Articles By Carol Edwards
POCD: How To Make Your Life Better
how enhancing one's erp techniques could help improve its effectiveness
I once helped out in an OCD group. While there, I talked with several people who struggled with paedophile-intrusive thoughts seen in obsessive-compulsive disorder (OCD).
I saw how the group's aversion to these obsessions affected them. For example, how their emotional responses interfered with their work, family and leisure, to the extent they didn't know what to do anymore.
My advice was to say, "It's just your OCD; accept the thoughts and allow them to come and go." It followed strongly with something on the lines of, "And please, all of you, do pay attention to response prevention. You must resist all rituals to squash those obsessions!"
But resisting the rituals in exposure-response prevention (ERP), which is the evidence-based treatment for this disorder, wasn't enough for some members of the group, or so it seemed. They systematically faced their fears (exposure) and resisted the compulsions (response prevention), but it wasn't working.
As a consequence, their careers continued to suffer. Their families questioned why they were withdrawing at mealtimes. Friends wondered why they'd started to alienate themselves from fun nights out, and colleagues seemed puzzled as to why they were opting out on coffee and lunch breaks.
But little did their friends and families know that each of them was struggling with paedophile-intrusive thoughts. What was worse is that on the one hand, they had an aversion to the thoughts, and on the other hand, they felt as though they had a strange desire for them. Some felt automatic groinal response, which they loathed, but what they hated more was how the initial response increased to stronger arousal. They were becoming depressed. Still, they continued with the group's ERP toolkit and hoped for the best.
Solving The Mystery
But something was missing. Something about the desire factor seemed to be preventing some of these individuals from reaching their recovery goals. And I wanted to know what it was. So I decided to do some research to figure out why some people experience intrusive desire amid aversion in sexual obsessions, and why some struggle with heightened arousal.
After some digging on the biology of OCD, I discovered something that could, in part, solve the mystery. Away from OCD, I found that the brain can experience both aversion and desire at the same time, giving the impression that you can like and dislike something simultaneously. A septum separates this part of the brain (nucleus accumbens) and is only a fraction of an inch thick. It induces pleasure on one side, aversion on the other side and a mixture of both at the same time. (I write more about the nucleus accumbens in my book.)
Now, because our noses have a septum between each nostril, it allowed me to experiment with it to show that a theory concerning uncertainty could be plausible. What I did was press my finger on my left nostril, and with the right side, I sniffed a stale odour. And then I held my right nostril and smelled a fresh aroma. The purpose was to see if I could remember each scent separately and both together, and I did. It proved how a combined effect could impact somebody's senses. However, the point is that I had doubts about whether I liked or disliked the blended aroma, which could, I thought, explain one's uncertainty about intrusive thoughts (the plausible theory). For example, "I don't like this unusual scent, but on the other hand, maybe I do?" With OCD, it might be, "I hate these thoughts and sensations, but at the same time, what if I like them?"
So what about prolonged arousal?
Research says it pertains to somatic symptoms of anxiety. If that's the case, then it shows it is nonsexual, meaning there is no agreement between an individual and the sensation. For example, the groinal response in a sexual obsession is automatic, a primaeval mistake or reaction to anxiety. And with the attention on one's genitalia, such as checking for unwanted arousal, well, doing that increases anxiety. Thus a somatic sensation (sweating or throbbing down there) can be mistaken as authentic sexual feelings and urges (Ferreira C. et al. 2020). However, since all sexual-intrusive thoughts are empty of meaning, it confirms that the desire factor is also invalid.
But there was another missing piece to all of this, which brought my attention to thinking errors. For instance, saying, "I hate these paedophile-intrusive thoughts, but something makes me think I like them, but I don't know why" explains one's uncertainty, mentioned before. What was vital for this group, therefore, was not only understanding how ambivalence appears to play a role in sexual obsessions but also how to correct their thinking errors.
One way to correct thinking errors is with cognitive therapy with and without erroneous desire. It can help people better prepare for ERP and improve its effectiveness. As a revised example of the error above, one might say, "I'm having thoughts with nonsexual arousal. I will let the thoughts and anxious sensations come and go by accepting they are there but not engaging with them. And I will resist all other compulsions to ward off perceived danger and reduce anxiety."
In short, a clear understanding of how groinal response and thinking errors work in OCD can improve your ERP treatment goals and thus, make your life better.
SUNIL PUNJABI IS A MENTAL HEALTH COUNSELOR AND MINDSET COACH AT UNSHACKLE.IN
Read more about the points raised in this article in Sunil Punjabi's interview with Carol Edwards, and on her book "Desire-Intrusive Thoughts: What To Do When Sexual, Religious, And Harm Obsessions Carry Unwanted Arousal".
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