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The goal of the first three steps is to use your knowledge of OCD as a medical condition caused by a biochemical imbalance in the brain to help you clarify that this feeling is not what it appears to be and to refuse to take the thoughts and urges at face value, to avoid performing compulsive rituals, and to Refocus on constructive behaviours. You can think of the Relabel and Reattribute steps as a team effort, working together with the Refocusing step. The combined effect of these three steps is much greater than the sum of their individual parts. The process of Relabeling and Reattributing intensifies the learning that takes place during the hard work of Refocusing. As a result, you begin to Revalue those thoughts and urges that, before behaviour therapy, would invariably lead you to perform compulsive behaviours. After adequate training in the first three steps, you are able in time to place a much lower value on the OCD thoughts and urges.
We have used the concept of the "Impartial Spectator," developed by 18th-century philosopher Adam Smith, to help you understand more clearly what you are actually achieving while performing the Four Steps of cognitive biobehavioral therapy. Smith described the Impartial Spectator as being like a person inside us who we carry around at all times, a person aware of all our feelings, states, and circumstances. Once we make the effort to strengthen the Impartial Spectator's perspective, we can call up our own Impartial Spectator at any time and literally watch ourselves in action. In other words, we can witness our own actions and feelings as someone not involved would, as a disinterested observer. As Smith described it, "We suppose ourselves the spectators of our own behaviour" He understood that keeping the perspective of the Impartial Spectator clearly in mind, which is essentially the same as using mindful awareness, is hard work, especially under painful circumstances, and requires the "utmost and most fatiguing exertions.". The hard work of which he wrote seems closely related to the intense efforts you must make in performing the Four Steps.
People with OCD must work hard to manage the biologically induced urges that intrude into conscious awareness. You must strive to maintain awareness of the Impartial Spectator, the observing power within that gives you the capacity to fend off pathological urges until they begin to fade. You must use your knowledge that OCD symptoms are just meaningless signals, false messages from the brain, so you can Refocus and shift gears. You must gather your mental resources, always keeping in mind, "It's not me--it's my OCD. It's not me--it's just my brain." Although in the short run, you can't change your feelings, you can change your behaviour By changing your behaviour, you find that your feelings also change in time. The tug-of-war comes down to this: Who's in charge here, you or OCD? Even when the OCD overwhelms you, and you give in and perform the compulsion, you must realize that it's just OCD and vow to fight harder the next time.
With compulsive behaviours, simply observing the fifteen-minute rule with consistency and Refocusing on another behaviour will usually cause the Revalue step to kick in, which means realising that the feeling is not worth paying attention to and not taking it at face value, remembering that it's OCD and that it is caused by a medical problem. The result is that you place a much lower value on--devalue--the OCD feeling. For obsessive thoughts, you must try to enhance this process by Revaluing in an even more active way. Two substeps - the two A's - aid you in Step 2: Reattribute: Anticipate and Accept. When you use these two A's, you are doing Active Revaluing. Anticipate means "be prepared," know the feeling is coming, so be ready for it; don't be taken by surprise. Accept means don't waste energy beating yourself up because you have these bad feelings. You know what's causing them and that you have to work around them. Whatever the content of your obsession--whether it is violent or sexual or is manifested in one of dozens of other ways--you know that it can occur hundreds of times a day. You want to stop reacting each time as though it were a new thought, something unexpected. Refuse to let it shock you; refuse to let it get you down on yourself. By anticipating your particular obsessive thought, you can recognize it the instant it occurs and Relabel it immediately. You will simultaneously, and actively, Revalue it. When the obsession occurs, you will be prepared. You will know, "That's just my stupid obsession. It has no meaning. That's just my brain. There's no need to pay attention to it." Remember: You can't make the thought go away, but neither do you need to pay attention to it. You can learn to go on to the next behaviour There is no need to dwell on the thought. Move ahead. This is where the second A--Accept--comes in. Think of the screaming car alarm that disturbs and distracts you. Don't dwell on it. Don't say, "I can't do another thing until that blankety-blank car alarm shuts off." Simply try to ignore it and get on with things.
You learned in Step 2 that the bothersome obsessive thought is caused by OCD and is related to a biochemical imbalance in the brain. In the Acceptance substep of Reattributing, you realise that truth in a very deep, perhaps even spiritual, way. Do not get down on yourself. it makes no sense to criticize your inner motives just because of an imbalance in the brain. By accepting that the obsessive thought is there despite you, not because of you, you can decrease the terrible stress that repetitive obsessive thoughts usually cause. Always keep in mind, "It's not me--it's the OCD. It's not me--it's just my brain." Don't beat yourself up trying to make the thought go away because in the short run, it will not. Most important, don't ruminate and don't fantasize about the consequences of acting out a terrible obsessive thought. You won't act it out because you don't really want to. Let go of all the negative, demeaning judgments about "the kinds of people who get thoughts like this." For obsessions, the fifteen-minute rule can be shortened to a one minute rule, even a fifteen-second rule. There is no need to dwell on that thought, even though it lingers in your mind. You can still go on--indeed, you must go on--to the next thought and the next behaviour In this way, Refocusing is like a martial art. An obsessive thought or compulsive urge is very strong but also quite stupid. If you stand right in front of it and take the full brunt of its power, trying to drive it from your mind, it will defeat you every time. You have to step aside, work around it, and go on to the next behaviour You are learning to keep your wits about you in the face of a powerful opponent. The lesson here goes far beyond overcoming OCD By taking charge of your actions, you take charge of your mind--and of your life.
We who have OCD must learn to train our minds not to take intruding feelings at face value. We have to learn that these feelings mislead us. In a gradual but tempered way, we're going to change our responses to the feelings and resist them. We have a new view of the truth. In this way, we gain new insights into the truth. We learn that even persistent, intrusive feelings are transient and impermanent and will recede if not acted on. And, of course, we always remember that these feelings tend to intensify and overwhelm us when we give in to them. We must learn to recognise the urge for what it is--and to resist it. In the course of performing this Four-Step Method of behavioural self-treatment, we are laying the foundation for building true personal mastery and the art of self-command. Through constructive resistance to OCD feelings and urges, we increase our self-esteem and experience a sense of freedom. Our ability to make conscious, self-directed choices is enhanced.
By understanding this process by which we empower ourselves to fight OCD and by clearly appreciating the control one gains by training the mind to overcome compulsive or automatic responses to intrusive thoughts or feelings, we gain a deepening insight into how to take back our lives. Changing our brain chemistry is a happy consequence of this life-affirming action. True freedom lies along this path of a clarified perception of genuine self-interest.
Step 1: Relabel Recognise that the intrusive obsessive thoughts and urges are the RESULT OF OCD.
Step 2: Reattribute Realise that the intensity and intrusiveness of the thought or urge is CAUSED BY OCD; it is probably related to a biochemical imbalance in the brain.
Step 3: Refocus Work around the OCD thoughts by focusing your attention on something else, at least for a few minutes: DO ANOTHER BEHAVIOUR.
Step 4: Revalue Do not take the OCD thought at face value. It Is not significant in itself.