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Sophief

Theory A/B exercise with 'Pure-O'.

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Hello,

My copy of Break Free From OCD arrived this afternoon and I've just finished it.

I have a question regarding the Theory A/B exercise. If a person's OCD revolves around 'Pure-O' how do you complete the Theory A/B exercise? I tried but it felt like rumination and memory checking and I became so anxious that I asked for reassurance.

I understand that the basic principles of recovery - rejecting the urge to check and ruminate, and not engaging with magical thinking - apply across the board. 

I haven't been able to identify a root cause for my OCD other than 'it's my worst nightmare'. Does that matter or do I just need to keep working at it?

How does a person with Pure-O (I'm sorry, I know labels are frowned upon) stop carrying out compulsions? No memory checking and no asking for reassurance?

Thank you for all of your advice so far.

Edited by Sophief

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I don't know anything about Theory A/B. Personally I am dead set against any kind of attention given to intrusive thoughts, even if that attention involves trying to prove them wrong.

The principles of CBT apply for whatever theme you are dealing with. 

It doesn't matter what the cause of your OCD is. Stop trying to find it. We know how to treat it and that's all that matters.

You stop compulsions by stopping. Reduce and delay are two good tactics to use.

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If you just got break free this afternoon, doing a behavioural experiment may have been a little soon. Did you do the previous exercises looking at what your problem is, the meaning you put on your thoughts and your vicious flower? These are important steps because you need to understand how your compulsions fuel your problem and how you use emotions as evidence that there is something wrong. 

Before you do a behavioural experiment you need to agree with yourself that you won't do any compulsions at all. However, if you memory check it can be almost automatic, so try to learn from your experience and note when your anxiety increased. Did you mental check and then get anxious? That is evidence your problem is one of worry, because thinking back buys into the idea that you are responsible to make sure everything is OK. You now know it actually makes you more unsure and more anxious so is fueling your problem not making it better.

My advice is take your time and read all the stages before the behavioural experiments carefully so you'll know better next time you try :)

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Good advice Sophie. 

The book is one to work at then understanding blossoms. Gemma is right - leave the behavioural experiments till you have learned all about the disorder first. 

But there is no "Pure O" - we are simply sufferers without obvious rituals. Look for your mental responses to intrusions -re-assurance seeking, googling, ruminating, confessing etc. These are the compulsions from OCD thoughts. 

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10 hours ago, Sophief said:

How does a person with Pure-O (I'm sorry, I know labels are frowned upon) stop carrying out compulsions?

I think before you focus on doing therapy exercises it would be helpful to spend some time (even the next week, just mindfully observing) examining what are your compulsions are, because there will be some.   In fact Snowbear and I are just finishing an article that touches upon this for the OCD-UK members magazine. 

Pure O doesn't mean anything because it doesn't really explain what your OCD fears/obsessions are, but some usual compulsions that are commonplace with some types of the so called Pure O are checking for groinal responses, checking if attracted to children/particular sex, seeking reassurance, avoidance of people/places/objects, trawling through past memories and nearly all of these are a form of 'checking' so you see that's why the Pure O term is useless because it's so imprecise. 

But yes, this is a great exercise for anyone with any type of OCD, create a notepad on your phone (or be old fashioned and use a real pen and notepad) and just think and jot down your compulsions... you may not immediately think of any or many, but focus on that for a week or even a month and you will be amazed how big the list grows.  I think then at that point you can start tackling the OCD because you have identified your obsessions and compulsions. 

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7 hours ago, Gemma7 said:

If you just got break free this afternoon, doing a behavioural experiment may have been a little soon. Did you do the previous exercises looking at what your problem is, the meaning you put on your thoughts and your vicious flower? These are important steps because you need to understand how your compulsions fuel your problem and how you use emotions as evidence that there is something wrong. 

Before you do a behavioural experiment you need to agree with yourself that you won't do any compulsions at all. However, if you memory check it can be almost automatic, so try to learn from your experience and note when your anxiety increased. Did you mental check and then get anxious? That is evidence your problem is one of worry, because thinking back buys into the idea that you are responsible to make sure everything is OK. You now know it actually makes you more unsure and more anxious so is fueling your problem not making it better.

My advice is take your time and read all the stages before the behavioural experiments carefully so you'll know better next time you try :)

I've researched OCD until I'm blue in the face, at this stage it may well be a compulsion in itself. I tried completing the viscious flower but I struggled because I don't relate to the burden of responsibility aspect. My OCD isn't as typical (I don't think) as some of the cases I've read because I know that what I fear is untrue, I know it with certainty. However, the mere thought of it is so horrible that I got stuck in this 'what if' loop and so I would recall events in order to reassure myself 'see, it's ok'. Eventually, I couldn't rely on my memory anymore because the anxiety felt too real to ignore. 

I definitely check, as above, and I ask for reassurance. It feels like I'm just stuck in an anxiety loop. Oy vey.

Thank you for your help all.

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You don't need to feel a burden of responsibility to complete a vicious flower diagram you only need to have an intrusive thought, an interpretation (obsession) and meaning placed on the thought and then compulsions and emotions that drive the cycle of thinking and behaviour.

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Revulsion at the thoughts is another common OCD issue Sophie, you aren't any different to others who have that response 

Edited by taurean

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On 24/11/2017 at 02:27, PolarBear said:

I don't know anything about Theory A/B. Personally I am dead set against any kind of attention given to intrusive thoughts, even if that attention involves trying to prove them wrong.

 

I must admit I have sometimes had similar concerns about the theory A/B technique - like it is an exercise in rumination and giving the thoughts credibility that they don't deserve.

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It's very popular in modern CBT. 

My young therapist,a graduate with a PhD in clinical psychology,  loves it and suggested I added a bit of fun to it by treating it like a courtroom drama. 

I didn’t fancy that approach, but I can see it would be appealing to some. 

You pays your money and you takes your choice. As we know only too well, what works for some may not work for others. 

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I think there is some misunderstanding about what theory A/B is. It isn't about proving your obsession wrong, it is basically about building evidence that compulsions make you feel worse, that the problem is one of worry. If you ruminate because of theory A/B then you aren't doing it correctly.

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6 minutes ago, Gemma7 said:

it is basically about building evidence that compulsions make you feel worse, that the problem is one of worry.

Correct :)

 

Edited by taurean

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14 minutes ago, Gemma7 said:

I think there is some misunderstanding about what theory A/B is. It isn't about proving your obsession wrong, it is basically about building evidence that compulsions make you feel worse, that the problem is one of worry. If you ruminate because of theory A/B then you aren't doing it correctly.

My understanding is that theory A is that the obsession is true, and you list evidence for that (generally nothing other than intrusive thoughts/images etc), and theory B is that the problem is one of worry, and you list evidence for that (eg. "I have never done the thing I fear before", "other people think my fear is silly").  To me this listing evidence is not that far away from rumination. 

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2 minutes ago, gingerbreadgirl said:

My understanding is that theory A is that the obsession is true, and you list evidence for that (generally nothing other than intrusive thoughts/images etc), and theory B is that the problem is one of worry, and you list evidence for that (eg. "I have never done the thing I fear before", "other people think my fear is silly").  To me this listing evidence is not that far away from rumination. 

The idea is that you do the exercise, then accept its findings. 

If you don't accept its findings, and want to keep repeating the test "just in case"  that would be ruminating. 

Edited by taurean

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Just now, taurean said:

The idea is that you do the exercise, then accept its findings. 

If you don't accept its findings, and want to keep repeating the test "just in case"  thst would be ruminating. 

I understand this, and I totally accept that this really works for a lot of people, but for me it feels as if doing this exercise in the first place is telling your brain that these thoughts are reasonable and can be rationally debated.  I think Polarbear is saying he prefers not to even give the thoughts the time of day, treat them as the rubbish they are, and I have to say after much to-ing and fro-ing about this I am inclined to agree.

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19 minutes ago, gingerbreadgirl said:

My understanding is that theory A is that the obsession is true, and you list evidence for that (generally nothing other than intrusive thoughts/images etc), and theory B is that the problem is one of worry, and you list evidence for that (eg. "I have never done the thing I fear before", "other people think my fear is silly").  To me this listing evidence is not that far away from rumination. 

It isn't theory A the obsession is true, in Break free from OCD it is theory A OCD says, theory B OCD is. The wording is important and it shows that guidance from a therapist is important. There is also more to theory A/B then just this part.

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OK  - I see what you're saying - but even with the change in wording it is still, in my opinion, rationalising/debating with the obsession.  This is just my opinion though - obviously I am not a professor and OCD expert!!

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1 hour ago, Gemma7 said:

I think there is some misunderstanding about what theory A/B is. It isn't about proving your obsession wrong, it is basically about building evidence that compulsions make you feel worse, that the problem is one of worry. If you ruminate because of theory A/B then you aren't doing it correctly.

Gemma is right (I find myself saying this a lot!!!) 

I think the formulation (or OCD roadmap as we call it in the next magazine) and theory A/B perhaps link together.  We are covering the formulation concept in the magazine, and I will perhaps follow that up in the subsequent magazine with an explanation (hopefully simplified) around theory A/B.

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From my own personal experience and from reading a lot of forum threads, once you have a fair bit of insight into your OCD then there isn’t a lot of value in the theory a/theory b exercise. If it’s being used as a way of deciding (and reassuring yourself) that your fear probably isn’t true each and every time you get a trigger, then it’s really serving as a ruminatory tool for reassurance. Its probably a useful tool at the outset of treatment, so that you can make a forward decision on what you will do next time you get triggered. 

I actually feel that the main problem people seem to have is finding the courage to take a leap of faith - to say ‘I will accept the fear associated with the possibility that my fear is true’, and therefore I will not do any compulsions that are only there to make me feel less afraid. There’s not enough emphasis on the value of ACT, and mindfulness, as useful tools for OCD. 

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1 hour ago, Franklin12 said:

actually feel that the main problem people seem to have is finding the courage to take a leap of faith - to say ‘I will accept the fear associated with the possibility that my fear is true’, and therefore I will not do any compulsions that are only there to make me feel less afraid. There’s not enough emphasis on the value of ACT, and mindfulness, as useful tools for OCD. 

I agree Franklin, nicely put. 

But let's remember the primary - and core - "tool" to recover from OCD is CBT. Acceptance and Commitment Therapy (ACT) has some good additional points, and mindfulness is a great way to shift focus from, and helps to then stay free from, obsessing and compulsing - but, for me, only when all the understanding from CBT is firmly in place,and is maintained . 

Edited by taurean

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For me, some things in ACT go deeper than CBT, so work well as an additional to it. 

As you would expect from the name, acceptance is given importance in ACT. We are told -  instead of just not connecting, not giving belief to, not trying to push away or neutralise intrusions - to first open up to them, accept them, let them in, welcome them in but then remember that they are not our thoughts or any for which we are responsible. After practice, they can lose interest in us and lose power. 

It may seem an odd approach, but for me acceptance doesn't get the attention it may need in CBT, so this may be helpful. 

The mindfulness angle I was taught in mindfulness based CBT for OCD explains more about how the brain works. Simplistically put, we obsess and compulse in the active "doing"  part of the brain, which is geared to seeking answers and solutions before its alert mechanism will allow us stand down. Because we can't find the answer, we can't stand down, hence anxiety leading to disorder. 

But when we have been able to shift from that part of the brain to the benign, just "being" part of the brain, our focus lies just in the here and now and on the task or relaxation in hand. 

What I found difficult was switching parts of the brain where my focus lay, but I am much better at this now, and spend far more time being mindful. 

Edited by taurean

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20 hours ago, Franklin12 said:

I actually feel that the main problem people seem to have is finding the courage to take a leap of faith - to say ‘I will accept the fear associated with the possibility that my fear is true’, and therefore I will not do any compulsions that are only there to make me feel less afraid. There’s not enough emphasis on the value of ACT, and mindfulness, as useful tools for OCD. 

I agree with this, Franklin x

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I think any exploration of our illness can only be a good thing as long as it isn't compounding the condition. Different people will find different methods helpful. I think it's really good to investigate all these CBT methods and then try them out in a correct way, ie, in the way they were intended.

If your OCD is 'atypical', really explore that. What are your triggers, what are your motivations? What are your feelings around your obsessions and compulsions? I don't think it's ruminating if you do it concisely, write it down, keep it to the point and then don't repeat. 

But at the end of the day what has worked the best for me is to wholeheartedly agree with the thoughts... "yes, I am going to abuse my child, yes I'm going to... oh well. Never mind." As soon as I did that things really changed for me. So simple, so hard to do, but so freeing! As soon as I agreed the thoughts dropped away! The urges and groinal responses reduced! The OPPOSITE of what I thought would happen, happened.

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59 minutes ago, JennieWren said:

 

But at the end of the day what has worked the best for me is to wholeheartedly agree with the thoughts... "yes, I am going to abuse my child, yes I'm going to... oh well. Never mind." As soon as I did that things really changed for me. So simple, so hard to do, but so freeing! As soon as I agreed the thoughts dropped away! The urges and groinal responses reduced! The OPPOSITE of what I thought would happen, happened.

That's a key element of CBT and a great example of how the unexpected solution becomes the solution. 

Doesn't work for everyone  - common problem with OCD. But when we do find what works I agree, it's so healing, so freeing. 

I would say that if we are truly determined, truly willing to apply what we are taught, however difficult, truly willing to track down missing techniques, our chances of finding that same Nirvana are very high. 

Edited by taurean

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2 hours ago, taurean said:

There’s not enough emphasis on the value of ACT, and mindfulness, as useful tools for OCD. 

There's a good reason for that!  Tools yes, treatments for recovery, perhaps not. 

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