Taking America Off Drugs: Why Behavioral Therapy is More Effective for Treating ADHD, OCD, Depression, and Other Psychological Problems

5. OCD: Obsessive-Compulsive Behavioral Problems

Chapter 5 OCD Obsessive-Compulsive Behavioral Problems People given the label “obsessive-compulsive disorder,” or “OCD,” have excessive, unwanted, intrusive, repetitive thoughts, and they engage in excessive, repeated, ritualized behaviors. These aversive obsessions and compulsive behaviors can become so excessive that the person who suffers from them is unable to function normally in society (e.g., hold down a job or maintain friendships). If you wash your hands after every trip to the bathroom, before every meal, and after every time you come in from outside, then it is not likely you would be considered obsessive compulsive. But if you cleaned your apartment for 4 hours every day, took 12 showers a day, or washed your hands 50 times a day until they bled, but continued washing, then you would likely be labeled an OCD “cleaner.” If you checked to see if your doors were locked and set your alarm and got into bed, only to get out of bed a few minutes later to recheck your doors and alarm, then it is not likely you would be labeled “OCD.” But you would likely be labeled an OCD “checker” if you checked every door and every window (downstairs and upstairs, winter and summer) every night, exactly 15 times, and checked every appliance , even ones that had not been used in weeks, in the same order every night, exactly 15 times, and if you got out of order, you started over again. The drug companies would like us to believe that OCD is “caused” by a “chemical imbalance in the brain,” and that it is best treated by the SSRI drug brain whitewash. But having obsessive thoughts and engaging 63 in compulsive behaviors are things people do. They are learned behaviors. People labeled “OCD” believe that some thoughts and overt behaviors are unacceptable. Often an early experience or teaching is responsible for these beliefs, such as a childhood illness that was believed to be caused by uncleanliness and perceived as life threatening, or a fundamental religious teaching—“masturbation is a mortal sin.” Regardless of the initial source(s) of the unwanted thoughts, the very act of trying to suppress the thought will make it more frequent and intrusive (Salkovskis & Campbell, 1994). To illustrate, do not think about Tom Cruise in his underwear. What did you just imagine? For people suffering with obsessive-compulsive behavioral problems, however , the obsessions are perceived as very real and felt as very aversive— germs causing infection and death, one’s family burning alive due to a fire from a faulty electrical appliance, burning in hell forever for imagining one’s teacher while masturbating. Because the obsessions are aversive , the sufferer tries not to have them. But the more the person tries to suppress the thoughts, the more intrusive they become. Thus behaviors meant to escape the obsessions or avoid the perceived disastrous consequences are performed and rapidly become rituals or compulsions. That is, for the person suffering from obsessions, the compulsions are believed to serve a purpose, to be functional. The compulsions escape or avoid the obsessions’ catastrophic consequences—technically speaking , the compulsions are maintained by negative reinforcement. Once the ritual is completed, there may be a temporary feeling of relief or appeasement. Often the compulsions become so entrenched that the original real or imagined reasons for engaging in the ritual may be forgotten . The compulsions seem to “take on a life of their own.” Even if the reasons for the compulsions are lost, the sufferer feels extreme anxiety or even guilt until the ritual is performed, which in turn produces a reduction in anxiety. AN EXPERIMENTAL MODEL The development of phobias is identical to what happens in “signaled avoidance,” and the obsessive-compulsive problem is nearly identical to the “unsignaled avoidance” experimental paradigm that experimental psychologists have been studying for almost 50 years. In signaled avoidance , a light is turned on, followed 10 seconds later by a mild electrical 64 TAKING AMERICA OFF DRUGS shock to the experimental animal. But if the rat goes into another experimental chamber in less than 10 seconds after the light comes on, the rat avoids the shock. Thus the rat develops a “phobic fear” of the light. Every time the light comes on the rat will do whatever possible to escape the light. To extinguish the rat’s fear, the rat is exposed to the light for extended periods, without being shocked and without being allowed to...