Perhaps you struggle with obsessive-compulsive disorder. Maybe it’s someone in your life. Either way, you know how confounding and torturous it can be. And you also know relief doesn’t come easy. That said, let’s take a look at a cutting-edge treatment…
Providing a patient with necessary insight separates them from their anxiety. Further, it allows her/him to learn that anxiety has a beginning, middle, and end.
And you know what? My guess is it’s much more prevalent because so many stay in the shadows out of embarrassment and shame.
By the way, I’m one of that “some 3%.”
Eda Gorbis, PhD, LMFT is founder and director of the Westwood Institute for Anxiety Disorders. She’s also an adjunct clinical assistant professor of psychiatry and biobehavioral sciences at the University of Southern California Keck School of Medicine.
Most importantly, Dr. Gorbis specializes in treatment-resistant (refractory) OCD and complex comorbidities, and her work is recognized as cutting-edge worldwide.
I’m telling you, this information needs to be available to the OCD masses. And I’m glad to have it here on Chipur.
(Oh, long article alert. So read it in a couple of sittings, right?)
Dr. Gorbis’ Intensive OCD Program
As background for her work, Dr. Gorbis points-out that OCD was untreatable until British psychologist Victor Meyer developed the first modern exposure and response prevention (ERP) treatment in 1966.
Gorbis believes that when correctly used, behavioral therapy can produce a 76% rate of continuing symptom relief three months to six years after treatment cessation.
In her therapy, she uses a variation of cognitive behavioral therapy (CBT), incorporating writing techniques, which increase mindfulness and awareness of the maladaptive associations that typically reinforce OCD symptoms.
And this is really important: Patients have to realize what they’re obsessing about and/or what they’re overvaluing. That’s where writing comes into play, as according to Gorbis it utilizes the brain’s highest level of cognitive functioning. And that aids in untangling the complicated web of thoughts and emotions that exist in the brain of someone struggling with OCD.
Simply, written self-analysis results in clarity and logical understanding of one’s condition.
OCD and Cognitive Distortions
Gorbis observes that there are several cognitive distortions commonly floating around in the minds of OCD patients. Typically, the distortions involve all or nothing (“polarized”) thinking, interpreting a thought as an experience, or feeling that a failure to perform a ritual perfectly, or when mandated, will result in disastrous consequences.
Pertaining to “disastrous consequences,” those with OCD have a tendency to not only overvalue the “dangerousness” of a situation, but think that despite hundreds of positive experiences under the same circumstances, disaster looms if the ritual isn’t performed.
According to Gorbis, those dealing with OCD fail to see situations accurately. That’s why she teaches mindful awareness, which she believes can be done best by adding analytical writing to CBT. Her theory is that when spoken word is translated into written form, it requires the most complicated processing of the word and the thought.
Gorbis believes writing is max-therapeutic because it enables us to reprocess the information we’ve been “regurgitating.”
Gorbis’ “Fear-Structured Skeletons”
In Gorbis’ work, “fear-structured skeletons” are worksheet assignments designed to increase mindful awareness via identifying internal and external cues.
Here’s how it works. Patients describe the internal and external cues of their obsessions in a repetitive manner, reprocessing and re-summarizing information in their own words.
The exercise is crucial in coming to understand the triggers for obsessive thoughts, be they things that are seen or experiences and feelings that generate obsessions. Keep in mind, it’s common for patients to exhibit several triggers, and the writing process allows for an analysis of a multitude of obsession causal factors.
On top of that, patients are taught to come up with what Gorbis refers to as their Subjective Units of Distress (SUDS) levels, rating their anxiety on a 0-10 scale. This allows a patient to self-diagnose, self-treat, and prevent relapse.
Bottom-line: Providing a patient with necessary insight separates them from their anxiety. Further, it allows her/him to learn that anxiety has a beginning, middle, and end.
I can’t express how huge that is.
The Intensive OCD Program: Structure
Here are the nuts and bolts of Gorbis’ program. Psychoeducation about self-treatment, writing, and self-evaluation takes four to five days, entailing 14-15 self-administered tasks and tests.
The patient’s situation is analyzed by the therapist and a determination of the common denominators of the fear structures is made. Only then is a custom-tailored program assigned.
The program must utilize two of what Gorbis refers to as the best approaches available to OCD patients. The first step is the prolonged exposure and response prevention (ERP) program designed by Drs. Edna Foa (under whom Gorbis trained) and Michael Kozak.
From Gorbis, here are Foa/Kozak’s steps…
- Patients increase their mindful awareness via training and recording of ritualized behavior
- Patients are taught to stay in an OCD situation, without giving-in to compulsions until discomfort decreases
- Patients receive help in concentrating on, and are guided through, targeted situations
- Exposures are repeated daily using patient specific stimuli until distress significantly dissipates
To this, Gorbis adds a combination of imaginal and actual exposure, which helps to prevent relapse.
When therapy commences, Gorbis teaches the patient to “re-label,” recognizing that the intrusive thoughts and urges aren’t real, rather the result of their OCD. She then moves-on to teaching the patient to “reattribute,” realizing that the intensity and intrusiveness of the thought or urge is due to a biochemical imbalance in the brain.
Gorbis posits that when a patient learns that s/he can induce OCD, the realization hits home that the OCD itself can be significantly reduced – eliminated.
Indeed, through self-induction and overloading the brain with disturbing and distressing images, at a frequency and intensity that exceeds obsessive-compulsive intrusions, the patient gains control of her/his disorder.
Let’s Tie a Bow
Don’t know about you, but I find Dr. Gorbis’ treatment approach, and its foundation, fascinating and, yes, cutting-edge. And as a 3%’er, it hits home.
What are your thoughts?
Now, I realize embarking upon a therapy program in Los Angeles wouldn’t be practical for most of us. However, there’s still the information – the knowledge – that can be used for self-improvement and comfort. Heck, if you’re already working with a therapist, share this article or get her/him on Dr. Gorbis’ site.
Yes, it’s true, relief doesn’t come easy. But it really is an option for those who pursue knowledge and work their butts off.
Please check-out Dr. Gorbis’ work at the Westwood Institute for Anxiety Disorders. Whole lot of great info.
Hey, here’s a collection of Chipur articles pertaining to OCD…