#body-focused

In my post about the treatment of sensorimotor OCD, a reader asked about the ultimate goal of treatment. Should the goal of treatment be to never notice an unwanted thought or symptom?

Suppressing Unwanted Thoughts & Sensations in Pure-O & Sensorimotor OCD

Let's explore this idea in detail. Suppose I adopt the goal of being 100% symptom free. After all, this is the endpoint of treatment that most people are seeking.

What are the implications of this goal?

You will likely slow down your progress.

Why? Because every day you will encounter something that violates your expectations.

Unwanted thoughts are a normal part of the human experience. Everyone has thoughts that are unwanted, aggressive, selfish, perverse, or deviant at times. For people without OCD, these thoughts tend to be fleeting because the thoughts themselves aren't treated as significant. They are accepted as normal brain noise. These thoughts may register, but they quickly get buried beneath other more pressing or interesting thoughts.

For people with Pure-O OCD, unwanted thoughts may occur over and over again. Often these thoughts are considered dangerous or preventable, or they may be regarded as problems in need of solutions. Many people with Pure-O OCD become emotionally invested in filling their heads with the "right" kinds of thoughts.

It is largely the importance we attribute to our unwanted thoughts that determines whether or not they get stuck. As soon as we shift into problem-solving mode via a behavioral ritual or a mental compulsion, we increase the salience and power of the perceived threat.

Rituals reinforce and sustain what-if's, which is why rituals are so good at maintaining OCD symptoms over many days, months, and years.

If you read my last post about thought control in OCD, you recognize that never having an unwanted thought is an impossible goal. Our brains just don't work that way. If you insist on being symptom-free, "normal" body-noise and thought-noise becomes a potential threat. This is because it leads you to characterize something normal as unwanted and dangerous.

If you think about it, you'll realize that it is often not the actual occurrence of symptoms themselves that creates anxiety, but rather the personal ramifications of those symptoms. For people with Pure-O OCD, fear is often based on the possibility that having an unwanted thought means something about you (e.g., maybe you secretly want to harm a family member or maybe you're really gay). For people with sensorimotor OCD, fear is often based on the idea that you'll notice unwanted sensations for the rest of your life and that these symptoms will prevent you from living the type of life you want.

Because of these fears, many people with Pure-O OCD (including sensorimotor OCD) adopt thought control as a means for managing, preventing, or reducing the impact of obsessions. Unfortunately, attempts at thought control and fear about a future dominated by symptoms often create a self-perpetuating cycle of fear and avoidance.

Unwanted Thoughts: OCD Feedback Loop

Because thought control is incompatible with the way our brains actually work, it is destined to fail. As soon as it fails and your unwanted thoughts return, your desperation and fear is likely to increase exponentially. This causes many people with Pure-O to re-double their efforts at thought control because they don't see any other way out. Again, these efforts fail. After repeating this cycle multiple times, individuals often conclude that they are "doomed."

Moreover, because individuals don't want their current experience to be "tainted" by their symptoms, they frequently begin avoiding and isolating. They disengage from work responsibilities, stop dating, no longer go to the movies, quit playing golf, etc. Avoidance comes to pervade much of daily life. When avoidance is extreme, symptoms can become a person's only companion.

Because our brains are constantly abuzz with noisy thoughts, we are guaranteed to notice something unwanted if we look hard enough. If we insist on being 100% symptom-free, it's easy to become hypervigilant and more sensitized to potential threats. We then are primed to notice smaller and smaller deviations from what we consider "normal".

As you are engaging in treatment and are getting better, how you handle breakthrough symptoms will largely determine your outcome. If you say, "Aha! It's still here! I'm never going to escape this!" you turn up the volume on your symptoms. If instead you say, "I can do complex things, even if some of my attention is focused on my symptoms," the volume is dialed down.

Recovery from OCD involves breaking this cycle by re-engaging in life. It involves treating breakthrough symptoms as normal and unavoidable.

In some ways, this is a very Acceptance & Commitment Therapy (ACT) based way of thinking about your symptoms.

OCD Treatment Goals

Back to the original question...what should be one's ultimate treatment goal? It should not be to control your thinking. We all have unwanted or "unacceptable" thoughts at times. It is how we respond to these thoughts that either perpetuates them or allows them to drift elsewhere.

Instead, we should work on living according to our values and building the types of lives we want for ourselves despite our symptoms. In a way, embracing coexistence with the unwanted actually creates more space in ourselves for those things we truly want.

Questions? Comments? What have you adopted as your treatment goals? Share below.

...or continue the discussion on Facebook, Twitter, or Google+.

OCD & Thought Control

Can I learn to eliminate my OCD thoughts?

I hear this question all the time from new patients who are searching for ways to suppress their unwanted thoughts. When I answer this question with a resounding "no", there is often much surprise and grief. After all, this is why they're coming to see me.

Many people with Pure-O OCD imagine thought control to be the only way to improve the quality of their lives. Unfortunately, thought control conceptualized in this way is not an attainable goal in OCD treatment. Our brains just don't work like that.

I explain it like this, "A penguin obsessed with flying is an unhappy penguin."

Expecting thought control to work is a little bit like a penguin flapping its wings and expecting to fly. It may work for the other birds, but it won't work for the penguin. The penguin's wings are not designed to work this way.

This doesn't mean that penguins can't be happy. It simply means that a penguin who becomes preoccupied with an unattainable goal is likely to experience a lot of unnecessary suffering.

Our brains are not equipped to simply ignore situations we perceive as threatening. If you were walking in the woods and noticed a snake slithering up next to you, your brain wouldn't allow you to just ignore it. Instead, it would come up with solutions for surviving the situation. Fight-or-flight is biologically-based. Because survival is critical, our brains are hard-wired to act quickly and aggressively to guarantee it.

As much as you might wish to never have bad thoughts, you can't change the way the human brain fundamentally works.

There is a solution, however.

It does not involve suppressing the thought or never having the thought in the first place.

Instead, it involves becoming less afraid of your thoughts and learning to correct any threat misappraisals to which you might be vulnerable.

If you're a snake trainer, you have logged enough hours with snakes so that you're much less afraid of them. You could even be around a whole nest of snakes and not break a sweat.

Exposure and response prevention for OCD is a bit like becoming a master snake trainer. Your fear won't evaporate overnight, but with practice you will learn to be more comfortable and less distressed by your thoughts. This, in turn, makes the thoughts less newsworthy and thus less likely to stick to your sticky OCD brain.

Unwanted thoughts are normal. You can't reprogram your brain to work in a way it wasn't designed to work. Maybe someday when we're all cyborgs, we'll be able to delete the code in our brains that represents OCD-related fear. Until then, the next best thing for OCD is exposure and response prevention (ERP).

Questions? Comments? What is your opinion on thought control? Share below.

...or continue the discussion on Facebook, Twitter, or Google+.