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Taming Obsessive Thoughts


Taming Obsessive Thoughts


Obsessive thinking can be tamed using cognitive-behavioral techniques.
Published on June 28, 2010 by Robert London, MD in Two-Minute Shrink

Have you ever gotten a thought stuck in your brain, akin to an awful pop tune from the eighties that just keeps replaying in your mind and won’t go away? A person I’ll call Rachel came to me to help her with a horrifying obsessive thought that was starting to affect her daily functioning. In it, she was being destroyed by a plague of locusts, much like the one that had attacked Egypt in biblical times.

cycleA successful physics professor at a West Coast university, Rachel needed professional help for this recurring, obsessive thought, which had become so vivid over the years that living with it had become almost unbearable. She tried five years of psychotherapy, and then switched to a psychiatrist, who recommended medications that were ineffective and caused unpleasant side effects. Finally, the patient tried a “geographic cure”– a sabbatical to New York. But Rachel continued to experience the terrifying obsessive thoughts. At that point, she was referred to me.

As always, I took a thorough history. I then explained the type of treatment I had in mind. The time frame was to be three or four sessions lasting 90 minutes each. I planned to apply two cognitive techniques and one behavior modification strategy to treat the patient’s obsessive thoughts.

First, we discussed the P&P (possibility and probability) concept. There was certainly a possibility that the locusts could attack her (this generated some humor), but the probability of this happening was significantly slim. As a physicist, she easily related to that concept. That discussion lasted about 30 minutes.

Next, we discussed Newton’s third law of motion: For every action, there is an equal and opposite reaction. When translated into her treatment strategy, this became “for every thought, there is an equal and opposite thought.”

She easily accepted that theory, and it helped to relieve the anxiety of her obsessive thoughts. Taken further, that concept evolved into thinking that for every thought there is a lesser thought — and possibly even no thought. The no-thought concept helps the patient get long-term relief from the obsessive thought.

Finally, we applied the practice of thought stopping. Thought stopping is a method in which the patient induces the thought that is so distressful and is then taught how to stop it. We used guided imagery to induce the terrifying thought of the locust attack.

Here’s how it worked: I asked Rachel to imagine a large movie screen, onto which I invited her to project the scene she had so often envisioned. As she progressed into this stressful imagery, I made a loud noise by hitting my desk with a ruler and simultaneously shouting “Stop!” In that procedure, the image she was thinking or projecting was automatically interrupted, blocked, and stopped. We practiced several times. After six trials, I stopped using the ruler and just shouted “Stop!” It worked. As we proceeded through this technique, Rachel began to take over the entire strategy and began to shout the word “Stop” to control the obsessive thought.

Moving along, we reached a point at which she was able to subvocalize the word “stop” and get the same result as if an outside force had interrupted, blocked, and stopped the thought.

Rachel’s treatment was completed in three 90-minute visits. She was quite pleased that she had gained control over her obsessive thoughts. To reinforce our work together, we audio taped the sessions so she could review them whenever the obsessive thinking began to recur. Having learned how to use the movie-screen approach to project an obsessive thought, Rachel now had a tool she could use on her own. I explained that she could also change images from the obsessive thought to a pleasant scene to help reduce the anxiety that the thought produced.

When Rachel returned to her university, she resumed her thriving and demanding academic career free of that terrifying obsessive thought.

Behavioral treatments like these are hard work, for both the therapist and the patient. Often, we need to structure the treatment to the patient’s thinking, career, and lifestyle, as I did in this case by using the laws of physics for the physics professor. In this, as in so many cases, I am continually amazed at how resilient and changeable the human mind is when people really want to heal, and customized cognitive and behavioral approaches have proven time and again to provide a quick and effective solution.

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This blog aims to present psychiatric/psychological information to a general readership, offering insights into a variety of emotional disorders, as well as social issues that affect our emotional well-being. It includes the ideas and opinions of Dr. London and other leading experts. This blog does not provide psychotherapy or personal advice, which should only be done by a mental health care professional during a personal evaluation.


From “glee”
“Emma” has OCD

How facts about the brain can be used in real life


act one: As the brain changes, the mind changes, for better or worse.

Take this quiz to learn how mindful you are.Register for our upcoming full-day seminar with Dr. Hanson on “Taking in the Good.”

Watch clips from Dr. Hanson’s Greater Good last talk.

Learn more about Dr. Hanson’s work, including his books Buddha’s Brain and Just One Thing, on his website.

For example, more activation in the left prefrontal cortex is associated with more positive emotions. So as there is greater activation in the left, front portion of your brain relative to the right, there is also greater well-being. That’s probably in large part because the left prefrontal cortex is a major part of the brain for controlling negative emotion. So if you put the breaks on the negative, you get more of the positive.

On the other hand, people who routinely experience chronic stress—particularly acute, even traumatic stress—release the hormone cortisol, which literally eats away, almost like an acid bath, at the hippocampus, which is a part of the brain that’s very engaged in visual-spatial memory as well as memory for context and setting.

For example, adults who have had that history of stress and have lost up to 25 percent of the volume of this critically important part of the brain are less able to form new memories.

So we can see that as the brain changes, the mind changes. And that takes us to the second fact, which is where things really start getting interesting.

Fact two: As the mind changes, the brain changes.

These changes happen in temporary and in lasting ways. In terms of temporary changes, the flow of different neurochemicals in the brain will vary at different times. For instance, when people consciously practice gratitude, they are likely getting higher flows of reward-related neurotransmitters, like dopamine. Research suggests that when people practice gratitude, they experience a general alerting and brightening of the mind, and that’s probably correlated with more of the neurotransmitter norepinephrine.

Here’s another example of how changes in mental activity can produce changes in neural activity: When college students deeply in love are shown a picture of their sweetheart, their brains become more active in the caudate nucleus, a reward center of the brain. As the mind changes—that rush of love, that deep feeling of happiness and reward—correlates with activation of a particular part of the brain. When they stop looking at that picture of their sweetheart, the reward center goes back to sleep.

Now the mind also can change the brain in lasting ways. In other words, what flows through the mind sculpts the brain. I define the mind as the flow of immaterial information through the nervous system—all the signals being sent, most of which are happening forever outside of consciousness. As the mind flows through the brain, as neurons fire together in particularly patterned ways based on the information they are representing, those patterns of neural activity change neural structure.

So busy regions of the brain start stitching new connections with each other. Existing synapses—the connections between neurons that are very busy—get stronger, they get more sensitive, they start building out more receptors. New synapses form as well.

One of my favorite studies of this involved taxi cab drivers in London. To get a taxi license there, you’ve got to memorize the spaghetti-like streets of London. Well, at the end of the drivers’ training, the hippocampus of their brain—a part very involved in visual-spatial memory—is measurably thicker. In other words, neurons that fire together wire together, even to the point of being observably thicker.

This has also been found among meditators: People who maintain some kind of regular meditative practice actually have measurably thicker brains in certain key regions. One of those regions is the insula, which is involved in what’s called “interoception”—tuning into the state of your body, as well as your deep feelings. This should be no surprise: A lot of what they’re doing is practicing mindfulness of breathing, staying really present with what’s going on inside themselves; no wonder they’re using, and therefore building, the insula.

Another region is the frontal regions of the prefrontal cortex—areas involved in controlling attention. Again, this should be no surprise: They’re focusing their attention in their meditation, so they’re getting more control over it, and they’re strengthening its neural basis.

What’s more, research has also shown that it’s possible to slow the loss of our brain cells. Normally, we lose about 10,000 brain cells a day. That may sound horrible, but we were born with 1.1 trillion. We also have several thousand born each day, mainly in the hippocampus, in what’s called neurogenesis. So losing 10,000 a day isn’t that big a deal, but the net bottom line is that a typical 80 year old will have lost about 4 percent of his or her brain mass—it’s called “cortical thinning with aging.” It’s a normal process.

But in one study, researchers compared meditators and non-meditators. In the graph to the left, the meditators are the blue circles and the non-meditators are the red squares, comparing people of the same age. The non-meditators experienced normal cortical thinning in those two brain regions I mentioned above, along with a third, the somatosensory cortex.

However, the people who routinely meditated and “worked” their brain did not experience cortical thinning in those regions.

That has a big implication for an aging population: Use it or lose it, which applies to the brain as well as to other aspects of life.

That highlights an important point that I think is a major takeaway in this territory: Experience really matters. It doesn’t matter only in our moment-to-moment well-being—how it feels to be me—but it really matters in the lasting residues that it leaves behind, woven into our very being.

Which takes us to the third fact, which is the one with the most practical import.

Fact three: You can use the mind to change the brain to change the mind for the better.

This is known as “self-directed neuroplasticity.” Neuroplasticity refers to the malleable nature of the brain, and it’s constant, ongoing. Self-directed neuroplasticity means doing it with clarity and skillfulness and intention.

The key to it is a controlled use of attention. Attention is like a spotlight, to be sure, shining on things within our awareness. But it’s also like vacuum cleaner, sucking whatever it rests upon into the brain, for better or worse.

For example, if we rest our attention routinely on what we resent or regret—our hassles, our lousy roommate, what Jean-Paul Sartre called “hell” (other people)—then we’re going to build out the neural substrates of those thoughts and feelings.

On the other hand, if we rest our attention on the things for which we’re grateful, the blessings in our life—the wholesome qualities in ourselves and the world around us; the things we get done, most of which are fairly small yet they’re accomplishments nonetheless—then we build up very different neural substrates.

I think that’s why, more than 100 years ago, before there were things like MRIs, William James. the father of psychology in America, said. “The education of attention would be an education par excellence.”

The problem, of course, is that most people don’t have very good control over their attention. Part of this is due to human nature, shaped by evolution: Our forbearers who just focused on the reflection of sunlight in the water—they got chomped by predators. But those who were constantly vigilant—they lived.

And today we are constantly bombarded with stimuli that the brain has not evolved to handle. So gaining more control over attention one way or another is really crucial, whether it’s through the practice of mindfulness, for instance, or through gratitude practices, where we count our blessings. Those are great ways to gain control over your attention because there you are, for 30 seconds or 30 minutes, coming back to focus on an object of awareness.

Taking in the good
This brings me to one of my favorite methods for deliberately using the mind to change the brain over time for the better: taking in the good.

Just having positive experiences is not enough to promote last well-being. If a person feels grateful for a few seconds, that’s nice. That’s better than feeling resentful or bitter for a few seconds. But in order to really suck that experience into the brain, we need to stay with those experiences for a longer duration of time—we need to take steps, consciously, to keep that spotlight of attention on the positive.

So, how do we actually do this? These are the three steps I recommend for taking in the good. I should note that I did not invent these steps. They are embedded in many good therapies and life practices. But I’ve tried to tease them apart and embed them in an evolutionary understanding of how the brain works.

1. Let a good fact become a good experience. Often we go through life and some good thing happens—a little thing, like we checked off an item on our To Do list, we survived another day at work, the flowers are blooming, and so forth. Hey, this is an opportunity to feel good. Don’t leave money lying on the table: Recognize that this is an opportunity to let yourself truly feel good.

2. Really savor this positive experience. Practice what any school teacher knows: If you want to help people learn something, make it as intense as possible—in this case, as felt in the body as possible—for as long as possible.

3. Finally, as you sink into this experience, sense your intent that this experience is sinking into you. Sometimes people do this through visualization, like by perceiving a golden light coming into themselves or a soothing balm inside themselves. You might imagine a jewel going into the treasure chest in your heart—or just know that this experience is sinking into you, becoming a resource you can take with you wherever you go.

This article is printed here with permission from the Greater Good Science Center (GGSC). Based at UC Berkeley, the GGSC studies the psychology, sociology, and neuroscience of well-being, and teaches skills that foster a thriving, resilient, and compassionate society.  More from Rick Hanson, a neuropsychologist and author.


Let us change the world



in Norway we are on 2 place when it comes to overall happiness. So why don`t we do more for others?

When you think about the world today, its easy to get overwhelmed. We see news every day, where the current themes are war, unemployment, hunger, extreme weather and people dying of different diseases. I am lucky, and live in one of the wealthiest countries on earth, just because we were lucky and had a lot of oil that we could sell to the rest of the world. We have also saved a lot of the money, so that it grows fat and can protect us in the future. We have it all. I remember a friend in United Kingdom (a wonderful man who doesn`t realize it himself) shaking his head because we actually GET paid for studying, and we can study for 8 years without having a severe effect on our economics. He worked from


early morning to late in the evening, and he was lucky, because it is so hard to actually find a job in London. Here this would lead to outrage and news in the papers (in the local news, it was actually top news that one doctor had worked for several years without a proper summer holiday). We are also a country that contributes a lot to the welfare of other countries and we often give of our own money when it comes to a good cause, but more than that, we don`t do. Of course its easy to feel a bit miserable and overwhelmed when you live in luxury while you know that so many people don`t. When we throw away food, because it is a bit too old, while somebody could kill another man for just one bite, our view on ourselves as good human beings, falter. Therefore, we have to construct a reason for not doing more, and here, I think, is where our brains help us.

Heard of cognitive dissonance before? If not, please read this before continuing:Cognitive Dissonance & Self-Justification (htycm.wordpress.com).The basics are: If we do something that don`t fit our view of ourselves, we find an explanation for not doing the “good” thing. For example, if we know smoking is bad for us, but still not quit, it must be because “we know a lot of people who haven`t died from smoking”. That is one of the reasons they include a phone number on cigarettes, so people feel they actually can DO something with the problem, since research show, that when we have the possibility to do good, we often do so. Especially if we see others “do the right thing”. Maybe that`s why exercising together with friends, or quitting smoking together with your partner, might be extra motivating. We are often more concerned by what others think about our will to commit, then we are if we break our own mental “standards”.

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So, what is the reason that I write about this at all? If we so easily give up, why bother at all? That might be a conclusion, an actually an example of cognitive dissonance. Because something seem to be hard, doesn’t mean it’s impossible to change it. We see the effect of one person gathering people who care all the time (but maybe don`t hear to much of it in the news) and if more people started to actually believe in themselves and at least try to do something, I don’t think this necessarily would take a lot of time. Think about how popular earth hour has become. For 1-2 hours the whole world turn of their light, and this small and easy effort done by everyone, helps the environment so much. What if all persons were supposed to at least ONE time during the year, not take the car for work, but a bus/cycle or walk instead, would not everyone want to contribute? In the oil crisis in -73 people started to talk together so that they had to share cars, thereby decreasing traffic, and even getting more social as an extra bonus (main complaint from a lot of patients I see: They feel lonely and unconnected to th8dd9e94b2822927172ef658f516ad7bee world). A lot of people know how influenced our climate gets by pollution, but since we do nothing to change it ourselves, cognitive dissonance sets in (our contribution is just a drop in the sea, anyway). But all these small drops can have an enormous effect! A lot of hotels these days, have some kind of information about saving energy and water; by installing environmental friendly equipment for the shower or putting up a request for guest to use their towel twice, to save water.

C. P. Pierce says it like this:

As soon as we start thinking about making a donation, we start thinking of reasons not to do it. Money’s too tight at home. The person to whom we’ll give it will spend it unwisely. The buck in the envelope is just a drop in the bucket. Oh, Lord, the problem’s so big and my wallet is so small. The modern reflex seems to be that the worst thing we can do for a problem is to “throw money at it,” even though very few problems ever get solved for free.In fact, as much as we inveigh against it biblically, or deplore the heedless pursuit of it, money is one of the few things that truly unites us. Our common currency is, well, common currency in almost all our essential interactions, including our most beneficent ones. Warren Buffett, eBay founding president Jeff Skoll, and the Google people seemed to realize this over the past couple of years. By giving away their money, they cement together some vital elements of our commonwealth. dec5872938ddb5d7f7a59ad79cae526eSmaller transactions have the same effect. Over this past holiday season, a management group in Rhode Island gave its employees money on the express condition that the employees then give it away to someone else in need. The company then asked their employees to share the stories of their charity at a company meeting. Thus does the act of giving away money form a kind of oral history, from giver to recipient and then to the people to whom the story is told. There is a spark of the collective consciousness in that, which hearten not only those people involved in the transaction but those who hear the story and pass it along. There is something like art there.When giving away your money, it helps to think of it as more than bits of paper and scraps of metal. That’s not a $20 bill you’re slipping into the envelope there. It’s a bagful of flour. It’s soup or a blanket or a bottle of medicine. That handful of quarters is a handful of rice. You can even make this art out of raw self-interest. Giving away money can be the most selfish thing you do. With a father and four of his siblings dead from the same disease, I can look at the check I send to the Alzheimer’s Association and see something that is every bit as therapeutic as any new therapy that money may help create. I see new drug trials, and respite care, and a light against enveloping darkness.There is nothing more visceral than cynicism, nothing more brutish than greed. These are reflexes, common and unremarkable, of the undeveloped spirit. But charity in its finest sense is always an act of the creative imagination.

So who knows, maybe we will save the world after all.

Sweet Charity: The Benefits of Giving Back
By Charles P. Pierce