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Pure-O OCD patients can use these helpful steps, including response delay, written exposure and vocal exposure, to fight their OCD.
Obsessive-compulsive disorder is extremely difficult to treat, especially when the patient is afraid of their own thoughts (a condition known as pure obsessions, or "Pure-O").
The following steps will not work for everyone, nor should they take the place of a therapeutic or psychiatric treatment plan. However, these guidelines may help OCD patients see some of the steps involved in treating OCD.
This article assumes that the pure obsessions sufferer still has certain compulsions, even if they are entirely mental. The focus of the article is on decreasing the anxiety that involuntary obsessions cause, and on stopping the compulsions they lead to. (If the patient does not feel that they have compulsions, they can ski steps two and three.)
Step 1 - Education About Pure-O OCD
It seems logical that one would have to know that they have Pure-O OCD before being able to cure it. But a diagnosis alone is not enough. One should learn that they are not responsible for nor the cause of the thoughts, and that they aren’t made an evil or dangerous person just because evil and dangerous thoughts come into their head. Such OCD education should also include an overview of exposure-response therapy.
For example, “Joan,” who experiences horrible thoughts against God should learn that the thoughts, given their involuntary nature, are not sinful and that OCD – not the person – causes these disturbing thoughts.
Step 2 - Delayed Response to OCD Thoughts
The next step is to begin delaying a response to the thoughts and images that one might be afraid of. This can be done in increments.
Joan may delay repenting for involuntary thoughts for five minutes, then ten, then thirty, then an hour. This is the first step in exposure-response therapy for involuntary thoughts.
Step 3 - Withheld Response to Obsessive-Compulsive Thoughts
Eventually, as their education progresses (step 1 is an ongoing process), the OCD patient may feel comfortable enough to stop responding to the thoughts in their head. This is a possibility when they realize a number of things; primarily, it's realized that the thoughts are not deliberate, and that they have no effect on the person or on anyone around them. Joan would stop repenting for her involuntary images and thoughts at this point.
Step - Deliberate Mental Exposure to Thoughts
Once the patient feels comfortable not responding to the thoughts when they arrive, they can start willingly exposing themselves to the thoughts. This can be done by repeating thoughts in their head, imagining thoughts as lyrics to instrumental music, or thinking them in tune with a ticking clock. The point is to repeat the thoughts over and over until the anxiety decreases. Joan, if she is ready, may repeat violent thoughts about harming God in her head.
(Note: response withdrawal should continue for this step to make a difference.)
Step 5: Written and Vocal Exposure
Next, the thoughts are vocalized and written down—so as to further reduce the anxiety they cause. In their OCD Workbook, Bruce Hyman and Cherry Pedrick suggest dividing a piece of paper in half, then repeatedly writing a certain feared thought on one side and the stress level it causes on the other.
This exercise may be repeated over 50 times, Hyman and Pedrick say, before one’s anxiety reaches a manageable level. Joan may repeatedly write an anxiety-producing thought (like “God is bad,” for example) until she is not as stressed over it.
The authors of the OCD Workbook suggest getting a recording device, then saying a thought repeatedly. The patient with OCD can then play the audio sample back until their stress level begins to reduce.
(Note: response withdrawal should continue for this step to make a difference.)
It's vital that patients with Pure-O OCD realize that saying or writing a thought does not mean agreeing to or endorsing the thought. For example, even though Joan writes “God is bad” as part of the written exposure exercise, all she is doing is repeating a thought so as to decrease its stress level; she believes that God is great and completely good.
These five steps are not the only ones one should take, especially if there are religious aspects to the obsessive-compulsive disorder. However, they do form a simple guide to dealing with pure obsessions OCD, a difficult disorder to treat.
The copyright of the article Treatment for Pure-O Obsessive-Compulsive Disorder in Obsessive Compulsive Disorder is owned by Kenneth Burchfiel. Permission to republish Treatment for Pure-O Obsessive-Compulsive Disorder in print or online must be granted by the author in writing.
Comments
Aug 24, 2009 8:44 PM
Guest :
whenever I try this method i can handle till the 3rd step but when I move
on to the 4th i.e. deliberate exposure, that just becomes intolerable!
help. i can defeat all other obsessions of mine with these steps but, the
'wishing bad' problem is just too much!
Oct 1, 2009 12:40 PM
paranoia35 :
I have scrupulosity, and have been receiving psychiatric and psychological
help for 9 years now (though the scrupulosity has only been with me for 6
years). I am a well-qualified and experienced teacher, but I can no longer
find work here in Australia because my condition led to alcohol-abuse in my
last teaching job (self-harm and suicide attempts too) though fortunately I
seem to have got beyond alc-dependence (for now, who knows, it may return).
I am on meds but they only help to a point. I have read some of the
articles on here, and I don't think I could ever write or speak the words
that assail me. My main problem at the moment is that these blasphemous
thoughts seem at some level to be intentional (though I would never want to
think them!) I know that sounds paradoxical. But being aware of the paradox
doesn't seem to change anything. Sometimes I can avoid the compulsion if
the thoughts feel sufficiently intrusive and unwanted, but the other ones,
the ones that seem intentional, are much more devastating. My life is in a
big mess, I also have a mood disorder, and the OCD has caused severe
depression. I have other types of OCD too, but these are not quite as
'compelling' (though still powerful some days)... not sure I will ever be
able to work again... the stress of getting to work on time raises the ante
and OCD swiftly steps in. I want to work though! And I want to go to
church! I feel a strong sense of God in my life, but a poor sense of Jesus.
As you can imagine, the scrupulosity plays on this a lot (especially as the
statement "No-one comes to the Father, except through me", from
the New Testament). My mind endlessly fights with the divinity of Christ,
but I wish it wouldn't!!
Oct 1, 2009 12:52 PM
paranoia35 :
I have scrupulosity, and have been receiving psychiatric and psychological
help for 9 years now (though the scrupulosity has only been with me for 6
years). I am a well-qualified and experienced teacher, but I can no longer
find work here in Australia because my condition led to alcohol-abuse in my
last teaching job (self-harm and suicide attempts too) though fortunately I
seem to have got beyond alc-dependence (for now, who knows, it may return).
I am on meds but they only help to a point. I have read some of the
articles on here, and I don't think I could ever write or speak the words
that assail me. My main problem at the moment is that these blasphemous
thoughts seem at some level to be intentional (though I would never want to
think them!) I know that sounds paradoxical. But being aware of the paradox
doesn't seem to change anything. Sometimes I can avoid the compulsion if
the thoughts feel sufficiently intrusive and unwanted, but the other ones,
the ones that seem intentional, are much more devastating. My life is in a
big mess, I also have a mood disorder, and the OCD has caused severe
depression. I have other types of OCD too, but these are not quite as
'compelling' (though still powerful some days)... not sure I will ever be
able to work again... the stress of getting to work on time raises the ante
and OCD swiftly steps in. I want to work though! And I want to go to
church! I feel a strong sense of God in my life, but a poor sense of Jesus.
As you can imagine, the scrupulosity plays on this a lot (especially as the
statement "No-one comes to the Father, except through me", from
the New Testament). My mind endlessly fights with the divinity of Christ,
but I wish it wouldn't!!
Oct 1, 2009 6:35 PM
Kenneth Burchfiel :
It may seem terrifying to vocalize or write out your involuntary thoughts.
I think this is especially true for scrupulosity sufferers, since for many
people, just saying these thoughts out loud will seem blasphemous. (In
other forms of OCD with involuntary thoughts, you'll still have disturbing
ruminations, but I doubt it would seem as dangerous to say those out loud.)
It's good to hear that you've been talking with psychiatrists
and psychologists. They can help you out far more than I am able to, and
I'm sure they've been a big support. But with regards to exposing yourself
to these blasphemous thoughts, I might be able to provide a little input.
You're likely familiar with the concept of habituation, where
repeated exposure to an anxiety-causing stimulus (in this case, the
thoughts that you do not wish to write out) will lead to a decrease in your
response to them (e.g., your fear and compulsions) because your mind has
adjusted to the anxiety they cause. Simply listening to your thoughts
without reacting is a good first step. But consider this: if you were to
speak your thoughts out loud and write them down, you'd be exposing
yourself to them on a very high level--a higher level than just having them
go through your head. If you can learn to not respond to those thoughts
when you're saying them out loud, I would imagine that your responses to
the thoughts in your head would go down dramatically!
I know of
one person who used to repent for a long time whenever a thought like
"**** You, Jesus" went through his head. But at one point in
their OCD treatment, they ended up vocalizing thoughts like those into a
camera recorder, then listening to them playing out loud. (With help from a
clergy member, they recognized that they were speaking these thoughts in
order to expose themselves to them, not because they actually wanted to
curse at Jesus. Thus, they feel that the act was not sinful.) By not
responding to the spoken thoughts, their responses to the internal thoughts
went down very rapidly--as did the thoughts themselves!
We both
know that God wants you to have peace and comfort in your life; is that not
what Jesus died and rose for? (Along with salvation, of course!) Don't be
afraid to take all the steps necessary for your scrupulosity to go away.
Kenneth
4 Comments
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Apr 28, 2009
