CASE STUDY 6:
OBSESSIVE COMPULSIVE DISORDER

There are certain mental health or behavioural disorders that dominate and demand attention, some of these are the ones that present practitioners and health providers with the most resilient complexities that they appear very resistant to change. Addictions of course are one of these areas, another one might be Obsessive Compulsive Disorders (OCD).  This is not an area I have any experience in. But, in the depth of work that I have done with addiction and discovered new ways of understanding what is happening within an addictive/compulsive condition or behaviour, I have developed models of formulation and techniques which arise from this that may have application elsewhere.   I see addiction as a problem of neurological imbalance working on the level of hemispherical imbalance, resulting from high emotional valence and its consequent effects on asymmetry in the hemispheres. Meaning that a natural state of balance, symmetry has been upset. The result of this is that the system tries to rectify itself, by reducing the over stimulation, this is the 'acting out' of the compensatory behaviour, the substance misuse. 

I call this a discharge behaviour, an attempt to regulate and lower overall arousal and regain balance. But, the actual valence, emotional intensity in the system is not being effected, it remains, and so a continuation of the impulsive attempts at regulation persist. The continuation of this imbalance, which has been accrued over long periods of time, and the playing out of an internal attempt at rebalance create the disordered behaviour, utilising the familiar learned behaviour as its externalising outlet. An expression of neurological imbalance, the need is therefore for a reinstatement of balance and natural symmetry back to the brain

The case below are the results obtained from the application of this therapeutic system, learned and derived from addiction issues as applied to a new area, Obsessive Compulsive Disorder. With having no experience of treating OCD prior, I had nothing of what I may have learned or been trained in to apply. I was familiar with exposure therapies of CBT, but had heard of many accounts of these not having been being useful. The reason I see for this is that the person is in a constantly high arousal state, and any engagement with what they fear is only going to increase that, therefore reinforcing their resistance. Mirroring what people report who have tried it. This also highlights an important point, the gap between documented theory and practice, the illusion of expected outcome and what to do in the shortfall? When practitioners rely on theory without a thorough understanding of how and why, they leave themselves open to confusion and inability to adjust. 

In addiction this was something which I would see very early on in my professional life. Failed treatments leading to an affirmation and compounding of a sense of defeatism with no practitioner accountability or explanation. Such accounts shared with me became the seeds of formulating a reflective approach to practice that adopted the failures elsewhere to create a comprehensive model that filled these gaps. It meant that my learning was met at source, explained through research and refined through feedback, observation and practice. 

I hypothesised a parallel between OCD and addiction on the level of emotional regulation and its frustration.  OCD is effectively a situation of perpetual emotional hyper regulation. Excess stress continually gets acted out in physiological ways. This behaviour via discharge manages the limits of capacity.  Addiction does something similar related to emotional regulation also, but through a substance directed outlet.  The purpose is the same, the lowering of valence. This is involuntary, due to this being the body's attempt to reduce internal pressure and self regulate, as it does with blood temperature, a similar principal.

Homeostasis is what complex systems do naturally, they maintain their equilibrium through contradictory processes, keeping a functional range in the middle. So when emotional pressure is too high the body will dump excess  to maintain a median. It is a necessity. 

What it struggles to do though, is reduce overall valence, or accumulated stress as well as stress that is continually being re fed into the system. This is feedback which is being produced by the person themselves. 

 

An anxious stressed person becomes stressed and anxious about being stressed and anxious. The brain can not rectify this. It is a feedback loop caused by the person due to a lack of understanding and a lack of self awareness to contain it. Therefore they unwittingly become central to its perpetuation, which the brain has to counter act to survive and prevent overload, ie. too much valence in the autonomic nervous system - the heart, blood pressure, reproductive functions etc. To protect the biological machine excess pressure will be discharged by externalisation. 

OCD as I see it is this process in action. The compulsive behaviour is the excess pressure being externalised physiologically. It is 'blow off.' The person has long lost the ability to emotionally regulate internally, more pressure has been added and continues to be added by worry and new anxiety, thus always topping it up. This overspill continually trickles over the top, much like an infinity pool. The homeostasis is happening at maximum capacity, at the brim, at the boundaries of the body and the outside world....in 'acting out' energy through physical activity.

The associated anxiety experienced cognitively and linguistically in the left hemisphere...'something bad will happen if I don't do this', is true, but not in the way understood. It is a distortion of context which it is dependent on the right hemisphere to provide understanding of. Meaning that the person is suffering from a defecit of right hemisphere contextual interpretation, thus they are stuck with not knowing what to do and innaction.  

In the application of technique an explanation of correlative relationship between the person and the biology of the hemispheres is initiated and set up.  It is the changing of a pattern of positive feedback due to an absence of corrective feedback, and the reinstatement of one to interpretative resistance and containment.

 

This redirects energy back into the system through the body via the newly activated right hemisphere. The right hemisphere works in the frame of metaphor and large complex information processing, so central to this method is high levels of explanatory information shared by the practitioner. This both stimulates and informs the vast data networks of the brain to interpret, identify and decode. Negative emotion is the realm of the right hemisphere also, thus its engagement processes the emotional overload. 

Without containment complex emergent systems naturally move toward decay and break down (entropy).  Regulation occurs through containment of work. The brain, its lateralisation,  right and left hemispheres, the sympathetic nervous system and  the parasympathetic nervous system respectively require homeostatic balance in a system that maintains autonomic processes upstream. They all work together and rely on co-optive regulation for systemic harmony. When this balance is thrown out unless caught, it will continue....which are the precursor circumstances that gravitate toward an addiction or an OCD type behaviour emerging.

The person 'in charge' of their neurology is unaware that they have a role of maintenance to play. In that absence there is not a governance system, only an  assumption that this works by itself, which is an absence. In the absence of self governance there is no constraint, thus entropy or decay, a move toward chaos will result. 

Metaphorically; in the absence of a trained driver a vehicle will career along haphazardly with no sense of control or understanding in a random fashion. Under the control of a trained and practiced driver self advancement is both efficient and directed. In order to achieve this a thorough and comprehensive process of learning and practice is necessary. 

The case below shows how in the presentation of this theory as an applied tool, a meticulous attention to detail in layering up learning and application enabled a house bound chronically anxious person to become gradually able to go back to life freely and with control.  The presence of OCD behaviours became reduced by magnitudes of degrees. Underlying accumulated stress was observed to decrease as was outside freedom of movement. OCD behaviours reduced correlated to this.

Natural emotional relativism returned, with normal anxiety expressions coming and going relevant to everyday circumstances. Valence of accumulated stress decreases and OCD becomes an alien concept, but remains as for now on a familiar habit/comfort level, but some 80% less expression than it had been. But it is no longer associated to anxiety.  Emotional regulation is handled on a cognitive and interpretative level as the accumulated stress is no longer in the system. Attention returns to everyday external functioning and demands of life.

   

After spending years in and out of different therapies from the age of 17 with little to no improvement I concluded that I was meant to feel anxious constantly, having experienced anxiety since the age of 14. Within the last two years things felt like they were going from bad to worse. OCD started affecting me detrimentally, which seemingly came out of the blue, though in reality I was struggling with it for a lot longer than I had previously realised, that paired with the increasing anxiety was becoming relentless. I was both mentally and physically broken at this point, running on two hours sleep courtesy of OCD and I hadn’t left my home in over three months. I was aware that the OCD wasn’t helpful and was causing more problems than it solved yet I couldn’t stop the compulsions and they were taking over my life. I was confused, scared, upset, and frustrated with what my life (or lack of) had become.  

The last five months of counselling sessions I have had the opportunity to transform as a person. I don’t want to put it lightly in the sense that just talking has magically made the anxiety and OCD disappear – it’s not that simple. I have put hard work in to get to the position I am in today and had the guidance and support I have needed to safely and effectively to become my true self. I have been provided with activities such as keeping a journal for my thoughts as well as been given theory to further research such as ‘The Chimp Paradox’. The entire counselling process was explained to me a step at a time with the appropriate science and theory behind it at each relevant stage, having this further level of understanding allowed me to see that I wasn’t ‘broken’ and gave me the clarity needed to make change where necessary - this is where previous therapies had faltered, giving people activities or exposure exercises to complete isn’t helpful if they are not in the correct mind state to do so and do not understand the reason behind it comprehensively.  

Working with the method of combining activities with the knowledge of science and theory allowed for changes to be made and overall was a more flexible process - if things were not working for me particularly well, I had the opportunity to approach it from a different angle and do what seemed best for me at that time. Therapy shouldn’t be a one size fits all – everyone is different and has different experiences. Whilst the core principles of therapy remain, having the opportunity to mould the process to fit the individual is more forward thinking and ultimately shows the best results. The counselling process allowed for incremental changes at a steady pace. Any teething problems along the way were always followed by discussions and further clarity which let me continue to make progress. Having small changes happen over a period provided the opportunity to appreciate and fully understand the process and the person I was uncovering.

 

When I started this process, I did not know what to expect or if it would even benefit myself, but the last few months has provided me with more knowledge about the human mind and how it works, allowing me to implement it into my life, than years of previous therapy ever did. I’m now a more confident person, who gets a lot more sleep and has a ‘normal’ functioning life. My only regret is that I wish I knew all the information I now know years ago so that I didn’t have to suffer for as long as I did. Nevertheless, I am grateful for my journey and the things I have learnt about myself and continue to learn to keep growing as a person.