How to treat OCD? – Breif strategic therapy Case of obsession of contamination and compulsion to wash hands over and over again. Obsessive ideas are unreasonable repetitive fixations from which individuals cannot free themselves without performing specific compulsive thinking, formulas or ritual actions. However, the attempt to take the matter in hand themselves leads the person to lose control over the situation, and compulsions become inevitable. patients with OCD, notoriously resistant to change, usually ask for help when they lose power over their own actions and thoughts and the problem becomes so much diffused as to affect most aspects of their life. Compulsions, of their own nature, are not illogical. But rationalistic explanations do not lead to any therapeutic success. The use of a non-ordinary logic (opposed to the traditional, rationalistic Aristotelian model) then becomes necessary in order to reorient the symptom towards its self-annulment. First, it is conveyed to patients that what they think and do, makes sense. They are given the illusion that the therapist knows a more functional way to manage the situation. In other words, the BST professional needs to follow the logic that underlies the patient's ideas and actions. Nardone and Portelli11 defined five reasons that trigger compulsive thoughts and actions: (1) the turning up of a doubt generating the need for reassuring answers; (2) an excess of ideological rigidity as well as extreme moral respect or religious belief; (3) the excess of rational reasoning processes, until they become completely unreasonable; (4) an extreme health prevention that becomes a phobia and (5) the attempt of reducing anxiety and distress generated by a trauma. For each of these reasons, the purpose may be to prevent or repair something that ‘might’ happen or ‘has’ happened, respectively, as well as to propitiate or ensure that things continue to go well. After having discriminated whether the compulsion is phobic or non-phobic based, in order to achieve the pragmatic knowledge of how to build a successful therapeutic intervention, the Brief Strategic model focuses on the patient’s attempted solutions, which in the case of a person suffering from OCD are typically represented by: (1) avoidance of situations that cause anxiety; (2) request for help, reassurance or protection from others in the form of delegation of tasks or in seeking assistance for avoiding contact with fearful stimuli and (3) control of anxiety-laden situations through performing rituals: preventive, propitiatory and reparatory. Other important discriminations to be made are: (1) whether the compulsion is represented by repetitive visible actions or remains at a mental level and (2) if the ritual follows a specific sequence, either numerical or analogical (figure 1). In order to interrupt the attempted solutions which worsen the situation, the brief strategic therapist, through the use of specific therapeutic communication techniques (strategic dialogue), starts restructuring the perception of the patient's reality by the use of a direct form of communication Example: the more you avoid the fearful situation, the more frightening it becomes’ or ‘the more you ask for help, the more incapable you become. It invalidates you more and more’) aimed at instilling the doubt about the correctness of the person's thoughts and actions. Therapeutic prescriptions or injunctions need to be implemented between sessions, in real life, so as to make the patient autonomously learn how to fight his or her obsession and to change their coping actions.11 1. When the ritual holds a sequence, and thus is numerical, the intervention proceeds to give the patient a specific numerical preset counter-ritual, which fits the particular pathological ideas and actions leading to a catastrophic change. This is the case of a person who needs to check something a number of times to ensure that it has been done correctly. 2. Progressive violations of the sequence of the ritual, from small to total violation, in order to break the established rigid control. In this case, the release prescription, which can then be generalized to many variants of pleasure-based doc, is what in Brief Strategic Therapy we define the "ritualization of the ritual" (Nardone, Portelli, 2013) which consists in asking the person, for a period of two weeks (which is the amount of time necessary to ensure that the indications between one meeting and the other can have their maximum effect), to go in front of the mirror at any time of day and, once there, plucking for a variable amount of time, often a minute, the hairs that usually tear. If listened to by laymen, this indication may appear bizarre and senseless, while, analyzed from a strategic process point of view, it acts on several fronts. it allows the person to gain control over the disorder, having to voluntarily decide to perform the actions first hostage of the obsession, so the behavior is no longer compulsive, but voluntary; it allows to postpone the execution of the ritual, having to be carried out once an hour, so the behavior is no longer acted on the request of the obsession, but on the decision of the person; it creates an interval between the request of the obsession and the reaction of the individual, interrupting the perceptive-reactive sequence that characterizes the disorder; from being pleasant the ritual becomes more and more unpleasant, given the obligation to carry it out regardless of the necessity of the moment, at any hour of the day. Having become able, following the instructions of her therapist, to voluntarily perform a behavior that as obliged is no longer a source of pleasure at every hour of the day, postponing its execution to specific times, after only five meetings, the girl was able to avoid to practice the ritual, so much so that soon she no longer needed the bandana. The ritualization of the ritual therefore allowed to act on the logic of maintaining the problem, putting the disturbance in the condition of not being able to fail to collapse, using the stratagem of "making the enemy go up to the attic and remove the ladder" (Nardone, 2003). STRATEGIC THERAPY'S CONTRIBUTION: "PRESCRIBING THE SYMPTOM" Strategic therapy is a new approach for treating OCD. Its unique contribution is that it recognizes the patient's compliance as a sine quo non for therapy to be effective. It takes at its first therapeutic challenge the reduction or elimination of patient resistance. While Strategic therapy is a well-documented approach used in family therapy (Haley, 1976; Madanes, 1981; and others), it is less well known as an appropriate approach for treating clinical disorders. Warnock-Parkes_Salkovskis_Rachman.pdf This approach was used to work on changing the meaning David had attached to key events that led to his contamination feelings. For example, David being treated particularly badly by staff at a Jobcentre. The meaning of this memory to David was that “I was treated like rubbish, I’m worthless”. Cognitive restructuring helped David to start to develop an alternative view, “I am a good person, worthy of respect”. David was encouraged to re-script the memories to represent his new meaning. David chose to completely transform the image to one where he was being treated like this: the image moved to him being in a hotel, being addressed by his full name and treated with the respect he deserved. This process was repeated for a number of David’s key memories: the meaning of each shifting from one of pollution to a more helpful alternative. David was observed to have poor stimulus discrimination, i.e. any small similarity between a current stimulus and those present at the time of his betrayals would trigger the memory and associated distress. Therefore, during some experiments a version of stimulus discrimination, a technique described by Ehlers and Clark (2000) and often used in PTSD treatment, was utilized. David was encouraged to observe the differences between “then” (at the time of the betrayal memories) and “now” (holding the brown envelope in the session without any current threat to himself) to realise any distress was a type of “echo” of the past. Explaination of Bhushan sir Sir said ki our brain consist 100% with thoughts Content of thoughts 1)Old Memory – purana data – From childhood - all the thoughts said by outside ppl, all thoughts entered through tv, all thoughts entered through music. 2)Now incoming memories – through all our 5 senses 3)Evolutionary memory – jyada garam is not gud, jyada Thanda is not gud, pyaar from ppl feels gud, Eating fud feels gud. To survive we have to feel gud. You have to choose partner. These all thoughts are coming from other places not from inside. So all these thoughts are not yours. Apke thoughts wo hai jisko sochke apko aacha feel hota hai and wo sochne se apko shaanti and sukun milta hai aur kisi ka validation ka zarurat nahi hota hai. I was telling haa baat kr 5 log se mujhe nahi farak pdta this thought was not mine. Mereko farak pdta hai. I was telling him just for his validation. Taki usko lage mai kitni achi hu. Truth is mujhe farak pdta hai but ab kam padta hai and mai usko ache se manage kar letii hu. Sir said ki 20 % thoughts kaam ke hote hai productive baki 80 % thoughts kisi kaam ke nahi hote hai. And humari capacity itni hai ki 1 din me 20 % thoughts pr hi kaam kar paate hai. Baaki 80 ko nahi attention dete hai. But ocd wale 20 % jo kaam ka hai usko chodke …..80% wale ko priority dekr uspe sochte chale jate hai jisko misinterpret kar liya gaya hai. The advanced model of brief strategic therapy (BST) According to the Brief Strategic treatment for OCD, if the disorder is not completely ‘solved’, symptoms tend to reoccur, and empirical evidence shows BST as being particularly effective in guaranteeing long-term stability of therapeutic outcomes.23 Clinical evidence demonstrates that BST is effective in treating several forms of psychological suffering, including OCD. The Brief Strategic approach makes a self-corrective operative diagnosis of a problem, which means that theoretical knowledge of OCD can be achieved only after a series of solutionbased strategies have been applied, resulting effectively in addressing the symptoms. In other words, knowing a reality through the strategies that can change it. The fundamental concept of BST is that when a problem or difficulty arises, patients try to solve it, either relying on past experiences by reapplying solutions that have been successful in solving a similar situation in the past, or by attempting new strategies. If these expedients do not work, rather than making use of alternative solutions, the natural tendency is to reiterate them, giving rise to a complex process of retroactions which maintain or exacerbate, instead of modify, the problematic situation. So, the ‘attempted solutions’ themselves become a problem. Thus, psychological problems are the result of a dysfunctional or pathogenic perceptive–reactive system,23 defined as a ‘redundant modality through which a given individual perceives and consequently reacts to his own reality in relationship with himself, with others, and with the world’ (ref. 24, p. 23). 1. For - I will get money 2. I will feel secure in my abilities to earn money bcz as my father always say I cant earn money. 3. 4. I don’t have to sit at home. I will learn as. Against 1. I cant give my enough time for preparation of ugc mphil. 2. I am getting less money 3. My father will mock me for getting less money. 4. If I go to delhi then I hv to leave job. 5. I m bit concerned about how they will see me as unprofessional. See Ankita when you do something – wash the clothes of all house members, aata saanti hu hamesha, mai shampoo lene jati hu, stationary lene jati hu, ghar ka chota mota samman lene jati hu. After some time of doing it every day I get axhausted and feel ki hamesha mai hi karti hu, koi aur kyu nahi karta. I mean ab chod rahi hu aisa nhi but I expact ki thode tym ke liye koi aur kr le aur mujhe thoda chutti de de. So I will say to my father itna din kiya ab aap jakar karo. What he will reply ki aisa nahi hota hai…..aage jb sasural jayegi toh sb tereko hi karna padega and harr baar karna padega don’t expect ki tera koi aur krke dega……tu thaki hoy a kuch bhi ho…..karna toh padega hi… Ye natak mat kar …warna addat lg jayegi …..kab sikhegi……..tu aisa kar rahi hai bcz tujhe aata nahi hai saman kharidna……tu aise thodi na sikhegi……hum kb tk karke denge tujhe…..hamesha thodi krle denge. Imagine ki mai bohot thaki hu ek din….mera ankh laal hai…..mujhe periods h,,,,mera pet dukh raha hai…..mai naraz hu…..mera mood nahi hai…..bs mann nahi h bahar jane ka….and I refused to go out to saaman lane. And father starts to bash me and invalidate my feelings and pain. And say all those nonsense things ki abhi nahi sikhegi toh kb sikhegi…..natak mat kar…..apna phone dekhne ko barabar tym hai but saaman lane ko tym nahi hai. I will feel like he don’t understand me…..i thinks I m doing natak…..i will not trust him. I will not share my feelings n pains with him…bcz I knw he will say ki meri hi glti h …..pain he will invalidate….so I wont be able to share my pain with him…. WhATS WITH th statement ki ……….aacha ye karne me tereko itni takleef ho rhi hai phone dekhne ke tym pe nhi ankh dukh rha…….. But the truth was he was completing his homework and not playing game in his phone. Maine use galat samjha….i thought he was doing natak…..but he was not doing it…….he Has his own reasons to not go to bazar.
