Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (15 page)

The Refocus step is at the core of self-directed cognitive-biobehavioral therapy. The key to Refocusing is to realize that you must go on to another behavior even though the OCD thought or feeling is still there. You’re not going to let those thoughts or feelings determine what you do. Your battle cry is never “I have to get rid of this feeling.” If it were, you’d be the guaranteed loser. You can’t do much of anything to make the awful feeling quickly go away, just as you can’t make the annoying false alarm in the car shut off. You must work around it. One of the great ironies of life is that when we don’t really care whether we get something, it often comes our way. The same principle applies to fighting the symptoms of OCD. When you say, “Hey, who cares if they go away or not? I’m going to do something constructive,” you actually increase the chance that they’ll go away. Meanwhile, you are doing something that gives you pleasure, rather than pain. You are using your Impartial Spectator—that observing voice of reason within you—to say, “Oh, that? That’s OCD. Let me do something else.” By doing another behavior, you’ll also be improving how your brain functions.

As our research at UCLA has proved, the ability to work around the OCD is a powerful weapon. When you do it, you actually change the way your brain works—in essentially the same way that medications change brain chemistry. You fix the broken filtering system in the brain and get the automatic transmission in the caudate nucleus to start working again. When those OCD urges come on, you try to wait at least fifteen minutes without acting on them. At the end of that time, maybe you’ll be able to say, “Well, it’s still bothering me, but not as much. I’ve noticed a change.” If it doesn’t happen on the first try, be patient; it will happen in time. As you learn to manage your anxiety, your powers of observation will improve. You will develop a powerful mind, a mind that is sensitive to subtle changes and able to see the implications of those changes. The applied use of your Impartial Spectator is the ultimate in mental power. So after one successful fifteen-minute wait, you may assess the situation and decide, “Hmmm…it’s not bothering me as much. I’m going to wait another fifteen minutes.” People who can do so always get better. I have yet to see anyone who reaches that level of mental resolution who fails to improve.

IF YOU’RE WORKING, YOU’RE WINNING

Now, how do I define “getting better”? Since OCD is a chronic disease, my definition of getting better is reaching a point where the OCD affects your everyday functioning far less, where it is no longer making you act in ways that you regret, no longer interfering with your performance on the job, no longer interfering with your personal relationships, no longer commanding your constant attention. And I can guarantee that you can do this for yourself. Even though your OCD may still try to sneak in and make your life miserable, you now know that it’s not how you feel, it’s what you do that counts. As our research at UCLA has shown, when you focus on working around your OCD, you start to feel more comfortable inside because your brain starts to work better. On the other hand, if you just sit there, repeating over and over, “I have to feel more comfortable,” you’re not going to change your behavior, you’re not going to change your brain, and you’re not going to get better. You need to be active; you cannot be passive.

Just because your orbital cortex is stuck in gear and sending you false messages doesn’t mean you have to listen to it. That’s the important mind-brain discovery around which our UCLA team has structured the Four-Step program. Many scientists and philosophers have been inclined to say, “If the orbital cortex says it’s a go, it must be a go.” But it’s not a “go”—unless
you
go.
You’re
the one who decides whether you’re going to listen to those foolish messages and act on them, not your orbital cortex. Your orbital cortex may be telling you, “Wash!” but that doesn’t mean that you must wash. As it turns out, if you refuse to give in and wash, you’ll start to make positive changes in the way your orbital cortex works. Your orbital cortex will tell you, “Wash this! Check that!” If you listen to it, it will get hotter and hotter and hotter. But if you refuse to listen to it, we have learned, it will cool down. (Remember those brain photos on the book jacket?)

By learning to put off acting on an obsessive thought for fifteen minutes—or even five minutes—you are teaching yourself response prevention. You do not need to spend hours in therapy with a medical professional, as was once thought necessary. This is truly self-directed therapy in the sense that you are your own therapist. Of
course, you can always get additional help and support. But you will find that as you apply the Four Steps—Relabel, Reattribute, Refocus, Revalue—you will be able to expose yourself for longer and longer periods to those terrible thoughts and urges without performing compulsive rituals in response to them. Initially, you may have to remove yourself from the sink very quickly so as not to give in and wash your hands again or move away from the door so as not to check the lock again. It’s okay at first to put some physical distance between yourself and the sink or the lock. But never say to yourself, “Oh, my God. I gave in. I’m terrible. I’m a loser. I’m never going to get better.” If you do a compulsion, just tell yourself that OCD won this round—and vow that next time you’re going to work to ignore the sink or the door and try to Refocus on doing something worthwhile and pleasurable. Just realizing that this is a form of behavior therapy, even if you’re doing a compulsion at the same time, prevents you from taking the compulsive behavior literally at face value (it’s not “washing your hands,” it’s “doing a compulsion”) and keeps your Impartial Spectator active and in play.

Typically, a person with OCD experiences the urge to perform a compulsion many times during a day. However much time you’re able to put between getting the urge and acting on it is time well spent, even if it’s only a minute or two. At the end of that period, it’s important that you reassess the bothersome urge and make a mental note of any change in the intensity of the urge during the time you were able to hold it at bay. Even if there is an almost imperceptible change in its intensity—which often happens—you will have learned that you can control your behavioral response to the OCD thought.

RECORDING YOUR SPIRITUAL SUCCESS

It’s important to keep a journal or diary in which you record your successes at Refocusing. It can be just a little spiral notebook to tuck into your pocket or purse. Why is this important? Well, for two reasons. In the heat of battle against a compulsive urge, it’s not always easy to remember which of your Refocusing behaviors was the most effective. What’s more, having a written record will help you place these helpful behaviors more firmly in your mind. Your diary can
also help you build confidence as you see your list of successes grow.

There is a spiritual aspect to overcoming OCD, as well as a biological one. In the Bible, the Book of Galatians says: “Be not deceived; God is not mocked: For whatever you may sow, that you will also reap.” It seems that the way God wired the human system, when people focus too much on how they
feel
, they don’t
do
what they must to overcome OCD. You can change your brain. But you have to do the sowing to reap the rewards. No one can do the work for you.

From studying OCD, we have learned a great deal about the relationship between how the brain works and what’s going on in the human mind. I continue to enjoy doing research on the causes and treatment of OCD largely because people with OCD are very rewarding to work with. They’re not only hard workers, in general, and very appreciative of help, but tend to be creative, sincere, and very intense. One woman in my OCD therapy group said, “Whatever I do is serious, even if it’s choosing a breakfast cereal.” In learning the Four Steps, this intensity is an asset. However, people with OCD also tend to become de-energized, worn out from what they have come to view as a hopeless struggle against a fiendish disease. Refocusing helps to re-energize them.

The best Refocusing activities require concentration and strategy and involve other people. Jogging alone, for example, is less apt to take your mind off your obsessive and compulsive thoughts than a good game of bridge or even solving some work problem—as long as what you do gives you pleasure. (This is not to deny that jogging alone can be helpful for many people.) Here again, my patients are very creative. One man used to be afraid to shave because he was terrified of hurting himself as punishment for having obscene obsessive thoughts. Now he can use shaving as a Refocusing activity when these thoughts arise. The result is that both his face and his mind have become very clean!

THE MIND-BRAIN CONNECTION

The study of OCD is intellectually stimulating. Unlike those who suffer from many other psychiatric diseases, people with OCD can tell you in pretty clear language how they feel and what’s bothering
them. They can describe in minute detail ominous feelings and intrusive urges and the misery and suffering that these feelings and urges cause. As a result, we have a pretty good idea of what’s going on in the mind of a person who has these urges to wash or check or whatever. Since we now know a fair amount about what goes on in the brain of a person with OCD, we can gain a better understanding of the relationship between what goes on in the brain and how the person feels inside. Understanding the relationship between what the brain does and a persons internal life is very important, both for medical reasons and because it is such a fascinating subject in its own right. Three factors are at work here: the capacity of people with OCD to tell how they feel inside, the emerging understanding of the underlying brain problems that cause OCD, and the intriguing fact that among all psychiatric conditions, OCD is one of the few that does not respond very well to so-called placebo treatment—blank pills. Even with schizophrenia and depression, when people are given blank pills—pills that they think may be helping them—a fair number of them actually improve in the short term. But with persons with OCD, generally less than 10 percent get better when they are given placebos, so if something active isn’t being done to combat their symptoms, nothing really happens—or they get worse. Put all these findings together, and you can begin to see why studying OCD can be so revealing about the relationship between the mind and the brain. Both the strong evidence that the brain changes when people with OCD improve (and they tend to improve only with truly effective treatment), and the fact that people with OCD can accurately relate how they think and feel before and after treatment add up to powerful sources of information on the relationship between the brain, behavior, and a person’s mental life.

STAY ACTIVE!

I firmly believe that allowing or encouraging patients to be passive is a problem with much of modern medicine. A person goes to a doctor, the doctor does what the doctor does, and the person waits to get better. Our UCLA treatment method teaches people what they can do to help themselves. Medications are fine, if used to help peo
ple help themselves (the “waterwings” theory). In treating OCD, medications make it easier for many people to learn to do the Four Steps. They certainly make the unpleasant OCD symptoms fade more quickly when you do the fifteen-minute rule. But eventually, as you keep working at your self-directed cognitive-biobehavioral therapy, you find that you can do it successfully with less and less medication. And that’s a good thing.

The bottom line is that as you do fewer and fewer compulsive behaviors and pay less and less attention to your obsessive thoughts—work around the thoughts—those thoughts and urges will fade more and more quickly.

So the familiar brain trio—the orbital cortex, the cingulate gyrus, and the caudate nucleus—have ganged up on you. The orbital cortex is sending you false messages that “something is wrong” the cingulate gyrus, which is wired right into your heart and guts, is making you feel, “Oh, something terrible is going to happen if…” and the caudate nucleus is not shifting gears to enable you to abandon repetitive, nonsensical behaviors and move on to other, appropriate behaviors. But once you start using the Four Steps, you will no longer act unthinkingly and automatically on those false messages. You will know what’s going on up there and you will stop reacting like a puppet. Your Impartial Spectator will keep you in touch with reality and tell you, “That’s good, that’s bad,” just as your tongue tells you, “That’s sweet, that’s sour” and your eyes tell you, “That’s red, that’s green.” You will look at yourself and be able to ask, “What is this feeling?” The answer? It’s Brain Lock. Once you realize that the feeling has no deep meaning, that it’s just a false alarm, you will be able to largely ignore it and go about your business. You shift gears and
do another behavior
. (And preferably, since you’ve Anticipated and planned ahead, you’ll know in advance what behavior you will do.)

WHAT IT MEANS: NOTHING

But if you take OCD’s false messages at face value, you will spend your time fretting and worrying. “Did that guy touch me? Maybe he scraped against me when I wasn’t looking. Oh, my God. What does it mean?” Deep down, to be honest, you know it doesn’t mean any
thing. You know that you are not contaminated because of your “encounter” with that mystery man. But without the Four Steps as tools to reassure you, the feeling is so strong that you’re apt to buy into it.

What you
don’t
want to do right off the bat is say, “You know, those two hundred compulsive behaviors I have, well, tomorrow I’ve got to stop doing them.” Do what’s easiest first: Tackle one and try to wait fifteen minutes before responding to its silly commands. It may be wise to start with the one that causes you the least stress. Keep a list, a kind of stress meter, if you think it will be helpful (see Chapter Eight: The Four Steps and Traditional Approaches to Behavior Therapy).

As a member of the human species, you have a little edge at the starting line. Dogs can get a disorder that causes them to lick their paws, fur, and skin, compulsively and destructively—a condition that, Dr. Judith Rapoport of the National Institutes of Health found, can be treated with the same medications that are used to treat OCD. But you cannot say to a dog, “It’s not you—it’s just your canine dermatitis. It’s caused by urges from your brain. Refocus. Go dig in the back yard.” However, as human beings we have the capacity to observe our own behavior, to use our Impartial Spectator, to increase our mindful awareness, and to make thoughtful decisions about how we’re going to value and respond to the signals our brain is sending us. Our patients at UCLA have developed their own techniques for distracting themselves from doing their compulsions. One young man snaps the fingers of both hands. One woman gently slaps her face a few times. You do whatever works.