Brain Lock

Jeffrey M. Schwartz

• Éditeur: Harper Perennial
• Année: 2016
• ISBN:
  9780062568656
• Sujet: Personal Development
• Sous-sujet: Mental Health & Wellbeing

The definitive classic that has helped more than 400, 000 people defeat obsessive-compulsive behavior, with all-new material from the author An estimated 5 million Americans suffer from obsessive-compulsive disorder (OCD) and live diminished lives in which they are compelled to obsess about something or to repeat a similar task over and over. Traditionally, OCD has been treated with Prozac or similar drugs. The problem with medication, aside from its cost, is that 30 percent of people treated don't respond to it, and when the pills stop, the symptoms invariably return.

In Brain Lock, Jeffrey M. Schwartz, M.D., presents a simple four-step method for overcoming OCD that is so effective, it's now used in academic treatment centers throughout the world. Proven by brain-imaging tests to actually alter the brain's chemistry, this method doesn't rely on psychopharmaceuticals. Instead, patients use cognitive self-therapy and behavior modification to develop new patterns of response to their obsessions. In essence, they use the mind to fix the brain.

Using the real-life stories of actual patients, Brain Lock explains this revolutionary method and provides readers with the inspiration and tools to free themselves from their psychic prisons and regain control of their lives.

PART I

The Four Steps

1

Step 1: Relabel

“It’s Not Me—It’s My OCD”

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Step 1. RELABEL

Step 2. Reattribute

Step 3. Refocus

Step 4. Revalue

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Step 1: Relabel answers the question, “What are these bothersome, intrusive thoughts?” The important point to keep in mind is that you must Relabel these unwanted thoughts, urges, and behaviors. You must call them what they really are: They are obsessions and compulsions. You must make a conscious effort to keep firmly grounded in reality. You must strive to avoid being tricked into thinking that the feeling that you need to check or to count or to wash, for example, is a real need. It is not.

Your thoughts and urges are symptoms of obsessive-compulsive disorder (OCD), a medical disease.

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THE FAR SIDE © Farworks, Inc./Dist. by Universal Press Syndicate. Reprinted with permission. All rights reserved.

Professor Gallagher, as you see, has his own ideas about “curing” patients who suffer from frightening and intrusive thoughts or obsessions.

He is actually performing a cartoon variation on what is known in the language of traditional behavior therapy as “flooding.” Unfortunately, this poor patient more than likely ended up crazed rather than cured.

In working with patients with OCD, our UCLA team has had excellent results using behavior therapy, sometimes in conjunction with medication. Ours is not Gallagher’s sink-or-swim approach but, rather, a long-term self-directed therapy we call cognitive-biobehavioral self-treatment.

Typically, our first consultation with a person with OCD begins with the person explaining with a considerable amount of embarrassment, “Doctor, I know this sounds kind of crazy, but . . .”

The person then describes one or more from a checklist of classic OCD symptoms: compulsive washing or checking, irrational violent or blasphemous thoughts, or feelings of impending doom or catastrophe unless some bizarre or senseless ritual is performed.

These people usually know that no one is supposed to think such weird thoughts. As a consequence, they feel humiliated and at their wit’s end. Their self-esteem has plummeted, their OCD may well have affected their ability to perform on the job, and they may even have become socially dysfunctional, withdrawing from family and friends in an attempt to hide these awful behaviors.

IT’S NOT INSANITY, IT’S BRAIN LOCK

In treatment, the person is first assured that the diagnosis is just OCD. It is just the brain sending false messages. We show pictures of the brains of people with OCD that prove conclusively that OCD is associated with a biochemical problem that causes the underside of the front part of the brain to overheat.

In short, the person is suffering from Brain Lock. The brain has become stuck in an inappropriate groove. The key to unlocking the brain is behavior therapy, and that begins with the Relabeling step.

Relabeling simply means calling the unwanted thoughts and urges by their real names—obsessive thoughts and compulsive urges. These are not just uncomfortable feelings like “maybe it’s dirty,” but gnawing and unremitting obsessions. Not just bothersome urges to check for the fourth or the fifth time, but brutal, compulsive urges.

This is war, and the enemy is OCD. In fighting back, it is critical to keep in mind what that enemy really is. The person with OCD has a powerful weapon: the knowledge that “It’s not me—it’s OCD.” He or she works constantly to prevent confusing the true self with the voice of OCD.

All well and good, you may say, but OCD has a mind of its own. It won’t shut up. To this I reply, “Yes it will, but it takes time.” Praying for OCD to go away won’t instantly make it happen, nor will idle and futile cursing.

If you wish to pray, what you should pray for is the strength to help yourself. God helps those who help themselves, and it’s only reasonable to believe that God would help someone engaged in such a worthwhile struggle. In this case, it means concentrating on doing the right thing, while letting go of an excessive concern with feelings and comfort level. This is, in the best sense, performing a good work!

At the same time, it is medical self-treatment that begins with accepting what you cannot change—at least in the short term.

Right off, it is vital to understand that the simple act of Relabeling will not make your OCD disappear. But when you see this enemy for what it is, OCD, you sap its strength and you, in turn, become stronger.

In time, it won’t matter that much to you whether the bothersome thoughts totally go away because you are not going to act on them. Furthermore, the more you are able to dismiss the importance of your OCD, the more you will feel in control and the more it will go away. On the other hand, the more you focus on it, wishing and hoping and begging for it to leave you alone, the more intense and bothersome the feelings will become.

TALKING BACK TO OCD

Because OCD can be a fiendishly clever opponent and a demonically self-protective one, it will deny that it is simply a false message from your brain. You may say, “A plane is not going to crash because I didn’t wash my hands again.” But OCD will say, “Oh, yes it will, and many people will die.” That’s the time to show some faith and strength because you know what the truth is.

You can’t afford to listen. If you sit and fret about whether OCD is going to invade your life on a given day, you’re only assuring yourself more dread and pain. You must say, “Go ahead, make my day. Just try to make me wash my hands one more time.”

Then you must deal with the ever-present uncertainty, “How can I be sure that this is not me, just my OCD?” Well, perhaps there are no metaphysical guarantees that there is no possible relationship between hand washing and a plane crash, but I can guarantee that if you give in and wash your hands again, things will only get worse and the OCD will only get stronger. On the other hand, within a few minutes of Refocusing on another behavior and not responding to the OCD, the fear of some dreadful consequence will begin to fade, and you will begin to see the OCD compulsion as the ridiculous nonsense it is.

The decision is clear-cut: Listen to your OCD and have your life disrupted and ultimately destroyed, or fight back, secure in the knowledge that within a few minutes you will begin to feel more and more certain that planes aren’t going to fly into mountains and cars aren’t going to crash just because you didn’t wash your hands or check the lock again.

It is a matter of exerting effort so that good triumphs over evil.

IT’S JUST A CHEMICAL

At UCLA, our patients have come up with amazingly creative ways of applying the Four Steps—Relabel, Reattribute, Refocus, Revalue.

Chet, who has since successfully controlled his OCD through behavior therapy and is now in dental school, was obsessed by violent thoughts. If he saw a fire, he thought he had started it. If he heard that someone had been fatally shot across town, he obsessed that he had done it. He would walk around saying to himself, “Man, you’re just one messed-up guy. You’re a bad person.” He was in a dead-end job that he hated and was dealing with debt. These factors made his stress level escalate and his OCD symptoms worsen. Stress commonly heightens OCD anxieties.

At first, when Chet began Relabeling, telling himself that his violent thoughts were just OCD, his OCD would talk back, “Oh, is this upsetting you? Why? Maybe because you really will do it.” By gaining the knowledge that OCD is a biochemical imbalance in the brain, Chet was eventually able to use this phrase with his OCD: “Don’t be polemical—it’s just a chemical.”

Anticipation is an important substep in Relabeling, and Chet understood it perfectly. Watching a movie in which he knew a violent scene was coming, he would tell himself, “Okay, here comes my obsessive thought.” When he did that, it didn’t hurt as much.

In combating his OCD, Chet was both pragmatic and philosophical. He had always wished that he were six inches taller, he reasoned, but he knew that wishing wasn’t going to make him grow and he could deal with being short. He realized it was the same with OCD: Wishing wouldn’t make it go away, but he could learn to deal with it.

Chet found another way to best the OCD: Every time he had an OCD thought, he would do something nice for his fiancée—buy her roses, perhaps, or cook her dinner. Whenever the OCD wanted to make him miserable, he would make himself happy by making his fiancée happy.

A deeply religious man, Chet also turned to the Scriptures for inspiration and found comfort in the passage “The Lord searcheth all hearts and He understands all the imaginations of the mind” (I Chronicles 28:9). Chet clearly understood how this passage applied to him: God understands my heart and knows that my mind is messed up. I must work to stop beating myself up over it.

It’s interesting to note that there is a centuries-old precedent for this. John Bunyan, the seventeenth-century British author of The Pilgrim’s Progress, suffered from what we now know was OCD. Because Bunyan was an intensely religious man (an itinerant preacher who was imprisoned for preaching without a license), he agonized over his OCD-induced blasphemous thoughts. He dealt with his guilt—as does Chet—through a conviction that God would be upset with him for punishing himself for having false and meaningless thoughts. For this brilliant insight, I consider Bunyan the father of cognitive-behavior therapy for OCD.

THE IMPARTIAL SPECTATOR

In learning to Relabel, it is not enough to shrug and say, “It’s not me—it’s my OCD” in an automaton-like manner. Mindful awareness is essential. Mindful awareness differs from simple, superficial awareness in that it requires you to consciously recognize and make a mental note of that unpleasant feeling, Relabeling it as an OCD symptom caused by a false message from the brain. As the feeling sweeps over you, you must say to yourself, “I don’t think or feel that my hands are dirty; rather, I’m having an obsession that my hands are dirty.” “I don’t feel the need to check that lock; rather, I’m having a compulsive urge to check that lock.” This will not make the urge go away, but it will set the stage for actively resisting the OCD thoughts and urges.

We can learn from the writings of the eighteenth-century Scottish philosopher Adam Smith, who developed the concept of “the impartial and well-informed spectator,” which is nothing more or less than “the person within.” Each of us has access to this person inside us who, while fully aware of our feelings and circumstances, is nonetheless capable of taking on the role of spectator or impartial observer. This is simply another way of understanding mindful awareness: It enhances our ability to make mental notes, such as “That’s just OCD.”

In Relabeling, you bring into play the Impartial Spectator, a concept that Adam Smith used as the central feature of his book The Theory of Moral Sentiments. He defined the Impartial Spectator as the capacity to stand outside yourself and watch yourself in action, which is essentially the same mental action as the ancient Buddhist concept of mindful awareness. People with OCD use the Impartial Spectator when they step back and say to themselves, “This is just my brain sending me a false message. If I change my behavior, I’ll actually be changing how my brain works.” It is inspirational to watch people with OCD shift from a superficial understanding of their disorder to a deep mindfulness that allows them to overcome their fears and anxieties, to mentally organize their responses, to shift gears, and to change their behavior. This process is the basis for overcoming OCD.

Once a person with OCD learns behavior therapy and resolves to change his or her response to an intrusive, painful thought by not performing some pathological behavior, a willful resolve kicks in: “I’m not going to wash my hands. I’m going to practice the violin instead.” But, in the beginning, the person is beset with fear and dread and may very well have catastrophic thoughts, such as, “But then my violin will get contaminated. . . .”

Adam Smith understood that keeping the perspective of the Impartial Spectator under painful circumstances is hard work, requiring, in his words, the “utmost and most fatiguing exertions.” Why? Because focusing on a useful behavior when your brain is bombarding you with distracting doubts and disturbing mental aberrations takes a great deal of work.

Of course, performing a compulsive behavior repetitively, ad nauseum, is also exhausting. But it is exhaustion with no positive payoff. When the Impartial Spectator is attended to, when an action is done mindfully, it makes a significant difference in how the brain functions. And that is the key to overcoming Brain Lock. This is what our scientific research at UCLA has shown.

WHO’S IN CHARGE HERE?

There will be times when the pain is too great and the effort required too debilitating, and you will give in and do a compulsion. Think of it as a tiny backward step. Tell yourself that you’ll win next time. As Jeremy, a man with OCD, put it, “Even when you fail, you succeed—so long as you persevere. So long as you take on this enemy, OCD, with mindful awareness.”

Anna, a philosophy student, described how she used the Relabel step in battling an obsession that her boyfriend (now her husband) was unfaithful to her. Although she knew her fears had no basis in fact, she would bombard him with questions about past romances, about whether he had ever looked at pornographic magazines, about what he drank and how much, what he ate, and where he was every minute of the day. Her relentless interrogations almost led to the breakup of their relationship. Anna recalls, “The first step in beginning to conquer my OCD was to learn to Relabel my thoughts and urges. The second step was to Reattribute them to OCD. In my treatment, these went hand in hand. On an intellectual level, I knew that OCD was a chemical problem in my brain and that the sensations this problem produced were more or less meaningless side effects of the chemical problem. Still, it is one thing to know this intellectually and another to be able to say while in the midst of an OCD attack that what you are feeling really isn’t important per se. The irritating thing about OCD is that when you have it, your worries, urges, and obsessions seem like the most important things in the world. Stepping back from them long enough to identify them as OCD-generated is thus no mean feat.”

In the early stages of Anna’s learning to Relabel, her boyfriend, Guy, kept reminding her that her obsessions were “just OCD,” but he could not always convince her. Over time—and with practice—she became, in her words, “pretty good at recognizing what is OCD and what is a ‘real’ worry or anxiety. As a result, I can frequently avoid buying into OCD when it strikes. I no longer become mentally distressed each and every time an obsessive-type thought enters my mind. Often, I can look beyond it and say to myself, ‘You know, it won’t do any good to get all upset about this thought. I’ve been through all this before, and it doesn’t accomplish anything to allow myself to be sucked into OCD’s tricks.’ Doing this allows a certain calm and satisfying detachment.” Anna found that the intrusive thought—or at least the intense anxiety surrounding it—dissipates, usually within fifteen to thirty minutes.

For Dottie, who had the obsession about her son losing his eyesight and who coined the phrase “It’s not me—it’s my OCD,” Relabeling was the biggest help in combating her compulsion. “It was not dwelling on it, recognizing it, and saying, ‘It’s okay, it’s just a thought and that’s all it is.’ Most days, that works for me. Some days it’s a struggle. I say people with OCD will always have OCD unless they find some magical pill.” But, as you’ll learn from the stories throughout this book, the mental strength and power you gain while fighting OCD can never be gained from any “magic pill.”

Jack, the hand washer, had been looking for that magical pill. “That’s America. You take a pill and your life will be wonderful; you’ll be a whole new person, more aggressive or nicer or thinner or whatever.” But when medication did not make his OCD symptoms abate and the side effects of medication grew too bothersome, he turned to c...