Brain Lock: Free Yourself From Obsessive-Compulsive Behavior (6 page)

Of course, performing a compulsive behavior repetitively, ad nauseum, is also exhausting. But it is exhaustion with no positive payoff. When the Impartial Spectator is attended to, when an action is done mindfully, it makes a significant difference in how the brain functions. And that is the key to overcoming Brain Lock. This is what our scientific research at UCLA has shown.

WHO’S IN CHARGE HERE?

There will be times when the pain is too great and the effort required too debilitating, and you will give in and do a compulsion. Think of it as a tiny backward step. Tell yourself that you’ll win next time. As Jeremy, a man with OCD, put it, “Even when you fail, you succeed—so long as you persevere. So long as you take on this enemy, OCD, with mindful awareness.”

Anna, a philosophy student, described how she used the Relabel step in battling an obsession that her boyfriend (now her husband) was unfaithful to her. Although she knew her fears had no basis in fact, she would bombard him with questions about past romances, about whether he had ever looked at pornographic magazines, about what he drank and how much, what he ate, and where he was every minute of the day. Her relentless interrogations almost led to the breakup of their relationship. Anna recalls, “The first step in beginning to conquer my OCD was to learn to Relabel my thoughts and urges. The second step was to Reattribute them to OCD. In my treatment, these went hand in hand. On an intellectual level, I knew that OCD was a chemical problem in my brain and that the sensations this problem produced were more or less meaningless side effects of the chemical problem. Still, it is one thing to know this intellectually and another to be able to say while in the midst of an OCD attack that what you are feeling really isn’t important per se.
The irritating thing about OCD is that when you have it, your worries, urges, and obsessions seem like the most important things in the world. Stepping back from them long enough to identify them as OCD-generated is thus no mean feat.”

In the early stages of Anna’s learning to Relabel, her boyfriend, Guy, kept reminding her that her obsessions were “just OCD,” but he could not always convince her. Over time—and with practice—she became, in her words, “pretty good at recognizing what is OCD and what is a ‘real’ worry or anxiety. As a result, I can frequently avoid buying into OCD when it strikes. I no longer become mentally distressed each and every time an obsessive-type thought enters my mind. Often, I can look beyond it and say to myself, ‘You know, it won’t do any good to get all upset about this thought. I’ve been through all this before, and it doesn’t accomplish anything to allow myself to be sucked into OCD’s tricks.’ Doing this allows a certain calm and satisfying detachment.” Anna found that the intrusive thought—or at least the intense anxiety surrounding it—dissipates, usually within fifteen to thirty minutes.

For Dottie, who had the obsession about her son losing his eye-sight and who coined the phrase “It’s not me—it’s my OCD,” Relabeling was the biggest help in combating her compulsion. “It was not dwelling on it, recognizing it, and saying, ‘It’s okay, it’s just a thought and that’s all it is.’ Most days, that works for me. Some days it’s a struggle. I say people with OCD will always have OCD unless they find some magical pill.” But, as you’ll learn from the stories throughout this book, the mental strength and power you gain while fighting OCD can never be gained from any “magic pill.”

Jack, the hand washer, had been looking for that magical pill. “That’s America. You take a pill and your life will be wonderful; you’ll be a whole new person, more aggressive or nicer or thinner or whatever.” But when medication did not make his OCD symptoms abate and the side effects of medication grew too bothersome, he turned to cognitive-biobehavioral therapy. For him, the first step in Relabeling was to recognize the absurdity of his hand washing and to convince himself that it was not logical. When he was at home, he washed almost continuously, but when he was out, it didn’t seem so important to wash. “In behavior therapy, I thought, ‘Wait a minute.
You go out to fast-food places and you don’t wash your hands, then you handle money or they handle money, and nothing bad has happened to you yet, you know. And even if you use their rest rooms to wash your hands, it’s hard to get out without touching a doorknob.” Jack didn’t have dirty hands; he had OCD, and he was beginning to use his rational mind to overcome it.

Barbara, who had obsessions about Mr. Coffee, spoke of mindful awareness as a tool that helped her to Relabel. “By putting myself into a deliberately aware or conscious state when checking, I could walk away from the site of the compulsion with, if not the certainty that the appliance was off, at least with the real, firm knowledge that the check had been performed. I also learned to say to myself when feeling the horrible uncertainty that, say, the stove was not off, ‘This is not me—this is my OCD. It is the disease that is making me feel uncertain. Although I
feel
the stove is not off, I have checked it mindfully and should now walk away. The anxiety will lessen eventually, and fifteen minutes down the line I’ll feel even more certain that the stove is off.’” If you have problems with checking compulsions, take particular note of Barbara’s description. It’s excellent advice on how to perform checking behaviors in a way that prepares you to deal with compulsive urges.

Lara, who has the terrifying obsession about knives, learned to tell herself, “Lara, it’s only an obsession. It’s not reality. You’re frightened because it seems so horrific and unbelievable. This is a disorder, just like any other disorder.” Understanding that OCD is a medical condition and that obsessions are false messages with no real power or meaning “lessens their power and punch,” Lara learned. Obsessions
don’t
take over your will. You can
always
control—or at least modify—your responses to them.

Jenny developed a lingering obsession about nuclear contamination while working in the Soviet Union. Learning that she had a biochemical problem in her brain “lifted some of the burden,” she said. “I’d always been so angry with myself. ‘How can you be so strong and successful in so many areas of your life and still have this problem?’ I’d always felt that I was entirely at fault because I was not able to psychoanalyze myself. I could never get in there and find out what was bothering me or find the right mantra, the right shrink,
whatever.” Now, when OCD attacks strike, she talks to herself, telling herself, “Well, I know what
that
is.” And, usually, she manages to move on.

Roberta, who has the obsession that she has hit someone while driving, said, “I still have the unwanted thought, but it is now controllable. Now, when I go over a bump in the road, I tell myself that it is just a bump. The thought that I hit someone is just a wrong message. It’s OCD—not me! I try not to look back or to retrace my route. I force myself to keep going forward. I am no longer afraid to drive. I understand that if the obsessive thought comes, I know that I can deal with it. When I’m getting frustrated, I even say out loud, ‘It’s not me—it’s the OCD.’ And then I’ll say, ‘Okay, Roberta, just keep going straight ahead.’”

Jeremy, an aspiring young screenwriter, is largely free of OCD after eight months of behavior therapy. Today, he says, “I still feel the anxiety of freedom. It hurts, but it is the price to pay to be a free man.”

From childhood, Jeremy had been overwhelmed by touching and checking compulsions that he performed without fail, fearing that a family member would die “and God would damn me to hell for it.” Home became a “torture chamber” of rituals. By his teens, Jeremy was seeking escape in alcohol and drugs. As a young adult, he kicked his drinking habit with the help of Alcoholics Anonymous, but he began to obsess that something he had eaten contained alcohol. It could be Rice-a-Roni or something equally nonsensical. Logic played no role here.

At his gym, Jeremy imagined that someone had used drugs or alcohol before touching the bars and weights and that he would somehow absorb it. In a public bathroom, he would be seized by the thought that a drunk had vomited in the toilet just before he used it and, through some kind of magical transference, the alcohol was going to get into his system. Mentally and emotionally, Jeremy was exhausted from dealing with his obsessions and compulsions. When he first came to UCLA seeking help, he said, “I feel like I have been through the jungle in Vietnam.”

During treatment, Jeremy kept with him a small spiral notepad on which he’d written
CAUDATE NUCLEUS
. That’s the part of the brain
that’s not filtering out the OCD thoughts properly. This was his constant reminder that he had a brain-wiring problem, that he had OCD. It helped him to be mindful that he had to screen the OCD thoughts through his own mental power. “Once the pain had a name,” he says, “the pain wasn’t as bad.” Making mental notes eventually made his brain’s filtering system begin to work better.

Earlier, I mentioned the Relabeling substep, Anticipation. The other substep in Relabeling is Acceptance. Jeremy became adept at both. Before treatment, he had lived in fear of being caught in some imaginary dastardly act and being fired from his job as a night watchman. With behavior therapy, he was able to say, “Big deal. Nobody’s perfect. Let them fire me; I’ll get another job. Worst-case scenario? I’ll eat at soup kitchens. Hey, George Orwell did it and wrote a great book about it,”
Down and Out in Paris and London
. And if there really was forbidden alcohol in something he’d eaten, Jeremy would say, “Just a slip. Not intentional.” No guilt. No recriminations.

Once free of OCD symptoms, Jeremy had a reaction that is not uncommon. “For years, OCD had run—and been—my life. I thought of little else. I actually mourned my O’CD.” But this mourning period was short, and soon Jeremy began to fill the vacuum with positive, wholesome activities.

RX: ACTION

Learning to overcome OCD is like learning to ride a bicycle. Once you learn, you never forget, but getting good at it takes practice. You’ll fall off, but you must get back on. If you give up, you’ll never learn. Most patients find that it helps at first to have training wheels for the bike. That’s where the medication comes in. In combination with behavior therapy, medication has been shown to produce an 80 percent success rate.

The vast majority of those who fail to respond to this treatment combination do so because they become demoralized and throw in the towel. It is essential that you never do the compulsion and tell yourself, “I can’t avoid doing it. It’s bigger than I am.” It’s okay to
feel overwhelmed by the compulsion, and even to act on it if you must, as long as you remind yourself, “This is a compulsion. Next time, I’m going to fight it.”

Passivity is your enemy. Activity is your friend. The biggest enemy is boredom. Having something else you really need to do—something much more important than that nonsensical ritual—is a great motivator. People with nothing to do may not develop the mental and emotional strength to shift those gears in the brain and move on to a positive behavior. If you have a job, you’re apt to lose it if you go home to check that lock once more, so you’ll be much more motivated to pull yourself away. When you pull yourself away, you’re treating your OCD. Idleness is indeed the devil’s workshop. If you’re not up to working, you can get a volunteer job, but the important thing is to
stay busy.
Make sure you have something useful to do. Being useful will increase your self-confidence and motivate you to get better because others need you. It’s also a tremendous aid to the Refocus step.

Some people are too depressed to work. Depression often, but not always, goes hand in hand with OCD. If your sleep pattern is radically altered, with repeated waking during the night; if you’re not eating properly and are losing weight; if you have poor energy and serious suicidal thoughts, you may have a severe depression. If that is the case, you must see a doctor.

As you have learned, acting on a compulsion brings only momentary relief, followed very quickly by an increased intensity in the intrusive urge or thought—a true vicious cycle.

After treating about a thousand people with OCD, I find that one of the most amazing things about OCD is that people continue to be shocked by their internal feeling that something is dreadfully wrong—that the stove is not turned off, or whatever—no matter how many times a day that thought intrudes. They would get used to, say, an electric shock after a while, but they never seem to get used to these OCD fears and urges. That is why mindful awareness, mental note taking, is so important. In step one, Relabel, you increase your insight. You call an obsession an obsession and a compulsion a compulsion.

HANGING TOUGH

After Relabeling, many patients ask, “Why the hell does this thing keep bothering me?” It does so because of a brain-wiring problem. The struggle is not to make the feeling go away; the struggle is
not to give in to the feeling
. Emotional understanding will not make the OCD symptoms magically disappear, but cognitive-biobehavioral therapy will help you manage your fears. If you can hang in through the first few weeks of self-directed therapy, you will have acquired the tools you need. You will have become stronger than your OCD. Mastering these therapy skills is like having exercise equipment in your head. It makes you strong. OCD is a chronic disease. You can’t run from it, and you can’t buy your way out of it, but you
can
fight back.

Patients often say to me, “Oh, if only I could have someone wash my clothes whenever I feel that they need to be washed over and over….” They think that would take care of the OCD. They’re dead wrong. Remember Howard Hughes? That’s precisely what he did—and look where he wound up. OCD is insatiable. You cannot do a compulsion enough times—or have someone else do it for you—to get a feeling of “That’s enough.” The more you do it, the worse it gets. It doesn’t matter whether you wash your clothes or hire someone to wash them. Giving in to OCD is giving in to OCD. It makes things worse!