I am a girl with severe obsessive-compulsive disorder. When I wash my hands, I can count, up to more than 1 times, which is a waste of water. What should I do?

Hello: The treatment of obsessive-compulsive disorder is generally combined with medication and psychotherapy, which can produce good results. 1. Psychotherapy The purpose of psychotherapy is to make patients have a correct and objective understanding of their own personality characteristics and diseases, a correct and objective judgment of the surrounding environment and the actual situation, and to get rid of mental burdens to reduce their sense of insecurity; Learn reasonable stress methods, enhance self-confidence and reduce their uncertainty; Don't aim too high, but don't overdo it, so as to reduce its sense of imperfection. At the same time, mobilize their relatives and colleagues to neither tolerate nor overcorrect patients, and help patients actively engage in sports, entertainment and social activities, so that they can gradually get rid of the situation of indulging in exhaustion. Behavioral therapy, cognitive therapy and psychoanalytic therapy can all be used for obsessive-compulsive disorder. Systematic desensitization therapy can gradually reduce the number and time of patients' repetitive behavior. For example, when treating a patient with forced hand washing, it is stipulated that hand washing should not exceed 2 minutes each time in the first week and not exceed 5 times a day; No more than 15 minutes each time in the second week, no more than 3 times a day; Then it will decrease in turn. If you are anxious, you will relax and be quiet. Every time the hand washing time is reduced, the patient has anxiety at first. In addition to teaching the patient to relax muscles, diazepam and propranolol can also be used to alleviate anxiety. The aversion therapy of snapping the arm to treat obsessive-compulsive concept can be tried for those who are ineffective in drug treatment. When the patient presents some uncontrollable concept, he will snap his arm with his hand stretching the rubber band for dozens or even hundreds of times until the concept can be suppressed. 2. Tricyclic drugs are mainly used in drug treatment, and clomipramine is the most commonly used. The daily dosage is 15 mg ~ 3 mg, taken twice. Generally, it takes 2 ~ 3 weeks to start to take effect, and it must start with a small dose. Those who are ineffective after 4 ~ 6 weeks can consider switching to other drugs or combining them, and the general treatment time should not be shorter than 3 ~ 6 months. Fluoxetine and paroxetine of SSRIs can also be used to treat obsessive-compulsive disorder, with similar effects as tricyclic drugs, but with fewer side effects. In addition, people with obsessive-compulsive disorder and serious anxiety can be combined with benzodiazepines, such as clonazepam; For refractory obsessive-compulsive disorder, mood stabilizers such as carbamazepine or sodium valproate can be combined. I hope you get well soon!

Research shows that "exposure and non-reaction" is an effective method to treat obsessive-compulsive disorder. Besides, under the professional guidance, OCD patients learn how to expose themselves under the stimulation of compulsive thoughts. And learn how to resist compulsive thoughts and impulses. For example, instructing a patient who is too afraid of being dirty to touch dirty things and not to wash his hands is called "exposure and non-reaction". You will learn to avoid habitual compulsive behavior and replace it with new and healthy behavior.

This manual basically lets you know how compulsive thoughts and behaviors come from, and you can learn how to deal with anxiety and fear caused by obsessive-compulsive disorder. Dealing with your fears properly can make behavioral therapy more effective. The four steps to be emphasized here are as follows:

Step one, reconfirmation

The most important step is to learn to "recognize" the thoughts and actions of obsessive-compulsive disorder. Maybe you don't want to do this step at all, but you must work hard and be fully aware so as to understand that the trouble at the moment comes from compulsive thoughts or behaviors.

everyday awareness is almost automatic and superficial. "Wholehearted awareness" is deeper and more careful, and it can only be achieved through dedicated efforts. Remember that it may take weeks or months to change the biochemical changes in the brain to reduce obsessive-compulsive impulses. If you want to get rid of these obsessive-compulsive symptoms in a few minutes or seconds, you will be disappointed! In fact, it will make obsessive-compulsive symptoms worse! In behavioral therapy, you should learn to control yourself from responding to compulsive thoughts, no matter how disturbing they are. The goal is to control your reaction to obsessive-compulsive symptoms, not to control compulsive thinking or impulsiveness.

The next two steps are to help you learn new ways to control your behavioral response to obsessive-compulsive symptoms.

Step 2: Attribution

Say to yourself, "It's not me, it's obsessive-compulsive disorder! Obsessive thinking is meaningless, it is a wrong message from the brain. You should deeply understand why the rush to check or "why my hands are dirty" is so powerful that people can't bear it. If you know these ideas are unreasonable, then why do you react to them? Understanding why compulsive thinking is so strong and why you can't get rid of it is an important key to strengthen your willpower and strengthen your resistance to compulsive behavior. The goal of this stage is to learn "re-attribution": the source of forced thoughts comes from the biochemical imbalance of the brain.

There is a place in the brain called the "Cephalic Nucleus", which is the place where you get sick and get obsessive-compulsive disorder. The head nucleus is a place to filter information, just like the transmission of a car. It receives information from the forebrain, which is a place for planning, thinking and understanding. If there is a disorder in the cephalic nucleus, there will be obsessive-compulsive symptoms, so the thinking action will not be smooth. The forebrain becomes too active and uses too much energy, just like a car stuck in the mud, constantly turning the tires, but it gets deeper and deeper. The part of the forebrain is called the frontal cortex of the eye, which is stuck in the mud because of the wrong detection of reflux. This may be the reason why obsessive-compulsive disorder makes people feel "something strange and lingering". You must get this car out of the mud. Use manual gear instead of automatic gear to repair the faulty transmission. We now know that we can change the biochemical balance of the brain, which takes weeks and months. At this time, understanding the role of the brain in causing obsessive-compulsive disorder will help to avoid the most frustrating incorrect idea of "trying to completely get rid of obsessive-compulsive symptoms." Although you can't make a big change right away, remember: "You don't have to react to obsessive-compulsive symptoms right away! The most effective way is to learn to put aside forced thoughts and feelings and then do other things, so as to help yourself and change the biochemical reaction of the brain.

this is what we call "shifting gears": doing other behaviors! If you try to get rid of forced thinking, it will only increase your stress troubles, and stress will make obsessive-compulsive disorder worse.

Using "attribution again" can help you avoid using ritual behavior to make yourself feel better, such as feeling complete. If you know that these forced thoughts come from the imbalance of brain biochemistry, you can learn to ignore these impulses and continue to do what you should do. Remember: "that's not me, that's obsessive-compulsive disorder!" If you resist following impulses or resisting reactions, you will change your brain and reduce the feeling of obsessive-compulsive disorder. If you react to the impulse, you may be relieved for a while, but soon, the impulse is bound to get worse. This may be the lesson that OCD patients need to learn most! That will help you avoid being a nerd or being taken in by obsessive-compulsive disorder.

"Reconfirmation" and "Re-attribution" are often done together, so patients will have a deeper understanding of the causes of obsessive-compulsive disorder. First, I am fully aware that obsessive-compulsive disorder is forcing me, and then I understand that it is caused by pathological changes in the brain.

Step 3: Divert your attention

It's really time to get to work! The initial psychological construction is: no pain, no gain! What you have to do in this step is: you must shift gears yourself! You use your hard work and focused mind to do the natural and easy work of your brain. For example, it is natural for a surgeon to brush his hand before operation from the beginning to the end, and he naturally feels that he has brushed enough. But obsessive-compulsive disorder patients brush again and again, endlessly! The automatic mechanism of his brain has been destroyed. Fortunately, these four steps can repair it.

distraction is to distract attention from obsessive-compulsive symptoms, even for a few minutes. First, choose certain behaviors instead of forced hand washing or inspection. Any interesting and constructive action will do. It is best to engage in your hobbies, such as walking, sports, listening to music, reading, playing computer and basketball.

When you have obsessive-compulsive thinking, you first "re-confirm" that it is obsessive-compulsive thinking or impulse, and "re-attribute" that it comes from your disease-obsessive-compulsive disorder, and then "divert your attention" to do other things. Remember not to get caught up in habitual thinking. You must tell yourself: "My obsessive-compulsive disorder has committed again, and I must do other behaviors." You can decide not to react to compulsive thinking. You should be your own master and not be a slave to obsessive-compulsive disorder!

(1) The fifteen-minute rule:

It is not easy to divert attention. It takes great effort and pain to break down forced thinking and then do what should be done. We use the 15-minute rule, that is, delay the reaction for at least 15 minutes. You can start with a five-minute delay at the beginning. The principle is consistent, that is, never react immediately without delay. Note that this is not a passive waiting for 15 minutes, but we do "reconfirmation", "attribution" and "diversion" during this time. Then you should do other interesting and constructive activities. After a period of time, re-evaluate the impulse of obsessive-compulsive disorder to see if the intensity drops and record it. Even if it drops a little, encourage and reward yourself. Obsessive-compulsive disorder patients often have the mentality of seeking perfection and 1 points, so they are often not satisfied with a little achievement, and always think that they are not doing well enough, so that behavioral therapy cannot succeed. The goal is to delay for more than 15 minutes. As long as you keep practicing, the intensity of obsessive-compulsive disorder will be greatly reduced. Generally speaking, the more you practice, the easier it will be. It will be delayed for 2 minutes or more soon.

(2) As long as you do it, you will gain

It is very important to divert your attention from other things. Don't expect these thoughts or feelings to go away immediately. Don't do what obsessive-compulsive disorder wants you to do. You should stick to the activities you choose, so the compulsive impulse will weaken or even disappear because of your delay. Even if the impulse is hard to change, you will still find that you can control your reaction a little.

Using "whole-hearted awareness" and being a "bystander" will make you more powerful. The long-term goal of this step is not to respond to obsessive-compulsive disorder. The immediate goal is a slight delay before the reaction. Don't let forced thinking decide what you should do when you study.

sometimes the compulsion is so strong that you can't help doing compulsive behavior. But if you keep practicing these four steps, you can expect to change the biochemistry of the brain. Always remind yourself: "It's not that I feel dirty and need to wash my hands, but obsessive-compulsive disorder is affecting me. Obsessive-compulsive disorder won this time, and I will wait longer to react next time! This exercise, even if you finally do compulsive behavior, also contains the elements of behavioral therapy. It is very important to reconfirm that compulsive behavior is an obsessive-compulsive disorder, which is a kind of behavioral therapy, and it is better than just doing compulsive behavior without thinking about it.

Here's a secret for friends who resist compulsive inspection: If your difficulty is to check the door lock, please try to lock the door wholeheartedly. Be aware of the inner impulse to lock the door, and then lock the door carefully and slowly, so that this action is deeply remembered, for example, "This door is locked now, I see the door is locked!" You get a deep impression that the door is locked, so when you are forced to check the door lock, you can immediately "reconfirm", that is: that is obsessive-compulsive thinking, that is obsessive-compulsive disorder! You can "re-attribute" that is: it's not me, it's just my brain! You can divert your attention from other things and make sure that you have locked the door carefully.

(3) Recording behavior therapy

It is also very important to record successful distracting behaviors, because you can go back and see what behaviors are most helpful for your distraction. When the listed projects achieve the expected results, it can help you build confidence. Recording can help you "shift gears" when obsessive-compulsive symptoms are severe, and train yourself to remember what you have done in the past. The more successful experience you have, the more you are encouraged.

only record the successful experience, not the failed experience. You must learn to support yourself and give yourself some encouragement, which is of great help to enhance your self-confidence.

Step 4: Re-evaluate

The first three steps are to use the existing knowledge of obsessive-compulsive disorder to help you clarify that obsessive-compulsive disorder is a physical disease, that is, the biochemical imbalance of the brain, instead of being driven by forced thinking, and at the same time shift your attention to constructive behavior. "Reconfirmation" and "re-attribution" are linked together, followed by the step of "diverting attention". The overall strength of these three steps is greater than the sum of the strength of individual steps. The process of "reconfirmation" and "re-attribution" can strengthen "distraction". Before behavioral therapy, you begin to "reevaluate" those compulsive thoughts and impulses. After the first three steps are properly trained, the value of compulsive thoughts and impulses can be reduced in time.

We use the concept of "partial observer" developed by 18th century philosopher Adam Smith to help you understand the implementation of the four steps more clearly. Smith described that some observers are part of us, just like another observer in our hearts, who knows our feelings and state. When we want to strengthen this part of the observer, we can call him out to observe his behavior at any time. In other words, we can witness our actions and feelings as bystanders. As Smith described it, "We are observers of our own actions.

patients with obsessive-compulsive disorder must try to deal with obsessive-compulsive symptoms. You must strive to maintain the role of bystander, so that you can resist pathological impulses until they disappear. You must understand that obsessive-compulsive symptoms are meaningless and come from the wrong information in your brain, so you must divert your attention and shift gears. You must concentrate all your efforts and always remember: "this is not me, this is my obsessive-compulsive disorder!" Although you can't change your feelings for a while, you can change your behavior. By changing your behavior, you will find that your feelings will also change.

The ultimate goal of reevaluation is to devalue obsessive-compulsive symptoms and not dance with them.

There are two key points:

First, be psychologically prepared: that is, know that the feeling of obsessive-compulsive disorder is coming, and be prepared to bear it, and don't be frightened.

second, accept it: when you have obsessive-compulsive symptoms, don't waste your energy blaming yourself. You know where the symptoms come from, and you know how to deal with them. No matter what the content of obsessive-compulsive symptoms is, whether it is violence or sex, you know that these symptoms will happen hundreds of times a day. You don't have to respond every time, as if it were an unpredictable new idea. Refuse to let it hit you, refuse to let it beat you. By mentally preparing for the compulsive idea, you can immediately identify it and do the work of attribution. You can also do re-evaluation work. When obsessive-compulsive disorder occurs, you are already mentally prepared.

You will know: "That's my ridiculous compulsion. It's meaningless. It's just an obstacle to my brain. Don't pay attention to it. You can learn to jump to the next action, and you don't have to stay in this thinking. The next step is to "accept" the results of obsessive-compulsive disorder. Don't blame yourself for weak willpower. In fact, this is all caused by the imbalance of the brain and has nothing to do with you. Avoid all negative and critical thoughts, such as, "How bad people are who have such obsessive-compulsive thoughts, ..."

People with obsessive-compulsive disorder must exercise their minds and don't think according to obsessive-compulsive feelings.