Self-directed cognitive behavioral therapy in adult patients with Obsessive-Compulsive Disorder

Abstract

Obsessive-Compulsive Disorder (OCD) is a chronic condition that significantly impairs the quality of life of those who suffer from it by generating a persistent cycle of obsessions and compulsions that is difficult to control. The objective of this article was to describe the elements that constitute self-directed cognitive behavioral therapy for adult patients with OCD. A narrative review of the literature was conducted through the analysis of scientific articles with various designs, retrieved from the MEDLINE (PubMed), LILACS, BIREME, and SciELO databases. Additionally, the self-directed cognitive behavioral therapy approach proposed by Schwartz and Beverly Beyette was examined. The findings indicate that self-directed psychotherapy consists of four steps. The first, called “re-labeling,” involves learning to recognize obsessive thoughts and compulsive urges through conscious perception reinforced by the impartial observer—an inner observing power that every person possesses—thereby repelling the pathological impulse, which is a false alarm no matter how real it may seem; to this end, strategies of anticipation and acceptance are promoted. The second step, attribution, assumes that obsessions and compulsions are due to biochemical alterations in the brain; one becomes aware that the intrusion and intensity of the thoughts are due to an illness. The third step, refocusing, involves learning to circumvent intrusive thoughts and compulsive impulses by directing attention to another behavior one enjoys, even if only for a few minutes. Finally, the fourth step, revaluation, seeks to progressively modify the importance attributed to obsessions and compulsions, reducing their emotional and behavioral impact. It concludes that obsessive thoughts and compulsive impulses are false messages from the brain. One should not struggle to get rid of them; instead, they can and should be avoided through engaging behaviors, by consistently implementing the four steps, thereby achieving neuroplasticity that supports functional recovery and improved quality of life.