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The purpose of therapy


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Hi, 

I understand the general premise behind erp - exposing yourself to the things that make you anxious and feed the ocd. But I've seen people comment about the cognitive side of things. Which bit is that? With ocd therapy do you try and work out where the anxieties come from or is that irrelevant? (I hope that makes sense) 

Thanks 

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I'm right here.

Snowbear is our resident expert on the cognitive side but I'll give you a brief overview.

The cognitive side looks to get you to think differently about the intrusive thoughts. Part of that is knowledge, knowing what is going on inside your head and how obsessions and compulsions work. The problem sufferers face is not just compulsions. It's that they attach meaning to the thoughts. So if a therapist can help you see that there is no meaning to the thoughts you'll tend to treat them differently in the future.

Usually you look at cognitive distortions too. Like, I have some mud on the bottom of my shoe  therefore my whole house is contaminated. That's all or nothing thinking and it's simply not true.

Also, if you think differently about the thoughts, you have less reason to do compulsions. 

That's a taste. Maybe snowy will be by to give a better explanation.

Edited by PolarBear
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Hi Em,

Generally in CBT for OCD you explore Cognitive distortions/thinking biases. Usually therapists will ask for a brief history to identify where the cognitive distortions started (as part of their 'Formulation' of the problem [i.e. its origins and the factors that maintain it]), which can help when challenging thoughts. For example if patient A thinks that they have to wash their hands very often to prevent infection but reveals that in the past they had a baby that was born prematurely and in that instance not washing hands would pose a risk of illness then this is useful information for the therapist who can then help that patient to identify their thinking biases- for example that they are overgeneralising from the situation to all other situations where the risk is much lower and they are catastrophising that terrible things will happen etc. 

CBT differs from Psychoanalytic therapies though in that it does not involve an overemphasis on past experiences, repressed emotions and subconscious desires. 

 

 

Edited by BelAnna
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2 hours ago, Em00 said:

With ocd therapy do you try and work out where the anxieties come from or is that irrelevant?

Understanding why you're anxious about something doesn't help to overcome the anxiety. That's why psychotherapy based on analysis doesn't work. 

The cognitive side is about understanding how thoughts influence feelings and behaviours, and vice versa. It's about helping you to choose alternative ways to interpret your thoughts and alternative ways to behave in response.

Sometimes you need to explore if there are underlying beliefs which are maintaining the anxiety despite changing how you think and respond, but that's still not the same as 'working out where the anxieties come from'. 

I think Polar Bear and Bel Anna have explained it more clearly though. Seems I've been tipped off the 'expert' throne. :;  (Not that such a thing ever existed!) 

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Thank you all for your helpful replies. I don't know if it's 'me', if it's my Aspergers, or my obsessive tendencies (or all of the above! ?) but I find it hard if I don't understand things. I find it difficult believing what others say/believe about my obsessions and I don't know why. ? 

They should be calling tmrw about a psychology assessment. I'm tired of it all. ? 

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The others have answered well, I think the basic thing to remember with dealing with OCD is that it's not the intrusive thought itself that is the problem, it is our interpretation of the thought, and how that interpretation makes us feel and believe about ourselves too.  That's what the cognitive part will help a person address. 

I have uploaded an illustration that explains the model of OCD which may help you understand why we need to do the cognitive aspect and not just ERP, I hope it helps you understand (and doesn't confuse further!)

OCD Cycle004.jpg

Ashley.

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1 hour ago, Ashley said:

The others have answered well, I think the basic thing to remember with dealing with OCD is that it's not the intrusive thought itself that is the problem, it is our interpretation of the thought, and how that interpretation makes us feel and believe about ourselves too.  That's what the cognitive part will help a person address. 

I have uploaded an illustration that explains the model of OCD which may help you understand why we need to do the cognitive aspect and not just ERP, I hope it helps you understand (and doesn't confuse further!)

OCD Cycle004.jpg

Ashley.

Thanks Ashley, that's a helpful diagram. Just trying to understand the relevance of your thinking and where it comes from and whether this is taken into account. 

Another therapy thing I was going to ask was, obviously if you have one 'flavour'  of ocd that's quite 'straightforward' (I'm using this phrase for ease, I know things are never straightforward!), you're offered a set number of sessions of cbt and methodically work through it (hopefully). If you have lots of 'flavours' of ocd, where do you start and how do you work through it in a limited time frame of cbt? 

I've got a psychology assessment next week and as you can imagine I'm very anxious!! 

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2 minutes ago, Em00 said:

If you have lots of 'flavours' of ocd, where do you start and how do you work through it in a limited time frame of cbt? 

When people have several 'flavours' of OCD going on there is often an underlying theme which links them all and if you (together with the therapist perhaps) can identify this link then you can work on that and cover several bases at once rather than get into the specifics of one intrusive thought at a time.

For example, someone might have issues around contamination from dirt, compulsions to keep the house organised a particular way, and intrusive thoughts about jumping in front of a train. At first glance they don't seem related, but it could be an underlying fear based around loss of control. Therapy can then focus on the 'control' issue rather than three separate OCD themes.  

Hope that helps. 

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Thanks snow. That's what I was hoping. If things are all complicated, surely there's merit in trying to pick them apart a bit? I have a few set flavours and then my head dances around various others as it sees fit. I know I find it awful dealing with uncertainty and know that fits in with my Aspergers too... 

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