Alternative Therapies
There are many alternative therapies out there, but for me, the two most prominent ones are the 'Four Steps Method' and 'ACT Therapy'
Four Steps Method
The four steps method was invented specifically for OCD. It combines CBT and mindfulness.
Its premise is that your brain is producing irrational thoughts due to a neurobiological condition
Its aim is to get you to ignore the thoughts (and associated anxieties) by getting you to you focus on something else, such gardening or playing a musical instrument. The method is as follows:
Relabel – recognize your obsessions and compulsions as symptoms
Reattribute - the thoughts are the result of a neurobiological/medical condition
Refocus - engage yourself in constructive behaviours instead of giving in to the compulsion
Revalue - see OCD thoughts for what they truly are—distractions without any real importance
When I first got OCD many years ago, this was the primary therapy I used, as it explained things in a more scientific way, which I liked. And, in the short run it worked. Within 9 months my OCD symptoms reduced by 90%, and I thought I was basically cured. But then later, the OCD made a comeback. It made a comeback because the four steps method only deals with the symptoms, and does not fix the root cause
That is, the method assumes the root cause of OCD thoughts are a neurobiological condition. But, it doesn't try to fix that neurobiological condition, instead it tries to reduce the number of OCD thoughts, and their intensities.
The method suffers from the same flaw as standard CBT, which is that, in the short run, the subconscious mind may reduce the number of OCD thoughts it generates, if it thinks the conscious mind is hearing its message (which is heard when the person experiences the anxiety). But if the root cause is not fixed in the long term, then the subconscious realises it has been tricked, and so it starts ramping up the number of OCD thoughts again
Therefore, with this method, for the rest of your life you will be stuck in a cycle of recovery and relapse
So, the four steps method is for the short-run only, and can replace standard CBT
The inventor of the four steps method is Dr Jeffrey Schwartz. He summarises his method in the below YouTube video, which lasts around 35 minutes
https://www.youtube.com/watch?v=uixONPLVKEg
If you want to go into the details of the method, he wrote a book about it called ‘Brain Lock’. The book is interesting and may help you
Acceptance and Commitment Therapy (ACT)
This therapy is an updated version of CBT, combined with mindfulness
The aim of traditional Cognitive therapy (i.e. the 'C' part CBT) was to eliminate irrational thoughts, and didn't really care where those irrational thoughts came from
ACT updates traditional Cognitive therapy by suggesting that some of those irrational thoughts come from peoples tendency to relate one set of words to another, even if the link is tenuous.
For example, let’s say an individual has lost his job. In his head he might frame the situation in the following way: ‘men with jobs are providers; men who don’t provide are inadequate’. As he lost his job, he will now come to the conclusion that he is inadequate.
No one is telling him he is inadequate; it is he who has linked the situation of not having a job to being inadequate
Also, given how most people frame inadequacy, it would be a short step from there for the person to additionally derive the belief that they are ‘bad’
ACT’s understanding of irrational thoughts has some merit, and could be used to reduce or eliminate some irrational thoughts. But despite this, it does not aim to stop irrational thoughts!!
Instead, ACT takes a behavioural approach to treatment. That is, its primary goal is behaviour change
So what's the point of the therapy for OCD sufferers ?
To answer this question, we first need to explain how ACT classifies emotional distress. It says there are two types of anxiety.
The first type it calls 'clean' anxiety. This is the original anxiety, for example the anxiety caused by an OCD thought.
The second type it calls 'dirty' anxiety. This is where you are you anxious about the original anxiety. For example, when getting an OCD thought, the intensity of the anxiety maybe six out of ten. If you then worry 'what if the anxiety gets even higher', then you will be creating more anxiety. The worry of getting higher anxiety is classed as 'dirty' anxiety
The aim of ACT is stop the 'dirty' anxiety, but not the 'clean anxiety.' So, overall you will experience less anxiety, as you not adding fuel to the fire that is already burning
The question which then arises is 'why doesn't ACT try to stop the 'clean' anxiety ?
To stop 'clean' anxiety you need to look for its root cause, but ACT says that is difficult or impossible, and so just assumes 'clean' anxiety cannot be stopped.
ACT has created a tool whose primary aim is to reduce 'dirty' anxiety, but if you apply it to 'clean' anxiety, it can reduce that too, even though they don't know why or how it reduces the clean anxiety.
I have two possible explanations as to why the ACT tool could reduce 'clean' anxiety. These explanations come from applying the brain/mind model I presented earlier in the website, and is as follows
The first is that by doing mindfulness, the brain gets to learn that there is actually no danger. That is, when doing mindfulness, you are allowing the brain to experience OCD thoughts such as 'if I don't wash my hands many times after going to the toilet, I will get ill'. If you wash you hands only once, then after a period of weeks/months, the brain will learn that the need to wash hands many times is false, and consequently, it will generate little or no anxiety
The second explanation is about the appeasing of the subconscious mind. That is, an OCD thought is a message from the subconscious mind to the conscious mind to warn it that something else needs fixing (e.g. trauma, self-esteem). If the subconscious feels that its message is being heard by the conscious mind (because the conscious mind is allowing the 'clean' anxiety), then the subconscious mind might produce less of the 'clean' anxiety
ACT therapists will no doubt disagree with me on the above two points, and stick to their 'we don't know why' story.
Anyway, back to the official understanding of ACT
The overall name for the above mentioned tool is ‘psychological flexibility’. The tool has six parts in total. The first four parts reduce psychological distress (and come from mindfulness). Parts five and six are behavioural in nature, and are about living your life in a meaningful manner
The six parts are below:
Defusion – relating to your thoughts in a new way, so they have less impact on you
Expansion – making room for unpleasant feelings and sensations instead of trying to push them away. When you do this, the feelings and sensations bother you less, and go away quicker
Connection – connecting fully with whatever is happening right now, rather than dwelling on the past or worrying about the future
The Observing Self – a powerful aspect of the mind, which has largely been ignored by Western psychology until now
Values – clarifying and connecting with your values is an essential step for making life meaningful
Committed action – a rich and meaningful life is created by taking action, even if it seems difficult sometimes
Of the six parts, the one I used heavily in the past is expansion. When I first got OCD, it was causing me to have multiple panic attacks on a daily basis. The panic attacks hit me in my chest. So, each time I got a panic attack, I stopped what I was doing, and put my entire attention on the severe discomfort on my chest, without trying to stop the discomfort. Withing a month or two, my panic attacks completely went.
I was now only left with anxiety attacks (which are less intense). I also applied expansion to these anxiety attacks and it worked. In fact, I became good so good at it that if I was watching TV, I could still concentrate on watching the programme and doing expansion at the same time. Expansion is brilliant, and everyone with OCD (and other anxiety disorders) should learn this skill
Expansion points to a key thing in ACT, which is experiential avoidance. It (experiential avoidance) is where we try ignore/supress a thought or feeling. ACT states that this an impossible task in both the short-run and long-run.
I agree that you cannot stop a thought/feeling in the short-run, but it is possible to stop them in the long-run (by looking for their root causes)
So, my overall opinion of ACT is that is only for the short-term, because it won’t directly cause fix the root causes of OCD, because it doesn’t look for them
Despite not fully agreeing with it, ACT can help some OCD sufferers
A really good book that explains ACT in a simple way is ‘The Happiness Trap’ by Russ Harris
For the short-term, if you don’t like standard CBT, you could replace it with ACT. It probably is a better therapy, as it incorporates mindfulness. It is not prominent in mainstream therapy yet, because it is a relatively new form of therapy
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