By Laurie Krauth, MA, LLP*
People with OCD display extraordinary courage in fighting a disorder that, by its very nature, torments them with equally extraordinary fear, according to a leading expert on OCD.
"People whose problem is intense fear behave courageously on a day-to-day basis," Jack Rachman, professor emeritus at the University of British Columbia, said in a keynote address to the 12th Annual OCF Conference in San Diego July 30.
"Having intense fears doesn’t preclude courage," said Dr. Rachman, the author and editor of numerous book and articles on OCD and other anxiety disorders. In fact, courage can be learned and cultivated. "Ordinary, average citizens are capable of courageous behavior," he said.
OCD clients can develop their capacity for courage, encouraged by the clinicians who help them. Courage is central to the principal OCD treatment of Exposure and Response Prevention (ERP), which is a part of cognitive-behavioral therapy. With ERP, clients choose to actively expose themselves to their obsessive thoughts and resist performing the physical and mental rituals they normally use to allay their anxiety. It takes great courage for someone to choose to feel and even heighten anxiety and then not give in to the intense desire to reduce it through ritualizing.
Ironically, it took the courage of British psychologist Victor Meyer almost 40 years ago to bring this courage-based therapy to OCD treatment.
"What he did was very brave," said Dr. Rachman. Dr. Meyer applied to humans what studies had shown applied to frightened animals: if they were exposed to what scared them for a prolonged time and prevented from leaving the situation, they became less scared.
"Therapists were scared to do it with patients," he said. But Dr. Meyer, a former World War II fighter pilot shot down in France and taken as a prisoner of war, was willing to take a risk. In 1966, he began ERP with two hospitalized patients. One, incapacitated by fears of disease and dirt, spent most of the day cleaning. She had not been helped by shock treatment, drugs, or supportive therapy, and was being considered for surgery, Dr. Rachman said. Dr. Meyer, and later a nurse, exposed her to objects that triggered her anxiety and prevented her from carrying out her cleaning rituals. They turned off the water in her room and severely limited her access to cleaning agents.
"She was very frightened at times but she managed to cooperate with treatment," said Dr. Rachman. After four weeks of intensive therapy, she was less anxious, and after eight, even less so. Her compulsive cleaning dropped to tolerable levels.
Meyer’s second patient was incapacitated by recurrent, disruptive blasphemous thoughts about sex. It took her up to six hours to get dressed each day. Shock therapy, drugs, eleven years of psychoanalysis and then psychosurgery all had failed her, and she was being considered for a second surgery.
Instead, she underwent this new behavior therapy. Her anxiety was heightened through exposure to triggering items and imaginal scenes while she was prevented from performing any anxiety-reducing behaviors. After nine weeks of difficult and distressing intensive therapy, her OCD symptoms dropped to manageable levels. Neither was cured, but both regained normal lives.
"The consequence of Victor Meyer’s success was spectacular. He had broken the ice," said Dr. Rachman.
Over the decades, clinicians and researchers have continued to study and experiment with ways to improve ERP techniques and better understand how to help people with OCD.
Recognizing the importance of cultivating courage in OCD patients, Dr. Rachman and his colleagues realized they needed to understand where such courage comes from and how to encourage and enhance it. They decided to interview people who needed courage to do their jobs, such as fire fighters, police, and security people. Ultimately they chose bomb disposal operators in the United Kingdom during a time of great conflict with the Irish Republican Army.
In a 10-year period, the operators took 31,000 calls, two-thirds of which were hoaxes, he said. But they entered each situation knowing their lives could be in danger, and that a mistake could be fatal.The researchers wondered how the bomb disposal squad was chosen, assuming courage was a prerequisite. Instead, they learned, all military personnel were expected to do the job once they received extra training.
The operators’ fear decreased as their confidence in their abilities increased, he said. From 60 percent confidence before training, their confidence increased to 90 percent after training, and up to around 97 per cent once they had succeeded in one or more disarmaments.
"This had obvious application to psychological treatment, including Exposure and Response Prevention," said Dr. Rachman. "In the course of this treatment [for OCD], I was struck by how patients’ lives were being damaged, how they were extremely frightened people. And our treatment required coming in contact with the sources of their greatest distress: We expected them to willingly be exposed to them day after day."
The researchers were impressed by patients’ resilience, and by how quickly they regained their composure after each exposure session. Researchers and clinicians continue to investigate new techniques, drawing on patients’ courage and advancing cognitive-behavioral therapy, to provide even more effective treatment, Dr. Rachman said.
People with OCD, despite their terror, can draw on their innate courage and fight back. As they succeed, their success will boost their confidence to continue the fight. Clinicians, for their part, must promote courageous behavior in their patients by helping them draw on those resources and sustain the effort.
"All people are capable of courage," concluded Dr. Rachman, "including the most fearful of us."
"People whose problem is intense fear behave courageously on a day-to-day basis," Jack Rachman, professor emeritus at the University of British Columbia, said in a keynote address to the 12th Annual OCF Conference in San Diego July 30.
"Having intense fears doesn’t preclude courage," said Dr. Rachman, the author and editor of numerous book and articles on OCD and other anxiety disorders. In fact, courage can be learned and cultivated. "Ordinary, average citizens are capable of courageous behavior," he said.
OCD clients can develop their capacity for courage, encouraged by the clinicians who help them. Courage is central to the principal OCD treatment of Exposure and Response Prevention (ERP), which is a part of cognitive-behavioral therapy. With ERP, clients choose to actively expose themselves to their obsessive thoughts and resist performing the physical and mental rituals they normally use to allay their anxiety. It takes great courage for someone to choose to feel and even heighten anxiety and then not give in to the intense desire to reduce it through ritualizing.
Ironically, it took the courage of British psychologist Victor Meyer almost 40 years ago to bring this courage-based therapy to OCD treatment.
"What he did was very brave," said Dr. Rachman. Dr. Meyer applied to humans what studies had shown applied to frightened animals: if they were exposed to what scared them for a prolonged time and prevented from leaving the situation, they became less scared.
"Therapists were scared to do it with patients," he said. But Dr. Meyer, a former World War II fighter pilot shot down in France and taken as a prisoner of war, was willing to take a risk. In 1966, he began ERP with two hospitalized patients. One, incapacitated by fears of disease and dirt, spent most of the day cleaning. She had not been helped by shock treatment, drugs, or supportive therapy, and was being considered for surgery, Dr. Rachman said. Dr. Meyer, and later a nurse, exposed her to objects that triggered her anxiety and prevented her from carrying out her cleaning rituals. They turned off the water in her room and severely limited her access to cleaning agents.
"She was very frightened at times but she managed to cooperate with treatment," said Dr. Rachman. After four weeks of intensive therapy, she was less anxious, and after eight, even less so. Her compulsive cleaning dropped to tolerable levels.
Meyer’s second patient was incapacitated by recurrent, disruptive blasphemous thoughts about sex. It took her up to six hours to get dressed each day. Shock therapy, drugs, eleven years of psychoanalysis and then psychosurgery all had failed her, and she was being considered for a second surgery.
Instead, she underwent this new behavior therapy. Her anxiety was heightened through exposure to triggering items and imaginal scenes while she was prevented from performing any anxiety-reducing behaviors. After nine weeks of difficult and distressing intensive therapy, her OCD symptoms dropped to manageable levels. Neither was cured, but both regained normal lives.
"The consequence of Victor Meyer’s success was spectacular. He had broken the ice," said Dr. Rachman.
Over the decades, clinicians and researchers have continued to study and experiment with ways to improve ERP techniques and better understand how to help people with OCD.
Recognizing the importance of cultivating courage in OCD patients, Dr. Rachman and his colleagues realized they needed to understand where such courage comes from and how to encourage and enhance it. They decided to interview people who needed courage to do their jobs, such as fire fighters, police, and security people. Ultimately they chose bomb disposal operators in the United Kingdom during a time of great conflict with the Irish Republican Army.
In a 10-year period, the operators took 31,000 calls, two-thirds of which were hoaxes, he said. But they entered each situation knowing their lives could be in danger, and that a mistake could be fatal.The researchers wondered how the bomb disposal squad was chosen, assuming courage was a prerequisite. Instead, they learned, all military personnel were expected to do the job once they received extra training.
The operators’ fear decreased as their confidence in their abilities increased, he said. From 60 percent confidence before training, their confidence increased to 90 percent after training, and up to around 97 per cent once they had succeeded in one or more disarmaments.
"This had obvious application to psychological treatment, including Exposure and Response Prevention," said Dr. Rachman. "In the course of this treatment [for OCD], I was struck by how patients’ lives were being damaged, how they were extremely frightened people. And our treatment required coming in contact with the sources of their greatest distress: We expected them to willingly be exposed to them day after day."
The researchers were impressed by patients’ resilience, and by how quickly they regained their composure after each exposure session. Researchers and clinicians continue to investigate new techniques, drawing on patients’ courage and advancing cognitive-behavioral therapy, to provide even more effective treatment, Dr. Rachman said.
People with OCD, despite their terror, can draw on their innate courage and fight back. As they succeed, their success will boost their confidence to continue the fight. Clinicians, for their part, must promote courageous behavior in their patients by helping them draw on those resources and sustain the effort.
"All people are capable of courage," concluded Dr. Rachman, "including the most fearful of us."