Monday, November 2, 2009

Cognitive-behavioral strategies to manage my OCD

This post is directed toward those with obsessive-compulsive disorder (OCD). I developed OCD during my last year of high school, and it became a serious disorder during college (combined with tics). At the time, I didn't try to get treatment, and I had no idea that I even had OCD. In my mid-twenties, I began seeing a psychiatrist, and started on a drug called Anafranil, which helped a lot. I was on Anafranil for 10 years, with 2 of those years combined with Zoloft. I combined the medication with my own cognitive-behavioral strategy. I found that existing psychological treatments (e.g. exposure therapy) didn't work very well for me. After 10 years of Anafranil along with my own strategies, I no longer needed medication. My OCD remained sub-clinical, i.e. although I still had an obsessive-compulsive personality, it no longer impacted my functioning. This was 3 years before I started investigating the link between my OCD/tics and the Earth's magnetic field (which I present in my website).

My symptoms were mainly obsessions about philosophical issues. I also had checking and cleaning compulsions. The compulsions weren't as bad as the obsessions. During my early and mid-twenties, virtually any reading or writing could trigger obsessions and tics, which would last for days. I believe that the obsessions derived from my extreme interpretation of the Ayn Rand/Objectivist philosophy. I'll expand upon this connection at another time.

My strategies to deal with the OCD involved refraining from mental suppression and mental forcing. Mental suppression is the willful cutting off of thoughts, images, and feelings as they arise from the stream of consciousness. Mental forcing is the willful forcing of thoughts, images, and feelings that would otherwise have not come from the stream of consciousness. Both of these behaviors are self-stimulatory, addictive, and destabilizing. Daniel Wegner's book White Bears and Other Unwanted Thoughts is a good source on the futility of trying to suppress thoughts.

To avoid these behaviors, you need to distinguish between mental forcing/suppression, which are internal behaviors, and triggers, which are external behaviors and stimuli. I believe that people with OCD should avoid triggers. Triggers are basically anything that can set off an obsessive/compulsive state. They involve an interaction with the person and his environment (as opposed to a strictly internal thing like mental suppression). As I stated earlier, before I started with medication almost any reading or writing served as triggers for me. Triggers include being in an unclean or disordered environment, and any kind of change or stress. Medication helped reduce the number of triggers, and also the severity and duration of the dysfunctional state that ensued. That's why I support the use of medication to control OCD.

Exposure therapy says that OCD is an anxiety disorder (based on the DSM categorization), and just as exposing anxious people to things they fear helps them (e.g. exposing people with claustrophobia to a confined space), exposing people with OCD will help them overcome their obsessions and compulsions.

There are several problems with the theory behind exposure therapy for OCD. One problem is that OCD isn't really an anxiety disorder. It's usually treated by antidepressants. If it was a true anxiety disorder, it would be treated by anti-anxiety meds like Xanax or Valium. The other problem is that obsessions and compulsions are addictive, self-stimulatory behaviors. One doesn't treat addictive behaviors by exposing the addict to things that can trigger the addiction. For example, one doesn't treat alcoholism by exposing the alcoholic to wine or liquor.

I don't know why some people and therapists claim that exposure therapy is effective for OCD. Perhaps some people with true anxiety are misdiagnosed with OCD. Perhaps others are helped in the short term by exposure therapy, only to have different obsessions and compulsions replace the ones that they were exposed to. Others likely relapse.

I hope the above strategies help some people with OCD. Feedback is welcome.

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