![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 42 to 66 of 91. Go back in thread:
Posted by zenhussy on June 3, 2003, at 0:59:30
In reply to Re: sexy pharmaceuticals vs hokey cbt » zenhussy, posted by mattdds on June 3, 2003, at 0:55:53
> Zenhussy,
>
> Thanks, you have no idea how much that means.
>
> Best,
>
> MattGlad to have helped. I just muffed up post on other board indicating to me I need to eat a bit and hit the hay. I am not typing clearly nor thinking (that stopped hours back! ha ha) well so I'll try to gracefully bow out.
zenhussy (tripping over chair as she gets up from pc desk falling across cord under chair, etc.)
Good night Matt = )
Posted by Squiggles on June 3, 2003, at 6:44:19
In reply to Re: responsibility and blame » Squiggles, posted by mattdds on June 2, 2003, at 21:56:02
Hi mattdds,
I think you are absolutely right --- a discussion
about the dynamics of CBT would be more to the
point.My scepticism about its power is based on
an assumption about how we think, not on
experience. So, you should take my argument
with a grain of salt.Also, i did not realize you were only 25 yrs.
old, and that may put things in perspective
a bit - as i am twice your age and very
conservative in my views about psychiatry.Sorry, to be so uptight.
Squiggles
Posted by Larry Hoover on June 3, 2003, at 7:50:06
In reply to Re: responsibility and blame » mattdds, posted by Squiggles on June 3, 2003, at 6:44:19
> Hi mattdds,
>
> I think you are absolutely right --- a discussion
> about the dynamics of CBT would be more to the
> point.
>
> My scepticism about its power is based on
> an assumption about how we think, not on
> experience.More than one assumption, I think.
> So, you should take my argument
> with a grain of salt.Already had to. That's not a put-down. Let me explain.
At times, your thinking seems almost visible, following a predictable course. Thinking patterns are habits.
When you start listing the reasons why a certain conclusion seems valid to you, it is as if you are trying to convince yourself, not us, that your initial reaction is a valid and rational response. Moreover, such a tactic is distractionary, more likely to divert attention to the minutiae of individual propositions, rather than the original point in discussion.
Because thinking patterns are habits, the more ingrained the habits are, the more difficult it becomes to change them. Your conclusion that some people are unable to do this work is not supported by the evidence; it is supported by certain types of habitual thinking. An example, you provided right here:
> Also, i did not realize you were only 25 yrs.
> old, and that may put things in perspective
> a bit - as i am twice your age and very
> conservative in my views about psychiatry.Although rigid might be more precise, I read into this a version of, "You can't teach an old dog new tricks."
> Sorry, to be so uptight.
>
> SquigglesThe quintessential requirement for CBT therapy is a desire to change. If you're happy where you find yourself, or if fear of change exceeds your willingness to change, then you will remain where you are. If the pain of staying the same exceeds the fear of change, then you'll do something proactive.
You said something quite different, yesterday. "Cognitive behaviour therapy is good for those who do not need therapy at all, but simply a good shoulder to cry on or a good friend to speak to." CBT is good for people who are willing to face themselves. And, you also said, "my problems are not mine, but other people's." If you think you'd be happier without problems, or more specifically "other people's problems", you've failed to recognize that you're the one who's not happy. If you can't disempower other people's problems in your cognition, then you're the one with the problem.
These are the dynamics of CBT, as you requested. It really is a dynamic process. You have to act your way through every part. It isn't some dry "couch visit" with an academic. You leave each session with a set of challenging new behaviours to try out (and those behaviours include new cognitions, because thinking is a behaviour).
Methinks you're dismissing something that you would find helpful. Recall from last week my comments vis a vis your parents and their take on your mental illness....you felt relieved by those new thoughts that I offered up. That's CBT in a nutshell.
Lar
Posted by Squiggles on June 3, 2003, at 8:05:55
In reply to Re: responsibility and blame » Squiggles, posted by Larry Hoover on June 3, 2003, at 7:50:06
Well, you write very well, that's for sure.
As i said in my earlier post, i don't want
to continue a critique of the value of
CBT and its merits.For what it's worth, i will say that i appreciate
having the net to exchange ideas. And regarding
my personal problems, i am certain that the
things which are in your power you may be able
to change, but the things which are in other
people's power, you cannot -- only your attitude
to them.Social psychiatry, which is what CBT seems to
fall in, is a lot more like politics than
medical treatment.Squiggles
Posted by Dr. Bob on June 3, 2003, at 22:11:03
In reply to Re: responsibility and blame » mattdds, posted by Squiggles on June 2, 2003, at 20:47:28
> Cognitive behaviour therapy is good for
> those who do not need therapy at all, but
> simply a good shoulder to cry on or a good
> friend to speak to.Please don't post anything that could lead others to feel put down, thanks.
Bob
Posted by Squiggles on June 4, 2003, at 9:50:26
In reply to Re: please be civil » Squiggles, posted by Dr. Bob on June 3, 2003, at 22:11:03
Sorry Dr. Bob,
Being on your site is going to be
a lesson in diplomatic skills.Thank you for holding up a mirror.
Squiggles
Posted by Dr. Bob on June 4, 2003, at 18:52:04
In reply to Re: please be civil » Dr. Bob, posted by Squiggles on June 4, 2003, at 9:50:26
Posted by Dinah on June 7, 2003, at 11:39:22
In reply to Re: responsibility and blame » Dinah, posted by Larry Hoover on June 2, 2003, at 12:48:05
And if I'm responsible for making myself better, aren't I to blame if I don't?
I still don't understand. Can you use baby words?
Posted by Dinah on June 7, 2003, at 11:51:43
In reply to Re: But if I do bad things, aren't I bad?, posted by Dinah on June 7, 2003, at 11:39:22
I have a fear of vomit.
This week we went to the beach, which I associate with Spring Break. Ok, I know it probably isn't accurate to assume that every inch of the hotel, hotel room, and beach was covered with vomit, but you get the idea. Plus people throw up off the side of boats into the ocean.
Ok, I know that spring break was a while ago. And the hotel has been cleaned. I know that the ocean is a big place and fish probably eat the vomit anyway.
I did the right things. I played in the surf with my son, I made sand castles. I slept in the hotel room. My clothes fell on the hotel room floor and I wore them anyway. I let my son walk in his socks aroung the hotel and then get in his bed. I acted ok. I reminded myself of all of those things that I knew that made my fear of vomit unreasonable.
But there wasn't one second there that I wasn't aware that the entire place was contaminated by vomit. As the sand and water got *everywhere* there wasn't one minute I didn't feel contaminated. If you were to ask me if I had a good time, I would say yes, it was terrific. But at some more visceral part of myself I would acknowledge no, I didn't. I could barely sleep and the whole vacation is just surrounded in a miasma of vomit for me. I hated that vacation. I hate going to the beach.
I've been dealing with this fear for close to thirty years. I've exposed myself to this degree many many times. I can hold the bowl when my son is sick without running away screaming. I can do my breathing to keep from panicking.
Can CBT offer me anything else in this area?
Posted by mattdds on June 7, 2003, at 13:19:21
In reply to Re: But if I do bad things, aren't I bad?, posted by Dinah on June 7, 2003, at 11:39:22
Hi Dinah,
You are asking two questions.
1) If I do bad things am I bad?
2) If I am responsible for making myself better, then, am I to blame if I don't improve?1) This is a belief that involves an error in thinking called "all or nothing thinking", "should statements" and "labeling".
First of all, I don't even know what "being bad" even means. It seems to make sense, but really does not hold up under closer scrutiny. We could try to propose definitions for "bad", but these would be very arbitrary. Let's say that being bad means you have committed 500 "bad acts". That definition would include the whole entire human population, so at least you'd be in good company. We could lower the standards, but any number of "bad acts" that we set as the mark for all of a sudden becoming "bad" would be arbitrary and senseless, right?
We all do bad things, some do more, some do less. Where do we make the cutoff line as to who's bad and good? It is learning to think in shades of gray, rather than black or white, or good or bad. Even the definition of "bad *things*" is very arbitrary, which compounds the problem even more.
So why bother with the label of "good" or "bad"? We learned to think this way when we were younger, because it served a heuristic function back then (strangers = bad, mommy = good). Now that we are older, if we think about it, these words really do not make much sense as labels to highly complex things like human beings.
Labels like "bad" do nothing to solve problems. They merely place a vague label on something that disctracts from what is really going on. This robs us of opportunities for growth, because we are not defining the problem in *specific* terms. After all, how can we solve problems if we do not define them? Let's say for the sake of argument that you yelled at someone while angry (bad behavior). What is the advantage of calling yourself "bad" over defining exactly what the problem is (you yelled at someone when you were angry), and coming up with a highly specific problem for dealing with it? You see, life is nothing more than a series of discreet, definable little problems. If we deal with each of these individually and rationally, this would make a whole lot more sense, and we would grow much more.
2) I think you have a different idea of what responsibility means that I do. I defined it earlier for you, but perhaps you missed the post. However, embedded in your question about responsibility and getting better is a hidden "should statement", "I should get better"
But why *should* you get better? And what do you mean by this? Should can mean a couple of things. It can imply that something is morally unacceptable. It can also mean that something will probably happen (e.g. or the sun should rise tomorrow).
Getting better is not a moral issue, as being mentally ill is not against the code of any religion (that I'm aware of). Thou shalt be happy at all times? Never heard that one ;).
Another way of writing your statement is "I shouldn't be feeling bad". Shouldn't in the *non*-moral sense means "probably will not" But the fact is that you are feeling bad. So this doesn't really make sense either.
So now that it reality that you are indeed feeling bad, and we've decided that it is useless to compound the problem by beating yourself up about it, there is a question: what can I do to make myself feel better? This is responsibility, in my opinion.
*Responsibility* - a sense of awareness of the things that one can do for one's own improvement. It also includes an awareness that some things are outside your control. These things are accepted and dealt with. The focus of responsibility is what you *can* do; that is where you are directing your attention. Responsibility in the therapeutic sense has no moral implication, it is not like being "responsible" for murder. This is a different meaning of the word.
*Blame/Fault* - selective and arbitrary negative attention to one's own role in a complex problem that contains many variables. Blaming does not take into consideration the other variables that were involved in the problem.
Another reason: if you don't take responsibility for doing all you can to improve, then who will?
I seem to need to stress that this is *not* a moral issue. If you do not get better, then it is OK! It is not your "fault". Faulting yourself is just compounding the first problem (feeling bad) with a second problem (beating yourself up about it). Taking responsibility is just doing all you can do and accepting the rest
This may be hard to grasp, it took me a while. But once it did, and I saw that these terms really did not make any sense, I slowly stopped feeling "bad", and began to see things in more discreet, definible ways. People being "good" and "bad" seems a bit nonsensical to me now.
From a religious standpoint (You are Christian, right? I think I remember some of your posts on the faith-babble), Jesus said to separate the sin from the sinner. I think he was saying essentially the same thing here. People may do bad things, but there is no such thing as a bad person.
Does this help at all? I hope so.
Best,
Matt
Posted by mattdds on June 7, 2003, at 13:57:47
In reply to Re: Another CBT question. Very specific., posted by Dinah on June 7, 2003, at 11:51:43
Hi again Dinah,
Sounds more like an obsession than a fear, am I correct? This all sounds like a classical, but partially controlled, form of OCD. I'm just using the term "OCD" here for heuristic purposes here, because CBT treatment differs for OCD. Do you have OCD as a diagnosis? Just curious.
I know there are CBT treatments that are very effective for OCD, but I'm afraid I don't know much about them. I think they've shown in a number of studies that CBT was just as effective as high-dose SSRI's for OCD, with better long-term recovery.
But I digress.
It appears you have done some CBT of your own. It's called "response prevention". In other words, you didn't continuously mop the floors, or wash your son's feet, every time you had an intrusive thought about vomit. So it appears you are halfway there. You have straightened out your behaviors, but not the cognitions. You said you enjoyed your vacation, at least on some level. But on another, you did not. You even made sand castles in that quagmire of vomit ;). In all seriousness, you are quite the stoic for behaving normally despite all those (gross) intrusions of thought. You have done an excellent job here.
Your question was: can CBT do more? I think it could. But first off, you must do a cost-benefit analysis. How much is it worth it to you to straighten out this little quirk? Is it significantly affecting your quality of life? Do you have obsessive intrusion about other things, or just vomit?
I ask this because I can relate. I have a fear of peeing in public. In the men's bathroom, we have urinals, and if there is someone next to me, I literally CANNOT urinate. I don't feel the need to go through all the behavior therapy for this (and such therapy does exist) because I can just go in the stall and pee freely! So there is no treatment indicated. I just accept that as one of my many quirks. I used to be very self-conscious about this. But now I am not. Now, I actually even tell my guy friends that "I have stage fright", and go in the stall. They just laugh. If they think I'm weird or whatever, I think that's their problem, not mine.
I don't know if this is relevant, but hopefully it's a bit humorous ;)
Is your obsession with vomit significantly affecting your life? I love going to the beach, and can empathize with you. It would be a bummer to be at the beach on an otherwise nice vacation, and to be plagued with intrusions about regurgitated Corona beers and fish tacos.
So first, tell me how much it bothers you, and I'll try to come up with some ideas (first I have to read up on OCD, don't know as much about CBT treatment for OCD as I do about depression and anxiety, sorry :))
Regards,
Matt
Posted by Oddipus Rex on June 7, 2003, at 14:47:53
In reply to Re: Another CBT question. Very specific. » Dinah, posted by mattdds on June 7, 2003, at 13:57:47
Hi Dinah I found this by doing a google search.
http://www.gut-reaction.freeserve.co.uk/cbt-treatment.htmOne thought that occurred to me is that you may be "white-knuckling" it through these situations and it might work better to gradually desensitize yourself. That is, you would stay in the situation which was evoking these thoughts until you reached a stage of moderate discomfort and then retreat until you returned to a normal level of comfort and then return again and stay until you reach a stage of moderate discomfort,etc. When you stay in the situation with willpower while you are extremely uncomfortable, you are actually reinforcing your association between the situation and extreme discomfort.
It's possible to create a safe place to retreat to in your mind by using visualizations or meditation as well as physically retreating. At least in theory :)
The website suggested some ways to set up situations to desensitize yourself like vomit videos and inducing nausea.
I'm sorry you didn't enjoy your vacation more. It's nice to have you back again.
Posted by Dinah on June 7, 2003, at 19:39:44
In reply to Re: Another CBT question. Very specific., posted by Oddipus Rex on June 7, 2003, at 14:47:53
It's nice to have you back again too, stranger. How're you doing? I've missed you.
Thanks for the link. I've just discovered the whole emetophobia world, and I'm immersing myself in it, so to speak.
I don't think that in this instance I white-knuckled through it. Although there have been plenty of occasions in the past where I did. Like the plane trip where I was seated next to the rest room. When I got off the plane, my face was as red as a Maraschino Cherry. It scared my husband to death. Or the bachelorette party of a good friend with a surprise visit to the biggest drunkest bar in the area. Those sorts of things I make through on sheer willpower. This wasn't that bad.
Thanks, Oddipus. And don't be a stranger. :)
Posted by Dinah on June 7, 2003, at 19:41:44
In reply to Re: But if I do bad things, aren't I bad?, posted by mattdds on June 7, 2003, at 13:19:21
Thanks Matt. One day it just might seep in. These things take a while with me. On the one hand, I take enormous care sometimes to come up with just the right word with just the right shading. But at other times, I just can't tell the difference between concepts. I'll keep plugging away at it.
Posted by Dinah on June 7, 2003, at 19:54:32
In reply to Re: Another CBT question. Very specific. » Dinah, posted by mattdds on June 7, 2003, at 13:57:47
Hi again, Matt. Yes, I am diagnosed with OCD. And have practiced both home-grown and formal CBT for it. The vomit thing is just one of many where I seem to get so far, and can't get any further. You'd think almost thirty years of exposure and response prevention would have me happily wading through the stuff. Especially with all the lovely vomit scenes that come up on TV and movies lately.
I get better, but not well. Like with cars, I don't drive around the block several times to see if that bump was someone I rolled over. But I still have the uneasy feeling that pedestrians are missiles aiming for my wheels. And no amount of logical thought shakes that.
Or my work. I no longer have to get up in the middle of the night to race to the office to make sure I didn't write obscenities on my work product. But I can't shake the sense that my work is evil, or will cause me harm in some way. Again, logical thought doesn't affect that.
And although I can do what I need to do with the vomit obsession/phobia, it always remains in the background. OK, I still do have some avoidance behaviors. I don't go to bars, and am very careful at amusement parks. But I can do what I need to do.
My therapist appears to think I'm all better on these things. Or better enough. He's pleased that the behaviors have mostly stopped. And that's given me the idea that as far as OCD is concerned, there is a limit for how much can be expected from CBT, or perhaps any sort of therapy or meds. That functioning as well as I can is all that I can hope for.
And maybe that's true. Maybe there are disorders that can only be managed to a certain extent.
Posted by mattdds on June 7, 2003, at 21:49:02
In reply to Re: Another CBT question. Very specific. » mattdds, posted by Dinah on June 7, 2003, at 19:54:32
Hi Dinah,
I don't have OCD, so I probably can't understand completely what you are going through. I can conceptualize it, but have not experienced it. I imagine it is tough to deal with ego-dystonic intrusions all the time. My intrusive thoughts aren't ego-dystonic, but I do get all kinds of thoughts I don't like.
If I understand right, you have made a lot of progress in the behavioral department, but not so much in the way of intrusive ego-dystonic cognitions. And that you have sort of a split level of understanding; on one hand you realize it is illogical to worry so much about vomiting, but another (more irrational) part of you doesn't believe it. Did I get this right?
I've been doing some research on CBT thought on OCD, and the idea is *not* to settle for just behavioral improvement, but for improvement as far as the obsessions go as well. I would love to discuss this, and have some ideas, but it will take a lengthy exchange, if you are up for it.
My take is that you do *not* have emetophobia. This is just my opintion, but what you describe sounds more like a fear of a contaminated object (vomit). You are not so much afraid of vomiting yourself? Is this accurate?
CBT-ists call this Thought-Object Fusion (TOF). The belief (on some level) that thoughts can make things contaminated. This sounds a lot like what is going on with the fear of vomit, in your case.
You also described that you used to have to check your work to "make sure" you didn't write obscenities on it. This is referred to as thought-action fusion (TAF) by CBT-ists. There is the belief (on some level) that thoughts are fused to actions. Thinking something means that you will do it (or have done it). Another common example is worry about harming someone you love, like "what if I just stabbed my wife for no reason??!!". The corresponding compulsion would be to get rid of all the knives in the house, or something like that. This is thought-action fusion.
Just out of curiousity, are any of your intrusive thoughts religious (sacreligious?) in nature? This is extremely common. A good example would be a person who has thought intrusions that the devil will appear. He holds a belief (on some submerged level) that having this thought will make the devil appear! So the poor indidual will try to crowd out thoughts of the devil by praying or doing Hail Mary's or something like that. This is classic Thought-Event Fusion (TEF).
So these terms help to conceptualize the problem.
How do we solve it?
It appears you have the behavioral aspect pretty well nailed down. So now you work on the cognitive aspect of it. But here is where it gets tricky.
The goal is *NOT* to get rid of the intrusive thoughts! The goal is to change the beliefs about the meaning of the obsessive thoughts. In other words, freely let the thought intrusions enter. You might have heard about thought suppression experiments; they don't work! E.g. try hard for 30 seconds NOT to think of vomit....................................what just passed through your mind? Of course, vomit!
So trying to suppress the thoughts is not the goal, and will likely reinforce the belief that the thoughts are harmful or have some meaning (e.g. you are bad because you had such and such thought). Don't even try to figure out the cognitive distortions in the intrusions; they are self-evident, and already incredibly obvious to you.
Your problem likely is in your *appraisal* of the intrusions, i.e. fallacious beliefs about what "purpose" these intrusions serve. I remember in one of your old posts you wondered what "purpose" your panicky thoughts had when you were younger, and you said "they must have been important!"
Interestingly, this is where metacognition becomes important. The idea is to simply "watch" your intrusions pass through your mind non-judgementally. One method is to get purchase a golf stroke counter. Each time you have an intrusive thought, you simply make a click. "the vomit is EVERYWHERE" - click. "gross drunk teens probably barfed right where I was standing" - click. You get the picture. Keep a log of the number of intrusions. Supposedly, they will go up for a few days, as you become more aware of them. Then after a few weeks, they will go down. Try this with one particular set of thoughts once (e.g. vomiting), then move on to others.
I will do more research on this, but I'm quite sure the idea is NOT to try to control the thoughts; this just makes them come back stronger, as I'm sure you know. The goal is passive, non-judgemental observation of the thoughts, which hopefully will eventually de-fuse the thought intrusion from the action or object.
So CBT for OCD is quite different than for depression. It has certainly moved beyond the simple behavioral techniques. The problem is that most clinicians are too lazy/uninformed/busy/or whatever to keep up on the literature.
I got most of these ideas from Arian Wells books, a pioneer in cutting-edge CBT for OCD and generalized anxiety disorder.
"Cognitive Therapy of Anxiety Disorders : A Practice Manual and Conceptual Guide"
"Emotional Disorders & Metacognition: Innovative Cognitive Therapy"
Perhaps your therapist could take a look at these and formulate a treatment plan customized for you.
I'm only scratching the surface! There are many more techniques, but I'm already getting extremely long-winded. I hope I am not going overboard here!
I wish you the best,
Matt
Posted by janejj on June 7, 2003, at 22:21:12
In reply to Re: Another CBT question. Very specific. » Dinah, posted by mattdds on June 7, 2003, at 21:49:02
I'm sorry that but I haven't read through all these messages...just wanted to say that CBT seems to have worked for me, albeit I just read the very popular book by Dr Burns.
It helped me see the way I think is completely warped and hence my life has become much more bearable. For instance I never base my self worth on my ability to perform a certain task or base my self identity on one facet of my life (eg. Career)etc. I no longer let percieved judgement from other people completely paralyse and depress me and I don't think other people are better than me any more. Its gone a long way to a much more stable and happy life!
Anyway certain treatments work for some and not for others, its just what works for you that you should worry about.
Regards, Janejj
Posted by shar on June 8, 2003, at 3:54:02
In reply to Re: But if I do bad things, aren't I bad?, posted by Dinah on June 7, 2003, at 11:39:22
>But if I do bad things, aren't I bad?
Nay, m'lady. Tis like "hate the sin, love the sinner." If one does something bad, one has DONE something bad, not BECOME something bad. We are all a mix of good and bad. To follow the logic of your question on the flip side: if you do good things, aren't you good?
> And if I'm responsible for making myself better, aren't I to blame if I don't?
Another nay. That's called blaming the victim in my book. Just like if one had cancer; there are some folks who believe that their treatments work, and the person who isn't getting well isn't [praying hard enough, following the diet rigorously, meditating with a pure heart, etc.] or anything that doesn't reflect badly on the treatment. One who is making a good faith effort to improve, cannot blame oneself for not trying, if one is trying. It is circular logic and bad for the brain.
>I agree with matt (I think it was) who talked about using words like bad, good, etc. They are extremely value-laden, so what I think is good may be quite bad to someone else. Some people think that thinking something is just the same as doing it (so thinking of murder is the same as murdering someone). Whatever we end up labeling good or bad is very personal; and, while I'm not against labels per se (because they allow us to make sense of the world), they do need to be used carefully, I believe. Sometimes, in therapy we learn that labels continually cause us problems and we have to get to what's behind the label to make even greater progress (such as, "bad" may turn out to be "self-aware" or "good" could mean "submissive").
Hmmm, hope this made some sense.
Shar
Posted by Larry Hoover on June 8, 2003, at 9:50:47
In reply to Re: But if I do bad things, aren't I bad?, posted by Dinah on June 7, 2003, at 11:39:22
> And if I'm responsible for making myself better, aren't I to blame if I don't?
>
> I still don't understand. Can you use baby words?I don't know about baby words, but I'll take another crack at it.
Taking responsibility involves attributions of all outcomes, good, neutral, bad. Blame focusses only on the bad. (I don't like judgmental words like good or bad. They taint observations.)
Responsibility involves anticipation as well as retrospection. Blame only looks back.
Responsibility assumes that all decisions have effects. Blame is a tool to distort responsibility, magnifying responsibility in some cases, and minimizing it in others.
I keep thinking about that case a few years back where a woman successfully sued McDonald's because she was injured when she spilled a hot coffee in her lap. IMHO, the woman was responsible (she made a number of decisions which led directly to the incident, alternative ones preventing the adverse outcome), but McDonald's got blamed.
Lar
Posted by Larry Hoover on June 8, 2003, at 9:59:58
In reply to Re: Another CBT question. Very specific. » Dinah, posted by mattdds on June 7, 2003, at 21:49:02
> The goal is *NOT* to get rid of the intrusive thoughts! The goal is to change the beliefs about the meaning of the obsessive thoughts. In other words, freely let the thought intrusions enter. You might have heard about thought suppression experiments; they don't work! E.g. try hard for 30 seconds NOT to think of vomit....................................what just passed through your mind? Of course, vomit!
I snipped everything else because I want to absolutely emphasize how much I agree with this concept. If you can learn to ignore the intrusive thoughts (in other words, not react emotionally too them), they no longer stand out from all the other thoughts that you might have.
When you react to the thought, you "lock it in". It doesn't pass by and fade away, like all the other thoughts do.
Everybody has unusual thoughts that pass through their brain. Some are quite bizarre. If you don't react to them, they have no significance.
The problem is the reaction, not the thought itself.
There are a number of different techniques you can learn, to desensitize your reaction. That's a matter of personal preference. One I like is "I don't own that thought. It doesn't spring from my spirit."
Lar
Posted by zenhussy on June 8, 2003, at 10:06:34
In reply to Re: Accepting intrusive thinking » mattdds, posted by Larry Hoover on June 8, 2003, at 9:59:58
> The problem is the reaction, not the thought itself.
>
> There are a number of different techniques you can learn, to desensitize your reaction. That's a matter of personal preference. One I like is "I don't own that thought. It doesn't spring from my spirit."
>
> Lar
My personal favorite is: that thought isn't my cup of tea thank you very much.Polite and to the point for my muddled head.
Good CBT discussion. Thanks.
zenhussy
Posted by mattdds on June 8, 2003, at 11:05:55
In reply to Re: Accepting intrusive thinking » mattdds, posted by Larry Hoover on June 8, 2003, at 9:59:58
Hey Larry,
Good to see you here again!
>If you can learn to ignore the intrusive thoughts (in other words, not react emotionally too them), they no longer stand out from all the other thoughts that you might have.
Exactly. For people with OCD or strong negative appraisals of intrusive thoughts, thoughts become just another neutral event. The problem with thoughts is that sometimes we get too "locked in" on them. This is what Adrian Wells refers to as "object mode". Metacognitive mode is getting out of this and saying "hey, this is only a thought / feeeling / symptom, and not reality". These are just big words for simple concepts, but it gives them names so we can talk about them.
One insight that I remember reading somewhere is that with intrusions, the thoughts become the "object" to which one tries to become desensitized. The mechanism seems similar to a simple spider phobia. Exposure to the spiders while allowing disconfirmatory information to be processed (i.e. erasing old beliefs, making new ones about spiders) is therapeutic. In many ways, OCD is thought-phobia. Cognitophobia?
>>When you react to the thought, you "lock it in". It doesn't pass by and fade away, like all the other thoughts do.
I'ts "selective abstraction" or "mental filter". Something in your belief system is causing the direction of an undue amount of attention toward the thought. This is the "getting locked in" you decribe.
The goal is not to try to stamp out the thoughts. There are too many, it's like using a fly swatter in the jungle! The goal, perhaps is to tease out the metacognitive beliefs that are causing the attention to be directed so strongly toward the thoughts. Examples of metacognitive beliefs are:
1. I am bad for having X thought
2. Thinking these thoughts can something terrible happen
3. This thought is reality (usually we aren't aware of this belief)
4. etc, etc.>>Everybody has unusual thoughts that pass through their brain. Some are quite bizarre. If you don't react to them, they have no significance.
Everyone has them, right. My feeling is just that only the *beliefs* about the meaning of the thoughts is the difference. Beliefs direct attention. Attention causes thoughts to grow in consciousness.
>>The problem is the reaction, not the thought itself.
Perfect. I was raised in a strong religious family. When I would get intrusive sexual thoughts, I would get anxious. I, on some level believed I was bad for the intrusion; as if it meant something about me as a person. So guess where my attention went? I try to look at intrusions as *totally* uncontrollable now! I truly believe they are. That absolves me of all ownership of them. Interestingly, I don't get anxious about these intrusions anymore, but I still have them. Now they just seem like any other thought (well, maybe a bit better :))
>>There are a number of different techniques you can learn, to desensitize your reaction. That's a matter of personal preference. One I like is "I don't own that thought. It doesn't spring from my spirit."
Good idea. My dad likes "oh, there goes another one...oooh, wow look at that, there's another one!"
This is true. There are various ways of getting into a "metacognitive" mode of thinking.
Thanks Larry, these are great insights! Sounds like you reinvented Adrian Wells' wheel without even knowing it! You seem to have a grasp on things that 99% of clinicians don't!
Best,
Matt
Posted by Dinah on June 8, 2003, at 15:46:13
In reply to Re: responsibility vs. blame » Dinah, posted by Larry Hoover on June 8, 2003, at 9:50:47
Hmmm, perhaps with all this help, I'm getting a glimmer. But it takes a while for things to sink in for me. It took me twenty years to understand the song "Amazing Grace". I'll cogitate on the matter, and hope for an ah-hah experience.
Thanks for your patience. :)
Posted by Dinah on June 8, 2003, at 15:51:54
In reply to Re: But if I do bad things, aren't I bad? » Dinah, posted by shar on June 8, 2003, at 3:54:02
Hi Shar. My more emotional self focuses a lot on good and bad, and does tend to believe that I'm a good girl if I do good, or a bad girl if I do bad (or make someone angry, or any number of things).
And it's moreso right now. This self correcting world is piling all my corrections on me at once. I ignored my diet and weight and family history of diabetes, and am now paying the price of food choice deprivation. I spent with happy abandon, and now am paying with monetary deprivation that will last at least fifteen years (the life of my debt consolidation loan). I am overcome with my natural consequences and rather obsessed with the idea that it is because I was bad. Because if I had been good, these things wouldn't be happening.
Sigh. I know it's an immature way of looking at things, but I can be quite immature.
Posted by Dinah on June 8, 2003, at 16:27:27
In reply to Re: Another CBT question. Very specific. » Dinah, posted by mattdds on June 7, 2003, at 21:49:02
>
> I imagine it is tough to deal with ego-dystonic intrusions all the time.
I only wish I was sure they were ego-dystonic. Sure, I know they aren't true. But I am equally sure that they are completely true. Sigh.> If I understand right, you have made a lot of progress in the behavioral department, but not so much in the way of intrusive ego-dystonic cognitions. And that you have sort of a split level of understanding; on one hand you realize it is illogical to worry so much about vomiting, but another (more irrational) part of you doesn't believe it. Did I get this right?
That would be right.
> My take is that you do *not* have emetophobia. This is just my opintion, but what you describe sounds more like a fear of a contaminated object (vomit). You are not so much afraid of vomiting yourself? Is this accurate?The emetophobe purists would agree. But the more liberal emetophobes use the term for fear of either vomiting yourself, or having others vomit, or just vomit in general.
>
> CBT-ists call this Thought-Object Fusion (TOF). The belief (on some level) that thoughts can make things contaminated. This sounds a lot like what is going on with the fear of vomit, in your case.
>
Could be....> You also described that you used to have to check your work to "make sure" you didn't write obscenities on it. This is referred to as thought-action fusion (TAF) by CBT-ists. There is the belief (on some level) that thoughts are fused to actions. Thinking something means that you will do it (or have done it). Another common example is worry about harming someone you love, like "what if I just stabbed my wife for no reason??!!". The corresponding compulsion would be to get rid of all the knives in the house, or something like that. This is thought-action fusion.
>
OK, that I definitely have. If I think I've done something, it *feels* like it's possible that I did it. Reality doesn't seem that well defined from the vividly imagined, or something like that. How do you know *for sure* anything? If I see my keys in my hand, how do I know that I'm not just imagining I see my keys unless I rub my finger along the edge. Otherwise I might just think I picked them up, think I see them, when I really don't. Then I'd be locked out. If I think I wrote something, how can I really be sure I didn't? Even if I check to make sure, how do I know I'm just *not seeing* what I wrote but it's really there? By the way, I'm getting way better at that sort of thing. Way, way better. But it's the way the thoughts work.> Just out of curiousity, are any of your intrusive thoughts religious (sacreligious?) in nature? This is extremely common. A good example would be a person who has thought intrusions that the devil will appear. He holds a belief (on some submerged level) that having this thought will make the devil appear! So the poor indidual will try to crowd out thoughts of the devil by praying or doing Hail Mary's or something like that. This is classic Thought-Event Fusion (TEF).
I do have what would be considered scrupulosity, or responsibility OCD. But the thoughts aren't overtly religious in nature. And I don't have thought compulsions, except for occasional undoing rituals if I say something that I think the fates might misinterpret. (And yes, I know how weird that sounds).
>
> So these terms help to conceptualize the problem.
>
> How do we solve it?
>
> It appears you have the behavioral aspect pretty well nailed down. So now you work on the cognitive aspect of it. But here is where it gets tricky.
>
> The goal is *NOT* to get rid of the intrusive thoughts! The goal is to change the beliefs about the meaning of the obsessive thoughts. In other words, freely let the thought intrusions enter. You might have heard about thought suppression experiments; they don't work! E.g. try hard for 30 seconds NOT to think of vomit....................................what just passed through your mind? Of course, vomit!
>
> So trying to suppress the thoughts is not the goal, and will likely reinforce the belief that the thoughts are harmful or have some meaning (e.g. you are bad because you had such and such thought). Don't even try to figure out the cognitive distortions in the intrusions; they are self-evident, and already incredibly obvious to you.I've worked at those techniques. Watching the thoughts float like leaves down a stream. Singing the obsessions. Laughing at them. It helps. But it only goes so deep. Then stops. On a level inaccessible by intellect, there is a certain belief in the thoughts.
>
> Your problem likely is in your *appraisal* of the intrusions, i.e. fallacious beliefs about what "purpose" these intrusions serve. I remember in one of your old posts you wondered what "purpose" your panicky thoughts had when you were younger, and you said "they must have been important!"
>
OK, I'm trying to be open minded and flexible about CBT. If you could try to be open minded about what I'm about to say, I'd appreciate it.I really do believe that OCD, in some cases anyway, serves a useful purpose. Mind you, like most dysfunctional coping tools, it also causes problems. And perhaps in some cases it is a simple brain glitch where thoughts repeat. But I really do believe that in some cases it works as a pressure valve, or a better simile might be a controlled burn in a forest fire.
When I first developed it, I was in pretty bad shape emotionally. The only reason I wasn't an early Columbine type shooter is the lack of a gun, and a punitive conscience. And if I had had easy access to a means of suicide, I probably would have acted on it. In the circumstances, having an obsession to divert my attention to may well have saved my life. Constantly thinking about how to avoid vomit, where vomit might occur, planning what to do if someone vomited, directed considerable attention away from my very real life problems. Life problems that were completely beyond the ability of an eleven year old to solve. Even the choice of obsession, vomit, had symbolic overtones that are absolutely obvious in retrospect.
The resurgence of OCD came with my marriage to a terrific man. Such a terrific, disciplined, controlled man that I constantly fell short of his expectations, or (just perhaps) my assessments of his expectations. At the same time, I lost the safety net of being a daughter in my parents home and really entered the adult world. And surprise surprise, my OCD centered around making catastrophic errors. Errors in work, errors in driving, seeing those areas as "bad" because they were potential sources of errors.
And when I got that safety valve largely controlled, by controlling my OCD, other symptoms popped up like Whack the Mole. The OCD somehow protected me from the pressures that an ego held together with spit and scotch tape (or inadequate coping mechanisms in other words) just couldn't handle.
I think any CBT to be truly and completely effective has to reach back beyond the OCD, beyond the obsessions, to the pressures I am unable to handle. And has to be coupled with additional therapy to help me be better able to handle the stresses.
And that doesn't mean I'm anti-CBT. You've given me a lot to think about and a lot to research, and I will do it, and bring the results to my therapist (who really does appreciate CBT). Perhaps I will discover some toolst that will bring me past the behavioral aspects to the pure obsessive aspects.
Thank you, Matt.
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