A Doable Four-Step Self-Treatment for OCD


What you do and where you focus your attention influence the way your brain is wired. When you repeat an action over and over, the brain circuit linked to that action gets increasingly stronger.

This is true for actions that have positive life consequences such as taking a daily walk and those with negative associations such as repeated hand washing.

Knowledge of this led to the development of a four step method for treating the symptoms of obsessive compulsive disorder (OCD). Behind this technique is the idea that once people understand what their urges and thoughts are, they can manage the anxiety and delay their response to an urge.

The technique of mindfulness is applied to put off responding immediately to a compulsive thought or feeling. Mindfulness, or focusing on the present moment, combined with a pleasant activity, allows people with OCD to delay responding to their brain’s false alarms. The brain is slowly but steadily rewired.

The Four Steps

These steps need to be done every day for the technique to be effective. It helps to observe your thoughts and urges as if you are an objective or uninvolved bystander.

1. Relabel

Step one requires that you consciously recognize a thought as being obsessive, or an urge as being compulsive, and make a mental note of it. Then, you relabel the thought or urge to describe what it actually is.

For instance, you teach yourself to think, “I do not need to check the front door lock again. I’m am having a compulsive urge to check the door lock again.”

Why is relabeling important? Researchers have discovered that compulsive urges are caused by brain imbalances. They are false alarms telling you that something is wrong when it is not. Relabeling teaches you that your feelings, though urgent, are not based in reality. No matter how powerful the urge, your ability to relabel is within your control.

2. Reattribute

Understanding why OCD thoughts are so powerful and insistent, empowers you to delay the urge to follow them. It is important that you acknowledge the cause is a biochemical brain glitch. Knowing that OCD is a medical condition frees you to ignore the urges since they are not true.

What is going on inside your head? The caudate nucleus in your brain should automatically shift gears when you move from one activity to the next. In people with OCD, the caudate nucleus shift is not working; it gets stuck. A part of the frontal cortex notices this problem and sends out an alarm signal which you experience as a compulsive thought or urge.

3. Refocus

This step requires effort. It involves the mental exercise of "manually" shifting your brain’s gears from one activity to another. Your brain should do this shifting automatically but since it has OCD and cannot, the shift must be made consciously. You do this by refocusing your attention.

The point of refocusing is to delay your response to the urge. It's accomplished by choosing a constructive, pleasant behavior and engaging in it mindfully for at least a few minutes. The activity can be shooting hoops, listening to music, a computer game, or riding a bike.

Although the urge may persist, by delaying a response to it you will begin to realize it does not have to dictate what you do. The technique works best if the refocusing activity continues for 15 minutes or more, but when first using this method five minutes may be more realistic.

4. Revalue

As you work with relabeling, re-attributing, and refocusing, you will eventually be able to revalue the OCD urges and thoughts. You will view them with increasing objectivity and recognize them as false alarms that you feel but do not need to act upon.

You will place a lower value on your obsessions and compulsions, becoming less interested in them. This frees you to align with your deeper values and your true self.

Over time, this treatment method changes your brain chemistry but you do not have to wait to experience benefits. Using the four steps builds confidence and a sense of self mastery. Even beginners may notice a reduction in the intensity of their symptoms.

source: Schwartz, J. You Are Not Your Brain. Avery, 2012.

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