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Discussion - The cognitive part of CBT


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I agree that most is part of modern CBT - but I like the idea of an overall "borderless" expression that permits other ideas of cognitive activity to have a role - e.g. meditation.

The cognitive thinking distortions - e.g. mind-reading - which my wife is so good at, and I am helping her overcome - need more prominence in treatment alongside standard OCD treatments too, in my honest opinion. If you take any one of us, there will be elements of those distortions alongside OCD - if they are too prominent in daily living, they are likely to need tackling too.Mine were, and I am all the better for addressing them.

Edited by taurean
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Snowbear, I want to respond to your post on Caramoole's thread, as well as your messages on here, but don't know whether to keep both to this new thread.

I am short of time now, so will come back to it another day. But I will say this about my own learned behavior - my fear was as great in that sudden moment, out of the blue, so many years ago, as it is now after decades of reinforcement with multiple compulsions.

One question: in your opinion, can cognitive reprocessing affect emotions like love?

I'm aware of how remarkable the brain is and how neuroplasticity has been proven, but feel there are limits to its changing. If that were not the case I'd be a virtuoso musician by now.

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Personally I think that a good therapist will be able to pinpoint distortions in a sufferer as part of CBT which as you suggest will be incredibly helpful. If therapy is good therapy then it wouldn't be an add on but inherently part of it.

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It's a quirk of nature that the brain is wired to actively look for things which support what we already believe about the world (seek reassurance things are as we think they are) and to reject or overlook what doesn't support our current understanding. So when the voice in your head screams 'DANGER! This is a threat. I'm unsafe'' it confirms and reinforces its own belief system that the threat is real. But you can break this cycle by programming the voice in your head to repeat back to you what you want your new belief to be. ''This is ok. I'm safe.'' You won't believe it at first - because your brain hasn't heard it often enough to adopt it as a core belief yet. But over time you break the brain cell connections you made when you learned 'This is a threat' and instead make brain cell connections that reinforce the new belief 'I'm safe.'


Then, when the things that once triggered fear arise again, your newly taught emotional centre scans it's belief system, comes up with ''I'm safe'' and instead of screaming 'DANGER, FEAR!' it shrugs it off and leaves you to get on with your life. :)



Thank you PolarBear


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My gut instinct is that there is more than one cause of OCD. To me OCD is a condition whereby a sufferer is subjected to repeated negative thoughts that cause anxiety and the normal reaction is to do something about it (compulsions). Perhaps we are all genetically predisposed to have OCD but we require some stimulus, some event, to trigger it. Kids can get OCD like symptoms from a simple strep infection. Snowbear's idea that there is an underlying negative thought process going on fits. For other people it might be a severe imbalance in neurotransmitters (which accounts for some people getting better on SSRIs alone).

All food for thought.

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A couple of things snowbear.

I realize that change comes slow. You can't just think something new and expect it to take hold. It takes commitment and repetition.

You got talking about the underlying condition beneath someone's ocd. As far as I'm concerned the jury is still out on the causation of ocd. Maybe we all have some inherent misguided truths about us that led to our disorder. Time will tell I suppose. Is it some kind of trauma that starts the ocd ball rolling? Do our parents say just the wrong, negative thing to us during our formative years that's sets us off. Is it genetic? Is it environmental? It's interesting but I'm not sold that there is some inherent, core flaw in our thinking that causes ocd. I will say I'm willing to consider that if there is evidence.

Until the jury is back I'll keep advising tried and trusted CBT and ERP for the treatment of OCD.

Totally agree about the commitment and repetition. :yes:

Causal factors may be very interesting......I think so far as this thread is concerned, it's worthy of debating in a new light. Cause (generally) isn't thought to be important. Is it, isn't it? I thought not.....hence I'm interested (and open-minded) to hear alternative views/theories/research

Caramoole, this is such a huge topic it deserves a separate thread. LOT'S of new research on the causative angle. I'm on it. :scooter: Will post something later this weekend to get that discussion started. :)

It's very hard to prove causation in any experiment, and when you involve the human brain, well let's just say it's considerably more difficult. That said, SnowBear's post got me to reflect on the underlying beliefs that may keep my OCD running strong. And I do think there's a part of me that feels helpless and out of control, perhaps a victim waiting for his bully. All of this fits perfectly with what OCD can do to me if I let it.

I agree, cause is hard to prove and, more importantly, may not ultimately be relevant. (Does it really matter how the smashed egg got onto the floor? It's the fact the shell is broken and you have to clean up the mess that counts!)

I apologise if I misled anyone into thinking this questioning of beliefs was about looking for a cause (someone or something to blame for the OCD.) It's most definitely not. There's a danger, I suppose, that either the therapist or the sufferer might latch onto the idea of 'cause' and start examining personal history in detail instead of dealing with the thinking processes the person is using in the here and now.

I found it interesting to look at what might have made my OCD start (something I covered with a therapist nearly 10 years ago) but knowing what might have caused it originally hasn't been particularly helpful in overcoming the OCD in the present. (The insights gained did improve my relationship with my parents, but that's another story!)

What cognitive reprocessing is all about is looking at the mechanisms of thought that are maintaining the OCD. Examining your current belief system helps to identify what is preventing good advice such as 'don't engage with the thoughts', or 'don't do the rituals' from working. Why does it work for many, but bounce off the rest of us?

I'm going to try to break down a bit more what I mean by cognitive reprocessing and give some examples as I reply to others. Hopefully that will make it clearer. But you're on the right lines when you identified ''part of me that feels helpless and out of control, perhaps a victim waiting for his bully''.

There's a core belief lurking in that statement, maybe something like, 'I am powerless'.

If your subconscious mind secretly believes it is powerless, then every time you act powerfully (fight the OCD) you'll get just so far through sheer determination (conscious effort), but at the last minute your subconscious belief kicks in with an internal dialogue along the lines of, 'But I'm powerless, so this improvement can't be real. I can't get better, because you can only escape a bulky for so long before he comes after you again.'

This core belief may not be something you ever think in words. It's going on in a different part of the brain to where 'thoughts' happen, but it sabotages your thinking brain every time - and can land you back at square one. It's that non-verbal part of the brain we need to tackle and reprogramme.

Then the thinking part of the brain (cortex) can get on with making behavioural changes unfettered by an internal saboteur. :ninja:

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I'm wary of any kind of talk therapy to try and deal with ocd--like what might have caused it psychologically. I heard that they used to use this kind of approach in the past with no good results. I fear that you could get sidetracked for a long time trying to figure out what went wrong and never get rid of the ocd. Of course, since cbt and erp have been working for me, I'm biased toward this approach. I think if someone found talk therapy worked for them, then that's good too.

I'm wary and suspicious by nature, Doris. When new theories and research is published I never take the reports at face value but seek out the original research and read it carefully. I check the researchers used reliable scientific methods, that they looked for and addressed any potential holes in their arguments, and that the statistical methods they used were valid and not applied in a way which could distort the results. In short, I'm not an easy person to convince!

The original psychotherapy methods don't have much impact on OCD, but those methods started with Freud over 100 years ago. They evolved and were updated last century. Cognitive analytical therapy (CAT) was born out of this and it does help some people deal with their problems more effectively.

Some therapists include a bit of CAT in treating OCD, but typically if you seek therapy in 2015 it's 99% CBT (Cognitive Behavioural therapy) and if that doesn't work for you, you're on your own, effectively abandoned by the health care system.

In the last decade a whole new understanding has arisen of how we think, how we learn - and importantly, why we behave as we do. Sophisticated brain scans show in real time what areas of the brain become active when you think. They reveal how we process images, process language, how we interpret an event and assign an emotional response to it (long before you are consciously aware of feeling the emotion.)

Research psychologists now admit the swing from analysis to behaviour therapy may have gone too far. They have shown we need a balance of the two - BUT we should be doing a different kind of analysis - not looking at cause like before, but looking at what's going on in our underlying thought processes.

Sleep studies, genetic studies, and more, have revealed much about the chemistry of neurotransmitters within brain regions - how a complex series of 'switches' drastically change which chemicals are active in which regions at different times of the day and even during different stages of sleep. How mood affects this chemical process, and how thoughts translate into brain chemistry. We're only beginning to learn how genes, environment - and internal input from the brain itself (thoughts) - all work together to influence this chemistry at an individual cell level and also at the 'whole person' level.

I used to be horribly closed-minded about behavioural therapy because my experiences with it always made me so much worse. And the therapists sat back and said I had to get worse before I could get better. It all deteriorated into something like Bedlam in the 1600s! :sweat:

But I now understand the reason behavioural therapy was unsuccessful with me was because of my core beliefs and the learned thought processes I use to interact with the world day to day. Both of those can be changed - if you choose to change them - and that's where this cognitive reprocessing can really help people with OCD. Especially those of us who haven't had initial success with CBT.

I'm now at the stage where I've tackled the cognitive processes that were keeping me stuck and I'm slowly moving on towards behavioural therapy - amazingly, with positive results!!! :w00t:

I strongly believe nobody is beyond help. But it's 'horses for courses' as you say. Whatever suits the individual. :)

Edited by snowbear
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This is fascinating and important, SnowBear. I get a little hazy on the distinction between cognitive and behavioral techniques because most of my work is done mentally, since I tend not to avoid feared situations physically but do ruminate a lot about them. Can you provide an example of the kind of reprocessing you are doing, if you're comfortable being open about it?

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I can't see how cognitive reprocessing is different from the cognitive part of cbt if cbt is done well. I agree about looking at our core beliefs that have perhaps contributed to our ocd and I think this is well explained in 'break free from ocd'.

You mention snowbear about using one part of our brain to teach another but how do you suggest we do that. Surely the only way to teach our brain new ways of behaving is to behave differently by using ERP. The cognitive reprocessing you mention in my opinion can only explain why we might choose to behave differently.

You'd think learning new behaviours would be just a matter of practising those new behaviours, wouldn't you? It sounds so logical. :nerd:

Bash your head against the wall long enough and your forehead will eventually become flat. :wallbash: (Joking to make the point, obviously CBT isn't bashing your head stuff...)

But you can also change behaviour by changing the thinking process that results in a particular behaviour.

So instead of learning new behaviours by endless repetition, like repeating your multiple time tables as the teacher reads them off the blackboard, you learn through a different teaching style, a more 'discuss and reflect' style.

'Thinking like this makes me behave like that'. By reprogramming how your brain thinks on the automatic, reflex level, you can change the resulting behaviour.

You could say:

Behavioural therapy teaches your conscious mind what to do.

Cognitive reprocessing teaches your subconscious how to respond.

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You'd think learning new behaviours would be just a matter of practising those new behaviours, wouldn't you? It sounds so logical. :nerd:

Bash your head against the wall long enough and your forehead will eventually become flat. :wallbash: (Joking to make the point, obviously CBT isn't bashing your head stuff...)

But you can also change behaviour by changing the thinking process that results in a particular behaviour.

So instead of learning new behaviours by endless repetition, like repeating your multiple time tables as the teacher reads them off the blackboard, you learn through a different teaching style, a more 'discuss and reflect' style.

'Thinking like this makes me behave like that'. By reprogramming how your brain thinks on the automatic, reflex level, you can change the resulting behaviour.

You could say:

Behavioural therapy teaches your conscious mind what to do.

Cognitive reprocessing teaches your subconscious how to respond.

Cognitive reprocessing to me seems like you question why you think a certain way, realise it is flawed and then you see that you no longer have to do the compulsion.

Personally I think its seems like an avoidance of anxiety. Exposures take control back off ocd. At what point in cognitive reprocessing does your behaviour change? How does it change? Why would it change?

What research references cognitive reprocessing?

Edited by Gemma7
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So instead of learning new behaviours by endless repetition, like repeating your multiple time tables as the teacher reads them off the blackboard, you learn through a different teaching style, a more 'discuss and reflect' style.

'Thinking like this makes me behave like that'. By reprogramming how your brain thinks on the automatic, reflex level, you can change the resulting behaviour.

Can you expand on that a bit?

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What research references cognitive reprocessing?

I don't think she has to provide supporting research (unless of course she wants to and has the time)

Snowbear is explaining what seems to be working for her based on multiple sources she's read, it's not a thesis....people can take from it what is useful or interesting and then do their own research if they want corroboration.

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I don't think she has to provide supporting research (unless of course she wants to and has the time)

Snowbear is explaining what seems to be working for her based on multiple sources she's read, it's not a thesis....people can take from it what is useful or interesting and then do their own research if they want corroboration.

Snowbear has said previously that it had come from research so was wanting to read it.

If this works for Snowbear I couldn't be happier but I am entitled to ask where snowbear has heard about it.

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My granddad, dad and two brothers have OCD but not to the extent I have it. So I tend to believe this is a genetic problem but as I was faced with great anxiety as a child due to not so nice situations, did this stress make OCD more prevalent in me. Genes have been found in dogs which cause them a similar condition to human OCD, but it’s called canine compulsive disorder and they are looking for the same genes in humans so that one day they may be able to suppress these genes and our condition may improve, so this makes me think that the foundations of OCD are genetic but life events can cause it to come to light or not, but that’s just my feelings. Genes are also flexible so they can change if we try hard enough. Or can two people carry a faulty gene for OCD but not suffer from it themselves but when they have children , a child may suffer from OCD if it receives two copies of the same faulty gene.

One day I woke up and I was fearful of fibre glass insulation because we were having a porch built at the time and they put that in the roof, despite me going in the loft for years where it was. I think for that to happen it’s an inappropriate emotional response and some internal conflict within me and my fear of fibre glass came out in response, I think it has to be something like this as its two quick. Emotions can cause stress and I think stress is linked to OCD, as stress can have an effect upon us in so many ways that it’s not unreasonable to think it somehow plays a part in OCD and makes recovery from it challenging. So our genes make us all special as individuals and our genes may influence our emotional state. I am a very emotional person, probably over emotional, I feel deeply about things and I worry a lot. I have not talked to anyone else before who has OCD and are these common features of an OCD sufferer? and if so is this over sensitivity possibly caused by our genes which makes us vulnerable to OCD.

I do agree we have to be positive and I am a positive person but for me it’s not enough to say I am not in danger or I dont need to clean that, as that won’t stay with me unless I really believe it. For my improvement from a living hell off OCD I had to prove to myself I was not in danger, saying it never convinced me of that. I did slow exposure to desensitise myself to the things I feared and that allowed me to prove to myself I was not in danger.

I went to the Maudsley Hospital in London 20 years ago under Professor Isaac Marks. My therapist changed my life but I found contaminating myself and waiting for the anxiety to go never happened and I have explained in another thread why that was the case, but gradually exposing myself to my fears each day did help me. The anxiety and fear can only go if we are in a calms state to begin with, if we are in a high state of fear we can’t learn anything in that situation, our brain does not allow it.

Edited by Arrow
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This is fascinating and important, SnowBear. I get a little hazy on the distinction between cognitive and behavioral techniques because most of my work is done mentally, since I tend not to avoid feared situations physically but do ruminate a lot about them. Can you provide an example of the kind of reprocessing you are doing, if you're comfortable being open about it?

I'm happy to be open about my reprocessing efforts, Sodovka. If it's helped me, maybe it will help others. Sometimes it's a few words or a particular phrase somebody says that gets through to us when others saying the same thing 100 different ways has had no effect.

My OCD takes the form of contamination fears. Not dog pooh, or bacteria, or any kind of 'real' dirt, but emotional contamination. When people are inconsiderate, or tell lies, or try to manipulate others, it gets me riled! The person and the objects around them become 'unclean' and need to be sterilized (by disinfecting them) or neutralised with safety rituals.(Well you can't pour bleach over the postman, can you?) :unsure:

I'm a bit stubborn by nature and I HATE injustice. I hate to be told how to think, or what I 'ought' to feel. My knee-jerk response is 'Who put you in charge and made you think you know better than me?'

I've been labelled in the past as having ODD (Oppositional Defiant Disorder.)

My response to that was, 'You just don't like the fact I stand up for what is right and won't be pushed around.' :wontlisten:

So CBT was doomed to fail with me before it started because (to my way of thinking) it was somebody telling me they were right and I was wrong.

A therapist would say ''OCD is making you unhappy. Stop doing the rituals and you'll be happier.'

The words go in through my ears to the language processing centre inside my head. There the thought pathways of my brain, (the way I interpret and respond to the world) morph the meaning of the words into 'OCD is bad, you must stop doing the rituals'.

That message goes to the emotional centre of my brain. It responds (totally subconsciously so I'm not even aware I'm thinking it) 'Somebody is trying to manipulate you. Don't listen to them.'

So part of my brain was genuinely trying to stop doing the rituals while secretly another part of my brain believed stopping the rituals was the wrong thing to do! Is it any wonder I was mentally exhausted by the effort of fighting myself and gave up?

Cognitive reprocessing made me look at what was going on when I morphed the original message as it came in through my ears. I discovered there is a little voice in my head 24/7 saying, 'You are a powerless child. The adults are trying to hurt you. You must fight them. You must not give in to them. Your survival depends on it.'

When I was a child that stubborn refusal to let adults get away with mistreating me gave me the mental resilience I needed to survive. Trouble is, I learned that self-protective way of thinking so thoroughly that even as an adult I'm still applying it to everything that happens to me now.

So, with my therapists help, I started working on the core beliefs 'I am powerless' and the emotional response 'DANGER!.'

I've examined the evidence to support such beliefs - and found it lacking.

Over time, I've learned to recognise when the 'I am powerless' voice is kicking in, and am able to challenge it. By repeating and reaffirming the idea I have autonomy, the emotional centre of my brain is gradually being convinced that I'm not in constant danger from authority figures. Bit by bit it is adopting new ways of thinking that are more appropriate. So when the world expects me to behave in a particular way, I no longer think it's trying to control me. Instead of flagging up an immediate danger response, I am able to react rationally.

It's really not much different to standard cognitive therapy, except the teaching process goes one step deeper into the brain (to the emotional response parts) instead of all being in the rational, thinking parts of the brain.

For those wondering what's the difference between cognitive therapy and cognitive reprocessing, it's perhaps that one looks at what you're thinking, shows you it's not working, and so you try to change what you think. The other looks at what the way you process information and teaches you how to change your thought processes.

Edited by snowbear
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The odd thing is, I've noticed several people lately who seem to have an underlying, negative belief that seems to be at the core of their disorder, much the way snowbear has determined her root problem is a lack of control. Interesting.

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I think the distinction is interesting.

We need more therapeutic tools in our chest and this seems a good one.

I personally take only a passing interest in the source material of a new idea.

And I don't reckon that many people would care about that if I suddenly announced that I could switch off ruminating by reciting a certain poem backwards - the overriding feeling would be joy that I had found a new idea for people to try that might possibly aid them to stop ruminating!

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Cognitive reprocessing to me seems like you question why you think a certain way, realise it is flawed and then you see that you no longer have to do the compulsion.

Personally I think its seems like an avoidance of anxiety. Exposures take control back off ocd. At what point in cognitive reprocessing does your behaviour change? How does it change? Why would it change?

What research references cognitive reprocessing?

I agree with your first sentence regarding flawed thinking, but it's not about avoiding anxiety. Maybe my last post in reply to Sdovka will help explain how and why the behaviour changes.

I'm looking for an analogy and the best I can come up with is exposure therapy is like breaking in a horse: you show the horse who's boss, make it very scared and eventually break its spirit so it learns not to fight back.

Cognitive reprocessing is more like horse whispering: you study how horses communicate and learn to speak horse body language. Then you ask it to do what you want it to do and it complies of its own free will.

Can you expand on that a bit?

I tried to do expand a bit in my reply to Sodovka, If anything is still unclear, just ask.

Snowbear has said previously that it had come from research so was wanting to read it.

If this works for Snowbear I couldn't be happier but I am entitled to ask where snowbear has heard about it.

Absolutely you are! As Caramoole said, what I'm posting here is an amalgamation of personal experience and the result of reading many, many research papers and participating in discussions with university students and professors from around the world over three years of study. But I did make copies of a few of the papers. I'll see if I can dig any out over the next week and will happily post links to them online where you can read the research for yourself. :)

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I think you seem like a very intelligent lady Snowbear. I have read your response to Sodovka and I relate to what you are saying. I am not sure how much I think it differs from CBT though.

Don't agree with the ERP analogy, I think if done with good cognition ERP can be much more like horse whispering.

Any research is interesting but don't worry if you can't pull anything together :original:

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It seems a very sensible approach to me - I like the "horse whisperer" analogy.

If the cognitive reprocessing helps us move smoothly away from damaging responses it is good.

I think the mindful approach to treating OCD also helps me, because my understanding of how my mind works is all the better for considering a 2-part brain analogy which this uses; one part the active - doing part that chews on problems and looks for solutions - and misfires and gets stuck in OCD - and the other the benign - being - part of the brain that lets the body function autonomously in a relaxation response, and just focuses on the present moment, in the here and now, just on what our senses detect.

This has helped me greatly - and was worth every penny of the private consultation fees I paid - but I want more tools to have in my locker!

Edited by taurean
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Gemma,

I'm not trying to reinvent the wheel here, even if sometimes I sound like I am. :) In some ways this is cognitive therapy under a new name - or more specifically, a new branch of cognitive therapy; an extra arrow in the CBT bow.

Taurean,

I agree, it's good to have multiple strategies available to use. I find bits of mindfulness training very helpful (and bits of it irritating!) Being able to pick and choose from a smorgasbord of ideas has to be a good thing if ultimately it helps us conquer the OCD. :)

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I seem to be able to throw the switch/ cross the bridge to the benign - being - part of the brain more easily now - I am still considering how this is, but I think a lot of it is down to intense refocus - sometimes using 2 invoved activities at the same time to squeeze out the compulsive urges of OCD.

When I have thrown that switch/ crossed the bridge in my brain, the mindfulness then kicks in and all else gets forgotten.

In this state I find it quite easy to burn those new positive beneficial neural pathways onto my brain - the cognitive reprocessing.

Seems to me therefore that my mindfulness CBT is another portal into the cognitive reprocessing?

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My gut instinct is that there is more than one cause of OCD. To me OCD is a condition whereby a sufferer is subjected to repeated negative thoughts that cause anxiety and the normal reaction is to do something about it (compulsions). Perhaps we are all genetically predisposed to have OCD but we require some stimulus, some event, to trigger it. Kids can get OCD like symptoms from a simple strep infection. Snowbear's idea that there is an underlying negative thought process going on fits. For other people it might be a severe imbalance in neurotransmitters (which accounts for some people getting better on SSRIs alone).

All food for thought.

I agree about there probably being more than one cause. I don't think we're all genetically predisposed. I had no stimulus to trigger mine and I know of others who say the same.

I don't agree with the negative thought process theory, either, at least not in my case. I have a close relative who has always been very negative, but has no OC D. I was always very upbeat (yes, am now worn down by a lifetime of anxiety!) but had OCD at a very young age.

Apparently, only children who are predisposed to OCD are affected by strep.

Edited by Tricia
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I was just recalling how I attempted cognitive hypnotherapy a few years ago. I saw a very experienced hypnotherapist who told me the technique is ineffective for OCD. I'm now wondering why this is.

I know Ashley and Caramoole (along with almost every professional I've asked or read books by) feel hypnotherapy is not effective for OCD. But, when it focuses on cognitive reprocessing, why is this the case?

P.S. Snowbear, I was not being facetious when I asked about love. I hope you didn't think I was! I'm genuinely interested. I'm also interested to know why the thousands of hours dedicated to music did not turn me into a musician. I always assumed it was due to a lack of talent.

Edited by Tricia
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