How to Conquer Nagging Thoughts, Compulsive Behaviors

 Vijai P.Sharma, Ph.D. Clinical Psychologist

This is the seventh article in a series of eight on obsessive-compulsive disorder.

A wise saying goes like this, "To heal it, you have to feel it."  One has to feel the fear to overcome it.  Facing the fear and controlling the urge to escape or to distract oneself is good advice for success.

This can also be applied to conquering symptoms of obsessive-compulsive disorder.  Treatment must address both components of OCD, the obsessive thoughts and the compulsive behaviors.  Addressing only one may lead to only half success.  The most effective behavioral treatment is a combination of the two techniques, the "exposure" technique and the "response prevention" technique.

Behavior therapist monitor symptoms and gradually expose patients to the situations that raise their anxiety and trigger compulsions.  These techniques have been equally or more effective than medications.

An example of exposure technique is getting a patient to touch a feared object or a "contaminant" for increasing lengths of time.  The patient agrees not to perform those rituals for a specified period of time, say five minutes, thus increasing the length of the exposure and delaying the performance of the compulsive behavior.  Gradual prolonged exposure is more helpful than the approach of trying to do too much too fast, which results in greater frustration and avoidance of the situation.

With the combined use of exposure and response prevention, it is found that 60 percent to 70 percent of patients with ritualistic behaviors improve after three to seven weeks of treatment, a rapid improvement indeed when compared with just trying to stop the thought, such as of germs and cleaning, called "thought stopping technique," which had success in only 33 percent of the cases.

Increasing the frequency and intensity of the thoughts and/or adding humor or exaggerating the unwanted thoughts and images to a ridiculous point called "paradoxical __________________ _______________________"___ percent of the cases.  Thus, exposure and response prevention gives better results and saves time. 

"Imaginable exposure," that is imagining oneself holding a "contaminated" object rather than actually holding the object is successful in 30 percent to 40 percent of cases.  Actual exposure is found to be more effective than imaginable exposure.

There may, however, be situations that cannot be produced at will, or actual exposure may be too fear provoking, requiring imaginable exposure at least in the beginning.  This approach is likely to be more effective when imagination is nearly as good as the real experience.  Make it like the "virtual reality" experience.  Tape record your voice describing the scene in vivid details and play it back to aid your imagination during an imaginable exposure.

Whether the exposure is in imagination or reality, a moderately difficult situation must be tried first before the harder situation.  Exposure for one to two hours to a situation or an object gives good results and is also time-efficient.

However, exposure technique will only be effective if one doesn't give in to the anxiety-reducing compulsive behaviors.  That is what response prevention technique is all about.  You will be tempted but do not perform the compulsive rituals and behaviors in order to get rid of the anxiety.  Your patience will be rewarded with greater success as you continue.  

Patients with only obsessive _________________________ been very well studied, and it seems that psychological therapies and medications may both be required in such a case.  Medications such as Anafranil, Prozac, Paxil, Zoloft, Lonox, etc., show improvement in about 50 percent of patients after about three months of treatment.  It is likely that a combination of medication and imaginable exposure in the severe cases of OCD may be more effective than the single mode of treatment.

In essence, the more you learn to tolerate the discomfort of your feared and avoided thoughts rather than avoiding them or escaping them by performing some ritual or compulsion, the more quickly you will be able to rid yourself of the unwanted obsessive thoughts.

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Copyright 1996, Mind Publications 


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