Brain Lock: Free Yourself From Obsessive-Compulsive Behavior

BRAIN LOCK

Free Yourself from Obsessive-Compulsive Behavior

A Four-Step Self-Treatment Method to Change Your Brain Chemistry

Jeffrey M. Schwartz, M.D.

with Beverly Beyette

Dedication

This book is dedicated to the memory of my grandfather
H
ARRY
W
EINSTEIN

and to the memory of
V
EN
. M
AH
SI
S
AYADAW
for his monumental contribution to the practice of mindful awareness in this century

Contents

Dedication

Acknowledgments

Foreword

Introduction
Obsessions, Compulsions, and the Four-Step Self-Treatment Method

Part I:
The Four Steps

1
Step 1: Relabel
“It’s Not Me—It’s My OCD”

2
Step 2: Reattribute
“Unlocking Your Brain”

3
Step 3: Refocus
“Wishing Won’t Make It So”

4
Step 4: Revalue
“Lessons Learned from OCD”

Part II:
Applying the Four Steps to Your Life

5
The Four Steps and Personal Freedom

6
OCD as a Family Disorder

7
The Four Steps and Other Disorders
Overeating, Substance Abuse, Pathological Gambling, Compulsive Sexual Behavior

8
The Four Steps and Traditional Approaches to Behavior Therapy

9
OCD and Medication

10
University of Hamburg Obsession-Compulsion Inventory Screening Form

11
An OCD Patient’s Diary of Four-Step Self-Treatment

Part III:
Self-Treatment Manual for the Four-Step Method

Copyright

About the Publisher

The names and some of the external circumstances of the patients in this book have been changed to protect their confidentiality. All of the symptoms and therapeutic efforts are as they actually occurred.

Note: Part III of this book is a Self-Treatment Manual which contains a practical summary of the Four-Step Method. It can be read independently from the rest of the book, and can be referred to at any time for concrete guidance. There is also a video overview of the Four Steps at
http://ocduk.org/video/FourSteps/index/htm
.

Acknowledgments

This book could not have been created without the efforts of the many patients who helped me learn the Four-Step Method. Without the generous support of the Charles and Lelah Hilton family, the scientific work on which this book is based could not have been done. Jessica Klein and Steve Wasserman encouraged me to write this book and introduced me to my publisher, Judith Regan, who has recognized from the first the potential implications of the work described here. Christine Juska helped prepare early drafts. Julie Sherman earned special thanks for her contributions. Will Weston was very helpful with artwork, A. Lorre with photography.

The OCD Research Group at UCLA Medical Center created an excellent environment for doing these studies. Beverly Beyette made a tremendous effort to help the book be as good and useful to as many people as we could make it. Iver Hand was generous with his time and input. Jan Jablonsky, Marty Wax, and Dave Richmond, among others, made helpful comments. Pam and Roy Norman provided much-needed moral support during the hectic final stage of preparation. James Q. Wilson and Don Jefferys encouraged me to pursue some of the broader potential applications of this method.

All in all, you need a lot of help to write a book about self-treatment. Thanks to all the people who provided it.

Foreword

Howard Hughes was dining with actress Jane Greer at Ciro’s on the Sunset Strip in Los Angeles one evening in 1947. At one point in the meal, he excused himself to go to the rest room. To Greer’s amazement, he did not return for an hour and a half. When he finally reappeared, she was astonished to see that he was soaking wet from head to toe.

“What on earth happened to you?” she asked. “Well,” Hughes said, “I spilled some catsup on my shirt and pants and had to wash them out in the sink.” He then let them dry for a while, hanging them over one of the toilet stalls. Once he put his clothes back on, he explained, “I couldn’t leave the bathroom because I couldn’t touch the door handle. I had to wait for someone to come in.”

According to Peter H. Brown, coauthor with Pat Broeske of
Howard Hughes: The Untold Story
, Jane Greer never went out with Hughes again.

Howard Hughes was eccentric, certainly, but he was not a freak. He was suffering from obsessive-compulsive disorder (OCD), a classic and severe case. By the end of his life, in 1976, he was overwhelmed by the disease. He spent his last days in isolation in his top-floor suite at the Princess Hotel in Acapulco, where he had sealed himself in a hospital-like atmosphere, terrified of germs.
Blackout curtains at every window kept all sunlight out; the sun, he thought, might transmit the germs he so dreaded. Aides with facial tissues covering their hands brought him food, which had to be precisely cut and measured.

Rumors abounded that he was this reclusive because of drug abuse, a syphilitic condition, or terminal dementia. Actually, all his strange behaviors are readily understandable as symptoms of a severe case of OCD.

Sadly, there was no treatment for OCD in Howard Hughes’s lifetime. It would be another decade before the disease would be identified as a brain-related disorder.

I frequently cite the case of Howard Hughes to help my patients understand that this disease, OCD, is an insatiable monster. The more you give in, the hungrier it gets. Even Hughes, with all his millions—and a retinue of servants to perform the bizarre rituals his OCD told him to perform—could not buy his way out. Eventually, the false messages coming from his brain overwhelmed him.

If you are one of many who suffer from OCD, whether it is a mild case or one as severe as Howard Hughes’s, this book will show you how to fight and beat it. OCD is a tenacious enemy, but a strong-willed, motivated person can overcome it.

Along the way, you will also learn a good deal about your brain and how you can control it better. You will read the stories of courageous people who, by applying the Four-Step Method, learned how to overcome the dreaded feelings of “Brain Lock” that are caused by OCD. This method, which has been scientifically demonstrated to enable people to change their own brain function, will be described in such a way that you can readily apply it yourself.

Introduction

Obsessions, Compulsions, and the Four-Step Self-Treatment Method

We all have our little quirks—habits and behaviors—that we know we’d be better off without. We all wish we had more self-control. But when thoughts spin out of control, becoming so intense and intrusive that they take over against our will, when habits turn into all-consuming rituals that are performed to rid us of overwhelming feelings of fear and dread, something more serious is happening.

THIS IS OBSESSIVE-COMPULSIVE DISORDER (OCD)

The victims of OCD engage in bizarre and self-destructive behaviors to avert some imagined catastrophe. But there is no realistic connection between the behaviors and the catastrophes they so fear. For example, they may shower forty times a day to “ensure” that there will not be a death in the family. Or they may go to great lengths to avoid certain numbers so as to “prevent” a fatal airplane crash. Unlike compulsive shoppers or compulsive gamblers, people with OCD derive no pleasure from performing their rituals. They find them extremely painful.

Almost certainly, OCD is related to a biochemical imbalance in the brain that we now know can be treated very effectively without drugs. We know, too, that the Four-Step Self-Treatment Method
you will learn in this book enables people with OCD to change their own brain chemistry. Furthermore, this method can be applied effectively to take control over a wide variety of less serious, but troublesome and annoying, compulsive habits and behaviors. (If you think you may have OCD, the University of Hamburg Obsession-Compulsion Inventory Screening Form on Chapter 10 may help you find out. If you don’t, the techniques you learn in this book may help you overcome other troubling and annoying habits and behaviors.)

Simply defined, OCD is a lifelong disorder identified by two general groups of symptoms: obsessions and compulsions. Once thought of as a curious and rare disease, it, in fact, affects one person in forty in the general population, or more than five million Americans. A disorder that typically has its onset in adolescence or early adulthood, OCD is more common than asthma or diabetes. It is a devastating disease that often creates chaos in the lives of its victims—and those who love them. The preoccupation with repetitive behaviors, such as washing, cleaning, counting, or checking, causes trouble on the job and leads to marital strife and difficulty with social interaction. Family members may become impatient and angry, demanding, “Why don’t you just stop!” Or they may aid and abet the performance of the silly rituals to buy an hour’s peace (a very bad idea).

WHAT ARE OBSESSIONS?

Obsessions
are intrusive, unwelcome, distressing thoughts and mental images. The word
obsession
comes from the Latin word meaning “to besiege.” And an obsessive thought is just that—a thought that besieges you and annoys the hell out of you. You pray for it to go away, but it won’t, at least not for long or in any controllable way. These thoughts always create distress and anxiety. Unlike other unpleasant thoughts, they do not fade away, but keep intruding into your mind over and over, against your will. These thoughts are, in fact, repugnant to you.

Say that you’ve seen a beautiful woman and can’t get her out of your mind. That is not an obsession. That is a
rumination
, something
not inappropriate, something quite normal and even pleasant. If Calvin Klein’s marketing department had really understood the word
obsession
properly, the perfume would have been called “Rumination.”

GETTING THE (WRONG) MESSAGE

Because these obsessions don’t go away, they are extremely difficult to ignore—difficult, but not impossible. We now know that OCD is related to a biochemical problem in the brain. We call this problem “Brain Lock” because four key structures of the brain become locked together, and the brain starts sending false messages that the person cannot readily recognize as false. One of the main signal-processing centers of the brain, made up of two structures called the
caudate nucleus
and the
putamen
, can be thought of as similar to a gearshift in a car. The caudate nucleus works like an automatic transmission for the front, or thinking part, of the brain. Working with the putamen, which is the automatic transmission for the part of the brain that controls body movements, the caudate nucleus allows for the extremely efficient coordination of thought and movement during everyday activities. In a person with OCD, however, the caudate nucleus is not shifting the gears properly, and messages from the front part of the brain get stuck there. In other words, the brain’s automatic transmission has a glitch. The brain gets “stuck in gear” and can’t shift to the next thought.

When the brain gets stuck, it may tell you, “You must wash your hands again”—and you’ll wash, even though there is no real reason to do so. Or the brain may say, “You’d better check that lock again”—and you’ll check again and again, unable to shake off the gnawing feeling that the door
may
be unlocked. Or an intense urge to count things or to reread words may arise for no apparent reason.