For the most part someone suffering from the OCD, Obsessive Compulsive Disorder, is obsessed with unwanted, and unhealthy intrusive thoughts. These negative thoughts turn into a ritual of overwhelming repetitive actions, we call compulsions. The negative thoughts will send messages to do things you do not want to do, as in “It’s My Way or Else.” We find ourselves being hijacked into doing exactly what it tells us to do, and yet knowing that the relief is only temporary, we still listen. The thought process keeps repeating itself like a chain of commands to make sure that you keep doing it. What’s interesting is that the brain thinks that by this rumination it’s helping you resolve your issues. The fact remains that listening to these thoughts only reinforces the brain to strengthen the circuits supporting those actions making it harder for you to resist in the future. It is natural to surrender to these negative thoughts to avoid the enduring pain. Yet in time, this loss of control becomes a habit of impulsive urges that often leads to depression.
Our Two Minds
To treat this disorder, it’s best to explore the neuroscience involved. We have two pathways of the brain that can produce anxiety called the Cortex and the Amygdala. The frontal lobes located behind the eyes is divided into halves, the left prefrontal lobe, and the right prefrontal lobe, as often referred to as the neocortex. The neocortex is the internal thought processing pathway that provides you with the ability to understand and interpret situations. The neocortex’s job is to try to make sense of the information that is being provided. It is more of a conscious pathway that will use logic, analysis, and reasoning to plan ways of responding to any sort of anxiety. In addition, the neocortex has two major functions, and that is to determine both safety and danger, so that it can orchestrate a proper reaction. If the left neocortex is impaired, and is not capable of evaluating safety or danger, as with OCD, (2). the brain will feel preoccupied with a thought and be unable to stop thinking it. Obsessive thought tends to focus on contamination, danger, violence or orderliness. The compulsions often involve cleaning, checking, counting, or touching. When people try to resist the cortex, it will then activate its own anxiety, and send out distress signals to the amygdala.
As with the case of Kayla, a young college student, every morning for hours she could not stop brushing her hair. A few months ago, I received a distress call from Kayla’s mother. It was time for Kayla to start dating, but what would she tell a shadchan. When Kayla first arrived at my office, she was feeling despair, and hopelessness. Kayla made it clear that the information she found online was that OCD could not be cured, but with medication it could be maintained. It is interesting to note that she was taking four different drugs which included one for depression. The fact remains that her online information is not entirely correct. Depending on the intensity of the symptom’s, OCD can be maintained without medication, and with some cases almost eliminated. The OCD brain will not stop unless you find ways to intercept and distract the messages. Using hypnosis is one of many tools that uses the subconscious to intercept and distract those unhealthy messages. After only four session of hypnosis she was down to three drugs and feeling hopeful. In the months that followed she was down to two, and when she graduated, she was down to one. The good news is that she started dating, and continues to feel, Baruch Hashem, more calm, relaxed, and in control.
Help Is On The Way!
The amygdala is the alarm bell of the brain, and since it comes with attached negative bias, it’s on the lookout for any indication of harm or danger. The emotional response most often used is Fight, Flight or Freeze. Because the amygdala responds to thoughts just as to regular events it often creates a distorted perception as in negative self-talk, and catastrophes. On a good note it also provides a surge of adrenaline to the rest of the body so that you can respond in case of an emergency. Please note, as would be expected, the neocortex makes mistakes. For example, by sending a misguided message to call Hatzalah that the person is in cardiac arrest, when it’s more likely a panic attack, will cause the amygdala to respond with worrisome, intense anguish, and more impulsive fear.
Most medical doctors treat OCD with medication to calm the amygdala. Kayla was informed by her doctor that OCD could not be cured, but with medication it could be maintained. The fact remains that the medication’s side effects were worse than the OCD itself.
The Circuit Switch
As we noted above the neocortex has two hemispheres. They consist of a right lobe hemisphere, and a left lobe hemisphere, that is often referred to as the frontal cortex. Research suggests that the thoughts produced from right lobe circuits are connected to a variety of anxiety symptom like anger, fear and aggression. While the thoughts produced from left lobe circuits have a neural thermostat that calms the distressing emotional signals down, from the neocortex to the amygdala. In addition, it provides advice, “acts as a neutral thermostat, regulating unpleasant emotions (1).” It has many circuits which can regulate and inhibit unpleasant emotions by the cortex right lobe. When the frontal cortex is functioning at its best it has a circuit breaker with an off switch that will calm the distress signals to and from the amygdala. It seems with OCD, if the brain distress signals are impaired “to have impaired frontal cortex functioning”(2).The brain’s frontal cortex has a faulty emotional circuit breaker in the left cortex lobe, and will no longer regulate the right side of the right cortex lobe. As a result, anxiety, doubts, and intrusive obsessive thoughts won’t go away. In an effort for the brain to resolve these negative thoughts it will keep rumination going until the distress signal is answered. It is like a child on a road trip asking his parents, “Are we there yet?” and the parents don’t not answer. It seems that if the left neocortex that controls the emotional distress signals is impaired, and failure to activate the off switch will results with a dysfunctional emotional connection between the right and left brain hemisphere.
(1) Emotional Intelligence, By Daniel Goleman – Bantam Books, Pg. 26
(2) Emotional intelligence, By Daniel Goleman – Bantam Books, Pg. 27
I find that how you communicate with OCD can greatly reduce your anxiety, and possibly stop the OCD in its tracks. It starts with what we call cognitive fusion, that is understanding the difference between your frontal cognitive thoughts, and the induced amygdala emotions. The process requires that you stay in the present, something like a sports reporter taking notes, play by play of the distorted messages coming in.
Kayla Treatment Plan
1) Cognitive Restructuring. Do not Erase, Replace with better coping thoughts.
2) Hypnotherapy. In hypnosis we send messages to the subconscious – emotional part of the brain to calm the amygdala so this way we can empower real change.
Hypnosis uses the subconscious as the main pathway to communicate with the amygdala to lower the anxiety level, as not to overreact.
When the subconscious is calm and relaxed so too is the amygdala. This way cognitive restructuring interventions can better be utilized by neocortex to stop intrusive thoughts.
Script 1 – Changing Channels
Script 2 – Tight Fist
Script 3. – Thought Stopping
Script 4. – Mindfulness – Detachment
3) Neuroplasticity. Research has shown that the brain has levels of neuroplasticity, meaning the ability to change brain cells. The circuitry in your brain is shaped by specific experiences you’ve had, and it can be changed by new experiences and thoughts that your cortex produces.