Gives you an understanding of how obsessive thoughts and behaviors come about and helps you learn new ways to control your behavioral responses to compulsive symptoms. You can learn how to deal with the anxiety and fear caused by OCD. Dealing with your fears appropriately can make behavioral therapy more effective. The four steps to emphasize here are as follows: 1. Reaffirmation. 2. Re-attribute the cause. 3. Shift attention. 4. Re-evaluation. The first and most important step is to learn to “identify” the obsessive thoughts and actions. You may not want to do this step at all, but you must make an effort to become fully aware of the obsessive thoughts or actions that are causing the distress at the moment. Remember that it can take weeks or months to change the biochemical changes in the brain to reduce compulsive urges. Trying to get rid of these compulsions in a few minutes or seconds can be frustrating! In fact, it will make the compulsions worse! In behavioral therapy learn to control yourself from reacting to obsessive thoughts, no matter how intrusive they are. The goal is to control your reactions to compulsive symptoms, not to control compulsive thoughts or impulses. Step 2: Re-attribution Say to yourself, “It’s not me, it’s the OCD at work!” Compulsive thoughts are meaningless; they are wrong messages from the brain. You need to deeply understand why the urge to check or “why are my hands dirty” is so powerful that it is overwhelming. If you know these thoughts don’t make sense, then why do you react to them? Understanding why the compulsion is so strong and why you can’t get rid of it is an important key to increasing your willpower and strengthening your resistance to compulsive behavior. The goal of this phase is to learn to “re-cause”: the source of compulsive thoughts is an imbalance in the brain’s biochemistry. Remember: “You don’t have to react to the compulsions right away!” The most effective way to help yourself is to learn to put obsessive thoughts and feelings aside and do something else that will help you change the biochemical response in your brain. If you try to get rid of obsessive thinking, you will only add stress and worry, and stress will make OCD worse. Using “reattribution” can help you avoid using ritual behaviors to make yourself feel better, such as the whole feeling of completion. If you know that these compulsive thoughts come from biochemical imbalances in your brain, you can learn to ignore these urges and keep doing what needs to be done. Remember: “That’s not me, that’s OCD at work!” By resisting listening to impulses or resisting reactions, you will change your brain and make the OCD feel less compulsive. If you react to the impulse, you may be temporarily relieved, but soon the impulse is bound to get worse. This is perhaps the most important lesson for OCD patients to learn! ”Reconfirmation” and “reattribution” are often done together and therefore give the patient a deeper understanding of the causes of the OCD. It is important to first become fully aware of the compulsions that are pushing me, and then understand that they are caused by a pathology in the brain. Step 3: Distraction This step is where the real work begins! Begin with the mental construct that there is no pain, no gain! What you have to do in this step is: you have to shift gears yourself! You use the effort and concentration of the mind to do the very natural and easy work of the brain. For example, a surgeon’s hand brushing before surgery is a very natural action from start to finish, and he naturally feels that he has brushed enough. But a patient with OCD brushes his hands again and again, endlessly! The automatic mechanism in his brain has been damaged and fortunately doing these four steps can repair it. Diversion is the process of diverting attention away from the compulsion, even for a few minutes. Start by choosing specific behaviors to replace compulsive hand washing or checking. Any fun, constructive action will do. It is best to engage in your own hobby activities, such as walking, exercising, listening to music, reading, playing on the computer, playing basketball, etc. When you have compulsive thoughts, you “reconfirm” that they are compulsive thoughts or impulses and “reattribute” them to your disorder, OCD, and then “divert” your attention to something else. Do something else. Remember not to fall into habitual thinking, you must tell yourself: “My OCD is back, I have to do something else” You can decide “not” to react to compulsive thinking, you have to be your own master, not a slave to OCD! 1. The 15-minute rule It’s not easy to shift your attention. It takes a lot of effort and a lot of pain to dismantle the obsessive thinking and then do what needs to be done. But the only way to change the biochemistry of the brain is to learn to resist the compulsion, and in time the pain will be reduced. We use the 15-minute rule, which means delaying the response for at least 15 minutes. In the beginning, you can start by delaying for 5 minutes. The principle is the same: never react immediately without a delay. Note that this is not a passive waiting for 15 minutes, but during this time we do “re-confirmation”, “re-attribution” and “distraction”. Then you will do other interesting and constructive activities. After a period of time, reassess the compulsive urges to see if the intensity has decreased, and record it. Encourage and reward yourself for even a small decrease. People with OCD often have the mindset of striving for perfection and 100 points, so they are also often unsatisfied with the slightest achievement and always think they are not doing enough to make behavioral therapy successful. The goal is to delay for more than 15 minutes. With continuous practice, the intensity of the OCD will be greatly reduced. Generally speaking, the more you practice, the better you will get at it. Soon you will be able to delay for more than 20 or 30 minutes. 2, as long as you do it, there are gains It is important to shift your attention to do something else. Do not expect these thoughts or feelings can immediately go away. Do not do what the compulsion wants you to do, you have to stick to the activity of your choice, so that the compulsive impulse will be weakened or even disappear because of your delay. Even if the impulse is difficult to change, you will find that you can control your reactions slightly. Using “wholehearted awareness” and being a “bystander” will give you more power. The long-term goal of this step is to not react to the compulsion. The immediate goal is to delay slightly before reacting. You learn not to let compulsive thinking dictate what you should do. Sometimes the compulsive impulse is so strong that you can’t help but do the compulsive behavior. But if you keep rehearsing these four steps, you can expect to change the biochemistry of the brain. Always remind yourself, “It’s not that I feel the need to wash my hands dirty, it’s that the compulsion is affecting me. This time the OCD won, next time I will hold out longer before reacting!” Rehearsed in this way, even if you end up doing the compulsive behavior, it still contains elements of behavioral therapy. It’s important: it’s better to reaffirm that the compulsive behavior is a compulsion and that it’s a behavioral therapy than to just do the compulsive behavior and not think about it. A tip for those fighting compulsive checking: If your difficulty is checking the door lock, try to concentrate and lock the door wholeheartedly. Notice the urge to lock the door that arises within you, and then carefully and slowly lock the door, keeping the action engrained in your mind, e.g., “This door is now locked, I see that it is locked!” You get a deep impression that the door is locked, so when the compulsive impulse asks you to check the lock, you can immediately “reconfirm” that: that’s a compulsive thought, that’s a compulsion! You can “reattribute” it, i.e., it’s not me, it’s just my brain! You can divert your attention to other things and make sure you have locked the door carefully. It is also important to document successful distractions because you can go back and see what behaviors were most helpful to you. When the items listed achieve the desired effect, it can help you build confidence. Recording can help you “shift gears” when your compulsions are severe and train yourself to remember what you have done in the past. The more successes you have, the more you will be encouraged. Record only the successes, not the failures. You have to learn to support yourself and give yourself some encouragement, which will help a lot to increase self-confidence. Step 4: Reappraisal The first three steps are to use your existing knowledge of OCD to help you clarify that OCD is a physical disorder, that is, an imbalance in the biochemistry of the brain, without accepting the compulsive thinking drive, while shifting your attention to constructive behaviors. The “revalidation” and “reattribution” are linked together, followed by the “distraction” step. The overall power of these three steps is greater than the sum of the power of the individual steps. “The process of “reaffirmation” and “reattribution” can reinforce “distraction. Prior to behavioral treatment, you begin to “re-evaluate” those obsessive thoughts and impulses. By the time the first three steps are properly trained, the compulsive thoughts and impulses can be de-valued in time. The ultimate goal of re-evaluation is to devalue the compulsions and not dance with them. There are two key points: first, be prepared: that is, understand that the compulsive feeling is coming and be prepared to endure it without being frightened. Second, accept it: don’t waste energy beating yourself up when there are obsessive-compulsive symptoms. You know exactly where the symptoms are coming from and you know how to deal with it. No matter what the compulsion is, whether it’s violent or sexual, you know that these symptoms can happen hundreds of times a day. You don’t have to respond every time as if it’s a new and unpredictable idea. Refuse to let it hit you, refuse to let it defeat you. By preparing yourself mentally for the obsessive thought, you can identify it immediately and do the work of reattribution. You can also do the reappraisal work. When the compulsion occurs, you are ready for it. You will know: “That’s my ridiculous obsessive thought, it doesn’t make sense, it’s just my brain block, don’t pay attention to it. You can learn to jump to the next action and don’t have to stay with that thought.” The next step is to “accept” that the OCD has happened, and never blame yourself for the lack of willpower, which is due to an imbalance in the brain and has nothing to do with you. Avoid all negative, critical thoughts such as, “How bad it is to have these obsessive thoughts. ……” Conclusion People with OCD must exercise their mind and not think according to obsessive feelings. We must know that these feelings are a misdirection. In a gradual but gentle way, we change our reactions to the compulsive symptoms and try to fight them. We learn that even persistent, obsessive feelings are only temporary and will go away if we don’t dance with them. And of course we remember that when we surrender to the compulsions, they grow so strong that they overwhelm us. We must learn to recognize where these compulsive impulses come from and try to fight them.