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  1. #11

    Re: The Four Steps - Dr Jeffrey Schwartz - Brain Lock

    From an interview with Jeffrey Schwartz:

    Do you see empirical evidence that mindfulness is effective in decreasing suffering?

    There's a lot of scientific data, collected in the last five years, that shows that when you relabel something, it markedly enhances a frontal cortex area, mainly the lower aspect of the prefrontal cortex; and, through a circuit, that process decreases activity in an emotional part of the brain called the amygdala. So there's now evidence that putting labels on thoughts causes the front cortex to modulate the emotional brain. That's very understandable in terms of what's been known since ancient times about "impartial spectators" and mindful awareness.

    When in Doubt, Make Belief: An OCD ... - Google Books
    "What lies behind us and what lies before us are tiny matters compared to what lies within us." ~ Ralph Waldo Emerson

  2. #12

    Re: The Four Steps - Dr Jeffrey Schwartz - Brain Lock

    According to Dr. Schwartz, how his 4 Steps is both similar to and different from Exposure & Response Prevention:

    If you are familiar with a specific cognitive-behavioral therapy technique known as exposure and response prevention, Refocus with Progressive Mindfulness may seem similar. In some of the mechanics, it is—you are entering situations that distress you. However, the important distinction lies it what you do once you are in that distressing situation. The major difference between the two approaches is that exposure and response prevention asks you to enter a situation and then sit with—but do nothing about—your uncomfortable sensations. You do not focus your attention on a healthy behavior or attempt to regulate your sensations in any way. The presumption of exposure and response prevention is that your brain is no different from an animal's and that to change your behavior, all you need to do is experience incredibly intense spikes in your anxiety or distress level and then allow them to come down on their own—thus "teaching" your body and brain to no longer associate that specific situation with a threat or danger. When exposure and response prevention is done in that way, all your brain learns to do is calm down your Uh Oh Center and not associate that upsetting situation with danger, but it does not strengthen your Wise Advocate.

    In contrast, Refocus with Progressive Mindfulness encourages you to first face situations you currently are avoiding or to continue in an activity that causes you distress and then focus your attention on constructive, healthy activities while you are in that situation. This process results in your brain rewiring itself in ways that are beneficial to you and that adaptively retrain your Habit Center to work toward your true goals and values. Most important, it strengthens your Wise Advocate so you can apply what you learned about the falseness of your deceptive brain messages in this situation to other places in life where deceptive brain messages arise.

    You Are Not Your Brain: The 4-Step Solution for Changing Bad Habits, Ending Unhealthy Thinking, and Taking Control of Your Life
    "What lies behind us and what lies before us are tiny matters compared to what lies within us." ~ Ralph Waldo Emerson

  3. Re: The Four Steps - Dr Jeffrey Schwartz - Brain Lock

    I frequently use an abbreviated form of talking back to OCD. However, I'm unaware of a studying comparing the effectiveness of Schwartz's approach vs. Exposure/Response Prevention (ERP). I recently received excellent behavioral training through the OC Foundation's Behavior Therapy Training Institute (BTTI which I highly endorse). I inquired about Schwartz's approach. I was told that the presenters don't use it. When pushed a little further, they opined that it may work fine for mild to moderate OCD, but not severe OCD. Again, I'm unaware of data that compares the two.

    Mike Miller, PhD
    OCD Treatment Cleveland
    Mike Miller, PhD
    http://drmikemiller.com

  4. #14

    Re: The Four Steps - Dr Jeffrey Schwartz - Brain Lock

    My objection to ERP and my preference for the Four Steps/ACT approach is based on many years of clinical experience rather than a controlled research study.

    With ERP, anxiety is heightened considerably and I don't believe this is the best approach for ANY anxiety based disorder. What I have seen with patients treated with ERP is the original obsessive thought or compulsion may disappear but it is invariably replaced with another obsession and/or compulsion.

    The Four Steps/ACT approach, in contrast, basically teaches the patient to understand the origins and nature of obsessive thoughts and compulsions, to stop fighting them, accept them, and "watch them go by" - "thoughts are not facts", "they are just my way or worrying", "they are not magical or predictive", "I do not have to act on this thought or urge - it's just OCD again", etc.

  5. #15

    Re: The Four Steps - Dr Jeffrey Schwartz - Brain Lock

    Also, this isn't much (since it's a retrospective study), but it's something:

    Mindfulness-based behavioral therapy (MBBT) for severe obsessive- compulsive disorder improves therapy outcome for people who were previously unresponsive to traditional interventions

    OTOH, from the same article:

    How is the FSM ["Four Steps Method"] modified in the MBBT protocol?

    It is important to note that MBBT differs from Schwartz’s (1996) FSM protocol in important ways: 1. MBBT requires intensive and prolonged exposure in contrast to the shorter exposures allowed by Schwartz during his refocus step. For example, Schwartz’s protocol does not require the OCD patient to expose him- or her-self to a feared stimulus until habituation (Table 1) of fear occurs. Indeed, the FSM protocol allows for very brief exposures that do not always result in habituation. This is in direct contrast to the typical 90 min or more required for habituation of fear in ERP. Similarly, distraction toward pleasant events is not permitted as part of MBBT because evidence indicates this interferes with habituation of fear in the treatment of OCD (Grayson et al., 1982).

    2. The FSM permits a person with OCD to actually engage in compulsions while noting such compulsive behaviors mindfully. This is NOT permitted in MBBT. Identical to the protocol of Kozak & Foa (1997), if patients engage in a compulsion (e.g., hand washing) to decrease their fear level, they are required to immediately reactivate the fear (e.g., re-contaminate the body) by re-exposing themselves to the feared stimulus and then engaging in ritual prevention long enough for the fear to peak and diminish (Riggs & Foa, 1993; Steketee et al. 1982).
    Attached Files Attached Files
    "What lies behind us and what lies before us are tiny matters compared to what lies within us." ~ Ralph Waldo Emerson

  6. #16

    Re: The Four Steps - Dr Jeffrey Schwartz - Brain Lock

    Since that study above seems to be just adding mindfulness to traditional ERP, that may not be as interesting as this line of research:

    Metacognitive therapy versus exposure and response prevention for pediatric obsessive-compulsive disorder. A case series with randomized allocation.
    Simons M, Schneider S, Herpertz-Dahlmann B.

    Background: Exposure with ritual prevention (ERP) is the psychotherapeutic treatment of choice for pediatric obsessive-compulsive disorder (OCD). In the present study, a new treatment rationale – metacognitive therapy (MCT) for children – was developed and evaluated. Methods: Ten children and adolescents with OCD were randomly assigned to either MCT or ERP therapy condition. Patients were assessed before and after treatment and at the 3-month and 2-year follow-up by means of symptom severity interviews. Depressive symptoms were also assessed. Manualized treatment involved up to 20 sessions on a weekly basis. Results: We found clinically and statistically significant improvements in symptom severity after treatment. At the 3-month and 2-year follow-up, the attained improvements during treatment were retained. Conclusions:Despite some methodological limitations, results showed that MCT proved to be a promising psychotherapeutic alternative to the well-established ERP in the treatment of pediatric OCD. Further investigations into the efficacy of MCT are necessary to answer questions as to the working mechanisms underlying therapy for OCD.
    Hayes et al mentions that study by saying: "Metacognitive Therapy emphasizes changing attentional processes to alter the relation to thoughts instead of attempting to change thoughts themselves. This overlaps significantly with the mindfulness-based approaches but has certain distinct features...Simons and colleagues (2006), in an RCT comparing MCT to Exposure with Response Prevention, observed improvements in participants’ symptoms, but no difference was shown between the two interventions...A variety of other open trials and systematic case studies on MCT are available."

    ---------- Post added at 01:26 PM ---------- Previous post was at 12:59 PM ----------

    Similarly:

    Cognitive versus Behavior Therapy: Processes of Change in the Treatment of Obsessive-Compulsive Disorder
    (2008)

    Processes of change in cognitive-behavioural treatment of obsessive-compulsive disorder; current status and some future directions (2010)

    • Changes in dysfunctional beliefs are associated with effective treatment of OCD.

    • Patterns of change over the course of successful treatment can vary dramatically between patients

    • Optimally, process research could provide information for how to bring about change in different patients.

    Dysfunctional beliefs in the process of change of cognitive treatment in obsessive compulsive checkers (2010)
    Attached Files Attached Files
    "What lies behind us and what lies before us are tiny matters compared to what lies within us." ~ Ralph Waldo Emerson

  7. #17

    Re: The Four Steps - Dr Jeffrey Schwartz - Brain Lock

    "What lies behind us and what lies before us are tiny matters compared to what lies within us." ~ Ralph Waldo Emerson

  8. #18

    Re: The Four Steps - Dr Jeffrey Schwartz - Brain Lock

    Casey Anthony, Reasonable Doubt, and OCD - OCD Center of Los Angeles
    November 28th, 2011

    Using Cognitive Behavioral Therapy (CBT) and Mindfulness techniques, people with OCD and other anxiety conditions can learn that the best response is to tolerate uncertainty and to observe their thoughts (and the accompanying discomfort) as they rise and fall naturally. In most cases, their worst fears will be disconfirmed without any intervention.

    Conversely, continuing to respond and react to these distressing thoughts will only lead to an endless cycle of questions and more attempts to find answers. This cycle only serves to reinforce the OCD, and creates the exact opposite from the desired effect – more uncertainty.
    "What lies behind us and what lies before us are tiny matters compared to what lies within us." ~ Ralph Waldo Emerson

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