Articles By Carol Edwards
How To Make Sense Of The Groinal Response
how enhancing your erp techniques can help improve its effectiveness
As a former therapist, I once helped out in an OCD group. While there, I talked with several people who struggled with sexual-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 acknowledge and accept the thoughts and allow them to come and go without attaching meaning to them. I also mentioned how crucial it is to follow through with exposure-response prevention (ERP). That is to resist all rituals to squash the obsession.
But resisting the rituals in ERP (the evidence-based treatment for this disorder) wasn't enough for some group members, 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 about 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 sexual-intrusive thoughts. Most of them were afraid to open up to their loved ones. What made it difficult 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, thinking they liked the arousal. Consequently, they thought they were capable of doing what their thoughts were about. Still, they continued with the group's ERP toolkit and hoped for the best.
Solving The Mystery
I continued with the same advice to prevent colluding with reassurance-seeking. It's because it's a compulsion that feeds an obsession. Still, something about the group's approach to the ERP process appeared to be missing. It's as if the desire factor prevented them from reaching their recovery goals. 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 simultaneously experience both aversion and desire, giving the impression that you can like and dislike something together. 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 simultaneously. (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 perfume I don't like. And then I held my right nostril and smelled one that I do like. The purpose was to see if I could remember each scent separately and both together, and I did. It showed how two things could run parallel, making a combined effect impact somebody's senses. For example, having doubts about whether I liked or disliked the blended aroma, could, I thought, explain one's uncertainty about intrusive thoughts. For instance, I wouldn't say I like this blended 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, something makes me think I like them.
The point is that when a therapist tells their client, all thoughts are just thoughts, they are correct. Some thoughts are experienced or remembered as repugnant, some falsely desirable, and some a mixture of both.
So what about prolonged arousal?
Research says such arousal pertains to somatic symptoms of anxiety. Since that's the case, it shows it is nonsexual, meaning there is no agreement between an individual and the sensation. In other words, the groinal response in a sexual obsession is automatic and is not the person's fault. When the unwanted attention is on one's genitalia, it increases anxiety. Thus the somatic sensation (sweating or throbbing down there) also increases and 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. All intrusive thoughts, feelings, urges and images are the same and have no state of being real.
But there was another missing piece to all of this, which brought my attention to thinking errors. For instance, saying, I hate these sexual-intrusive thoughts. Still, something makes me think I like them. Therefore, I must be capable of doing something terrible explains a person's uncertainty, mentioned before. So, what was vital for the OCD group was understanding how ambivalence appears to play a role in sexual obsessions and correcting their thinking errors.
One way to correct thinking errors is with cognitive therapy. It can help people better prepare for ERP and improve its effectiveness. So, in place of the thinking error above, one might say, I'm having unwanted thoughts with nonsexual sensations. I do not need to check further.
In short, a better understanding of how groinal response and thinking errors work in OCD improved the ERP process towards remission for the above-mentioned group.
Read more about the points raised in this article in my interview with Sunil Punjabi.
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