Improve Treatment Resistant Obsessive-Compulsive Disorder with Compassion-Focused Therapy

Improve Treatment Resistant Obsessive-Compulsive Disorder with Compassion-Focused Therapy

 

By John M. de Castro, Ph.D.

 

“A big part of learning to live with OCD is to incorporate self-compassion. Instead of avoiding your anxiety, self-compassion invites you to look at it with understanding and gentle curiosity. This approach allows you to see your pain exactly how it is without self-judgment or self-criticism.” – Nancy Larsen

 

Obsessive-Compulsive Disorder (OCD) sufferers have repetitive anxiety producing intrusive thoughts (obsessions) that result in repetitive behaviors to reduce the anxiety (compulsions). In a typical example of OCD, the individual is concerned about germs and is unable to control the anxiety that these thoughts produce. Their solution is to engage in ritualized behaviors, such as repetitive cleaning or hand washing that for a short time relieves the anxiety. The obsessions and compulsions can become so frequent that they become a dominant theme in their lives. Hence OCD drastically reduces the quality of life and happiness of the sufferer and those around them. About 2% of the population, 3.3 million people in the U.S., are affected at some time in their life.

 

Fortunately, Obsessive-Compulsive Disorder (OCD) can be treated and many respond to Cognitive Behavioral Therapy (CBT). But some do not. Mindfulness training has been shown to be effective in treating OCD. One understudied meditation technique is Compassion -Focused Therapy. It is designed to develop kindness and compassion to oneself and others. On the face of it learning self-compassion would seem to be useful in dealing with OCD. But there is little empirical evidence.

 

In today’s Research News article “Compassion-Focused Group Therapy for Treatment-Resistant OCD: Initial Evaluation Using a Multiple Baseline Design.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835278/ ) Petrocchi and colleagues recruited patients with Obsessive-Compulsive Disorder (OCD) who had received 6-months of Cognitive Behavioral Therapy (CBT) and still have significant residual OCD symptoms. They received 8 weekly 2-hour sessions of Compassion-Focused Therapy after varying periods of baseline (Multiple Baseline Research Design). The treatment consisted of training in meditation and visualization practices during sessions and at home. It is designed to replace self-criticism with self-compassion. Before and after training and 1 month later they were measured for OCD symptom severity, OCD symptom presence and distress, depression, fear of guilt, self-criticizing, self-attacking, self-reassuring, and self-compassion.

 

They found that the patients all had large improvements in Obsessive-Compulsive Disorder (OCD) symptoms that were maintained at the 1-month follow-up. They also found significant improvements in fear of guilt, self-criticism, and self-reassurance. In additions, there were less reliable improvements in depression and common humanity. Hence, Compassion-Focused Therapy improved the symptom of OCD in patients who didn’t respond to Cognitive Behavioral Therapy (CBT).

 

These are important preliminary findings that must be followed up with a large randomized controlled trial. But these results suggest that Compassion-Focused Therapy may be effective in treating Obsessive-Compulsive Disorder (OCD) symptoms in patients who do not respond to the gold standard treatment of Cognitive Behavioral Therapy (CBT). The results may suggest that CBT should incorporate Compassion-Focused training when being employed to treat OCD. This should be explored in future studies.

 

So, improve treatment resistant obsessive-compulsive disorder with compassion-focused therapy.

 

people with OCD may feel better if they remind themselves that it is normal to worry, and that it is not their fault if their OCD symptoms get worse.” –  Jessica Caporuscio

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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Study Summary

 

Petrocchi, N., Cosentino, T., Pellegrini, V., Femia, G., D’Innocenzo, A., & Mancini, F. (2021). Compassion-Focused Group Therapy for Treatment-Resistant OCD: Initial Evaluation Using a Multiple Baseline Design. Frontiers in psychology, 11, 594277. https://doi.org/10.3389/fpsyg.2020.594277

 

Abstract

Obsessive–compulsive disorder (OCD) is a debilitating mental health disorder that can easily become a treatment-resistant condition. Although effective therapies exist, only about half of the patients seem to benefit from them when we consider treatment refusal, dropout rates, and residual symptoms. Thus, providing effective augmentation to standard therapies could improve existing treatments. Group compassion-focused interventions have shown promise for reducing depression, anxiety, and avoidance related to various clinical problems, but this approach has never been evaluated for OCD individuals. However, cultivating compassion for self and others seems crucial for OCD patients, given the accumulating research suggesting that fear of guilt, along with isolation and self-criticism, can strongly contribute to the development and maintenance of OCD. The primary aim of this pilot study was to evaluate the acceptability, tolerability, and effectiveness of an 8-week group compassion-focused intervention for reducing OCD symptoms, depression, fear of guilt and self-criticism, and increasing common humanity and compassionate self-reassuring skills in treatment-resistant OCD patients. Using a multiple baseline experimental design, the intervention was evaluated in a sample of OCD patients (N = 8) who had completed at least 6 months of CBT treatment for OCD, but who continued to suffer from significant symptoms. Participants were randomized to different baseline assessment lengths; they then received 8 weekly, 120-min group sessions of compassion-focused therapy for OCD (CFT-OCD), and then were tested again at post-treatment and at 1 month follow up. Despite the adverse external circumstances (post-treatment and follow-up data collection were carried out, respectively, at the beginning and in the middle of the Italian lockdown due to the COVID-19 pandemic), by the end of treatment, all participants demonstrated reliable decreases in OCD symptoms, and these improvements were maintained at 4-week follow-up for seven of eight participants. The intervention was also associated with improvements in fear of guilt, self-criticism, and self-reassurance, but less consistent improvements in depression and common humanity. Participants reported high levels of acceptability of and satisfaction with the intervention. Results suggest that the intervention may be beneficial as either a stand-alone treatment or as an augmentation to other treatments.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835278/

 

Love thyself

 

“Too many people overvalue what they are not and undervalue what they are.” ~Malcolm S. Forbes

 

There is a widespread problem in the west that many people don’t seem to like themselves.  The term used to describe this in psychology is self-loathing, although this term is far too strong and is not an appropriate descriptor for the majority of people. In general, the dislike of self has a much smaller magnitude than the word loathing implies. As a result I prefer self-dislike.

 

The self-dislike sometimes means that the individual dislikes every aspect of themselves; but most frequently people only don’t like certain aspects of themselves. Often it is there physical appearance, their school achievement, their career, their social behavior, etc. Making matters worse, they tend to overlook their strengths and discount them, focusing instead in the parts that they find problematic.

 

The discounting and overlooking of strengths shows up in what psychologists call the Imposter Syndrome. Here very successful people do not appear to be able to assimilate their success and instead attribute it to luck. The esteem with which they’re held makes them feel like imposters. It is estimated that two out of five successful people consider themselves frauds that 70 percent of all people feel like impostors at one time or another.

 

When this issue of self-dislike was raised to the Dalai Lama he was totally perplexed and repeatedly asked for clarifications. Not liking oneself is unheard of in his culture. So, he was dumbfounded and without comment. Hence, the problem seems to be primarily one of western culture. This suggests that self-dislike is learned within a particular cultural context with western culture and its values particularly adept at producing it.

 

There are sometimes circumstances that underlie self-dislike. Abuse or bullying, belittling parents, learning disabilities, physical appearance or disabilities are apt to result in self-dislike. But, most frequently it originates from western culture’s tendency to promote unrealistic expectations.

 

Physical appearance is a good case in point where the media holds up extraordinarily attractive individuals as what we should strive to be. Very, very few people can ever measure up and so can end up disliking their appearance. Academic achievement is another case where for many anything less than an “A” is seen as failure. Once again few can measure up and most end up disliking their intellectual ability. Sports are another case where the media holds up professional athletes as role models. These are exceptional people and the vast majority of the population can’t perform anywhere near their level and thus feel inadequate. It is relatively easy to think of many other unrealistic expectations prompted by our hyper-success oriented culture.

 

What can we do to overcome self-dislike. Unfortunately, the self-dislike is usually deeply ingrained and becomes resistant to persuasion or evidence. No matter how successful the person becomes or how much praise is received the person cannot truly believe that he or she has value or worth. They believe themselves to be imposters.

 

Self-dislike is an indicator that the individual is unsatisfied with the way things are. There is a strong desire for them to be different and the individual believes that if one or more aspects of themselves changed, then things would be much better. This is in fact rarely true. An overweight person who loses a significant amount of weight doesn’t usually become happier instead it frequently produces depression. A far better approach is for people to learn to accept things, including themselves, just as they are.

 

Meditation is uniquely suited to promote accepting things as they are. So, it would seem appropriate for dealing with self-dislike. Meditation focuses on awareness of the present moment. As we’ve seen, self-dislike is often rooted in the past. By learning to focus on now, the past recedes in importance. When individuals learn to look closely at what is actually going on in the present moment they can begin to see that there is nothing wrong at all. In fact, there is tremendous good present. So, meditation can move the individual away from the past where the self-dislike originated and can then move forward in the present moment to develop self-acceptance.

 

Another method to address self-dislike is to employ what psychologists call counterconditioning where one behavior or belief is eliminated by replacing it with its opposite. Self-dislike can be eliminated by replacing it with self-love.  Loving Kindness Meditation (LKM) is designed to do just that. We practice loving ourselves and wishing ourselves well. It seems overly simple, but experience and research has shown that it can have remarkable impact.

 

Self-dislike is deeply ingrained. It will not be changed overnight. It will take practice and patience to weaken and eventually overcome it. But, contemplative practice can help.

 

So, engage in contemplative practice and learn to love thyself.

 

You yourself, as much as anybody in the entire universe, deserve your love & affection.” ~Buddha

 

CMCS – Center for Mindfulness and Contemplative Studies

Stop Criticizing Yourself and Feel Better

 

Being self-critical is good; being self-hating is destructive. There’s a very fine line there somewhere, and I walk it carefully.– Daniel Radcliffe

 

It can be useful to constructively criticize yourself as long as your realize that you’re human and are not, and will not ever be, perfect. You can then use the self-criticism to try to improve, not become perfect, but a little better. But, when self-criticism becomes extreme it can lead to perfectionistic thinking where you are never happy with yourself. This can lead to great unhappiness and psychological distress.
Mindfulness has been thought to help prevent perfectionism from producing distress. In support of this mindfulness has been found to improve self-esteem (see http://contemplative-studies.org/wp/index.php/2015/07/17/why-dont-we-like-ourselves-mindfulness-as-an-antidote/) and a healthy self-esteem is counter to perfectionism. It’s difficult to be happy with oneself and critical of yourself as less than ideal at the same time. There is clearly a need to better understand the relationships between theses variables.

 

In today’s Research News article “Self-criticism as a mediator in the relationship between unhealthy perfectionism and distress”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1099687223388536/?type=3&theater

James and colleagues obtained measures of self-criticism, perfectionism, mindfulness and psychological distress with an on-line questionnaire. They found that self-criticism and unhealthy perfectionism were positively related to psychological distress. In other words the higher the level of self-criticism and unhealthy perfectionism the greater the distress.

 

In addition, they found that unhealthy perfectionism was positively related to self-criticism which in turn increased psychological distress. So unhealthy perfectionism increased psychological distress both by directly increasing distress and also indirectly through increased self-criticism which in turn increased distress. Present moment awareness was negatively related to unhealthy perfectionism; that is the higher the level of mindfulness the lower the level of unhealthy perfectionism.

 

Mindfulness appears to help the individual by reducing unhealthy perfectionism. This doesn’t mean that the mindful individual does not strive to excel. Rather, it suggests that the mindful individual can work toward excellence but does so in a psychologically healthy way.

 

So, practice mindfulness and overcome unhealthy perfectionism.

 

“Remember, you have been criticizing yourself for years and it hasn’t worked. Try approving of yourself and see what happens.” ― Louise L. Hay

 

CMCS – Center for Mindfulness and Contemplative Studies