Psychological approaches to addressing compulsive behaviours
May 17, 2016 3:02 PM Subscribe
Hi, can anyone point me to those? Not interested in pharmacological approaches. Bit more detail inside
Not talking about ritualized compulsions, or elaborated existential anxieties (or these are not the point of interest here). Interested in approaches looking more at more or less complex behaviours as compulsions, i.e. habits relating to impulse control. Interested in more *behavioural* theories / approaches that have been shown to be effective.
Example of a simple compulsion, onychophagia; tx = deterrents; managing the trigger (smoothing the nailbed, etc)
Example of complex behaviours of interest: internet use, smoking. You're maybe saying, ok, that is nothing like nail biting, obviously there's avoidance etc. happening, multiple factors at play. Acknowledged; interested in behavioural approaches, anyway :/
Bottom line slant I am interested in - difficulty stopping a rewarding behaviour in the absence of an internal sense of "completeness", and approaches that address that via behavioural methods.
Types of answers sought: resources - articles; names of people looking at these types of behaviours that way.
Not talking about ritualized compulsions, or elaborated existential anxieties (or these are not the point of interest here). Interested in approaches looking more at more or less complex behaviours as compulsions, i.e. habits relating to impulse control. Interested in more *behavioural* theories / approaches that have been shown to be effective.
Example of a simple compulsion, onychophagia; tx = deterrents; managing the trigger (smoothing the nailbed, etc)
Example of complex behaviours of interest: internet use, smoking. You're maybe saying, ok, that is nothing like nail biting, obviously there's avoidance etc. happening, multiple factors at play. Acknowledged; interested in behavioural approaches, anyway :/
Bottom line slant I am interested in - difficulty stopping a rewarding behaviour in the absence of an internal sense of "completeness", and approaches that address that via behavioural methods.
Types of answers sought: resources - articles; names of people looking at these types of behaviours that way.
The Mind and the Brain: Neuroplasticity and the Power of Mental Force taught me a lot about compulsive behavior and how the main author developed an alternative to exposure therapy for his patients in group therapy for OCD. I also found The Willpower Instinct and The Power of Habit, by a New York Times reporter, helpful. The latter two books are for a more general audience and focus more on changing bad habits and establishing good ones rather than compulsive behavior specifically. My main takeaway from The Mind and the Brain was the critical importance of setting up a healthy (or at least, less damaging) behavior to replace the harmful behavior. In the OCD group one of the patients kept knitting nearby so whenever she felt the compulsion to do X she would reach for her knitting instead. Sounds easy; as I'm sure you know, it's not. I can't remember that much about The Willpower Instinct (apart from thinking it was useful). What I remember about the Power of Habit was the author's unhappiness with a workday mid-afternoon cookie break. He tried to figure out why he wanted that cookie break and figured out/decided that it was socializing rather than sugar. So he came up with alternative behavior to address the socialization part that didn't involve a cookie. This stuff is hard. Best of luck!
posted by Bella Donna at 3:31 PM on May 17, 2016 [1 favorite]
posted by Bella Donna at 3:31 PM on May 17, 2016 [1 favorite]
Unbroken Brain: a Revolutionary New Way of Understanding Addiction by Maia Szalavitz.
posted by Violet Hour at 4:09 PM on May 17, 2016 [2 favorites]
posted by Violet Hour at 4:09 PM on May 17, 2016 [2 favorites]
Response by poster: Thank you for your answers! Looking forward to reading :)
So I did wind up poking around a bit... Without going into too much detail, I am thinking this might be relevant (source; related). Both diagnoses have actually been floated. Don't quite fit either; both seem to apply, partially. Drugs not on table for reasons.
posted by cotton dress sock at 5:01 PM on May 17, 2016
So I did wind up poking around a bit... Without going into too much detail, I am thinking this might be relevant (source; related). Both diagnoses have actually been floated. Don't quite fit either; both seem to apply, partially. Drugs not on table for reasons.
posted by cotton dress sock at 5:01 PM on May 17, 2016
Exposure and Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), and Rational-Emotive Behavior Therapy (REBT, SMART Recovery) all might be worth looking into.
Personally, the thing I like about ACT and other mindfulness-based approaches is that practicing mindfulness can help both ADHD and OCD/anxiety sufferers, by strengthening attention, improving your ability to notice urges and eventually put more space between urges and actions, and living with the discomfort that often results when you stop doing something compulsive. So you don't necessarily have to figure out which part is more important ahead of time.
posted by en forme de poire at 9:31 PM on May 17, 2016 [1 favorite]
Personally, the thing I like about ACT and other mindfulness-based approaches is that practicing mindfulness can help both ADHD and OCD/anxiety sufferers, by strengthening attention, improving your ability to notice urges and eventually put more space between urges and actions, and living with the discomfort that often results when you stop doing something compulsive. So you don't necessarily have to figure out which part is more important ahead of time.
posted by en forme de poire at 9:31 PM on May 17, 2016 [1 favorite]
Someone in my family is currently getting treatment at the OCD Institute at McLeans Hospital; it's the gold standard of treatment.
Two important things they've learned: while mindfulness is helpful for most people, it's a Very Bad Idea for people with compulsive behaviors because it gives them permission to get stuck in their heads when they really need to get out of their heads and get on with life.
Instead, the #1 way of dealing with the behavior is to acknowledge it then get back to whatever it is you were doing. Don't overthink it. You just say, "Hey, I was just about to do whatever compulsive thing, but right now I'm watching 'The Office' so I'm going to focus on how bad season 5 is."
And over time, you will build muscle memory (sort of) that recognizes when you want to do ______, it's easier and easier to ignore as you get back to whatever it was you were doing.
Granted, none of this is easy and it's very hard work. Getting Control is a helpful book, as is Imp of the Mind.
posted by yes I said yes I will Yes at 5:37 AM on May 18, 2016 [2 favorites]
Two important things they've learned: while mindfulness is helpful for most people, it's a Very Bad Idea for people with compulsive behaviors because it gives them permission to get stuck in their heads when they really need to get out of their heads and get on with life.
Instead, the #1 way of dealing with the behavior is to acknowledge it then get back to whatever it is you were doing. Don't overthink it. You just say, "Hey, I was just about to do whatever compulsive thing, but right now I'm watching 'The Office' so I'm going to focus on how bad season 5 is."
And over time, you will build muscle memory (sort of) that recognizes when you want to do ______, it's easier and easier to ignore as you get back to whatever it was you were doing.
Granted, none of this is easy and it's very hard work. Getting Control is a helpful book, as is Imp of the Mind.
posted by yes I said yes I will Yes at 5:37 AM on May 18, 2016 [2 favorites]
Instead, the #1 way of dealing with the behavior is to acknowledge it then get back to whatever it is you were doing.
It's interesting that you say that, because I would literally describe what you just mentioned as a mindfulness exercise -- naming/accepting thoughts and urges and then redirecting attention to the present moment is one of the core techniques of mindfulness practice. There's also a workbook specifically for mindfulness-based OCD treatments that has been endorsed by the co-founder of the McLeans Center (who wrote Getting Control), so my impression is that it is not generally thought to be off-limits or ineffective for people sufferering from OCD. I do think it's important to get information about mindfulness from a clinician who's experienced in using it and knows what the common pitfalls are, though, whether that's in the form of a book or better yet, a therapist.
posted by en forme de poire at 1:21 PM on May 18, 2016 [1 favorite]
It's interesting that you say that, because I would literally describe what you just mentioned as a mindfulness exercise -- naming/accepting thoughts and urges and then redirecting attention to the present moment is one of the core techniques of mindfulness practice. There's also a workbook specifically for mindfulness-based OCD treatments that has been endorsed by the co-founder of the McLeans Center (who wrote Getting Control), so my impression is that it is not generally thought to be off-limits or ineffective for people sufferering from OCD. I do think it's important to get information about mindfulness from a clinician who's experienced in using it and knows what the common pitfalls are, though, whether that's in the form of a book or better yet, a therapist.
posted by en forme de poire at 1:21 PM on May 18, 2016 [1 favorite]
Response by poster: Thanks guys, interesting conversation!
(It's not so much about intrusive, fearful thoughts - it's getting stuck in an engaging, rewarding activity and a) not noticing time passing, b) feeling like I don't want to stop doing activity X until I'm satisfied it's done (to a particular standard, or until it just feels right), or until I tire out, c) noticing that I need to attend to a different activity and stopping activity X. Compulsions: mostly just compulsively pursuing X until N time (hours sometimes). Nail biting - this is a symmetry thing, I think. Smoking - it's been suggested (by mefites here, as well as by my pdoc) that this is in part an attempt to regulate attention (I smoke more - lots more - when writing, for e.g.).
posted by cotton dress sock at 2:03 PM on May 18, 2016
(It's not so much about intrusive, fearful thoughts - it's getting stuck in an engaging, rewarding activity and a) not noticing time passing, b) feeling like I don't want to stop doing activity X until I'm satisfied it's done (to a particular standard, or until it just feels right), or until I tire out, c) noticing that I need to attend to a different activity and stopping activity X. Compulsions: mostly just compulsively pursuing X until N time (hours sometimes). Nail biting - this is a symmetry thing, I think. Smoking - it's been suggested (by mefites here, as well as by my pdoc) that this is in part an attempt to regulate attention (I smoke more - lots more - when writing, for e.g.).
posted by cotton dress sock at 2:03 PM on May 18, 2016
I would literally describe what you just mentioned as a mindfulness exercise -- naming/accepting thoughts and urges and then redirecting attention to the present moment is one of the core techniques of mindfulness practice
Yeah, I thought so too. The way it was explained to me is that their focus is as briefly as possible recognizing a thought and then immediately connecting back to the present whereas some mindfulness exercises have a person recognize a thought and sit with it. Then by sitting with it they see it's only a thought, etc. and that's what they said is really unhealthy for people with OCD. So they try to avoid the terminology of mindfulness exercises for that reason.
it's getting stuck in an engaging, rewarding activity and a) not noticing time passing, b) feeling like I don't want to stop doing activity X until I'm satisfied it's done (to a particular standard, or until it just feels right),
CDS, what you're describing is pretty much the definition of an intrusive thought. Having to do something until it feels right would be considered a behavior caused by that intrusive thought.
posted by yes I said yes I will Yes at 6:07 AM on May 21, 2016 [1 favorite]
Yeah, I thought so too. The way it was explained to me is that their focus is as briefly as possible recognizing a thought and then immediately connecting back to the present whereas some mindfulness exercises have a person recognize a thought and sit with it. Then by sitting with it they see it's only a thought, etc. and that's what they said is really unhealthy for people with OCD. So they try to avoid the terminology of mindfulness exercises for that reason.
it's getting stuck in an engaging, rewarding activity and a) not noticing time passing, b) feeling like I don't want to stop doing activity X until I'm satisfied it's done (to a particular standard, or until it just feels right),
CDS, what you're describing is pretty much the definition of an intrusive thought. Having to do something until it feels right would be considered a behavior caused by that intrusive thought.
posted by yes I said yes I will Yes at 6:07 AM on May 21, 2016 [1 favorite]
Ah, that makes a lot of sense! Thanks for explaining that :)
posted by en forme de poire at 3:10 PM on May 21, 2016 [1 favorite]
posted by en forme de poire at 3:10 PM on May 21, 2016 [1 favorite]
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posted by cotton dress sock at 3:13 PM on May 17, 2016