Tag Archives: Cognitive Behavioral Therapy

Childhood Trauma and Obsessive-Compulsive Disorder (OCD) Treatment

 

childhood trauma and obsessive compulsive disorder treatment

STOP OBSESSIVE THOUGHTS - CLICK IMAGE

STOP OBSESSIVE THOUGHTS – CLICK IMAGE ABOVE

In the last 2 posts on this condition I explained what OCD is. In this post, Part 3, I want to consider how it may be treated.

WHAT TREATMENTS ARE NORMALLY GIVEN?

Experts in the field of the treatment of OCD generally recommend cognitive-behavioural therapy (CBT) which is made even more effective if it is combined with medication – usually the medication will be an anti-depressant, although sometimes a benzodiazepam may be used.

Generally speaking, the anti-depressant is a long-term treatment, eg given for perhaps a minimum of a year, and up to a whole life-time, even if symptoms significantly improve (this is done in order to minimize the chances of a relapse occurring).

On the other hand, if the individual with OCD is prescribed a benzodiazepam, this will generally only be taken over a short period of time (eg a period when the symptoms are very acute) in order to minimize the risk of the individual with OCD becoming physically and/or psychologically dependent upon them (as they are addictive).

HOW EFFECTIVE IS TREATMENT?

If studies on the effectiveness of anti-depressants for the treatment of OCD are looked at as a whole, on average individuals with OCD who undergo such treatment significantly improve around about 45% of the time. Whilst any improvement is obviously extremely desirable, in general the improvements individuals make by taking anti-depressant medication are not great enough to eliminate the need for other treatments being given alongside.

As has already been referred to, cognitive-behavioural therapy (CBT) is usually the type of therapy to be used alongside medication – in fact, it is a specific type of CBT which is known as EXPOSURE WITH RESPONSE PREVENTION (which I’ll henceforth refer to as EWRP). As has also been mentioned, if symptoms are extremely severe then benzodiazepam may be prescribed over the short term before the EWRP can take place.

WHAT DOES EWRP ACTUALLY ENTAIL?

We have already looked at  how sufferers of OCD have obsessive thoughts which cause them distress. What EWRP is designed to do is to help the individual TOLERATE SUCH DISTRESS. For, example, one common way in which OCD manifest itself is by making the sufferer inordinately and irrationally fearful of germs. Therefore, s/he may constantly be acutely anxious that his/her hands are ‘dirty’ and that this is potentially ‘highly dangerous’ – this, in turn. leads to constant compulsions to wash their hands in order to relieve their distressing and acute anxiety. However, the sense of relief is extremely ephemeral and the compulsion returns, perhaps leading the afflicted individual to wash his/her hands 100 times a day.

In the above example, the approach EWRP takes is to help the person tolerate the distress that his/her perception of having ‘dirty’ hands causes him/her by encouraging him/her not to wash them for a given period of time. As the person becomes better and more used to the anxiety caused by not washing them, the period of time can be gradually increased. The idea is that the person will become desensitized to the anxiety associated with unwashed hands.

On top of this, CBT can be used to help the individual challenge irrational thoughts which are connected to his/her OCD. For example, in the case described above, the individual could be helped to challenge thoughts such as ‘having any dirt on my hands is highly dangerous’ and to understand that the thought is an enormous exaggeration of any objective danger.

STOP OBSESSIVE THOUGHTS - CLICK IMAGE

STOP OBSESSIVE THOUGHTS – CLICK IMAGE ABOVE

David Hosier BSc Hons; MSc; PGDE(FAHE).

‘Fighting’ Anxiety can Worsen It: Why Acceptance Works Better.

fighting anxiety

What Happens When We Try To ‘Fight’ Anxiety?

Trying to fight anxiety, research suggests (and, certainly, my own experience of anxiety would tend to confirm this) can actually AGGRAVATE the problem and lead to greater feelings of distress. Stating the shatteringly obvious, none of us wants to experience the feelings an anxiety condition brings; however, difficult as it may sound at first, DEVELOPING AN ATTITUDE OF ACCEPTANCE TOWARDS IT, rather than entering an exhausting mental battle with it, has been reported by many to be a superior strategy for coping with anxiety.

The psychologist Beck, to whom I have made several references already in this blog (he was one of the founders of the very helpful therapy called Cognitive Behaviour Therapy, or CBT, for people suffering from conditions such as depression and anxiety – see my posts on CBT) devised the acronym A.W.A.R.E for ease of remembering the key strategies for coping. Let’s take a look at what the acronym A.W.A.R.E stands for:

A Accept the anxiety (it sounds hard, I know, but so is constantly struggling to fight it):

The benefits of adopting this approach are that it may help to reduce the PHYSIOLOGICAL symptoms commonly associated with anxiety (eg accelerated heart rate, increased muscle tension, hyperventilation, sweating -or ‘cold sweats’- trembling, dry mouth etc). It may, too, help with PSYCHOLOGICAL symptoms (people report that an attitude of acceptance towards their anxiety makes them feel less distressed). A kind of motto which has come to attach itself to the acceptance approach to anxiety is: ‘if you are not WILLING to have it, you WILL’ (see what they’ve done there!)

W Watch your anxiety:

It is suggested that rather than get too ‘caught up’ in anxiety, together with all the distressing negative thoughts and fears it produces, to, instead, just observe it in a DETACHED and NON-JUDGMENTAL manner; this involves trying to adopt a kind of NEUTRAL MENTAL ATTITUDE towards it – in other words, neither liking it nor seeing the experience of anxiety as a terrible, unsolvable catastrophy (again, I realize, of course, that intense anxiety is very painful, so this, too, may sound difficult at first). People report that when they adopt this DETACHED, NEUTRAL view of their feelings of anxiety they starts to lose their, hitherto, tenacious grip on their lives.

A Act with your anxiety:

Severe anxiety can leave us feeling as if we are incapable of functioning on even a basic level. It is important to remember, however, as I have repeated at, no doubt, tedious length througout this blog, that just because we believe something it does not logically follow that the belief must be true. Indeed, when my anxiety was at its worst, I did not feel able, or even believe I could,shave or brush my teeth etc…etc… Many people report, however, that if they take the first (often, extremely challenging) step to try to carry on with normal activities, despite the feeling of anxiety which may accompany this, they can, after all, accomplish that which they originally believed they couldn’t. Success then tends to build upon success: completion of the first activity increases the self-belief and the confidence to go on to the second activity, the completion of which provides further self-belief and confidence…and so on…and so on…

In order to make this easier, it may be necessary to slow down the pace at which, in different circumstances, we would otherwise carry out the particular tasks that we set ourselves.

R Repeat the steps:

This just means that by repeating the ACCEPTING ANXIETY, WATCHING OUR ANXIETY (in a detached and neutral manner) and ACTING (despite the feelings of anxiety which may accompany such action) CYCLE, the anxiety may be slowly eroded away.

E Expect the best (even if it does not come naturally)

When we are depressed and anxious we, almost invariably, expect the worst. This is overwhelmingly likely to perpetuate the condition. However, just as expecting the worst can become a self-fulfilling prophecy, so, too, can expecting the best. If, like me, you are not a natural optimist, the concept of expecting the best may go against the grain. However, research shows that optimistic people are more likely to achieve their goals than those of us who do not appear to have been blessed with quite such a sunny disposition. It is worth adapting the strategy on, at least, an experimental basis. It is also useful to keep in mind that even if the best does not occur, we will still have the inner-strength necessary to cope.

eBook :

 

childhood trauma and depression

 

Above eBook now available for immediate download on Amazon.  CLICK HERE.

David Hosier BSc Hons; MSc; PGDE(FAHE).

Cognitive Behavioral Therapy: Challenging Our Negative Thoughts.

challenge negative thoughts

Challenging Negative Thoughts :

This article examines how we can use cognitive behavioral therapy to challenge our negative thoughts.

When we have negative thoughts, it is important to ask ourselves:

‘What is the evidence to support this negative thought/belief?’ OFTEN, WILL WILL FIND THERE IS VERY LITTLE OR AT LEAST NOT THE COMPELLING EVIDENCE WE’D ORIGINALLY SUPPOSED.

It is important for us to get into the habit of challenging negative thoughts in this way because very often the negative thoughts come to us automatically (due to entrenched negative thinking patterns caused in large part by our traumatic childhoods) without us analyzing them and examining them to see if they are actually valid.

So, to repeat, we need to try to get into the habit of CHALLENGING OUR NEGATIVE THOUGHTS AND ASKING OURSELVES IF THERE REALLY IS PROPER EVIDENCE TO SUPPORT THEM.

A SUGGESTED EXERCISE FOR CHALLENGING NEGATIVE THOUGHTS :

1) Think of two or three negative thoughts that you have experienced lately.

2) Ask yourself what evidence you have to support them.

3) Ask yourself how strong this evidence actually is.

4) Now think of evidence AGAINST THE NEGATIVE THOUGHT.

Step 4 above is very important.This is because when we are depressed and have negative thoughts we tend to focus on the (often flimsy) evidence which supports them BUT IGNORE ALL THE EVIDENCE AGAINST THEM (in other words, we give ourselves an ‘unfair hearing’ and , in effect, are prejudiced against ourselves). This is sometimes referred to as CONFIRMATION BIAS.

Challenging our negative thoughts and FINDING EVIDENCE TO REFUTE THEM is a very important part of CBT. It is, therefore, worth us putting in effort to search hard for evidence which weakens or invalidates our automatic negative thoughts/beliefs.

ALTERNATIVE THOUGHTS:

When we have successfully challenged our negative thoughts, and found, by reviewing the evidence, reason not to hold them anymore, it is useful to replace them by MORE REALISTIC APPROPRIATE THOUGHTS.

One way to get into the habit of this is to spend a little time occasionally writing down our automatic negative thoughts. Then, for each thought, we can write beside it:

1) Evidence in support of the negative thought.

2) Evidence against the negative thought.

3) In the light of the analysis carried out above in steps 1 and 2, replace it with a more realistic, valid and positive thought. Here is an example:

Negative Thought: I failed my exam which means I’m stupid and will never get the job I wanted or any other.

1) Evidence in support of negative thought:

‘after a lot of revision, I still didn’t pass.

2) Evidence against negative thought:

I only failed by a couple of per cent and was affected by my nerves – failing one exam does not make me stupid’.

3) Alternative, more valid, realistic and positive thought:

‘I can retake the exam and still get the job. Even if I don’t get my first choice of job, that does not mean there won’t be other jobs I can get, and they may turn out to be better.’

Getting into the habit of occasionally writing down negative thoughts, challenging them, and coming up with more positive alternative thoughts will help to ‘reprogram’ the brain not to just passively accept the automatic negative thoughts which come to us without subjecting them to scrutiny and challenging their validity.

 

Self-Help Link :

Ten Steps To Overcoming Negative Thinking. Click here for further information.

 

 

David Hosier BSc Hons; MSc; PGDE(FAHE)