52 Self-Help Books in 2019, Week 2: “Brain Lock: Free Yourself From Obsessive-Compulsive Behavior,” by Jeffrey Schwartz, M.D.
“Brain Lock” is Dr. Jeffrey Schwartz’s attempt to put down in a usable manual his four-step behavior therapy approach to treating Obsessive Compulsive Disorder.
Though, when you really get down to it, three of his four steps are substantively similar, and all of his steps basically amount to a version of cognitive-behavioral therapy, in that they involve the consistent redirection of thoughts and behavior to rewire the brain.
It seems I’ve seen Dr. Schwartz’s name associated with at least one other book oriented toward “rewiring the brain.” He’s a psychiatrist at UCLA who, if memory serves, has done research on the plasticity of the brain— that is, the brain’s ability to change itself based on environmental factors.
In other words, what happens to us and how we respond to it can literally change our brains— our brains are “moldable” in response to experience.
Obsessive-Compulsive Disorder, or OCD, is a disorder in which people are affiliated with powerful, intrusive thoughts, usually about the “wrongness” of something; and then seized with a powerful compulsion to do something in order to make it “right.” The stuff OCD sufferers are compelled to do may or may not have particularly strong relationships to the initial thought; for that matter, the thought itself may or may not have any particular relationship to reality.
Dr. Schwartz spends much of his book outlining cases of OCD he’s seen in his patients, the symptoms of whom range from the mundane to the bizarre.
The bottom line of most OCD sufferers, however, is that their symptoms end up disrupting the hell out of their lives, notably their relationships.
Doing the compulsions, while maybe temporarily relieving the anxiety instigated by the obsessions, does nothing to permanently resolve that anxiety; for that matter, giving in and performing those compulsions actually seem to make the obsessions come back in more powerful fashion later.
This is a particularly vexing problem, insofar as any behavior that reduces anxiety in the moment has the power to become addictive— taking drugs, performing a ritual, smoking a cigarette. When humans hit on anxiety-reducing behavior, we don’t give it up easily, no matter how nonsensical or ultimately destructive it may be.
Dr. Schwartz notes that OCD sufferers may vary in their acknowledgement of how reality-based, or not, their symptoms are.
A frequent pattern seems to be that sufferers start out truly believing that their compulsions are necessary to avoid not only the anxiety generated by their obsessions, but also the practical problem presented by what their brains are telling them is wrong. But, as their disorder deepens in severity, they lose any sense of proportionality, and go down a rabbit hole of obsessions and compulsions at that are less and less rooted in any kind of reality.
In the initial few chapters of “Brain Lock,” Dr. Schwartz gives us an overview of what brain imaging studies has revolted about OCD in the recent past. PET scans of OCD sufferers seem to indicate that a part of the brain called the orbital cortex— located right above our eyes— gets overheated in people with OCD; Dr. Schwartz explains this is part of the brain that informs us that something is wrong, and some action needs to be taken.
However, when that “something is wrong” signal is transmitted to other parts of the brain, namely the caudate nucleus and the putamen, something gets “stuck,” disallowing a person to come up with an effective behavioral response to the “something is wrong” signal from the orbital cortex.
Typically these brain structures should work together to coordinate behavioral responses to a “something’s wrong” signal— but, when someone has OCD, these brain structures kind of chase their tail, and the overheated orbital cortex keeps sending that “something’s wrong” signal with increasing urgency. All of which results in the anxiety and scrambled, ineffective behavioral responses of OCD.
The reason Dr. Schwartz gives us a rundown of what’s “stuck” in the brain of the OCD sufferer is because his four-step method of getting out of “Brain Lock” depends on the sufferer understanding, with emphatic certainty, that the obsessions they are experiencing are NOT a representation of reality— but rather of a misfiring brain.
Dr. Schwartz calls Step One of his method “Relabeling.” Whereas OCD suffered might have previously experienced their obsessions as a representation of reality, Dr. Schwartz teaches his patients to consistently relabel those obsessions as what they are: OCD.
It’s only by recognizing an obsession for what it really is, Dr. Schwartz argues, that a sufferer will develop the motivation, let alone the skillset, to fight back against the disorder.
By learning to recognize when a symptom, as opposed to a reality-baed event, is occurring, and by accurately relabeling it as a symptom, a patient can put themselves on notice that they need to run through the four-step routine— or run the risk of caving in to their compulsive urges and thus deepening and reinforcing their problem.
The second step in Dr. Schwartz’s method is “Reattributing.” In this step, a sufferer takes the “relabeling” step to its next level: once they’ve correctly labeled a symptom as a symptom, they then “reattribute” the symptom to a brain malfunction, NOT to anything happening in reality.
It may seem that the “relabeling” and “reattributing” steps are similar, insofar as they both focus on the patient reality-testing their obsessions. I think the “relabeling” step is more accurately an exercise in awareness that a symptom is occurring, whereas the “reattributing” step is more a cognitive-behavioral exercise in reframing the problem so as to feel differently about it (i.e., you’re going to feel very different about something you think of as just a brain malfunction vs. a serious, actual problem in reality).
That is to say: the “relabel” step is more about reality-testing, and the “reattributing” step is more about anxiety management.
The rubber really hits the road in Step Three, “Refocusing.” In this step. Dr. Schwartz claims that the OCD brain can actually become rewired in response to the sufferer choosing to do something OTHER than the compulsion for at least fifteen minutes.
On its own, this is a pretty standard Behavior Therapy intervention; but I happen to think there’s a subtle cleverness about this step. Dr. Schwartz isn’t asking people to get rid of the obsession or the anxiety that goes with it; he knows that’s a losing battle.
He’s asking people to go ahead and EXPERIENCE those symptoms; just make sure you DO something OTHER than what your brain is irrationally recommending.
It’s a cute little end-run around the idea that we need to effortfully change the obsessions themselves; that’s like telling a smoker to NOT want a cigarette.
You can want a cigarette, just like you can want to do a compulsion in response to an obsession. What matters is that you don’t actually DO what your brain wants you to do in that moment…and that you experience the fact that the world does not end in response.
Dr. Schwartz’s fourth step is “Revaluing,” which is kind of a callback to the “Relabeling” and “Reattributing” steps. After his patients have refocused on another behavior, he encourages them to “revalue” the compulsion that they did NOT pursue as worthless manifestations of OCD.
He encourages sufferers to really get tough on OCD, reminding themselves that OCD is pitilessly trying to ruin their lives and steal their joy.
At its core, this is another cognitive-behaviorally-driven reframing technique, designed to change how people feel when they experience obsessions or have the urge to perform compulsions.
And, like the other steps, it’s cute— by going through the four-step process every time one experiences an obsession or a compulsion, one can definitely rewire how one thinks about their symptoms and their behavioral options.
The book is padded out with extensive (very extensive, one might say almost superfluous) examples and case histories of OCD culled from Dr. Schwartz’s UCLA outpatient group. He devotes one chapter specifically to how OCD symptomatology has a way of chewing up families and relationships, and he strongly recommends family members not become enablers of OCD (which they seem to be prone to, just to minimize the strife and inconvenience caused by trying to argue with someone who is experiencing OCD symptoms).
Throughout the book, Dr. Schwartz also notes how medication can be supportive for people who are being treated for OCD— but only to the extent that the sufferers are working diligently in behavior therapy (i.e., don’t expect meds to “cure” OCD— only behavior therapy has been shown to rewire the brain).
Reading “Brain Lock,” one gets the impression Dr. Schwartz has seen OCD discourage and defeat many, many people, and he approaches the subject of his Four Steps with an almost evangelical fervor. My impression is that the extensive case studies are included so that sufferers can see that, no matter how bizarre or entrenched their own symptoms seem, that there is hope for them.
In fairness, all of the patients Dr. Schwartz describes seem to have come to him when they were at the end of their ropes: their OCD had become so smothering that they were desperate enough to try anything.
I think the ideas in “Brain Lock” are interesting and valid, if not particularly new— again, his Four Steps are mostly boilerplate cognitive behavioral therapy by any other name.
The truth is, if a patient is at the point of being willing to admit what they’re experiencing isn’t “real,” but instead the manifestation of a clinical disorder, more than half the work is already done.
Any working therapist can tell you that most of their day is spent convincing depressed people that things aren’t hopeless, anxious people that the world isn’t ending, and traumatized people that the past isn’t the present. If all patients were willing to “relabel” and “reattribute” as enthusiastically as Dr. Schwartz’s exemplary patients were…well, my job would be much easier.
But, in my experience, when anxiety is involved, nothing is quite that easy.
That said: I like Dr. Schwartz’s method.
I like his metaphor of getting the brain “unstuck;” I like his method’s emphasis on reminding the patient repeatedly that what they’re experiencing is a brain glitch instead of reality; and I especially like his emphasis on getting the patient to actually DO something different in the “refocus” step DESPITE their compulsion and anxiety gnawing away at them.
I also think the fact that behavior therapy has been proven to actually rewire the brain is useful, encouraging news for sufferers from everything from depression to anxiety to PTSD.
Relabel. Reattribute. Refocus. Revalue.