Jump to content

Doubting memories/false memories?


Recommended Posts

I’ve always suffered from responsibility OCD in the sense that if I think I’ve made a mistake, no matter how small, I’ll obsess over the potential catastrophic consequences of it and ruminate/replay the scenario over and over in my head. I’ve been learning to keep this in check with the support of my counselling psychologist. 

Lately I’m finding that I’m starting to doubt my own memory of things (mainly when it comes to driving), wondering if something bad happened that I’ve missed or if I’m mis-remembering things. It’s always after stressful scenarios ie someone came shooting out of a side road the other day so I had to brake and go around her. I know the road ahead was clear but afterwards I started doubting this and wondering if I nearly hit a car etc. This memory doubting is something I’ve never done before and I think it is due to amplified stress/tiredness as I have a newborn baby who hates being in the car at the moment and it’s virtually impossible to not have a physiological stress response to their cry! I don’t enjoy driving at the best of times anyway so when something happens on the road that I have react to I’m already in a heightened stress state.

Unfortunately this situation is not always avoidable as I have to drive to nursery/medical appointments etc. so i’m just looking for advice on what is the best way to deal with these ‘memory doubts’ when they crop up? Thanks 

Link to comment

1. As for mis-remembering - I'd make a confident guess that if (at the time - while driving) you noticed something bad had happened (e.g. you hit a car), you would almost certainly have stopped the car and sorted it out. If you agree, then one good piece of evidence that you didn't notice anything is that you didn't react as you know you would - by stopping the car. 

2. As for missing something - if you missed it, you missed it. Unlikely you would miss it, but if you did miss it you can't blame yourself for missing or not noticing something. You can't make yourself not miss something. 

3. I've just bought the wristband from the online shop. It says, "It's just a thought?". Maybe reminding yourself of this slogan would help at stressful times. 

DC. 

Link to comment
20 hours ago, leil said:

so i’m just looking for advice on what is the best way to deal with these ‘memory doubts’ when they crop up? Thanks 

Hi. Its more complicated than me writing it in a quick sentence, but basically you need to build up your tolerance for uncertainty. You are seeking reassurance to ease your mind that you didn't do anything harmful. I would suggest you work your way towards accepting the possibility that your memory is perhaps not clear and maybe something did happen. I realise this sounds horrendous to do and you will feel immense discomfort in trying to let go of worrying about proving your memory. But it's the long term solution to breaking the cycle of doubt, reassurance, doubt, reassurance, doubt.....

Here's a related article to help https://www.ocdonline.com/guilt-beyond-reasonable-doubt

Link to comment
59 minutes ago, Carooba Manooba said:

I would suggest you work your way towards accepting the possibility that your memory is perhaps not clear and maybe something did happen.

Leil, in my opinion, if you consider taking the advice quoted above, you might want to talk it through with your psychologist. My sense is that this could work for some issues, but perhaps your psychologist can assess whether that is the right way for you. I guess your psychologist might suggest strategies depending on where you are in your therapy, the nature of the worries, and your progress. 

Tolerance for uncertainty was mentioned. I've found that having a tolerance for ambiguity is important for me - accepting that I cannot 'know' anything for sure, in an absolute sense. This means resisting the ongoing pursuit for truth in everyday life, the unrealistic idea that we have to 'know' or can be 100% sure of anything, is more manageable. I focus on my logical thoughts and what is most probable. I do this by writing my logical assessment of a situation down on a piece of paper (in bullet point form) and keep reminding myself of it when I re-question things. I sometimes find that once I've written it down and gone back to it a few times, I don't need it so much - as I know it is in my pocket and I have the logical thinking with me. I find that it becomes easier to tell myself "it's just a thought", thoughts come and go. 

Link to comment

Hi all, thank you so much for your replies. I’ll definitely speak to my therapist about all of this, at the moment I’m not receiving any ‘therapy’ as such as she didn’t want to start whilst I was pregnant or still getting used to a new routine with a new baby but she does want to do EMDR with me as she thinks that will benefit me. However we have been talking things through and through this have uncovered a lot of deep rooted core beliefs that are fuelling all of this. She does tell me to a) try to resist ruminating compulsions as much as possible through distraction and b) challenge the thoughts by asking where the evidence is. She has mentioned accepting and building up a tolerance for uncertainty but this will take a while for sure.

I am trying to label concerns as just an ‘intrusive thought’ and trying to stop my mind running away with these. I am also working on her advice to try and be kinder to myself as pretty much all of my thoughts end up in me berating myself and requiring me to act 100% perfectly all the time and avoid all and any situations that could potentially harm or affect someone else. 

DC, I like your suggestion of writing down the logical assessment and using it to remind yourself. Is this an assessment of the more likely outcome of the scenario as opposed to the OCD fuelled, assumed catastrophic outcome? 

Thanks again everyone!

Link to comment
On 02/07/2019 at 22:05, leil said:

Is this an assessment of the more likely outcome of the scenario as opposed to the OCD fuelled, assumed catastrophic outcome? 

Hi Leil,

Actually, I write bullet points down sometimes while in discussion with my psychologist. The statements reflect the more sensible, logical assessments that I would otherwise revert to and accept, if I didn't have OCD. It is what the sensible and logical part of my brain is saying. I think I have a mixture of statements, most focusing on evidence or brief logical statements that my fears are unlikely. They might also include evidence that things don't mean what I worry about, and how the evidence actually might suggest something totally different.

I think, at least for me, OCD is pretty good at exploiting doubt and focusing on fears. Small, unlikely possibilities or even impossibilities, that start to feel like very probable and real possibilities. Then, after these are (incorrectly) assumed to be true, it will then move my mind on to focus on the implications of those unlikely/impossible fears...and so on and on. Exhausting.   

So, I try to capture the rational, reasonable assessments I have - which might sometimes get diluted and pushed away as fears and 'what if this, what if that', build up. So it is useful for me to do this with my psychologist sometimes. In discussion with my psychologist I try to confirm with her 'only once' (I push myself to avoid a never-ending journey of debate) that this is indeed a rational way of thinking. That takes a bit of work sometimes, to battle through the OCD. Then I write it down, and don't ask again for reassurance (easier said than done). Writing it down is a bit like taking a picture in my mind of a logical assessment. I have the rational reasons on the paper that I don't need to worry, or that my worry is excessive, unlikely and/or illogical. I then feel less need to seek reassurance, and it makes it easier for me to return to the sensible, rational thoughts when things are tough. Interestingly, once I have written it down I don't often need to actually look at it again - and I can fight the OCD a bit more easily in my mind. Maybe knowing I have the reassurance/reasons in my pocket helps. 

Part of this, for me, is accepting that I don't have 100% guarantees in my pocket (despite my OCD wanting perfection and certainty) - but I do have a better way of thinking in mind (and in my pocket).

I think the statements I write down also link to the point you made (RE: being kinder to yourself). I think I have also had to focus on reminding myself that I am human, that we (humans) cannot help but make mistakes sometimes, that I do my best in life, and that beating oneself up excessively (which I think happens without realizing) is not good, especially when we know that we have good intentions in life for our self and others. 

Hope that makes sense - it seems to work for me!  

This was meant to be a quick reply - good luck with the new baby! 

DC

Link to comment
1 hour ago, DC82 said:

Hi Leil,

Actually, I write bullet points down sometimes while in discussion with my psychologist. The statements reflect the more sensible, logical assessments that I would otherwise revert to and accept, if I didn't have OCD. It is what the sensible and logical part of my brain is saying. I think I have a mixture of statements, most focusing on evidence or brief logical statements that my fears are unlikely. They might also include evidence that things don't mean what I worry about, and how the evidence actually might suggest something totally different.

I think, at least for me, OCD is pretty good at exploiting doubt and focusing on fears. Small, unlikely possibilities or even impossibilities, that start to feel like very probable and real possibilities. Then, after these are (incorrectly) assumed to be true, it will then move my mind on to focus on the implications of those unlikely/impossible fears...and so on and on. Exhausting.   

So, I try to capture the rational, reasonable assessments I have - which might sometimes get diluted and pushed away as fears and 'what if this, what if that', build up. So it is useful for me to do this with my psychologist sometimes. In discussion with my psychologist I try to confirm with her 'only once' (I push myself to avoid a never-ending journey of debate) that this is indeed a rational way of thinking. That takes a bit of work sometimes, to battle through the OCD. Then I write it down, and don't ask again for reassurance (easier said than done). Writing it down is a bit like taking a picture in my mind of a logical assessment. I have the rational reasons on the paper that I don't need to worry, or that my worry is excessive, unlikely and/or illogical. I then feel less need to seek reassurance, and it makes it easier for me to return to the sensible, rational thoughts when things are tough. Interestingly, once I have written it down I don't often need to actually look at it again - and I can fight the OCD a bit more easily in my mind. Maybe knowing I have the reassurance/reasons in my pocket helps. 

Part of this, for me, is accepting that I don't have 100% guarantees in my pocket (despite my OCD wanting perfection and certainty) - but I do have a better way of thinking in mind (and in my pocket).

I think the statements I write down also link to the point you made (RE: being kinder to yourself). I think I have also had to focus on reminding myself that I am human, that we (humans) cannot help but make mistakes sometimes, that I do my best in life, and that beating oneself up excessively (which I think happens without realizing) is not good, especially when we know that we have good intentions in life for our self and others. 

Hope that makes sense - it seems to work for me!  

This was meant to be a quick reply - good luck with the new baby! 

DC

Thank you so much for taking the time to reply and explaining how that works for you. I can completely relate to all you said about how your OCD works; I too have found that any tiny crack of doubt will be exploited and then turned into an extremely likely, almost definite probability and not the opposite.  I find on my better days I have moments of clarity where my rational brain has kicked in and I can almost, not fully yet, but almost see these thoughts as what they truly are - irrational and excessive but then during the bad times where my irrational brain has kicked in it’s easy enough to forget that.  So I think that the techniques you describe could really work for me. Like you said it would be important not to use it as a crutch and end up caught in an endless loop internally analysing and debating if, as is the trap with OCD, but I think it would help just to know that it’s there.  My psychologist has discussed with me ‘where is the evidence’ and ‘what is the more likely outcome’ so I might ask her about this as well.

Thank you again, it’s really appreciated!

Link to comment

Hi. Firstly,  I hope you both manage to recover one day.

But I will say I disagree with the techniques your therapists are suggesting.  It's certainly not the way I learnt things from my readings, that ultimately led to my recovery.

I guess the following article excerpt from the specialist I got most help from sums up my feelings about the  evidence/logic type approach your therapists seem to be encouraging you to take:

"Although logically pointing out the absurdity of the "pure-O" patient’s mental rituals is very tempting, it is often insulting and clearly ineffective. You cannot "outlogic" OCD. People with OCD are understandably drawn to this type of therapy because the therapist is actually reassuring the patient by helping the desperately anxious patient see the irrational nature of these threatening ideas. This type of treatment ultimately can make the patient dependent on the therapist’s determinations of what is rational and what is not, and is therefore an ineffective treatment approach." https://www.ocdonline.com/rethinking-the-unthinkable

 

Link to comment
On 06/07/2019 at 19:28, Carooba Manooba said:

"Although logically pointing out the absurdity of the "pure-O" patient’s mental rituals is very tempting, it is often insulting and clearly ineffective. You cannot "outlogic" OCD. People with OCD are understandably drawn to this type of therapy because the therapist is actually reassuring the patient by helping the desperately anxious patient see the irrational nature of these threatening ideas. This type of treatment ultimately can make the patient dependent on the therapist’s determinations of what is rational and what is not, and is therefore an ineffective treatment approach."

I agree with this, in part. While I believe it is very difficult, challenging, and tiring trying to 'outlogic' OCD, I would question whether it is impossible for everyone. 

I have found that the conversations I have with my psychologist, about what is logical and how OCD is diverting my mind to other nonsensical and/or highly unlikely thoughts, builds a confidence within myself - that I can listen to the logical part of my brain, and that I can trust myself to identify what my OCD is doing and what is rational/irrational. Obviously, in some cases it would be sensible to face the possibility that I don't know something and that it might be possible. But not all OCD thoughts are, in my experience, reasonable or likely. I haven't opted to accept that anything and everything is likely. Some things simply aren't, they are ridiculously unlikely. 

I have focused on trying to reflect on how my thought patterns work, and how they jump from one possibility to another. I find I become more alert to what is going on in my mind, and can resist the more illogical thoughts/links more easily before they escalate in my mind and lead to repetitive behavior. I wish to challenge the logic of the fears and thoughts head on. Actually, I find the approach I describe helps me work independently, as I become more confident in myself and learn more about errors in OCD reasoning, I am less reliant on my psychologist and others for reassurance.

I accept others may have others methods and can probably recover in different ways, but so far I seem to be making some progress with this (I am on a journey of recovery, so who knows what other tactics I'll find or how this goes - maybe I'll report back here in 20 years and completely change my mind!). 

Edited by DC82
Link to comment

This is an interesting thread with different viewpoints. My feeling is that - for me - attempting to use logic to rationalise ocd never works. Ocd is not logical and it doesn't back down in the face of logic, it just grows from the attention. The only way to face it down is to starve it of this kind of attention and stop trying to "solve" it, either through logic or compulsions. Just leave it unsolved. For me, attempting to use logic just leads to "ah yeah but it COULD happen". The only answer for me is to leave it alone. 

Link to comment
On 10/07/2019 at 20:30, gingerbreadgirl said:

This is an interesting thread with different viewpoints. My feeling is that - for me - attempting to use logic to rationalise ocd never works. Ocd is not logical and it doesn't back down in the face of logic, it just grows from the attention. The only way to face it down is to starve it of this kind of attention and stop trying to "solve" it, either through logic or compulsions. Just leave it unsolved. For me, attempting to use logic just leads to "ah yeah but it COULD happen". The only answer for me is to leave it alone. 

I'm not an expert at all in how to beat OCD. But I do wonder to what extent personality and other individual differences affect how well different people respond to different strategies. I think that is obviously a complex question, which cannot be answered here. 

My impression has been that most people probably use exposure and response prevention (ERP) and cognitive restructuring techniques simultaneously and in different combinations and degrees, depending on the specific issue/thought they are dealing with - and the stage they are at in their recovery. Personally, I find cognitive restructuring (i.e. actively challenging and confronting the distorted thinking and faulty beliefs - specifically, using the bullet point logical statement list method I described above) to be useful (not easy - bit certainty helpful for me).

I would never suggest anyone does exactly what I do. Some people might try writing things down and it helps, others might find just 'leaving things alone' as gingerbreadgirl describes works. 

In case anyone is interested, there are (as noted in Hyman and Pedrick, 2010, p.49) some controlled studies that suggest some people "improve just as much when they actively challenge their beliefs about the situations that cause them anxiety as when they engage actively in exposure and response prevention to those situations". Now, this statement is not necessarily a fair reflection of what the research literature says overall, or what the majority of studies find,  and it does not mean it is an approach everyone should take - but I am finding my approach (as described) to actively challenge beliefs works for me.

It probably goes without saying that people would be best advised to discuss their OCD with a professional (e.g. their therapist or psychologist) and agree on their own approaches and strategies. 

Some interesting (*these are not meta analyses, and they are not representative of evidence overall) sources of interest: 

Cottraux, J., Note, I., Yao, S. N., Lafont, S., Note, B., Mollard, E., ... & Dartigues, J. F. (2001). A randomized controlled trial of cognitive therapy versus intensive behavior therapy in obsessive compulsive disorder. Psychotherapy and psychosomatics, 70(6), 288-297.

Emmelkamp, P. M., & Beens, H. (1991). Cognitive therapy with obsessive-compulsive disorder: A comparative evaluation. Behaviour Research and Therapy, 29(3), 293-300.

Van Oppen, P., De Haan, E., Van Balkom, A. J., Spinhoven, P., Hoogduin, K., & Van Dyck, R. (1995). Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder. Behaviour research and therapy, 33(4), 379-390.

(p. 49) Hyman, B. M., & Pedrick, C. (2010). The OCD workbook: Your guide to breaking free from obsessive-compulsive disorder. New Harbinger Publications.

 

Link to comment
6 hours ago, DC82 said:

In case anyone is interested, there are (as noted in Hyman and Pedrick, 2010, p.49) some controlled studies that suggest some people "improve just as much when they actively challenge their beliefs about the situations that cause them anxiety as when they engage actively in exposure and response prevention to those situations". Now, this statement is not necessarily a fair reflection of what the research literature says overall, or what the majority of studies find,  and it does not mean it is an approach everyone should take - but I am finding my approach (as described) to actively challenge beliefs works for me.

Yes there are different findings one can find online when researching.  I could counter the above with the following comments:

"Cognitive treatment for anxiety disorders relies on helping people identify the irrational nature of their fears and find the evidence of their irrationality. My work with thousands of patients has lent strong support to the idea that the cognitive element is not nearly as important as the more strict behavioral element, which focuses on providing effective strategies for managing the threatening ideas, rather than debunking the specific irrationality of the idea https://www.ocdonline.com/rethinking-the-unthinkable

the majority of people with OCD are aware of the excessiveness and absurdity of their thoughts and perceptions. Nevertheless, they continue to experience a great deal of distress from the thoughts. Therefore, helping OCD suffers to see the irrational nature of the thought content is counterproductive. https://www.ocdonline.com/cbtforocd

Using traditional CBT techniques to treat OCD, the sequence of therapy would go something like this: activating event A = "The thought of killing my daughter while changing her diaper" occurred; automatic thought (belief) B = "This means I'm a horrible parent and may actually be putting my child at risk by being alone with her;" emotional reaction C = anxiety/guilt; rational responses D = "The chance of harming her is minimal." What evidence do I have that I would ever harm any child, let alone my own? Cognitive restructuring may provide temporary relief from the anxiety that plagues the person. However, obsessions will inevitably focus on other elements of uncertainty that concern the person and will cause the anxiety to resurface. "Excuse me Doctor, all that makes sense but I did enjoy killing ants when I was a child and I heard a news report about a guy who went crazy and killed his children and himself shortly after hearing voices telling him the world is coming to an end." This CBT strategy presumes that the client is not aware of the irrational nature of the thoughts and can, therefore, be frustrating and alienating to those who suffer from them. OCD is less a manifestation of people who have irrational thoughts than it is an anxiety disorder in which people respond instinctually to feelings of being in grave jeopardy. Devoting a significant amount of time in an attempt to explain the irrational nature of the thought content misses the underlying characteristics of the disorder: this is an anxiety disorder, not a thought disorder. https://www.ocdonline.com/cbtforocd"

 

As you mentioned, it's ultimately up to the individual to go in the direction he/she wishes.  Most important is to choose a therapy style that will give you the best chance of long term sustainable recovery.  :)

Link to comment
4 hours ago, Carooba Manooba said:

This CBT strategy presumes that the client is not aware of the irrational nature of the thoughts and can, therefore, be frustrating and alienating to those who suffer from them

I accept it may not be 100% of the time, but I think a person with OCD can be aware in some instances that the thought or fear they are having is irrational, while having it or reflecting on it.

The OCD-UK website states: "People with OCD usually realise that their obsessional thoughts are irrational, but at the same time feels so very real and they believe the only way to relieve the anxiety caused by them is to perform compulsive behaviours (which includes avoidance and seeking reassurance)". See: https://www.ocduk.org/ocd/obsessions/

The presumption in the strategy you describe, suggests to me the strategy may be useful in some cases of OCD,  but possibly not all. I suspect cognitive restructuring can play a bigger and more useful role in cases where the person is able to acknowledge the thought processes and/or the obsessional thoughts they are having are irrational and that there is no logical link between X and Y. That might be discovered on reflection or as it happens. Being able to realise that the obsessional thoughts are irrational has (I think) been helpful for me in developing tools to recognize and respond (with some rationality) to what is OCD is doing when it strikes. 

I have foundthe explanation/approach described on the OCD-UK website to be fairly close to what I have done, and very useful to read: 

See: https://www.ocduk.org/overcoming-ocd/cognitive-behavioural-therapy/ 

"The aim of CBT isn’t to never have these thoughts, because intrusive thoughts cannot be avoided, but instead to help a person with OCD to identify and challenge the patterns of thought that cause their anxiety, distress and compulsive behaviours. What therapy teaches the person with OCD is that it’s not the thoughts themselves that are the problem; it’s what the person makes of those thoughts, and how they respond to them. 

Challenging the meaning attached to the thoughts: In CBT the person with OCD will explore alternative meanings or beliefs about the intrusive thoughts and rituals in all their guises (for example washing, checking, writing lists, tapping, touching, repeating, cleaning, trying to get a ‘just right’ feeling, praying)  and will learn what it is that ultimately keeps the meaning they attach to such thoughts and rituals going. So during the first few sessions a good therapist should spend time making sense of how  a person’s OCD works and what keeps it going. The idea and reason behind this is that if we can understand the factors that keep a problem alive, we can then take the next step, which is to think about alternative ways of viewing the problem and what we can then do to change it.Therefore CBT looks at how OCD convinces you that the rituals and compulsions performed are necessary, in order to prevent something bad happening.  If such a bad outcome were to be true as a result of the thought, the sufferer would be convinced it was entirely their fault and responsibility. We also look at the possibility that OCD is a liar. All the sufferer’s coping strategies have come about in the first place to make them feel safer and less anxious, when in fact they do the exact opposite, they make the person feel unsafe and scared. Even if they provide temporary relief from anxiety, the rituals make the meaning attached to the intrusive thoughts, images, urges and doubts feel even stronger, therefore becoming necessary for the sufferer to keep doing the rituals continuously. Ultimately making the thoughts seem even more real, and like there is even more truth in them.

The OCD-UK website also provides an example of exposure. 

"So how does CBT work in practical situations? OCD makes people feel they have to avoid all sorts of objects, people and places (for example public toilets, children’s playgrounds, people with diseases etc), but by avoiding such situations the sufferer never has the chance to find out what would really happen. So in CBT, people are asked to consider doing the opposite to avoiding the situation. So for example if OCD has made a person believe that they are at risk of dying from contamination from germs on a toilet – in treatment the therapist and patient might put their hands down the toilet. This behavioural experiment allows the person to find evidence for themselves about whether OCD has been lying and whether they have been needlessly avoiding situations for no reason at all. Of course, this is not straight forward, and the therapist will work with the patient to help them understand their worries and fears, to be able to approach such a challenging behavioural exercise".

My feeling is that the above 'behavioral experiment'; is very different from the example quoted below from a previous post, where it is suggested the person accepts the possibility their memory maybe be unclear and maybe something bad did happen. Small possibilities (or impossibilities) do not equate to being likely or probable. Instead of accepting something bad might have happened, in the example given in the first post I would have thought the ERP method would be to not avoid driving, while dealing with the obsessive thoughts using cognitive restructuring (e.g. thinking about alternative ways of viewing the problem/fear). 

It sounds to me that the quoted suggestion below goes beyond ERP (or is a more extreme form of ERP), and maybe describes 'flooding'? See this link: https://www.ocduk.org/overcoming-ocd/accessing-ocd-treatment/exposure-response-prevention/

i might be totally wrong about that? 

"Flooding involves immersing the person with OCD in the situation they fear the most and them staying in that situation until their anxiety reduces to a more normal level, becoming less bothersome".

On 27/06/2019 at 18:07, Carooba Manooba said:

work your way towards accepting the possibility that your memory is perhaps not clear and maybe something did happen.

I am still inclined to think that for some people, the above might not work - whereas an approach more consistent with the text highlighted in bold could (I think the bolded text from the OCD-Uk website is more consistent with the process I go through with my psychologist before writing down 'rational bullet points' that I put it in my pocket to help me).  

But, I see your points and understand what you describe may be very useful and have its place for some people. 

Like I said, I am not an expert - so if anyone reads this, please don't take what I say as advice! 

I'm not an authority - this is just discussing.  

Edited by DC82
Link to comment

Yes it's good to discuss differences in opinions (providing it remains civil).  I'm not knocking you or anyone for doing what  you believe is the best for  you. I'm all for that.  I just  strongly disagree with the logical/reasoning approaches your therapist and others I've read over the years.  I heavily lean towards the therapists who emphasize the behavioural ERP side of CBT.  But it's good to highlight the differences, particular for new people who are trying to learn.  And they can decide for themselves which approach to take..

 

I haven't got time to reply to other topics you brought up. I will do so at a later time.

 

14 hours ago, DC82 said:

 The presumption in the strategy you describe, suggests to me the strategy may be useful in some cases of OCD,  but possibly not all. I suspect cognitive restructuring can play a bigger and more useful role in cases where the person is able to acknowledge the thought processes and/or the obsessional thoughts they are having are irrational and that there is no logical link between X and Y. That might be discovered on reflection or as it happens. Being able to realise that the obsessional thoughts are irrational has (I think) been helpful for me in developing tools to recognize and respond (with some rationality) to what is OCD is doing when it strikes.

But one thing I will quickly as you is , which cases you believe it's helpful to highlight the irrational nature of their obsessions?

I for example obsessed about every theme imaginable.  I knew these fears were irrational and unlikely, but to try and point that out (reassure) was not just useless, but made things worse long term.

I obsessed about things like grabbing a knife and going around the street stabbing multiple people?  I knew this was almost no chance of happening, but trying to convince myself of that was pointless.

Link to comment
3 hours ago, Carooba Manooba said:

But one thing I will quickly as you is , which cases you believe it's helpful to highlight the irrational nature of their obsessions?

I for example obsessed about every theme imaginable.  I knew these fears were irrational and unlikely, but to try and point that out (reassure) was not just useless, but made things worse long term.

I obsessed about things like grabbing a knife and going around the street stabbing multiple people?  I knew this was almost no chance of happening, but trying to convince myself of that was pointless.

My opinion is that it depends on what the individual feels they can do. I, for example, would find it more useful long term to take an evidence based approach (e.g. there is no evidence i have done that before, I don't want to do it, and these are just thoughts - not predictions of the future or actions...etc...), than to accept that I might do it or that I may have done it. I understand how those thoughts of acceptance you mentioned might be viewed as exposure - but if there are compulsions associated with those obsessive thoughts (e.g. touching a light switch 3 times) I would have thought it would be better to apply exposure by resisting them, or sit at a table holding a knife, until the anxiety lessons and you start to develop new habitual thoughts around knives. For me, I would find it counter-productive, I think, to accept the possibility I could do something bad with a knife or that i did - since the probability is so low and there is no evidence it has happened before, or that I want to do it. Having the fear of doing it, is in-itself evidence you really don't want to do it. That thought is quite a powerful one for me. 

This might be affected by my general approach in life, as in my line of work I have to suspend belief until sufficient evidence presents itself. However, I don't find it easy when dealing with obsessive thoughts and fears affected by my OCD (which have never been work related). I personally find that (for me) in the long term I have got more benefit from knowing I am applying logic and reason (or that this is my lifeline) - the alternative, of accepting the possibility things I know are irrational could be true, would send my mind into all sorts of complex confusions, and I think I wouldn't be able to live with that. My long term goal isn't to accept that 'maybe something bad did happen'- but to accept some things are likely and some are not, and then stay strong and act accordingly without having to fix the fears and obsessions with compulsive thoughts and behaviors. In that process, I will become more aware of when OCD is taking over - and use cognitive restructuring to build my rational mind stronger in those instances so that I can examine my OCD thoughts and recognize them for what they are - absolute irrational nonsense. I've found that very, very hard during intense episodes of OCD (I have been suicidal at points in the past 10 years), but through more recent reflection and conversation with my psychologist, I try to unpick what is going on, see the rational path in the irrational mess, and become prepared for battle the next time it decides to take me to war. The pieces of paper in my pocket containing the sensible assessments of the fears hardly get used, but they are there - reminding me I have the power (a bit like a comfort blanket), allowing me to divert my mind elsewhere and stay focused on the reasonable line of thinking. I've used mindfulness meditations to stop, try to be calm, breathe, and reflect on manic moments of escalating, repetitive, thoughts, acknowledging that thoughts are just thoughts. 

Honestly, I could be breaking a lot of good practice rules here, and I will look at what you have said more and think about whether what you said is the way I could go - but what I describe (hopefully it is clear) is working for me. After 10 years of OCD, I am a little relieved to have something that does work for me. 

I'd be interested to know if anyone else does anything similar. 

Edited by DC82
Link to comment
On 17/07/2019 at 01:13, DC82 said:

"So how does CBT work in practical situations? OCD makes people feel they have to avoid all sorts of objects, people and places (for example public toilets, children’s playgrounds, people with diseases etc), but by avoiding such situations the sufferer never has the chance to find out what would really happen. So in CBT, people are asked to consider doing the opposite to avoiding the situation. So for example if OCD has made a person believe that they are at risk of dying from contamination from germs on a toilet – in treatment the therapist and patient might put their hands down the toilet. This behavioural experiment allows the person to find evidence for themselves about whether OCD has been lying and whether they have been needlessly avoiding situations for no reason at all. Of course, this is not straight forward, and the therapist will work with the patient to help them understand their worries and fears, to be able to approach such a challenging behavioural exercise".

My feeling is that the above 'behavioral experiment'; is very different from the example quoted below from a previous post, where it is suggested the person accepts the possibility their memory maybe be unclear and maybe something bad did happen.

Yes there are behavioural experiments / exposures to feared things.  However, there are also responses to use at other times, as a person can not just continuously stop and  do exposure experiments every time an intrusive thought enters their head.  The therapeutic responses are designed to leave ambiguity/accept the risk.  It's about not engaging in the unwanted thought.   The less you engage, the more the thought loses power. 

 "At some point most Purely Obsessional patients almost always come up with the same question: “Am I doing the therapy correctly?” It is very common obsessional reaction to someone doing behavior therapy. The mind tries to throw a monkey wrench into the therapeutic machine by asking the question, “Which is the actual therapeutic response: the performance of an exposure exercise or just accepting the risk?” The ensuing effort to secure the correct answer to this question ultimately can, unchecked, become a time-consuming ritual itself.

To illustrate this dilemma, let’s look at the naturally occurring behaviors of blinking and swallowing. For instance, the mind tells the patient to swallow or blink, now! The dilemma is as follows: “If I swallow now, won’t that be giving into the spike? If I resist giving into the command, then I’m avoiding engaging in the naturally occurring action of swallowing. What’s a good patient to do?” The very skilled patient will now accept that all blinks in the future will be the “wrong” blink and accept that all blinks are actually performing a ritual. This choice will influence the brain to stop scrutinizing “getting the therapy right.” Ultimately most Pure-O’s and people with a perfectionistic mentality end up spending a great deal of wasted time making sure that they are managing the disorder in a “correct” way. Living in a world of no answers is essential to being able to make a choice and move on." https://www.ocdonline.com/rethinking-the-unthinkable-3

 

 

On 17/07/2019 at 01:13, DC82 said:

 Small possibilities (or impossibilities) do not equate to being likely or probable.

But the problem is you can't convince someone displaying obsessive compulsive behaviour this.  Otherwise there would be no obsessive compulsive disorder in the first place, because you would just rationally answer an intrusive thought and it wouldn't spiral out of control.   It's the associated horrible feelings that come with the thoughts that cause the longevity. It's fear of the fear.

 

On 17/07/2019 at 01:13, DC82 said:

 Instead of accepting something bad might have happened, in the example given in the first post I would have thought the ERP method would be to not avoid driving, while dealing with the obsessive thoughts using cognitive restructuring (e.g. thinking about alternative ways of viewing the problem/fear). 

 

I would also not avoid driving, but also then as mentioned respond to the intrusive thought of possibly harming someone that "maybe I did", or "yep I reckon I ran right over them". Or let the thoughts come and go.  When you don't engage in the thoughts , your mind clears up and you can see them for what they are. Silly thoughts. Or irrational thoughts.  
 

On 17/07/2019 at 01:13, DC82 said:

 It sounds to me that the quoted suggestion below goes beyond ERP (or is a more extreme form of ERP), and maybe describes 'flooding'? See this link: https://www.ocduk.org/overcoming-ocd/accessing-ocd-treatment/exposure-response-prevention/ 

ERP often involves creating a hierarchy and working your towards your most feared of fears.

But whenever you are ready to immerse yourself in the fear and let it do it's worst, then that is when you see for yourself that there is nothing to fear about these thoughts.

The more discomfort you can tolerate , the better the results and the more clarity you start to get.

"those clients who have genuinely challenged the demon to do its worst, and are perfectly willing to confront and endure tremendous discomfort, even death itself, have made the most dramatic progress. They, in fact, have experienced the least amount of pain while performing exposure exercises. This exemplifies the critical nature of understanding the mental paradox. The more pain one is willing to endure, the less it is experienced."  https://www.ocdonline.com/speak-of-the-devil

I hope you get a chance to read this following article. It shows the mentality of facing your fears that give you the best results. It shows how he recovered from panic/obsessive behaviour by letting the feelings of dread to their worst. Be willing to die.   Like Jeff the author, I too took years to build up - or you could say sink to a low in life - where you are so utterly fed up with the same obsessive compulsive behaviour and feelings that you are willing to let go and let the fears happen.   The result of doing this is that  you get clarity.  But you need to go through the rain to get to the rainbow.   http://panicend.com/

 



 

Link to comment
  • 3 months later...

Hello Leil, 

I think the important word in your statement is lately. If you want to know as a rough guide, what is a true and what is OCD ********, especially older memories, ask yourself this; Did I worry about this before? If you did, your memory could be true. If you only started to worry about an old memory lately, chances are its OCD.

Link to comment

I’m not sure a long discussion about the finer points of CBT is going to help the OP. But is very interesting. 

It seems to my layman’s perspective that there are two slightly different approaches to exposure. In one you have an attempt to gather evidence to prove OCD wrong, an extension of Theory A/ Theory B work. 

In the other, it’s an attempt to acclimatise oneself to the discomfort of not doing compulsions.

probably need to do a bit of both. 

Link to comment

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
×
×
  • Create New...