The Four Steps - Brain Lock

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In the 1990s, Dr Jeffrey Schwartz made the discovery that a four-step cognitive behavioural therapy he pioneered is capable of changing the activity in a specific brain circuit of patients with obsessive-compulsive disorder. After publishing his findings in scientific journals in the mid-1990s, Dr Schwartz used his discovery (which is becoming a widely utilised treatment for OCD and has been corroborated by other research teams) as the basis for his book Brain Lock which leads readers through the four-step Cognitive-Behavioural Therapy that he devised to treat OCD.

OCD-UK believe the Brain Lock book is an invaluable tool to help patients whilst waiting for CBT treatment to begin.


The Four Steps

By Dr Jeffrey Schwartz

Watch our video introductory overview of the Four Steps treatment method for OCD. (Length - 34:47).

If you have obsessive thoughts and compulsive behaviours, you will be relieved to learn of significant advances in the treatment of this condition. Over the past twenty years, behaviour therapy has been shown to be extremely effective in treating obsessive-compulsive disorder (OCD).

The concept of self-treatment as part of a behavioural therapy approach is a major advance. In this manual, I will teach you how to become your own behavioural therapist. By learning some basic facts about OCD, and recognising that it is a medical condition that responds to treatment, you will be able to overcome the urges to do compulsive behaviours and will master new ways to cope with bothersome, obsessive thoughts.

At UCLA, we call this approach "cognitive-biobehavioral self-treatment." The word cognitive is from the Latin word "to know"; knowledge plays an important role in this approach to teaching basic behaviour therapy techniques. Research has shown that exposure and response prevention are very effective behaviour therapy techniques for treating OCD. In traditional exposure and response prevention, people with OCD learn--under the continuing guidance of a professional therapist--to expose themselves to stimuli that intensify their obsessive thoughts and compulsive urges and then learn how to resist responding to those thoughts and urges in a compulsive manner. For example, people who obsess irrationally about contamination from dirt may be instructed to hold something dirty in their hands and then not wash for at least three hours. We've made some modifications in this method to allow you to do it on your own.

The technique is called response prevention because you learn to prevent your habitual compulsive responses and to replace them with new, more constructive behaviours We call our method "biobehavioural" because we use new knowledge about the biological basis of OCD to help you control your anxious responses and to increase your ability to resist the bothersome symptoms of OCD. Our treatment differs from classic exposure and response prevention in one important way: We have developed a four-step method that enhances your ability to do exposure and response prevention on your own without a therapist being present.

The basic principle is that by understanding what these thoughts and urges really are, you can learn to manage the fear and anxiety that OCD causes. Managing your fear, in turn, will allow you to control your behavioural responses much more effectively. You will use biological knowledge and cognitive awareness to help you perform exposure and response prevention on your own. This strategy has four basic steps:

Step 1: Relabel

Step 2: Reattribute

Step 3: Refocus

Step 4: Revalue

The goal is to perform these steps daily. (The first three steps are especially important at the beginning of treatment.) Self-treatment is an essential part of this technique for learning to manage your responses to OCD on a day-to-day basis. Let's begin by learning the Four Steps.

The Next Chapter: Step 1: Relabel

You may wish to review the Four Steps introduction video (34 minutes) before or after reading the summary and the book Brain Lock.

Source: Brain Lock by Dr Jeffrey Schwartz

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