THE GREATER GOOD PERSPECTIVE SHIFT (GGPS)

The Greater Good Perspective Shift (GGPS) is a simple but powerful concept allowing people with OCD and others battling severe doubt to reframe their decision-making… even in the throes of great anxiety.  At its core are the following basic assumptions:

> Because an OCD sufferer's world is black and white, so too are the "default" choices he/she weighs: "right" vs. "wrong" or "good" vs. "bad."

> As seen through the distorted lenses of OCD… "good" choices are those that reduce fear and alleviate doubt; "bad" choices are those that increase fear and introduce doubt.

> Because compulsions (temporarily) reduce fear and/or doubt, they are almost always seen as "good" choices.

> A "Greater Good" framework acknowledges the perceived (though distorted) "good" of acting on compulsions, but also introduces a "greater good" choice—one that, in some way, serves purposes larger than OCD and tends to benefit others and/or enhance one's own sense of purpose.

> Because "purpose and service" tend to trump "fear and doubt" as human motivators (our contention!!), this framework shift serves to lead OCD sufferers to far more productive decisions… including those essential to tackling traditional ERP therapy.

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ABOUT OCD:

Obsessive Compulsive Disorder (OCD) is diagnosed when an individual has intrusive thoughts, images, or impulses (obsessions) that they find distressing, uncomfortable, and often times, intolerable. In an attempt to neutralize, or make these obsessions go away, behaviors are created (compulsions). Unfortunately, the compulsions, while providing temporary relief, do nothing to make the obsession, which is typically based in fear, go away. The compulsion actually acts to reinforce the condition of OCD, and what begins to emerge is patterned behaviors that can eventually run, even devastate, one’s life. As such, a formal diagnosis is made only when the symptoms are interfering or impacting one’s daily activities, social or interpersonal relationships, and/or educational/vocational endeavors. This is an important note, as many people can have symptoms of OCD, yet not have a diagnosis of OCD.

OCD can take on a variety of forms, including those most frequently spotlighted in the mainstream media: checking and washing. We, however, feel it’s important to stress that there is no typical way in which OCD manifests itself. It has many faces and disguises and can surface in ways that many would not believe. For instance, imagine waking up in the middle of the night and suddenly having the fear that you might stab your spouse. Most can expect that thought would be terrifying. Let’s think about the person that’s afraid that if he doesn’t "confess" every sin to God, or his "higher power," that he will be damned to eternal hell. How about the person that fears if she doesn’t walk through the same door she entered that someone she loves will die? These are just some of the examples of what OCD can look like.

What’s important to remember--and this is key--most people have intrusive thoughts that bother them. In fact, it is considered to be quite rare, if not highly improbable, for people not to experience some form of intrusive thoughts in their lives. In this context, the thought is in one’s awareness, but it tends to disappear just as quickly as it entered. There is no feeling attached to the thought. It is, in essence, harmless. What makes OCD sufferers different is that they question their thoughts, and begin to "doubt" whether what they fear might actually come true. Consequently the fear, which is now in experienced as being in the realm of possibility, needs to be extinguished, which in OCD, is channeled through compulsions. Unfortunately, because the feared consequences are irrational, illogical, and improbable, the compulsions do nothing to reduce the fear.  So, because OCD is rooted in a physiologically-based chemical imbalance, the fear remains, and the more compulsions one does, the more those compulsions actually feed the condition. Hence, the world of the OCD sufferer becomes increasingly limited, and ultimately controlled by compulsions.

We would like to note some important points.

• There is no case history of anyone with a diagnosis of OCD who has actually acted on a feared thought or impulse.

• OCD is only diagnosed when one recognizes his/her obsessions as being irrational and illogical. If one believes in the feared thoughts, then other diagnoses should be considered.

• There is no such thing as "Pure O," meaning obsessions without compulsions. When one is obsessing, one is actually compulsing.

• OCD is treatable.

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ABOUT ERP:

Exposure and Response Prevention (ERP) techniques are based in Cognitive Behavioral Therapy (CBT). While this approach can be enhanced with the implementation of medications, many people benefit from therapy alone. Cognitive Behavioral Therapy (CBT) has two components. First, it helps to change thinking patterns (cognitions) that have prevented individuals from overcoming their fears. And second, the behavioral component helps individuals to slowly come in contact with their fears. This is done through Exposure and Response Prevention Therapy (ERP) and is designed to systematically desensitize one to his/her fears. This evidence-based treatment is exceptionally effective and produces remarkable results, allowing individuals to learn that they can successfully face their fears. Repeatedly facing one’s fears and learning to manage the uncomfortable feelings and thoughts associated with these fears allows the anxiety to gradually fade away. Situations in which the fears may have caused anxiety that was paralyzing can become manageable. The person learns he can choose to "flee" or "fight", and what was once a "flight" response may become nothing more than an acknowledgement of the fear.

Here's how it works. The first step is to make a list of triggers. This may include objects, people, situations, words, images, and thoughts. For some, these lists will be quite long and extensive. Next, we explore the list of triggers and look to find those that produce the least amount of anxiety, which will be our starting point. We rate the triggers on a scale of 1 to 10. A "10" would be at the top and potentially create panic if exposed to it too soon; a "1" would be in the range of manageable. Once the first exposure is determined, the approach to the exposure is discussed. If it involves an object, the individual may not be ready to touch it, and may simply need to spend some time looking at it. The next step is to move the object closer until the individual is ready to come in contact with it (exposure). Then, the key will be to make sure there will be no compulsions, either during or after the exposure (ritual prevention). This process is then continued up the hierarchy until all feared objects, thoughts, or impulses are addressed.


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ANXIETY AND RELATED DISORDERS :

The following are common anxiety conditions and related disorders.

Obsessive-Compulsive Disorder (OCD) is anxiety from intrusive thoughts, images, or impulses (obsessions) that trigger repetitive behaviors (compulsions) that one feels driven to perform.

Social Phobia (Social Anxiety Disorder/SAD) is a fear of being in social situations in which an individual anticipates that he/she will feel overwhelmingly self-conscious, judged, scrutinized or criticized by others, or do something embarrassing that makes him/her want to avoid these social situations.

Panic Disorder occurs when one has recurrent, unexpected panic attacks that strike suddenly and produce a feeling of terror. The attacks cause physical symptoms that may include pounding heart, sweating, shaking, trembling, shortness of breath, and/or a fear of losing control or going crazy. Agoraphobia occurs when there is anxiety about being in situations that may trigger a panic attack where escape might not be possible. These situations are then avoided.

Generalized Anxiety Disorder (GAD) is excessive worry and anxiety about everyday events or activities (work, school, family, etc.). Daily, the sufferer finds it very difficult to manage or control the worry.

Posttraumatic Stress Disorder (PTSD) occurs when a person either witnesses or experiences a traumatic event that causes intense anxiety and feelings as if they are reexperiencing the trauma. This can result in nightmares, avoidance of situations that remind them of the event, difficulty focusing and concentrating, sleep disturbance, exaggerated startle response, and other symptoms.

Specific Phobia is an excessive fear, either in the presence of an object or situation, or anticipation of the object or situation, that is unreasonable. For example, fear of flying, spiders, rodents, heights, etc.

Body Dysmorphic Disorder (BDD) is a preoccupation with a physical aspect or part of their body that they feel is defective. This defect is imagined or exaggerated, and not observable by others. This concern leads them to avoid social situations due to fear of what people will think of them.

Hoarding/Saving behaviors occur when an individual saves/collects items or objects that are seemingly useless or unnecessary. To discard these items produces intense anxiety resulting in his/her home becoming overwhelmingly cluttered. 

Hypochondriasis occurs when bodily symptoms are misinterpreted and an individual develops a preoccupation with ideas and fears that they have a serious medical condition/illness, despite medical tests, evidence, and reassurance to the contrary.

Separation-Anxiety occurs in individuals who have excessive anxiety when separated from their home or important people to whom they are strongly attached. This can result in crying spells, refusal to go to school or sleep alone, nightmares, or worry that something might happen when away from home or separated.

Trichotillomania occurs when there is recurrent pulling of one’s hair resulting in a noticeable hair loss.

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Copyright (C) 2009.  Jeff Bell.  All rights reserved