Saturday, October 15, 2011

Reviews of OCD literature esp. relating how they mean 'cured'.

I read a book called Saving Sammy written by his mother, Beth Maloney. It was a very fascinating book. He Here is the summary from

The summer before entering sixth grade, Sammy suddenly began to exhibit disturbing behavior. He walked and ate with his eyes shut, refused to bathe, burst into fits of rage, slithered against walls, and used his limbs instead of his hands to touch light switches, doorknobs, and faucets.
Sammy’s mother, Beth, watched helplessly as her middle child descended into madness. Sammy was soon diagnosed with OCD and later with Tourette syndrome. Unwilling to accept the doctors’ prognoses for lifelong mental illness and repeated hospitalizations, Beth fought to uncover what was causing this decline. Racing against time as Sammy slipped further from reality, Beth’s quest took her to the center of the medical community’s raging debate about whether mental illness can be caused by infection. Beth searched until she found two cutting-edge doctors who answered that question with a definitive yes. Together, they CUREDSammy. Five years later, he remains symptom free.

He had strep virus or the antibodies running thru his system. They weren't giving him strep throat but were causing the ocd. He still has to watch his stress levels and stuff, but if there's a flare-up he goes back on the meds until it settles down again.

Train your mind Change your brain by Sharon Begley says this about ocd:

P8: The brain can be rewired. It can quiet circuits that once crackled with the aberrant activity that characterizes depression & cut pathological connections that keep the brain in the some-thing-is-wrong state that is ocd. The adult brain retains much of the plasticity of the devloping brain incl. the power to repair damaged regions, to grow new neurons

P139 Schwartz had another objection to erp: it’s cruelty. He looked for alternatives that were both more humane and more effective.

p 141 Willful, mindful effort can alter brain function. Mental action can alter the brain chemistry of an ocd patient.
So if mental action changes brain function does that mean drug free, or what? I'm getting Schwartz' books to see if i can find this answer. So far i found a summary of his and his collegue Dr Gladding's ideas from Brain Lock & You Are Not Your Brain at the website: Here is a short summary of the info found there:
OCD is caused by damage to a specific part of the brain called the basal ganglia. Thus, OCD is a biological disorder, rather than a "mental problem." Scientists proposed that any damage to the basal ganglia might result in the onset of OCD symptoms. Physical damage to a brain structure results in a neuropsychological condition.
Although the patient realizesthat these obsessions and compulsions are "unwanted, unreasonable and excessive," they cannot stop listening to the thoughts and acting on them because of the pure feeling of dread the patient experiences until the compulsions are correctly performed.
Researchers postulated that OCD occurs as a result of the OFC and ACG [parts of the brain]being overstimulated. If they are stimulated beyond normal ranges (hyperexcited), they cannot accurately detect errors and may fire at inappropriate times. Thus, they would send excessive, erroneous messages to the basal ganglia that there was a problem. This is exactly what patients report, a sense of "dread and an intractable feeling that ‘something is wrong’."
Medications passively alter brain chemistry and decrease the intensity of OCD signals, while in CBT patients consciously alter their brain chemistry by changing their responses to obsessive thoughts.
Train yourself to say, "I don't think or feel that my hands are dirty. I'm having an obsession that my hands are dirty."
We now know that these urges are caused by biological imbalances in the brain. By calling them what they really are--obsessions and compulsions--you begin to understand that they are simply false messages coming from the brain.
Just relabeling these thoughts and urges won't make them go away. The worst thing you can do is to try to make them vanish. It won't work because the thoughts and urges have a biological cause that is beyond your control. What you can control is your behavioral response to those urges.
STEP 2: Reattribute
"It's not me--it's my OCD." It is a reminder that OCD thoughts and urges are not meaningful, that they are false messages from the brain. "My hands are dirty" can be so powerful and overwhelming. Understanding why the thought is so strong and why it won't go away is the key to increasing your willpower and enabling you to fight off the urge to wash or check.
Deep inside the brain lies a structure called the caudate nucleus. In people with OCD, the caudate nucleus [C.N.] may be malfunctioning. Think of the C.N. as a processing center or filtering station for the very complicated messages generated by the front part of the brain. Together with the putamen, which lies next to it, the C.N. functions like an automatic transmission in a car. The C.N. and the putamen together take in messages from very complicated parts of the brain--those that control body movement, physical feelings, and the thinking and planning that involve those movements and feelings. They function in unison like an automatic transmission, assuring the smooth transition from one behavior to another. Typically, when anyone decides to make a movement, intruding movements and misdirected feelings are filtered out automatically so that the desired movement can be performed rapidly and efficiently.
In OCD, the problem seems to be that the smooth, efficient filtering and the shifting of thoughts and behavior are disrupted by a glitch in the C.N.
As a result of this malfunction, the front of the brain becomes overactive and uses excessive energy. It's like having your car stuck in a ditch. You spin and spin and spin your wheels, but without traction you can't get out of that ditch. With OCD, too much energy is being used in a frontal part of the brain called the orbital cortex. It's as if the orbital cortex, which has an error-detection circuit, becomes stuck in gear. This is probably why OCD causes people to get a "something is wrong" feeling that won't go away. You have to do the work to get it out of gear--to shift the gears. You have a manual transmission. People with OCD can teach themselves how to shift gears through self-directed behavior therapy. In doing so, they can actually fix this broken gearshift in the brain. We now know that you can change your own brain biochemistry.
Using the Reattribute step will also help you to avoid performing rituals. Knowing that the urge to get that "right feeling" is caused by a biochemical imbalance in the brain, you can learn to ignore the urge and move on. You will actually change your brain and make the feeling lessen.
Step 3: Refocus
This is what we mean by shifting gears: Do another behavior. This. Takes. Hard. Work. The Refocus step is where the real work is done. Mental exercise is like a physical workout. In Refocusing, you must shift the gears yourself. With effort and focused mindfulness, you are going to do what the C.N.normally does easily which is to let you know when to switch to another behavior. After a while a person gets a "feel" for when he's scrubbed enough. But people with OCD can't get the feeling that something is done once it's done. The automatic pilot is broken.
The idea is to work around the OCD thoughts and urges by shifting attention to something else, Any constructive, pleasant behavior will do. Hobbies are particularly good. For example, you may decide to take a walk, exercise, listen to music, read, play a computer game .
When the thought comes, you first Re-label it as an obsessive thought or a compulsive urge and then Reattribute it to the fact that you have OCD--a medical problem. Then Refocus your attention to this other behavior that you have chosen. As you keep practicing, the same amount of effort will result in a greater decrease in intensity.
Sometimes the urge will be too strong, and you will perform the compulsion. Never perform the compulsion without some time delay. This is not an invitation to beat yourself up. Just continue to Relabel the behavior and to acknowledge that this time the OCD overwhelmed you. Remind yourself "I'm not washing my hands because they are dirty, but because of my OCD. The OCD won this round, but next time I'll wait longer." Relabeling a behavior as a compulsive behavior is a form of behavior therapy and is much better than doing a compulsion without making a clear mental note about what it is.
If your problem is checking the door lock, try to lock the door with extra attention and mindful awareness the first time. This way, you'll have a good mental picture to refer to when the compulsive urge arises. Anticipating that the urge to check is going to arise in you, you will be able to Relabel it immediately and say, "That's an obsessive idea. It is OCD." You will Refocus and begin to "work around" the OCD urges by doing another behavior, with a ready mental picture.
Step 4: Revalue
For obsessive thoughts, Two substeps--the two A's--aid you in Step 2: Anticipate and Accept Anticipate means "be prepared," know the feeling is coming, so be ready for it; don't be taken by surprise. Accept means don't waste energy beating yourself up because you have these bad feelings. You know what's causing them and that you have to work around them. You want to stop reacting each time as though it were a new thought, something unexpected. Refuse to let it shock you.
So it sounds to me that he is saying that you can be med-free and after a while mostly symptom free, with a system in place for dealing with any thots that DO occur. However i will see what the actual book says since this is a summary of a summary.


  1. Brain Lock is a great book!

    I believe that the scientists are correct in saying that the brain is basically plastic and can be re-wired the cognitive behavior therapy and ERP which is why those things work. However, I personally wouldn't be able to do those things without my meds helping me to move those thought along.

    I have stopped thinking that I'll eventually be cured, for it only frustrates me when I have set backs. My mind set has changed and now I am only concerned with learning to managhe the disorder.

    It always suprises me to hear about people who get to a point where they are symptom free. Can that really be possible?

  2. I think this is one of the problems with how people discuss OCD. Many of the stories of "hope" are about people who had OCD, went to therapy for three months, and are now symptom free. How many people actually achieve this? Not me. I think more stories of "hope" should be about people who deal with OCD on a daily basis and have the courage to keep going day by day. Because I am like Elizabeth - I get frustrated when I have set backs (and these days there are a lot), and I also feel like a failure because I can't seem to get to that holy grail of "symptom free" for an extended period of time. I do think though that ERP is a necessary component of OCD treatment. I've tried just using the Brain Lock steps but it didn't work for me.

  3. When ocd is screaming at me in my head it is HARD to not just be obedient and do what it says. I can think about and do the erp assignment and be floored by a different ocd attack that because i haven't had a lot of time to think thru is just soooo strong i want to do just ANYTHING to get it out of my head and be 'normal' feeling again.

    i wouldn't wish this disease, illness, neurological impairment, what ever the hell it is on my worst enemy.

    -karin. Ha,i can't even post on my own blog!!! There are only 2 or 3 blogs i can post under automatically. i wonder what is going on here.