4 steps to overcoming OCD
Tips & tricks by Hari Govind
Many techniques have been developed to help manage the thoughts and behaviours associated with obsessive compulsive disorder (OCD). One of the most popular is Dr Jeffrey Schwartz's 4 Steps For OCD. Hari Govind explains the approach.
Numerous transformations have arisen in the last few years due to the Covid pandemic, including a significant rise in the incidence of secondary disorders, especially those related to mental health. The most common increases have been related to alcohol and other substance addictions, depression, and anxiety.
Another, perhaps less well-known rise has been seen in people experiencing symptoms of obsessive-compulsive disorder (OCD). The rise is somewhat predictable though: an emphasis on living life in a more reserved, isolated fashion, combined with a general sense of the possibility of infection by a potentially deadly virus, naturally resulted in a state of hyper-awareness for many. One study noted that OCD symptoms were exacerbated during the pandemic, particularly among people diagnosed with hand washing and cleaning compulsions.
In the UK, OCD is currently thought to affect around 1–3% of adults and 0.25–2% of children and most commonly affects people in their late adolescent years and mid-twenties. They will all be experiencing obsessions (repetitive, sometimes disturbing thoughts) and compulsions (a behaviour designed to repel the obsession) which can often have significant effects on quality of life.
So what exactly can people experiencing OCD symptoms do about their condition? Many methods and counselling techniques have been put forward and practiced over the years. But one of the most effective techniques is Dr Jeffrey Schwartz's Four Steps for OCD – a self-learning technique to deal with day-to-day issues.
What are Dr Schwartz’s Four Steps for OCD?
The four steps which are involved in the treatment plan are:
The most crucial step towards recovery is understanding the nature of the disease and the reason behind the occurrence of such thoughts and behaviour. This is done through a process of ‘relabelling’ obsessive thoughts as symptoms of a medical disorder.
There is a strong belief among people with OCD that by ignoring obsessive thoughts and not responding to them, they will eventually go away. But that isn't the case; in fact, such acts can actually make things worse. After all, these thoughts are believed to be due to chemical disturbances in the brain, so ultimately, the people experiencing them can’t control when they occur.
But they can be identified, or labelled. Voicing out or writing down obsessive thoughts and compulsive behaviours as "symptoms of OCD" is a good way to do exactly that as it helps the person with these thoughts to focus on their problem by pinpointing the abnormal thoughts and behaviour to look out for. This also helps in realising that the obsessive thoughts are not physically real and instead are manifestations of the disorder.
Reattribution is a continuity and a part of the previous step, meaning that both happen simultaneously. It is a manner of realising that the disorder is causing these thoughts and behaviour, not the person themselves.
It is perhaps easiest to explain this step with some examples. We do certain things in our daily life without much effort and focus, ranging from brushing our teeth to getting ready for work. We can perform these actions efficiently and swiftly without many hurdles and hindrances. They are possible due to a particular part of our brain known as the caudate nucleus. The nucleus is responsible for smoothly shifting actions from one to another without a profound error-checking function.
But in OCD, there is a defect in the caudate nucleus, which results in the activation of the error-checking function in the brain. As a result, the brain gives extensive focus and energy to performing all the activities of day-to-day life, providing a sense of incompleteness and repeated checking of everything the person does.
By attributing the symptoms of OCD as the result of a neurological abnormality, the person with OCD is actively trying to alter the defective circuit and disable the error-checking function of the brain.
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Refocusing is perhaps the most important part of rehabilitation and getting back to a regular life cycle.
This step involves actively shifting attention to something other than obsessive thoughts. So, rather than doing the compulsive behaviour when the mind wants to do it, focus is actively shifted towards a constructive and valuable behaviour. By doing this, the person with obsessive thoughts is essentially doing the work of the caudate nucleus – shifting smoothly from one activity to another.
Doing so isn’t a quick and easy process. Preferably, impulsive behaviours should be postponed for around 15 minutes, but this can be a very long time for someone with OCD. Consequently, delaying behaviours by 5 minutes and gradually increasing this over time is a far more realistic method of refocusing.
It is important to reflect during this time and, most importantly, noting that nothing harmful or destructive occurred by delaying the behaviour. Instead, it was a constructive and valuable activity.
The last step, revaluing, comes into use only when the first three steps are successful. Its key difference to the previous steps is in its underlying principle. Previous steps attempt to identify obsessive thoughts and avoid acting on them in a compulsive manner, whereas revaluing is more about analysing behaviour and looking at the changes in life when obsessive thoughts have not been acted on.
Attributing value to these thoughts, and the value of not giving into them, allows a person experiencing symptoms of OCD to better understand whether they need to act on them or not.
If you are reading this in the hope that you can begin to take back control of your own obsessive thoughts, please note that the process to doing so isn’t easy. It takes a lot of effort, willpower and practice to combat what can be a very intrusive condition.
But this is the same for anything truly worth it in life. And with these 4 steps courtesy of Dr Jeffrey Schwartz, and the right amount of patience with yourself and the process, you can give yourself a chance of overcoming OCD for good.