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confused about cbt approach


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I'm feeling confused about how one is to deal with intrusive thoughts.

My current approach is:

  1. Intrusive thought pops in.
  2. Urge to do compulsion.
  3. Try to apply cognitive exercise: "examine the evidence" or other exercise.
  4. See logical conclusion
  5. Proceed without doing compulsion despite anxious feelings.

 

But then I hear we should just agree with the thought that things are contaminated. so how does cognitive exercise fit in with this approach?

I'm thinking that agreeing with the intrusive thought is part of resisting the compulsion after we have done the cognitive exercise?

I thought I understood the approach but I'm feeling confused about it now after reading some of the posts on here...

 

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Hi Leif. I more or less with your five step approach.

With Point 3 I used the Theory A and Theory B approach which is described in Break Free From OCD and Overcoming OCD.

These are the two OCD therapy books which I found the most helpful and were recommended at the Centre for Anxiety and Trauma at the Maudsley.

So the approach which I take is not to agree with the thought but to examine it. More importantly, after examining it conduct an experiment. So for example, the thought occurs that I need to check that the gas is turned off because there might be an explosion. (The trouble with checking is that you check again and again.) So I do not check and leave my property. That is, I do not do the compulsion.

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I disagree. It should be:

1. Intrusive thought pops up.

2. Continue on with what you were doing and don't give the intrusive thought any attention.

That whole exercise thing can quickly become a compulsion. Plus, you can't be logical with an illogical disorder.

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6 hours ago, Angst said:

So the approach which I take is not to agree with the thought but to examine it. More importantly, after examining it conduct an experiment. So for example, the thought occurs that I need to check that the gas is turned off because there might be an explosion. (The trouble with checking is that you check again and again.) So I do not check and leave my property. That is, I do not do the compulsion.

yes ok this is what I learned as well and try and do as much as possible. The cognitive piece being the examining it; the behaviour piece being the experiment of leaving without checking.

That seems to be what works best for me so guess I will stick with that.

3 hours ago, PolarBear said:

1. Intrusive thought pops up.

2. Continue on with what you were doing and don't give the intrusive thought any attention.

I guess this approach sounds more purely erp without the cognitive side.

I  tend to find that doing the cognitive exercises helps me to stick with the erp.

 

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Hi leif, I'll see if I can add some clarity, since it's a confusion that I've gone through!

Everyone is right in a way, theory a/b exercises are great tools for tackling OCD. They are the structure you use to test out your beliefs. But PolarBear is also right using theory a/b in every situation means you begin to depend on it. 

So after having fallen in that trap here is what I've come to understand. Try your best to do a theory a/b behaviour experiment separate from when a problem randomly occurs. For example, say you want to look at intrusive thoughts. You might do a behavioural experiment where you think the thoughts you normally get and then not react to them. You track your anxiety, see that you can ignore them and note how you feel afterwards. You re-rate your belief in how important thoughts are and then get on with your day. Then when intrusive thoughts pop up, instead of relying on an exercise, you rely on what you learnt during a previous one, and then simply act like PolarBear suggested. Break free from OCD is an excellent book but it definitely needs a section on what to do when caught off guard by OCD :)

Angst approach is good too, that's like doing a behavioural experiment as things come about, great idea as long as you don't forget to learn so you can apply it later without the need for an experiment.

The key is not to analyse to look for evidence all the time, remember theory a/b is meant to be done when you're feeling more neutral emotionally because evidence can be quite confusing when we're anxious. What you have to get good at is taking a leap of faith that your problem is like others you have previously shown yourself you can face, if finding evidence or a lack of evidence reduces anxiety it can become a compulsion in itself. Hope that helps a little :)

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I agree that Theory A/Theory B should be done in relative calm. I remember it was done with me in a therapeutic dialogue in the therapist’s office as she sketched on a white board a representation of my OCD consciousness. I was very aware of intellectually understanding the nature of my OCD but deeper and emotional and instinctual learning only takes place when you take a ‘leap of faith’ or act of courage when you do not check or conduct a compulsion. You need to change your behaviour and not commit a compulsion and witness the consequences to learn. Another name for behaviourism is learning theory. The strength of the learning increases each time you do not commit a compulsion.

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Thanks for that explanation Gemma. That makes sense.

I have been finding that since doing more formal cbt  during this latest setback, it is definitely helping when I am getting surprise intrusive thoughts throughout the day and am more able to move along more easily without doing compulsions (and without having to think through it as much)....so hopefully it's doing what it's supposed to do!

Thanks as well Angst for that further clarification. Yes that leap of faith moment is the true learning time!

 

 

 

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