“It’s not me! It’s my OCD!”

In these earliest days, Schwartz didn’t really know where he was going, only his starting point. And what he asked of his clients was truly dramatic: He asked them to recognize an OCD-related thought as soon as possible and relabel it as unreal — merely a symptom of their OCD — without giving in to it. The group responded enthusiastically, but things took off after an older woman in the group, Dottie, suddenly exclaimed: “It’s not me! It’s my OCD!”

This became a rallying cry for the group. And Schwartz realized he’d found his first step, relabeling.

If a patient suffered from a constant obsession with dirty hands and a compulsion to wash them, Schwartz advised the patient to think: This is not an urge to wash my hands. This is a bothersome thought brought about by my OCD. As soon as he hit on this method, his patients came back the next week and reported improvement, claiming they no longer felt the disease controlled them.

Yet they were still symptomatic, and the symptoms interfered with their lives. Weeks in, as his patient group reported for another session, one of them asked, “Doc, can you just tell me why the damn thing keeps bothering me — why it doesn’t go away?” Schwartz happened to be carrying around some brain scans of OCD patients in a folder. “You want to know why it doesn’t go away?” Schwartz said. “I’ll show you why.”

Retrieving the scans with a flourish, he pointed to the OCD circuit he’d worked with Baxter to establish. “This region of the brain is hugely overactive,” he said, and then Pop! He saw a change in his patient’s face and the excitement in everyone listening. Paula was one of the patients who experienced this eureka moment and felt liberated. These strange thoughts about her boyfriend’s drug addiction were no longer a sign of insanity. They were no longer even a product of her self. They were just the faulty transmissions of a malfunctioning brain.

Schwartz felt the energy in the room rise, and he saw the previously defeated men and women of his OCD group rally and strengthen as surely as if they had just inexplicably gained more muscle tone. This became the second step: reattribute. He was teaching his patients to reattribute their OCD symptoms to some gnarled brain wiring, teaching them to see the functioning of their brain as meaningfully separate from their sense of self.

Over the following weeks, patients started to report victories regularly. At first these wins were small. Paula could hold off on questioning her boyfriend about his day for longer periods — first minutes, then an hour or more. She could get by while asking fewer questions. But as time passed, the patients reported something more remarkable: The intrusive thoughts of OCD were diminishing, occurring less frequently, and coming on with less power.

Schwartz believed that this was because his patients were in fact using the power of their minds to rewire their adult brains — a finding at odds with the view in those days that only children’s brains could go through such enormous change.

One evening, while out of the office, Schwartz realized his patients needed more to do, something to focus on besides the intrusive thoughts of OCD. He thought back over the practice of mindfulness and found an analogy he liked. In meditation, if he became emotionally invested in a particular train of thought, he sought to refocus himself by drawing his attention back to his breathing.

Using that same concept, he gave his patients license to replace monitoring their breath with whatever behavior they found most compelling. Some patients found it helpful to turn back to the same healthy behavior each time an OCD episode struck: going for a walk, perhaps, or gardening.

Schwartz had found three steps — relabel, reattribute and, now, refocus.

But he needed a final step, something to pull them all together. He called that step revaluing. The OCD thoughts that patients once considered so important were to be systematically deconstructed, understood and finally revalued as, in Schwartz’s words, “trash … not worth the gray matter they rode in on.” Conversely, Schwartz’s patients learned to value their alternative behavior highly.

Schwartz’s four steps worked, but it wasn’t easy. It took, and these words struck Schwartz as key, a tremendous force of will.

The Rewired Brain

Eventually Schwartz began to feel he was seeing free will in action: the people under his care choosing, again and again, to engage in a new behavior. But he needed to wait and see if that evidence would turn up in a brain scan. And after 10 weeks of treatment in the four steps, it was time.

His patients, their brains imaged before any treatment began, entered the hulking scanners a second time. Baxter crunched the data and told him the news: The amount of activity in these patients’ OCD circuits had decreased to a degree commensurate with the best results achieved by pharmaceutical therapy. The OCD circuit, so brightly lit in the baseline scans of his OCD sufferers, now glowed more softly.

Schwartz published his findings in 1992 and replicated them in 1996, adding nuance to our notion of adult neuroplasticity. But the ensuing years, have brought a host of theorists and tracts undermining free will — and the modus operandi of Schwartz’s therapy for OCD.

Neuroscientists Sam Harris and David Eagleman published books on the topic in the past couple of years, both of which made best-seller lists. Harris is unequivocal, referring to humankind as “biochemical puppets.” In his view, we can choose our path in life no more than the eight ball can choose whether or not to fall into the corner pocket.

In his book, Eagleman is less certain that free will doesn’t exist in some form, but ponders what this current vision of mind and brain means for crime and punishment: If we really don’t choose our actions, how can we blame criminals for the havoc and pain they cause?

Schwartz refers to all these arguments as “unhealthy” and “damaging,” especially to the dignity of his OCD patients and the hard work they put in to reclaim the hours and minutes of their lives. “They describe a struggle,” he says of his clients. “They sit there, sweating, shifting their attention away from the compulsion and toward some healthy new behavior.”

His influence might aid them for a short time, he allows, but his patients go home for a week or two to fight OCD on their own. In a purely neurological sense, if determinism held sway, his patients have no free will and no hope. The scans themselves, he says, suggest free will is alive and well.

Schwartz believes free will is so powerful it literally influences our evolution. In 2004 he even added his signature to The Discovery Institute’s “Scientific Dissent From Darwinism,” which supports the heretical concept of intelligent design. While Schwartz believes in evolution, he says that the mechanism of neuroplasticity, which changes the shape of our brains, has likely shaped human evolution, too. In his contentious style, he had made his views clear.

Nothing to Hide

My visit is almost over, and on Sunday Jeffrey Schwartz takes me with him to church. “This is who I am. I have nothing to hide,” says the Jew turned Buddhist turned Christian. As the church band unwinds one tune after another, it is a surprise to hear Jeffrey Schwartz — a man who spends so much time arguing — raise his voice for some other purpose: to sing. Schwartz’s instrument is imperfect, maintaining only an intermittent connection to the proper key, but it is strong and surprisingly smooth.

As the band performs the final song of the service, a gently rocking treatment of “How Great Thou Art,” Schwartz hits the crescendo at a volume that suggests his depth of conviction, his voice keening out over the rest of the people nearby.

The music ends, then, and Schwartz breaks into a buoyant grin, transformed into a portrait of something unexpected: a man at peace with his choices.

[blockquote style=”3″]It’s not me! It’s my OCD![/blockquote]

In these earliest days, Schwartz didn’t really know where he was going, only his starting point. And what he asked of his clients was truly dramatic: He asked them to recognize an OCD-related thought as soon as possible and relabel it as unreal — merely a symptom of their OCD — without giving in to it. The group responded enthusiastically, but things took off after an older woman in the group, Dottie, suddenly exclaimed: “It’s not me! It’s my OCD!”

This became a rallying cry for the group. And Schwartz realized he’d found his first step, relabeling.

If a patient suffered from a constant obsession with dirty hands and a compulsion to wash them, Schwartz advised the patient to think: This is not an urge to wash my hands. This is a bothersome thought brought about by my OCD. As soon as he hit on this method, his patients came back the next week and reported improvement, claiming they no longer felt the disease controlled them.

Yet they were still symptomatic, and the symptoms interfered with their lives. Weeks in, as his patient group reported for another session, one of them asked, “Doc, can you just tell me why the damn thing keeps bothering me — why it doesn’t go away?” Schwartz happened to be carrying around some brain scans of OCD patients in a folder. “You want to know why it doesn’t go away?” Schwartz said. “I’ll show you why.”

Retrieving the scans with a flourish, he pointed to the OCD circuit he’d worked with Baxter to establish. “This region of the brain is hugely overactive,” he said, and then Pop! He saw a change in his patient’s face and the excitement in everyone listening. Paula was one of the patients who experienced this eureka moment and felt liberated. These strange thoughts about her boyfriend’s drug addiction were no longer a sign of insanity. They were no longer even a product of her self. They were just the faulty transmissions of a malfunctioning brain.

Schwartz felt the energy in the room rise, and he saw the previously defeated men and women of his OCD group rally and strengthen as surely as if they had just inexplicably gained more muscle tone. This became the second step: reattribute. He was teaching his patients to reattribute their OCD symptoms to some gnarled brain wiring, teaching them to see the functioning of their brain as meaningfully separate from their sense of self.

Over the following weeks, patients started to report victories regularly. At first these wins were small. Paula could hold off on questioning her boyfriend about his day for longer periods — first minutes, then an hour or more. She could get by while asking fewer questions. But as time passed, the patients reported something more remarkable: The intrusive thoughts of OCD were diminishing, occurring less frequently, and coming on with less power.

Schwartz believed that this was because his patients were in fact using the power of their minds to rewire their adult brains — a finding at odds with the view in those days that only children’s brains could go through such enormous change.

One evening, while out of the office, Schwartz realized his patients needed more to do, something to focus on besides the intrusive thoughts of OCD. He thought back over the practice of mindfulness and found an analogy he liked. In meditation, if he became emotionally invested in a particular train of thought, he sought to refocus himself by drawing his attention back to his breathing.

Using that same concept, he gave his patients license to replace monitoring their breath with whatever behavior they found most compelling. Some patients found it helpful to turn back to the same healthy behavior each time an OCD episode struck: going for a walk, perhaps, or gardening.

Schwartz had found three steps — relabel, reattribute and, now, refocus.

But he needed a final step, something to pull them all together. He called that step revaluing. The OCD thoughts that patients once considered so important were to be systematically deconstructed, understood and finally revalued as, in Schwartz’s words, “trash … not worth the gray matter they rode in on.” Conversely, Schwartz’s patients learned to value their alternative behavior highly.

Schwartz’s four steps worked, but it wasn’t easy. It took, and these words struck Schwartz as key, a tremendous force of will.

The Rewired Brain

Eventually Schwartz began to feel he was seeing free will in action: the people under his care choosing, again and again, to engage in a new behavior. But he needed to wait and see if that evidence would turn up in a brain scan. And after 10 weeks of treatment in the four steps, it was time.

His patients, their brains imaged before any treatment began, entered the hulking scanners a second time. Baxter crunched the data and told him the news: The amount of activity in these patients’ OCD circuits had decreased to a degree commensurate with the best results achieved by pharmaceutical therapy. The OCD circuit, so brightly lit in the baseline scans of his OCD sufferers, now glowed more softly.

Schwartz published his findings in 1992 and replicated them in 1996, adding nuance to our notion of adult neuroplasticity. But the ensuing years, have brought a host of theorists and tracts undermining free will — and the modus operandi of Schwartz’s therapy for OCD.

Neuroscientists Sam Harris and David Eagleman published books on the topic in the past couple of years, both of which made best-seller lists. Harris is unequivocal, referring to humankind as “biochemical puppets.” In his view, we can choose our path in life no more than the eight ball can choose whether or not to fall into the corner pocket.

In his book, Eagleman is less certain that free will doesn’t exist in some form, but ponders what this current vision of mind and brain means for crime and punishment: If we really don’t choose our actions, how can we blame criminals for the havoc and pain they cause?

Schwartz refers to all these arguments as “unhealthy” and “damaging,” especially to the dignity of his OCD patients and the hard work they put in to reclaim the hours and minutes of their lives. “They describe a struggle,” he says of his clients. “They sit there, sweating, shifting their attention away from the compulsion and toward some healthy new behavior.”

His influence might aid them for a short time, he allows, but his patients go home for a week or two to fight OCD on their own. In a purely neurological sense, if determinism held sway, his patients have no free will and no hope. The scans themselves, he says, suggest free will is alive and well.

Schwartz believes free will is so powerful it literally influences our evolution. In 2004 he even added his signature to The Discovery Institute’s “Scientific Dissent From Darwinism,” which supports the heretical concept of intelligent design. While Schwartz believes in evolution, he says that the mechanism of neuroplasticity, which changes the shape of our brains, has likely shaped human evolution, too. In his contentious style, he had made his views clear.

Nothing to Hide

My visit is almost over, and on Sunday Jeffrey Schwartz takes me with him to church. “This is who I am. I have nothing to hide,” says the Jew turned Buddhist turned Christian. As the church band unwinds one tune after another, it is a surprise to hear Jeffrey Schwartz — a man who spends so much time arguing — raise his voice for some other purpose: to sing. Schwartz’s instrument is imperfect, maintaining only an intermittent connection to the proper key, but it is strong and surprisingly smooth.

As the band performs the final song of the service, a gently rocking treatment of “How Great Thou Art,” Schwartz hits the crescendo at a volume that suggests his depth of conviction, his voice keening out over the rest of the people nearby.

The music ends, then, and Schwartz breaks into a buoyant grin, transformed into a portrait of something unexpected: a man at peace with his choices.

Continued from Rewiring the Brain to Treat OCD – Part 1

Source: Discover

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