.
If we succumb to the symptoms and implement obsessive-compulsive behavior after prolonging the waiting time and trying to refocus. It doesn’t matter, what we need to do is try to continue [reconfirming] this behavior and let ourselves accept it. This time, we are overwhelmed by obsessive-compulsive disorder.
We need to remind ourselves:
As a result, even if we really wash our hands frequently and check doors and windows repeatedly, we have to count the number of floor tiles repeatedly, which also includes behavioral therapy factors.
This is because reconfirming compulsive behavior as compulsive behavior is a form of behavioral therapy, which is much better than carrying out a compulsive behavior without giving it a clear [psychological mark] in mind.
Step 4: Re-evaluate
After the third step, we can continue to follow the 15-minute rule and refocus on other behaviors, then we can proceed with the [reevaluation] step.
In this new step, we need to realize:
- The feeling of compulsion is not worth paying attention to at all. All thoughts, expressions and pains are just obsessive-compulsive disorder. It is just a disease.
As a result of accepting this evaluation, we will no longer attach so much importance to the feeling of obsessive-compulsive disorder.
1. Better reattribution
For the concept of compulsion, we must strengthen the above process with a more positive reevaluation. We can use the two steps of [foresight] and [acceptance] to better reattribute ourselves:
- [Foresight] means [preparation], that is, knowing [that feeling is coming], so be prepared for it and no longer be frightened by surprise attack; [Acceptance] means that we no longer waste energy and blame ourselves for having these bad feelings.
When we agree that [a series of problems brought about by obsessive-compulsive disorder are not worthy of attention, they are just obsessive-compulsive disorder], we can better decide [we must bypass them].
2. [Foresight] means no longer being caught off guard
Whether the content of the concept of coercion is what-violent, disastrous, disease-related, or expressed in dozens of other forms-we need to let ourselves know that it can happen hundreds of times a day.
We must stop acting like we have encountered a new and unexpected thought every time. We must stop being caught off guard every time.
We can refuse to let it frighten us and refuse to fall into a low ebb because of it.
3. [Anticipation] Better [Reconfirmation]
Predicting our own unique forced thinking can enable us to recognize its face immediately when it comes out and make [reconfirmation] immediately. At the same time, we can also positively [reevaluate] the idea.
In this way, when forced thinking appears, we are already ready to know:
- It is just a foolish idea of coercion. It is meaningless; It is only the product of my brain. There is no need to pay attention to it.
Remember: we cannot let the mind go away, but we can choose whether to pay attention to it or not.
We can learn to divert our attention and do something else-this is [refocus]-without having to speculate on the idea.
Move forward!
4. [Accepting] means no more remorse
Here, the second step [acceptance] will take over.
Think of the shrill whistle that constitutes interference and disturbs people’s hearts. Do we want to dwell on it? It doesn’t seem to work.
Needless to say [I can’t do it either in what unless the hateful car alarm is turned off], we just have to try to ignore it and do other things.
In the step-by-step [acceptance] of [reattribution], we have realized this fact in a very profound and even spiritual way.
Don’t dislike yourself, try to accept this: forced thinking will exist regardless of our wishes, it is not born of us.
5. [Acceptance] Can Better [Refocus]
We cannot eliminate compulsive thinking, but we can reduce the terrible pressure brought by repeated compulsive ideas.
Forced thinking or impulse is very powerful and stupid at the same time. If we confront it head-on, accept all its impacts and try to expel it from our minds, then we will lose every time.
[Refocus] Technology is like a martial arts skill for OCD.
In the face of a strong opponent, it is very important to remain alert and calm. Following the moves, we must stand aside, bypass it and continue to act.
You see, this course is far more than just about overcoming obsessive-compulsive disorder. It can teach us to control our minds and lives by controlling our actions.
Summary
We obsessive-compulsive disorder patients must learn to train our minds not to be fooled by the appearance of invasive feelings.
We must understand that these feelings mislead us. We must gradually and moderately change our reactions to those feelings and resist them. Even stubborn and invasive feelings are short-lived and cannot last long. If we do not impose compulsion on them, they will fade away.
Of course, we must always remember that if we give in to these feelings, they will easily become stronger and overwhelm us completely.
We must learn to recognize [it] as what and then resist it.
In the process of implementing the four-step method of behavioral self-therapy, we will establish the foundation of true [self-control] and [self-command].
This method enables us to resist the feelings and impulses brought by obsessive-compulsive disorder in a positive way, improves our self-esteem, and experiences the feeling of [free release]. Ultimately, it enables us to make conscious and self-directed choices.
More sense of control, real freedom, they are worth our efforts.