Obsessive Compulsive Disorder, Your Brain, and How to Treat OCD

Tuesday, April 11, 2017 by Meg   •   Filed under Treatment Techniques

Obsessive Compulsive Disorder evolved as a means of protection, a valuable system in times past to increase our chances of survival (more on this in The Evolution of Obsessive Compulsive Disorder, Postpartum OCD, and Obsessive Personalities.)

But just because it made us more likely to survive then, doesn’t mean it does jack shit to help us now. And if you have OCD, you probably don’t care what made it awesome then. You want to know why it’s happening to you and how the fuck you can make it stop.

I have answers. Let’s do it. (That’s what she said…or maybe what he said.)

Your Brain on OCD

According to Dr. Jeffery Schwartz, author of Brain Lock, biochemical imbalances in the brain cause four key structures in to get locked together and send false messages1

But how? 

Our main signal processing center is made up of the caudate nucleus and the putamen which work together to transmit signals and  coordinate thoughts and movements. 

Thoughts and movements. Obsessions and compulsions. Got it. 

In OCD, the caudate nucleus does not shift properly from one thought to another, and gets stuck in a seemingly never-ending loop of thoughts and behaviors. Energy is also higher in the orbital cortex, an area involved in error detection. If this area isn’t signaling properly, we may be more likely to keep doing the same old behaviors over and over even if they fail to assist us because we can’t see our mistake. It’s a cycle. When you engage in the behaviors, you reinforce the thought that something bad is coming and trick yourself into believing that you thwarted this imminent threat with the action, which of course leads the brain to see the environment as more and more dangerous. Except it’s usually wrong and you can’t see it. Which blows. Well, I mean it’s good that it’s wrong, but it blows that it keeps alerting you anyway.  

We also have an area called the stratum which takes over in automatic repetitive behaviors, like signing your name or driving. Once you master something, this area allows you to complete tasks without thinking about them, and filters only the necessary information from your surroundings. When it isn’t working properly, things break through the filter and individuals are overwhelmed with information on things that might be threats, urges to do things, and with fearful (though usually incorrect) thoughts to explain the urges

And then there’s the cyngulate gyrus, which helps you feel like something catastrophic is going to happen. This is another area that Schwartz notes is tightly locked to the orbital cortex in OCD, leading to all that dread. However, this area may begin working freely again when new behaviors begin to loosen those pathways. 

Wait…loosen those pathways? WE CAN DO THAT?!

Damn straight. 

Coping with OCD

While medications may help to temporarily cool off the caudate nucleus, drugs tend to provide only a temporary and incomplete solution to the issue at hand, says Schwartz. Medications may however allow for temporary relief in the beginning as individuals begin the cognitive behavioral work needed to alter the brain patterns and unstick problem switches. 

In Brain Lock, Schwartz advocates a four step process for the treatment of OCD: 

  • Step 1. Relabel: Change how you see the experience by calling the parts of the process what they are: obsessive thoughts, an obsession, a compulsion, a compulsive urge.  
  • Step 2. Reattribute: Tell yourself that these thoughts are related to a sticky switch in your brain, not to whatever the obsession  is. “There is nothing wrong with the stove; it’s a sticky switch that is causing the fear. Get the hell away from the stove!!” You might also try to take on the role of passive observer, as encouraged by Daniel Siegel in Mindsight2. A type of mindfulness practice (discussed more here), Siegel suggests pretending you are someone watching a boat in a storm from below, deep in the ocean where you cannot be affected. Then it isn’t you: it’s you OCD, your chemistry. You are not this. It’s just something that is happening to you. You might also remove yourself further by talking to that little piece of you who is freaking out, what Siegel calls the “checker.” You can try something like, “Thanks for trying to keep me safe, dude. But you’re way too fucking enthusiastic. Take that shit down a notch.” Or use your own words. Whatever works for you.
  • Step 3. Refocus: Turn your attention to more constructive behaviors when the obsessions and compulsions arise. Schwartz notes that it isn’t what you feel, but rather what you do that matters for healing. For instance, it is easy to believe in rituals that you engage in. After all, you checked the door and no one died, it’s logical that this non-death thing is due to your compulsion. It isn’t until you refuse the behaviors and no one dies that other possibilities cement themselves. So try to come up with some good distractions ahead of time and perhaps practice them when you aren’t feeling the urge to do a behavior. Then, when the urge strikes, try to avoid the compulsion, starting with 15 minutes at a time (and eventually working your way up to higher numbers). You might remove yourself from the room where the compulsion usually occurs, or do something with your hands if your compulsion involves them (even things like snapping a rubber band against the wrist can help). In general, this refocus step works best when you distract yourself with something you enjoy doing, particularly things that involve concentration or strategy. Playing an instrument (hands and brain), playing chess or cards, painting or writing would all fit this bill. 
  • Step 4. Revalue: Place less emphasis on the obsessions over time by valuing them differently through the above steps. Eventually, you will actually believe that they are just thoughts related to a physical condition, false messages that don’t make you a bad person or a crazy one. You will cement the notion that they can be comfortably ignored. This is a critical step because those with OCD tend to have new thoughts crop up later on in life. However, it is much easier to recognize and change a new obsessive thought than it is to alter entrenched ones. 

Other Helpful Hints to Combat OCD:

  • Find a Buddy: Spouses, friends, parents or any supportive partner can be of great assistance, particularly since playing cards can suck when you are playing alone. They may assist with the distraction step by playing a game, or they may talk to you on the phone and remind you that the thoughts are only misfirings in the brain and not actual danger. A partner may be there to encourage, to watch the time, to provide support. And while it isn’t necessary to have someone else around, it can be beneficial if they are effective distracters. Support rules. 
  • Physical Health; Work It Out: Exercise can help to regulate internal systems such as the hypothalamic-pituitary adrenal axis, a system involved in stress responses (more on that here in Using Your Workout to Fight Stress). Improving the body’s ability to regulate itself can be of assistance over time, while providing additional release for stress hormones such as cortisol. 
  • Exposure Therapy: Okay, so anyone who is suffering from OCD probably read that and wanted to click off this article, but stick with me for a minute. Because exposure to your worst case might help make it stop. Now obviously if your scary thoughts involve hurting someone else, I am not advocating for anyone to go out and run someone over with a car (and if you feel like this might be a good idea, I doubt you have OCD to begin with). This exposure thing is more applicable to cases where there are fears of contamination or danger due to unlocked doors or appliances turned on (read more here in Intrusive Thoughts and Exposure Therapy). 

Leaving a door unlocked overnight on purpose may help those with such fears provided the fear is unfounded. If you live in a high crime area, this won’t be your mode of treatment. Likewise, if you have an old-school coffee pot that doesn’t turn off automatically and might burn your shit down, for the love of all that is holy, don’t leave it on for the weekend and go to the beach. But if you have a pot that has a timer (and almost all the new ones do) leaving it on purposefully might help cement that you turning it off is irrelevant. 

But there are also other, slower, techniques that are less anxiety producing. Let’s say you have obsessive thoughts about contamination and germs. Make a list of things in order from least to most repulsive (these are often long and that’s okay). A short one might look something like: 

  1. Something gooey
  2. Sticky substances 
  3. Toilet seats 
  4. Fecal matter 

Start at the bottom and expose yourself to each one until all have been addressed. I am not encouraging anyone to play with shit or lick their dog’s ass, but leaving the poo in a toilet and sitting there, or changing a diaper can be effective for exposure. 

You can also try to desensitize yourself to the thought itself. Schwartz suggests tape-recorded loops of the thought that you can listen to over and over again, for around 45 minutes at a time (or for as long as you can, working up to 45 minutes). Though listening to your scary thoughts might induce high anxiety at first, mere exposure to it tends to make the thought more boring and thus less  anxiety producing over time.

  • Take It Easy On Yourself if you give in (more here in this post on Compassion Training). It’s the long-term pattern of behavior that  matters, not one night. If you don’t have the strength to fight right then, tell yourself, “I’m going to engage in this behavior right now, but it’s not a real threat.” Lock the door one last time and walk away with the knowledge that you’ll try again tomorrow. 

No system is perfect and OCD can feel like being in prison within your own skin. But it is a physiological brain condition that can reliably be treated with cognitive behavioral therapy and the patience to stick with it for as long as it takes to rewire a stuck system. You have the power to start changing it today.

You’ve got this. Start now.

Related Posts: 

  1. http://www.amazon.com/Brain-Lock-Yourself-Obsessive-Compulsive-Behavior/dp/0060987111
  2. http://www.amazon.com/Mindsight-New-Science-Personal-Transformation/dp/0553386395

Topic-Relevant Resources

Brain Lock: Free Yourself from Obsessive-Compulsive Behavior
Useful information and tools for addressing obsessive or scary thoughts and the behaviors that go with them.

The Mindfulness Workbook for OCD: A Guide to Overcoming Obsessions and Compulsions Using Mindfulness and Cognitive Behavioral Therapy (New Harbinger Self-Help Workbooks)
A step-by-step guide to overcoming OCD

Loving Someone with OCD: Help for You and Your Family
Tips for individuals and families to cope with the symptoms of obsessive compulsive disorder

Overcoming Obsessive Thoughts: How to Gain Control of Your OCD
Great guide to work through obsessive compulsive disorder