How To Deal With Pure Obsessions?
Obsessive-compulsive disorder is a diagnostic category reserved for cases in which the patient manifests pure obsessions and compulsions. In some less common cases, these patients may come to the clinic with symptoms based solely on obsessions.
This is called pure OCD or pure obsessions. Obsessions can be defined as recurring and persistent thoughts, impulses or images that are experienced, at a given point in the disorder, as intrusive or unwanted. And which, in most people, causes anxiety or significant discomfort.
Compulsions usually lead to very short-term relief. Anxiety or tension arising from obsessions is negatively reinforced by compulsive behavior.
This constraint maintains the problem and eventually becomes chronic. Because the patient learns that it is the only way available to get rid of the anxiety and the unpleasant thoughts that inhabit his mind.
The constraints are usually not realistically related to the fact that what is feared is not happening or is clearly excessive. For example, a patient may believe that if she taps the door three times on leaving and entering her house, her husband will not have a traffic accident on the way to work.
Patients who do not exhibit these types of symptoms, that is, who do not resort to compulsions to alleviate their discomfort, are more complex. Treating pure obsessions is more difficult, but psychological techniques are currently available to address it.
The key is habituation
The fact that obsessions reinforce each other in a negative way when practicing compulsion leads to the inability to get used to the anxiety or fear that they generate.
Therefore, it fuels the obsessions. And by feeding them gradually, they get bigger. Likewise, in pure obsessive disorders, treatment is based on habituation. In order for this to happen, it is essential to have exposure to the obsessions themselves.
Periodically, exposure is aversive to patients. Exposure with prevention of response may result in severe rejection and even discontinuation of treatment. This is one of its drawbacks. However, to date, empirical evidence shows us that these are the treatments that report the most therapeutic success in the majority of patients who are successful in completing them.
The goal, finally, is that the person is exposed to his thoughts or his images. So that, on purpose, she has to take them out and look at them. Habituation training stems from research by Salkowskis and Westbrock.
It is usually performed on audio tape. The patient records his pure obsessions and listens to them repeatedly until he gets used to them. The predictability of the stimuli to which the subject is exposed is the key factor in treatment. Through recording, the patient can predict what he will hear. Unlike what happens with pure obsessions which are not unpredictable.
In addition to audio recording, there are other strategies that can be used to present thoughts in a predictable way. Deliberately evoking thoughts by recounting them in session or writing them down and rereading them until the anxiety subsides.
It is necessary to explain to the patient in detail how anxiety works and how habituation follows a curve. In which it first increases, but at some point it begins to decline. Psychoeducation facilitates adherence to treatment and promotes the therapeutic relationship.
The Anxiety Curve of Pure Obsessions
The characteristic curve for anxiety is an “inverted U” shape. As we have already pointed out, when a person is exposed to their fears (either through pictures, live or in the case of pure obsessive-compulsive disorder by recording or in writing), they experience a substantial increase in anxiety.
This moment is essential because the patient thinks he is worse, he feels much more anxious. But this nasty climb ends. Physiologically and inevitably, the rise in anxiety has a limit.
When this discomfort reaches its maximum and if the patient does not perform any rituals, safety behavior or any other type of avoidance, the anxiety will gradually decrease. Why is this happening? First, emotionally, anxiety or any other emotion increases in a linear fashion. This is not the typical pattern. There has been no instance where the emotion soars to the point of killing anyone. Quite the contrary.
On the other hand, the simple fact of realizing that our cognitions are biased or unrealistic allows us to modify them by much more moderate methods, with which the anxiety begins to lose the anchors that it cultivated.
In the end, the key is to prevent the patient who is going to expose himself to his obsessions or any other stimulus that causes him anxiety from knowing that staying and persevering is the key to success. In fact, short exposures can produce an iatrogenic effect. By which the patient not only does not overcome his fear, but increases it.
Our thoughts While for centuries, decorum wanted them to be repressed, it is still recommended to know how to express your emotions to free yourself …
