Cognitive restructuring helps alter thoughts, feelings and behaviours, and improves insight. Subsequently, agreeing to face obsessions (exposures) and resisting compulsions (response prevention) shows how this active process eventually weakens obsessions, further increasing rational perception.
These illogical thoughts had latched on to what mattered most to John – his morals. Subsequently, and despite the real-event theft situation, he failed to see that his intrusive thoughts were at odds with his true moral values, or at least doubted it. This is an example of what is known as trait-guilt, meaning that the corresponding emotion is rigid. In other words, John’s previous healthy beliefs about himself shifted to thinking instead that he truly was a sinner and a traitor to his religion.
There is another factor to consider, which comes from Isaac Mark’s expression “obsessive phobia” which is not, as he puts it, ‘a direct fear of a given object or situation, but rather of the results which are imagined to arise from it’. While there is a distinction between a standard phobia and an obsession, an overlap can be noticed when a person shows signs of one and the other.
Exposure response prevention has been practiced for almost half-a-century and remains the most effective therapy for treating OCD. With Mindfulness integrated into the process this offers a solution for improving task engagement (in and out of the therapy room) and offers scope for preventing relapse.
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By understanding and using the “early warning system”, a therapist or caregiver can help a teen grasp the difference between feelings and facts and how to determine what it is that caused their mood change in the first place.
One of my exposures was leaving the door unlocked and living with risk; it helped me see that my decisions before remission were influenced by anxiety and emotional evaluation.