Reflections on the article “Choice” by Dr. Steven Phillipson

Dr. Phillipson is an OCD specialist and the Clinical Director at the Center for Cognitive Behavioral Psychotherapy in New York. He has written numerous articles on the topic of OCD that are available through his website, https://www.ocdonline.com/articles-phillipson.

 

I highly recommend reading the full article, “Choice,” through the following link: https://www.ocdonline.com/choice

 

You also can listen to Dr. Phillipson being interviewed about the article and more on a recent OCD Stories podcast: http://theocdstories.com/podcast/dr-steven-phillipson-recovery-from-thinking-the-unthinkable/

 

Dr. Phillipson starts his article by describing it as a “call to arms” – and I couldn’t agree more!

 

Of note, although his article focuses on the experience of OCD, the same concepts are equally relevant for those with other anxiety and OCD related conditions.

 

The message boils down to this – we all have independent systems within our mind and body that are not subject to choice or direct control; that is, we experience a cacophony of automatic thoughts and feelings on a daily basis. However, just because we think or feel something, it doesn’t mean that it is true, and we have a choice in how we will respond to these experiences. We are thought-generating machines, and this includes, as Dr. Phillipson calls them, “disruptive involuntary signals to our conscious awareness” that can confuse and pull us in.

 

OCD (put simply!) involves a misfiring of the amygdala, such that false alarm signals (i.e., irrelevant noise) are experienced as true alarm threats. It feels like there is real danger and that one must respond as dictated by the disorder; however, it is a misinterpretation of threat. As a part of Cognitive Behavioral Therapy, we aim to externalize the false alarms, often calling it a name, such as the “Brain Bully” or other opponent taunting us by overestimating threat. In a softer light, it can be perceived as an overprotective brain’s misguided effort to protect us.

 

Unfortunately, the more OCD is obeyed, the more demanding and debilitating it becomes. OCD management and recovery, therefore, requires an active choice to not react to the obsessions and urges to avoid/ritualize. Instead, management means facing fears and learning to “behave in a way that enhances your freedom and demonstrates to your brain that the “threat” about which it is warning you is irrelevant.” As Dr. Phillipson describes, this is the core goal of Exposure/Ritual Prevention, the key ingredient of Cognitive Behavioral Therapy for OCD. Making this active decision to “choose irrelevance” and accept the presence of these thoughts is the most significant step toward recovery.

 

He also comments on mindfulness being a necessary ingredient. In order to become the “Gatekeeper” and choose a different response, there must be the ability to observe these thoughts, feelings, and urges to avoid or escape. “Without being mindful of your ability to identify signals with an OCD theme, you most likely will give in to your brain’s impulse to escape.”

 

I appreciated how he emphasized an individual’s autonomous choice and participation within the treatment experience as well. As he states, ERP treatment for OCD (or any anxiety condition) is not something that is done to or for an individual. It requires a partnership, a working relationship, within which the therapist’s role is to guide and the patient’s role is to follow this guidance in an active manner while also contributing to the mission. I enjoyed his analogy of the patient being in the driver’s seat – in charge of the steering wheel as well as the gas and brake pedals – while the therapist remains in the passenger seat with a map to offer directions. For this partnership to be effective, it requires a shared decision about the destination and active participation on both parts to reach it. This is different than being a passive recipient – this involves active participation, collaboration and an ongoing autonomous choice to alter one’s responses to the OCD spikes.

 

As he states, “Left to its own devices, our brain will try to take the path of least resistance – seeking pleasure and avoiding pain.” Therefore, living a fuller, more meaningful life necessitates disciplined choices that reflect our long-term independent values and goals.

 

Therefore, “choose irrelevance,” seek opportunities to retrain the brain and learn how to be the driver of your life car!