October 12, 2011

Cognitive Restructuring & OCD

First off I will start with a couple of updates:

1.       I think the problem with commenting on others Blogger blogs is the security settings.  Something to do with cookies.  In my very limited knowledge of computers, IT etc, I googled it and played around with my security settings and allow more cookies and it seems to allow me to comment now on your blogs.  I hope you can even make sense out of what I just wrote there!  Anyway – you might want to try it and see what happens.  Thanks to everyone who has commented anonymously. 

2.       My Mom is still here.  She weighs barely 75 pounds, sleeps all day, is completely jaundiced (even the whites of her eyes), hallucinates, and isn’t eating.  I woke up this morning with anxiety that she is going to pass very soon.  Honestly, I hope for her sake that she does.  It has been very difficult witnessing her valiant effort as she so courageously goes through the end of life process.  But now.....it’s time. 

As I’ve said before, I’ve got a few ideas for some blog posts that I’ve wanted to write for a long time, but I’ve been so busy, and just haven’t felt inspired.  You know how they say that OCD can get either worse or better during times of stress?  I’ve had it go both ways, depending on the source of stress.  But right now, with my Mom dying, I have to say that OCD has mercifully backed off.  (At least until the last few days.)  I’ve been speaking with my therapist about this, and we both think it’s just because most of my rituals are mental, and I’ve had way too many other REAL problems to think about. 

Cognitive restructuring and OCD is a topic that I’ve wanted to write about for awhile.....the “C” in Cognitive Behavioural Therapy.  I have mixed feelings about traditional Cognitive Therapy as treatment for OCD (thought restructuring).  For a time, many people in the therapeutic community thought that thought restructuring was the best treatment for people with Pure O.  In fact, many thought that ERP wasn’t necessary, especially many psychologists who live around me.  This is due to a researcher by the name of S. Rachman, who actually did his research at The University of British Columbia (and I think trained a lot of the doctorate students).  Rachman did a lot of research on the nature of “maladaptive thinking” and how that relates to OCD.  The summary of his research goes something like this:  “obsessions are caused by catastrophic misinterpretation of the significance of one’s thoughts (images, impulses), and the obsessions continue as long as these misinterpretations continue, and diminish when the misinterpretations are weakened.”  (You can click here for one of Rachman’s studies.)

For those of you who read my blog regularly, you know that I have gone through the revolving door of therapists (many of them Cognitive Behavioural Therapists!) in an effort to try and find someone who knows how to treat OCD with mostly mental compulsions.  Several years ago after my first “OCD breakdown”, I was desperately looking for someone who knew what to do with me.  Heck, I knew that I had OCD (well, as much as a person with OCD can be sure!)......all the reading and researching I had done validated that for me.  I just needed to find a therapist who agreed that I had OCD (not GAD), and knew how to help someone with primarily mental compulsions.  (In those days, people thought that Pure O’s didn’t actually have compulsions.)  In my desperation, I went through an outpatient program through one of the local hospitals.  When I was going through intake, the psychiatrist who assessed me said that I clearly had issues with my father, and that if I was ever going to get any better I would be smart to spend time trying to resolve that problem.  I even remember mentioning to him that I thought I had OCD.  He dismissed my concerns, and very kindly (all sarcasm intended) agreed to put me in their one-night-per-week treatment program with their psychiatric nurse.  After completing this program, my OCD was even worse (go figure) and I was madly trying to find some support.  I came across a study being done at the University of British Columbia offering twelve cognitive therapy sessions for people with Primary Obsessions.  Perfect! 

I participated in this study, and had a very compassionate, kind therapist who helped me.  She was a graduate student, and had very little experience in treating anyone with OCD, let alone someone with Pure O.  But the treatment seemed to help.  It taught me to challenge my thinking.  To look alternative options for reality.  Maybe what I think might happen isn’t going to happen at all.  Maybe there are other ways to look at my fears and scary thoughts.  I left our sessions feeling great!  Now though, I realize what was really happening.  I was leaving our sessions feeling REASSURED. 

Don’t get me wrong.  I think there is a place for cognitive restructuring in the treatment of OCD.  But in my opinion, it takes someone who really understands the nuances and insidious nature of OCD to know how and when to apply this tool so that it doesn’t just become another compulsion.  The therapist that I am seeing now uses ALL of the tools – ERP, mindfulness, cognitive restructuring.  But he is great at helping me realize when my cognitive restructuring has become a compulsion – a skill that I don’t think a lot of therapists have developed.    I am now starting to understand why even the several Cognitive Behavioural therapists that I saw over the years couldn't help me with my OCD.  It's because though the model of CBT seems very simple, it takes a lot of skill and experience in order to apply it to the various disorders in such a way that it is effective.  Many therapists learn CBT in university and don't continue with their training.  And we all know that treatment for OCD is highly specialized.  
Nowadays, cognitive restructuring is a ritual for me at certain times.  By thinking about alternative, more rational options for reality, I feel reassured.....maybe the worst case scenario won't happen.  The problem is that cognitive restructuring doesn't help me with the ultimate goal - to learn to live with uncertainty.  Dr. Jonathan Grayson also discusses the fact that cognitive restructuring can become a compulsion in his book "Freedom from Obsessive Compulsive Disorder".  
I'd love to hear other's thoughts on this topic?  Do the rest of you struggle with cognitive restructuring that has become a compulsion?  What do you do to overcome this challenge?    


  1. I have been through the ringer with therapists as well. Let's start with my first therapist, who was a Christian "counselor." I told her about all of the thoughts I was having, and she said, "oh honey, everyone thinks crazy thoughts..." Reassurance. I knew that my thoughts we not the "normal" kind at all.

    Then, another talk therapist who told me my issues with men was because I really haven't met the right one... I had OCD, and I was suffering from OCD.

    Then, a Freudian psychotherapist for 3 years, 2x per week, countless dollars waisted, for tons of spikes in my OCD and a person who sat across from me and said hardly nothing.

    Then, I... Myself... I discovered I had OCD. I told my therapist that I was leaving her for an ERPT program and she was highly against it. I took a leap of faith and it was the best thing I ever did for myself.

    It's all about finding the correctly trained OCD therapist, I recommend Exposure Ritual Prevention Therapy.

    Hope you're doing good, POC. I'll pray for peace for your mom and for you as well... Good to hear from you.

  2. I also pray for peace for you and your Mom. This must be such a terrible time for you.


  3. Yes I think our journeys to finding a good OCD therapist are common. It's very frustrating!
    Thanks Lolly and Elizabeth for your support!!!

  4. Your post is very interesting. When my son Dan suffered from severe OCD, most of his compulsions were mental (that's one of the reasons we were so surprised when he told us he had the disorder; there were no obvious signs at the time). He spent nine weeks at a residential program engaging in intensive ERP Therapy, and this was the main therapy used, even for the mental compulsions. I think it was harder for him to do, and certainly harder for his therapist to monitor, but it did work. Thankfully, he is still doing very well, over three years later.
    My thoughts are also with you and your family...

  5. ocdtalk - yes cognitive restructuring is definitely an important part of ocd treatment, but if not taught properly and if one doesn't have a therapist skilled at recognizing when it becomes a compulsion - trouble can ensue. The cognitive portion of CBT definitely became an ingrained compulsion for me.

  6. As I know, cognitive restructuring is a psychotherapeutic process of learning to identify and dispute irrational or maladaptive thoughts, such as all-or-nothing thinking (splitting), magical thinking and emotional reasoning, which are commonly associated with many mental health disorders.