Cognitive Behaviour Therapy and OCD - Managing Compulsions and Obsessions (Dr. J.M. Schwartz)

My Intro: This article may not make sense to most people and that's okay. It is however a glimpse into my world and others who suffer with severe or even mild cases of Obssessive Compulsive Disorder.  I used to joke about having "OCD" but 've since learned if you really have it, its not cool.

For Christians, if you feel uncomfortable with the idea of Mental Illness you should really look into it and talk to real believers who have real mental illness issues. In this article, you can replace words such as "facts". "reality" etc with "The Truth of God's Word" and it might make more sense to you ( they are the same thing to me).

Managing Compulsions and Obsessions*

Return to Main Page

This page briefly describes a behavioral self-treatment program that can be used for dealing with compulsive and obsessive thoughts, urges and behavior. This approach has been shown effective in numerous studies conducted during the past twenty years for the treatment of obsessive-compulsive disorder (OCD), compulsive overeating, substance abuse, and pathological gambling. It is also thought to be helpful for compulsive sexual urges and behavior. Recent research by Schwartz and others at UCLA has demonstrated that this self-treatment program can also alter the neurochemical brain processes that seem to be associated with compulsions and obsessions. See also the page on this WEB site that deals more generally with Anxiety and the Treatment of Anxiety Disorders.
STEP 1: RELABEL
The first step is to learn to recognize your obsessive thoughts and compulsive urges as symptoms of a disorder. To do so, it is important to increase your mindful awareness of this pathological process at work. Some have referred to this awareness as the "Impartial Spectator" or the "Observing Ego", which is the capacity that resides in each of us to observe our behavior and recognize what is "real" as distinct from what is not real, or just a symptom. The capacity to distinguish between real needs and pathological symptoms allows us to fend off pathological urges until they begin to recede and fade. The goal of Step 1 is to learn to RELABEL intrusive thoughts and urges as obsessions and compulsions, and to relabel these assertively. It will serve you to refer to these urges in these terms - use the labels "obsession" and "compulsion". Train yourself to say, "I don't need or want to do this behavior; I'm merely having a thought that I need to do this." You must learn to recognize these intrusive, obsessive thoughts and urges as the symptoms of a disorder, and as such distinguish these from desires that are healthy for you to satisfy, and behaviors that will enable you to feel better over the long term. You must come to recognize these intrusive, obsessive thoughts and urges as symptoms that help keep the disorder in place. You might consider the urges you experience as similar to the irrational thoughts of the compulsive handwasher who believes that he must constantly wash his hands to be free of harmful germs and bacteria.
STEP 2: REATTRIBUTE
The essence of this step is to REATTRIBUTE your obsessive thoughts and urges to a disorder that involves the sending of false messages from your brain. It is important to not take your thoughts and urges at face value, and to remind yourself that "this is not me; this is my disorder at work." Research has demonstrated that individuals who develop obsessive-compulsive urges and behavior also tend to have certain brain areas (the caudate nucleus and associated frontal lobe structures) that are chronically overstimulated, which contributes to the intensity and urgency of obsessive-compulsive thoughts and urges. It is important to be aware of this underlying physiological process and to realize that it is impossible to make the thoughts and urges go away immediately. The important thing to realize is that you don't need to act on the urges. You don't need to listen to them. Don't take them at face value. They are false messages from the brain that are part of a disorder. The most effective thing you can do is to put the thoughts and urges aside and go on to another behavior. Do something else; trying to make the thoughts and urges go away will only create more stress, which serves to make the thoughts and urges more intense. The point is to not engage with the thoughts by either acting on them or trying to make them go away, but simply RELABEL and REATTRIBUTE them as symptoms of a disorder. Then move on to other things, as described in Step 3.
STEP 3: REFOCUS
This step involves taking action to refocus your attention to another subject. This ordinarily is the automatic work of the brain - specifically the caudate nucleus - but because the caudate nucleus is not functioning properly, this shifting of focus is something that you must do "manually". In REFOCUSING, the idea is to work around the intrusive thoughts and urges by shifting attention to something else, if only for a few minutes. This may involve making and following through with plans for the remainder of the day. It should lead to an activity that will absorb your attention, and that you will find satisfying and enjoyable. Hobbies can be particularly good. For example, you may choose to take a walk, exercise, listen to music, read, play a computer game, or practice a sport that you enjoy. The goal of treatment is to stop responding to the obsessive thoughts and urges, while acknowledging that, for the present, these uncomfortable feelings and urges will continue to bother you. You begin to "work around" them by doing another behavior. You learn that, even though the thoughts and urges are present, they do not have to control your behavior. You make the decision about what you're going to do, rather than responding to thoughts as a robot responds to commands. By REFOCUSING, you reclaim your decision-making power, and as a result the dysfunctional biochemical reverberations of the brain no longer dictate what you do.
 It is important to acknowledge that REFOCUSING is frequently not easy. It can take significant effort and even require tolerance of some very painful feelings. Therefore, it is important to observe the "Fifteen Minute Rule", which basically states that you will not act on an obsessive-compulsive thought or impulse without allowing at least 15 minutes to pass. During this 15 minutes you should work on RELABELING, REATTRIBUTING and REFOCUSING. In time, as you practice this, the process will become easier and will lead to greater reductions in the intensity of the compulsive thoughts and urges. Sometimes, however, the thoughts and urges will be too strong and you may find yourself performing the compulsion. This is not a time to berate yourself for succumbing to the obsessive-compulsive behavior. Simply acknowledge that your compulsion and disorder "won this round", and that your practice will make it more manageable the next time. It is also helpful to keep a JOURNAL of your successful REFOCUSING efforts. This will help to remind you of your successes and to identify which behaviors are most helpful to the process of refocusing. Also, as your list of successes gets longer, it will become inspirational and will be a place you can turn when the thoughts and urges "heat up." Record only your successes. There is no need to record your failures. You will be assisted by learning to give yourself a pat on the back, which is often difficult for people who experience compulsions and obsessions.
STEP 4: REVALUE
The Revaluing step comes into play after much practice of the first 3 steps. After you have had experience with relabeling, reattributing and refocusing - identifying your compulsive thoughts and urges as part of a pathological process - you will begin to REVALUE - actually put much less value on - the feelings that go along with this process. This is further assisted by two substeps to STEP 2: REATTRIBUTION: these are ANTICIPATE and ACCEPT. Anticipate means that you are prepared for the thoughts and urges to recur; you are not surprised by them, and you do not spend energy beating yourself up because you have them. You know what causes them and you work around them. You refuse to let these symptoms shock you, and you refuse to let them become a source of negativity about yourself. Obsessive thoughts and urges may occur hundreds of times each day. There is no need to dwell on them. This is where the second substep, ACCEPT, comes into play. Simply anticipate and accept that you have these thoughts and urges, and do your best to get on with other things. REFOCUSING is like a martial art, and a little like meditation. An obsessive thought or a compulsive urge is very strong, but also quite stupid. If you stand right in front of it and take the full brunt of its power, trying to drive it from your mind, it will defeat you repeatedly. Once you learn to step aside, acknowledging the thoughts as you work around them, you will find it progressively easier to move on to the next thing. You are learning to keep your wits about you in the face of a powerful opponent, an opponent that will also wither and die from your unwillingness to imbue it with attention and energy. Eventually, by taking charge of your actions, you will take charge of your mind and ultimately take charge of your life.

QUICK SUMMARY

STEP 1: RELABEL
Recognize that the intrusive thoughts and urges are the result of a DISORDER, which includes a reversible brain dysfunction that makes it difficult to automatically shift your focus.
STEP 2: REATTRIBUTE
Realize that the INTENSITY and INTRUSIVENESS of the thoughts and urges is also caused by dysfunctional brain processes.
STEP 3: REFOCUS
Work around the intrusive thoughts and urges by focusing your attention on something else, at least for a few minutes. DO ANOTHER BEHAVIOR.
STEP 4: REVALUE
Do not take the compulsive thoughts and urges at face value. These thoughts and urges are false messages from the brain that do not merit your active attention or concern. THEY ARE NOT SIGNIFICANT; acknowledge them for what they are and move on!

Maryland Institute for Individual & Family Therapy

7307 Baltimore Avenue, Suite 208, College Park, MD  20740

11249C Lockwood Drive, Silver Spring, MD  20901

301-277-3250 begin_of_the_skype_highlighting            301-277-3250      end_of_the_skype_highlighting

*Adapted from Schwartz, J.M. (1996). Brain Lock: A Four-Step Self-Treatment Method to Change your Brain Chemistry. New York: Harper Collins.

Return to Main Page      Return to Top of Page

Cognitive Therapy errors in thinking:

Ø      Emotional Reasoning ( How you feel instead of facts)

Ø      Catastrophizing ( Imagining worst case scenario and reacting as such)

Ø      Dichotomous Thinking (Either / Or , Absolute perfection or total failure)

Ø      Personalization ( Making everything that happens related to yourself and your actions)

Ø      Selective Attention ( The tendency to notice only certain aspects, usually negative, of a situation)

Ø      Exaggeration of `normal` concerns about a situation

Ø      Hyper – Responsibility

Ø      Overestimating negative outcomes of a situation

Ø      Having unrealistic expectations of performance

The Gospel According to Twitter

Grace Elizabeth - The Story of a Birth

Its been 1 month today since Grace Elizabeth first entered the outside world or as Dan Haseltine  put it “Since I first saw her breathing on her own”…

Its been 3 and a half years since the rather monumental decision to begin trying to have a child.

About 2 years since we lost our first child Chay at 14 weeks into pregnancy… that was on a Father’s Day.

I may not have seen Chay born into the outside world but I saw his little heart beating, via ultrasound, while God was yet forming him in the womb and my heart beat with it. 


Chay

After that there was a dark time in our lives. When it was safe we began trying again but it seemed like it took forever, every month a bitter sweet expectation; every menstrual period, a mourning period.  And then it happened and we looked at each other and we had no idea how to feel. We were scared a miscarriage might happen again. I was scared what that might do to my wife and we were very very cautious.

Its been a bit of a journey for us but I know so many other stories now from other people who have been through so much more, so much longer…. And it touched me deeply how merciful and supporting they were to us when they had so much of their own suffering.

And so we waited. We had the first ultra sound and things looked good, I was still very nervous and I think Sher was too. We gave each other knowing glances but didn’t speak aloud too much of our fears. 

Time marched on and things kept looking good and yet I was still very scared inside, worrying about the actual birth and the health and safety of our child.  I wrote to a friend and mentor of mine at the time expressing my fears and asking for prayer. Something he said in his reply stuck with me…. “Just remember you don't have to know what God is doing, just remember Who He is. He loves both of you very much and wants the best for you.”   I know this can be easy to say but the truth of it is real and it reminded me of where I should be putting my trust and what I should be resting in - God’s character, not just what He is apparently letting happen in my life.  Like I said, not easy, but true.

Then came March 13^th .  The due date was the 15^th and we were pretty prepared for an overdue baby as we had been warned many times that the first one was usually late.  Sherry had had some minor cramping the night before but had barely spoke of it (being the somewhat stubborn warrior she is). As it was Sunday we headed off to church, marvelling at the size of Sherry’s belly. That Sunday, the focus was on youth and as leaders in that area we were asked to come up to the stage. Pastor Larry encouraged us in our ministry, joked about the baby being ready and suggested we take a bumpy car ride to hurry things a long.  He then committed us to God in prayer.

We enjoyed the morning and Sherry showed no signs of stress nor mentioned anything out of the ordinary, so we continued on with our usual routine and went to Wendy’s for lunch with our family and friends and then went home for a rest before the youth would come over that evening for “Koinonia” ( a Greek word meaning fellowship), the name of our little group get-together for Bible study, discussion and prayer.

Did I mention that Sherry did not say that anything was out of the ordinary? 

All of a sudden I notice Sherry bent over the kitchen island in what looked like significant pain. I asked what was going on and she told me she had been having cramps all morning but didn’t want to ruin the day, now they were getting worse  - oh Sherry darling.  We decided we were in pre-labour (see your Baby’ Best Chance handbook!) and decided we should probably go up to the hospital to at least get checked out.

I had to admit I was a little surprised and a little happy about this (as I am not the most patient person in the world) . So I fairly calmly grabbed our “Hospital Bag” (Gentlemen, do not be without one!) and packed the car, still thinking in the back of my mind this was just a pre-caution. I called one of my youth leaders up and said I would put a key to the house in the mail box just in case we weren’t home in time.

Arrival at the Hospital. By now Sherry is in massive pain and scared and saying “I don’t think I can do this, I don’t think I can do this”, thinking of the hours and hours she would still have to go through (I thought of repeating what one of my old pastors had said to his wife when she was in labour – “Are you sure you still want to go through with this?” but I thought better J) .

We are put into a check up room and a very nice nurse named Susan comes in to look at the vitals. She heeds that labour is very long and not to get too excited, then she sees Sherry’s stomach almost reach out and slap her as Sher has a contraction. Seeming somewhat taken aback by the very visible movement she says “Well we better do an examination just to make sure”. Okay, that’s cool (by now I’m getting used to strangers invading my poor wife’s privacy – its takes a while guys, at first you just want to give them a knee to the head).  The nurse fiddles around a bit then pops her head up  “Oh my, you’re 5 centimetres, I think I‘ll give the doctor a ring” Yes, please do.

So by now all 3 of us are quite aware that Sherry is in Active Labour  (again see Baby’s Best Chance handbook) which explains Sherry’s earlier lament – she didn’t realize she was right in the thick of things, she thought it was only beginning  and was going to be infinitely worse etc…. Once again it was confirmed to me that my wife is a warrior… a princess warrior really. 

And so birth begins. Nurse Susan suggests I grab her other leg, with adrenaline running, I grab it like I’m putting someone in a headlock. I was in there like a dirty shirt and I didn’t even have time to think about it. All of a sudden I was a full blown coach spurring my wife on to the end of the marathon….  

This goes on for a while then, in the background somewhere, I hear someone yell down the hall for help. In a moment I am gently but firmly squished out of the inner circle as all kinds of nurses contort my wife’s body and I, rather oblivious to any threat, grab my camera and start taking pictures – pictures you will never see by the way.  Apparently our little daughter’s shoulder had gotten stuck and the umbilical cord was also dangerously near her neck and head. But alas, The Lord and the doctor worked this out …

…. and Grace was born.

8 lbs 6 oz. 5:51 pm – about 7 hours since we had been on the stage at church, about 3 hours since we first came to the hospital, about an hour before Bible study was to begin. She is thrown onto mom’s chest for a few minutes then checked over and handed to me while Sherry is looked after.

Birth was the most beautiful, intense, physically violent and spiritually mind-blowing thing I have ever seen.  The feeling of seeing my daughter enter the world was … well it was all that everyone said it would be and more. All the hype was true. And that rarely happens in this world.

I have written another little note concerning the meaning of our daughter’s name but in short God’s grace is a concept that few people have fully grasped. In the Bible, it can be a greeting or a gift. Most importantly though,  it refers to the work of redemption and transformation of a person’s life through Jesus Christ. 

As the song puts it,  “Grace, its name for a girl. It’s also a thought that changed the world.”

Elizabeth means an oath to God or worshipper of God. When we understand grace, we can but worship the One from Whom it flows.

I think I have always had a pretty high degree of respect for women but that degree was added to big time as I saw Sherry go through the process of pregnancy from first to third trimesters, deliver a child (in what has to be nature’s most painful experience) and then continue to nurse that child every 2-3 hours with little sleep - and yes I know there is much more to come for both of us!

And I don’t just say this to get brownie points with Sher or the fairer sex in general – but her stamina, toughness, patience, perseverance and love were and are something amazing for me to behold. God Himself compares His love and comfort to that of the mother:

Isa 66:13 “As one whom his mother comforts, So I will comfort you; And you shall be comforted in Jerusalem."

And the Lord takes it even further when He says:

Isaiah 49:15 "Can a woman forget her nursing child, And not have compassion on the son of her womb? Surely they may forget, Yet I will not forget you.

As a father I am only beginning to grasp how much my Heavenly Father must love me… from a child’s perspective my parents have done an amazing job and now my infant daughter will be teaching me His love….

1John 4:18-19   “ There is no fear in love; but perfect love casteth out fear: because fear hath torment. He that feareth is not made perfect in love.
We love Him, because he first loved us.”

Ephesians 1:6 “…to the praise of the glory of His grace, by which He made us accepted in the Beloved.”

Chay

As some of you know, Sherry and I recently suffered the loss of our baby due to a miscarriage. We had a scare at 6 weeks but all had turned out well so we thought we might be out of the woods by the time we hit 13 weeks, but alas it was not God’s plan.

I realize in writing this that many many people have experienced similar things and worse. This is simply a tribute to our son or daughter who went before us.

Some may say that a miscarriage is just nature’s way of stopping a life that has something flawed in it and I guess that is one reason. Of course I replace “nature” with “God”. As for the reasons God would do this, I do not speculate too much. There are many possibilities and I have learned enough to know my Heavenly Father makes His decisions with sovereignty and lovingkindness and I’m learning to trust that.

At our 6 week visit when there was a possibility of a miscarriage, we became somewhat frustrated with the comments of one of the nurses. The words of comfort offered to us were that “Its only 6 weeks, its barely the size of _________ (fill in the blank)”. While I understand the nurse probably sees this everyday and was being sincere, the fact remains that it doesn’t matter to us how old or large our baby was – what mattered is that that baby was a life, it was a person. This is what we believe… that life starts at conception, and that it is sacred ( See Psalm 139 at bottom of note)

Something good happened out of this 6 week visit though. Because of the complications, we were given an ultrasound and as we held each others hand we saw life before us… the beating of a heart. The ultra sound tech pointed this out to us even though he was not supposed to and I am so thankful he did…. That moment was a gift from God.

Our second visit to the emergency room and our second ultra sound was not such a happy ending. It showed that there was no heartbeat, that Life had left the womb. But we do not believe that it was extinguished but rather gathered up by our Heavenly Father. Let me say something here… I know that it is common for people to say their loved one is in heaven – but this is something we know to be true by faith. By the Word of God… this is what we put our hope in. When King David lost his baby he had this to say ….2 Samuel 12:23 “…I will go to him, but he will not return to me.” I take this to mean that David would go to see his son in the afterlife ( and again see the passage from Psalm 139 below).

When it was all over and I was sitting by Sherry in her hospital bed, the thought was brought up of naming our baby ( something I now realize that many many people who have had miscarriages have done). It reinforces the sacredness of that life and brings some peace and closure for the parents. After some thought, prayer and research one of the names we gave our baby was “Chay” (pronounced Shay) . This is the Hebrew word for “life”, and the name was inspired by that moment of seeing the heart beating, strong and clear.

The next week was difficult for both of us , especially Sherry, but the Lord was so very good to us. Our family and friends came out in droves to support us in anyway they could and for that we are eternally grateful. Thank you to all for your kind words, shared experiences and gifts of love. It has been a hard journey but one we have walked with God and those He has sent along… I don’t fully understand how Sherry has suffered from this, as she carried the baby in her own body, but she has been strong when she has needed to be and weak when she has needed to be…. His strength is made perfect in weakness. The male Gynecologist at our second visit pulled me aside and told me that for the woman, it is as if she had carried the baby to full term – he is also the one who suggested naming the baby. My Aunt told me the only way she could really get over the loss was to truly give her baby to the Lord (emotionally, mentally and spiritually) and trust Him to take care of them.

I think we both still feel the sting of emptiness at the loss of our baby and all of the dreams that went with him or her. I still feel that kind of “punch to the gut” that hits me every once in a while and brings me to my knees .But we press on and God gives us grace for each day and of course hope for tomorrow. We made a deal with each other that we wanted this to bring us closer to each other and closer to God – and only Gods grace can accomplish that, we continue to praise Him for that.

I was talking on the phone to my mom one day afterwards (they were in Ft. St. John at the time), when she handed the phone to my Grandma, and she said to me with tears in her voice “Joe, I have three boys playing on the Streets of Gold, and now you have one too”. I couldn’t keep back the tears at that point. Not just tears of sorrow but tears of joy as well… for he is with our Heavenly Father and, like David, we are going to him.



Psalm 139:13-16

For You formed my inward parts; You covered me in my mother's womb.

I will praise You, for I am fearfully and wonderfully made; Marvelous are Your works, And that my soul knows very well.

My frame was not hidden from You, When I was made in secret, And skillfully wrought in the lowest parts of the earth.

Your eyes saw my substance, being yet unformed. And in Your book they all were written, The days fashioned for me, When as yet there were none of them.

Welcome to Life - Some Thoughts On the Chilean Mine Rescue

I thought I would re-post this in honour of the 1 year anniversary of the rescue...

There is still much to pray for concerning the miners as they seek employment and restitution but the illustration of life and the Gospel remains pretty amazing...

Joe Aug 6, 2011

---------------------------------------------------------

I just happened to sit down for my 15 minute break at work when I glanced at the TV in the lunchroom and saw – live – the first miner emerge from the capsule known as the Phoenix. Pretty amazing timing… but what’s more amazing, of course, is this whole story.

On August 5^th, 2010 , 33 miners were trapped when the rock walls  caved in all around them. The first response is grim. The Chilean mining minister publicly stated that there chances of being rescued were slim.

 After 17 days ,  a drill bit reaches through to the trapped miners but the Chilean government still says it could be until Christmas before they are rescued.

We now know that all 33 men have been rescued, carried 1800 hundred feet safely to the top by the Phoenix capsule – 68 days after the cave in.

Last Sunday , my Pastor mentioned the news piece he had seen the night before about the miners and the rescue attempt – how the life saving drill had finally reached the miners. With tears in his eyes and voice , he thought of the pain and misery the miners must have experienced. The dark , stinking hole they were trapped in – and then… to see the light break through as the drill cracks the ceiling of their prison.

He said then, that he could not help but think of  God , who,  in flesh , came down to this earth… this dark , dank place,  and broke through with heaven’s light and a rescue plan of His own.

 God had come down in the form of a man,  Jesus Christ. After 33 years of living, He died as a substitute for us – and He made a way back to where He had come from, - not for Himself…but for us. You could say that a “capsule” to heaven - more importantly to the heart of God -  now awaited mankind. A rescue from a dark prison , whatever our own personal prison of sin may look like.

Now thinking of the miners - who of them, being in such a situation for 68 days, would not step into that capsule – that Phoenix? I can only imagine how scary it must have been for the first miner to step in and latch the door – certainly this was a leap of faith in those who engineered the rescue. But who would stay behind? Who would not take this offer of deliverance?

When the first miner reached the surface, he soon embraced the Chilean President, Sebastián Piñera , who said to him – “Welcome to life.”

And that’s what it is for him and the other miners – new life.  One of the miners, Mario Sepúlveda, said of being down there “I was with God and I was with the Devil – and God won…”

So many , when speaking of this miraculous rescue, keep using the term “born again” . Maybe that term sounds familiar… it comes from a key passage of the Bible where Jesus is speaking to a man looking for a rescue.

Jhn 3:3 In reply Jesus declared, "I tell you the truth, no one can see the kingdom of God unless he is born again. "
Jhn 3:4 "How can a man be born when he is old?" Nicodemus asked. "Surely he cannot enter a second time into his mother's womb to be born!"
Jhn 3:5 Jesus answered, "I tell you the truth, no one can enter the kingdom of God unless he is born of water and the Spirit.
Jhn 3:6 Flesh gives birth to flesh, but the Spirit ] gives birth to spirit.
Jhn 3:7 You should not be surprised at my saying, 'You  must be born again.'

And then Jesus explains to him how to be spiritually born again. In the renowned passage of Scripture, John 3:16, we hear His words…

Jhn 3:16 "For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life.

Jesus then goes on to explain…

Jhn 3:17 For God did not send his Son into the world to condemn the world, but to save the world through him.
Jhn 3:18 Whoever believes in him is not condemned, but whoever does not believe stands condemned already because he has not believed in the name of God's one and only Son.
Jhn 3:19 This is the verdict: Light has come into the world, but men loved darkness instead of light because their deeds were evil.
Jhn 3:20 Everyone who does evil hates the light, and will not come into the light for fear that his deeds will be exposed.
Jhn 3:21 But whoever lives by the truth comes into the light, so that it may be seen plainly that what he has done has been done through God."

I don’t think any one of those miners hated the light they saw in the last 48 hours.

 But what about us?