Patient's question:
Learned a new piece of knowledge but can't remember it, then deliberately make the somewhat clear knowledge muddled. When doing mathematical calculations, either there is disturbance or (for example, between the 3rd and the 29th, there are a few days, and you keep thinking what day it is on the 3rd, whether it's the 3rd itself or starting from the 2nd, then counting from day to day, or formulas in your head, getting nervous about how to remember them so clearly, and they immediately deliberately become confused, like an idiot, what to do?)Doctor's answer:
Here are the translations of the provided text into English, with the specified requirements followed:---
Hope these four steps can help you regain confidence.
Step 1: Reconfirm
The most important first step is to learn to "recognize" obsessive-compulsive thoughts and actions. You may not want to do this step at all, but you must make a conscious effort to be fully aware so that you can understand that the current distress comes from obsessive thoughts or behaviors. Daily awareness is almost automatic and superficial. "Full awareness" is deeper and more detailed, and requires focused effort to achieve. Remember that changing brain chemistry to reduce obsessive urges may take weeks or months. Trying to get rid of these obsessive symptoms in minutes or seconds will only disappoint you! In fact, it may even worsen the symptoms! In behavioral therapy, you will learn to control yourself from reacting to obsessive thoughts, no matter how disruptive they are. The goal is to control your response to obsessive symptoms, not to control obsessive thinking or urges. The next two steps will help you learn new ways to control your behavioral responses to obsessive symptoms.
Step 2: Reattribute
Tell yourself: "This isn’t me; it’s OCD at play!" Obsessive thoughts are meaningless—they are incorrect messages from the brain. You must deeply understand why checking or "why my hands are dirty" feels so powerful that it becomes unbearable. If you know these thoughts are illogical, why do you react to them? Understanding why obsessive thoughts are so intense and why you can’t shake them off is a key to strengthening your willpower and reinforcing your resistance to obsessive behaviors. The goal of this stage is to learn "reattribute": the source of obsessive thoughts is an imbalance in brain chemistry. There is a part of the brain called the "cingulate cortex," which is where the disease manifests. The cingulate cortex acts as a filter for information, like a car’s transmission. It receives signals from the prefrontal cortex, which is responsible for planning, thinking, and understanding. When the cingulate cortex is impaired, obsessive symptoms appear, making thoughts and actions feel disrupted. The prefrontal cortex becomes overly active, using too much energy, like a car stuck in mud, spinning its wheels but sinking deeper. The prefrontal cortex, also known as the prefrontal cortex, gets stuck in the mud due to faulty feedback loops. This may explain why people with OCD feel "something is off" and can’t shake the sensation—you must guide the car out of the mud. Use a manual transmission instead of an automatic to fix this faulty transmission. Now that we know brain chemistry can be changed, this process takes weeks or months. Understanding the brain’s role in causing OCD helps free you from the frustrating misconception that you must completely eliminate the symptoms. Although significant changes may not happen immediately, remember: "You don’t have to react to obsessive symptoms right away!" The most effective way is to set aside obsessive thoughts and feelings and do something else. This can help change your brain’s biochemical reactions. This is what we call "shifting gears": engaging in other behaviors! Trying to push away obsessive thoughts only adds stress and anxiety, which can worsen OCD. Using "reattribute" can help you avoid resorting to ritualistic behaviors to feel better, such as the sense of completion they provide. If you know these obsessive thoughts stem from brain chemistry imbalances, you can learn to ignore them and continue what you’re doing. Remember: "That’s not me; it’s OCD at play!" If you resist the urge or avoid reacting, you will change your brain, and the intensity of OCD feelings will decrease. If you give in to the urge, you might feel temporarily relieved, but the urge will likely grow stronger soon. This may be the most important lesson for people with OCD! It will help you avoid being a victim of OCD. "Reconfirm" and "reattribute" are often done together, giving you a deeper understanding of OCD’s origins. First, fully acknowledge that OCD is pressuring you, then understand that it stems from a brain abnormality.
Step 3: Shift Focus
This is where the real work begins! The initial mental preparation is: "No pain, no gain!" In this step, you must take control of shifting gears yourself! Use effort and focus to do what your brain naturally and effortlessly does. For example, a surgeon’s pre-surgery handwashing starts and ends naturally. They naturally feel they’ve washed enough. But an OCD patient may wash and wash, without end! Their brain’s automatic mechanisms are damaged, but thankfully, these four steps can help repair them. Shifting focus means diverting your attention away from obsessive symptoms—even for just a few minutes. First, choose specific behaviors to replace obsessive handwashing or checking. Any interesting or constructive activity works. It’s best to engage in your hobbies, such as walking, exercising, listening to music, reading, playing computer games, or playing basketball. When obsessive thoughts arise, first "reconfirm" that they are obsessive thoughts or urges, then "reattribute" that they stem from your illness—OCD—and then "shift focus" by doing something else. Remember not to fall into habitual thinking. Tell yourself: "My OCD is acting up again; I must do something else." You decide "no" to reacting to obsessive thoughts. You must be your own master, not a slave to OCD!
(1) The 15-Minute Rule
Shifting focus isn’t easy. Breaking obsessive thoughts and doing what you should do takes immense effort and pain. We use the 15-Minute Rule to delay your reaction by at least 15 minutes. You can start with 5-minute delays. The principle remains the same: never react immediately without delay. This isn’t passive waiting for 15 minutes but actively using "reconfirm," "reattribute," and "shift focus" during that time. Engage in other interesting or constructive activities. After some time, reassess the intensity of the obsessive urge and record it. Even a small decrease is worth encouraging and rewarding yourself. OCD patients often have a perfectionist mindset, expecting 100% results, so they rarely satisfy themselves with small achievements, always thinking they’ve done "enough." This can lead to behavioral therapy failing. The goal is to delay for 15 minutes or more. With consistent practice, OCD intensity will greatly decrease. Generally, the more you practice, the easier it becomes. Soon, you’ll be able to delay for 20 or 30 minutes or more.
(2) Every Action Counts
Shifting focus to do something else is crucial. Don’t expect obsessive thoughts or feelings to disappear immediately. Don’t do what OCD tells you to do; stick to your chosen activities. This way, obsessive urges will weaken or disappear due to your delay. Even if urges are hard to change, you’ll find you can slightly control your reactions. Using "full awareness" and adopting a "observer" stance will give you more power. The long-term goal of this step is to avoid reacting to OCD. The immediate goal is to delay your reaction slightly. You learn not to let obsessive thoughts dictate your actions. Sometimes, obsessive urges are too strong, and you can’t help but engage in compulsive behavior. However, if you consistently practice these four steps, you can expect to change your brain chemistry. Remind yourself often: "It’s not me who feels my hands are dirty and wants to wash them; it’s OCD influencing me. This time, OCD won’t win—I’ll resist for longer next time!" Even if you eventually give in to compulsive behavior, it still contains elements of behavioral therapy. It’s important to remember: "Reconfirm that this is OCD—a form of behavioral therapy—is better than just giving in to compulsions."
A secret for friends struggling with obsessive checking: If your problem is checking door locks, try locking the door with full focus. Notice the urge to lock the door, then lock it carefully and slowly, imprinting the action in your mind. For example: "This door is now locked. I see it’s locked!" This deep impression will help you immediately "reconfirm" that the urge is OCD when it arises: "That’s OCD! It’s not me!" You can "reattribute" it: "That’s not me; it’s just my brain being weird!" Then, "shift focus" by doing something else, confirming to yourself that you’ve locked the door carefully.
(3) Record Your Progress
It’s also important to record the behaviors that help you shift focus. This way, you can look back and see which activities work best for you. When listed activities achieve the desired effect, it can boost your confidence. Recording helps you "shift gears" during severe OCD symptoms and trains you to remember what you’ve done before. The more successful experiences you have, the more encouraged you’ll feel. Only record successful experiences, not failures. You must learn to support yourself and give yourself encouragement, which greatly helps boost confidence.
Step 4: Re-evaluate
The first three steps use your existing knowledge of OCD to help you understand that it’s a physical illness—brain chemistry imbalance—rather than being driven by obsessive thoughts. You avoid succumbing to these thoughts while shifting focus to constructive behaviors. "Reconfirm" and "reattribute" go hand in hand, followed by "shift focus." The combined power of these three steps is greater than their individual strengths. The process of "reconfirm" and "reattribute" strengthens "shift focus." Before behavioral therapy, you start "re-evaluating" the value of obsessive thoughts and urges. Once the first three steps are properly trained, you can promptly reduce the value of these thoughts and urges. We use the concept of the "partial observer," developed by the 18th-century philosopher Adam Smith, to help you better understand the execution of these four steps. Smith described the partial observer as an inner part of us, like another observer in our minds, who understands our feelings and states. When we consciously strengthen this partial observer, we can call it out to observe our behavior. In other words, we can adopt a "observer" role to witness our actions and feelings. As Smith put it: "We are observers of our own actions." OCD patients must actively deal with their symptoms. You must work to maintain the observer role, which gives you the ability to resist pathological urges until they fade. You must understand that obsessive symptoms are meaningless—they are incorrect messages from the brain. Therefore, you must shift focus and re-evaluate. Concentrate fully on remembering: "This isn’t me; it’s my OCD at play!" Although you may not change feelings immediately, you can change your behavior. By changing your behavior, you’ll find that your feelings will change too. The ultimate goal of re-evaluation is to devalue obsessive symptoms and not dance to their tune. There are two key points: First, prepare mentally: understand that OCD feelings will come and be ready to endure them without panic. Second, accept them: When OCD symptoms arise, don’t waste energy blaming yourself. You know where the symptoms come from and how to handle them. No matter what the content of the symptoms is—whether violent or sexual—you know they will occur hundreds of times a day. You don’t have to respond to them each time as if they were unpredictable new thoughts. Refuse to let them overwhelm you or defeat you. By mentally preparing for obsessive thoughts, you can immediately recognize them and perform "reattribute." At the same time, you can do "re-evaluate." When OCD occurs, you’re already prepared. You’ll know: "That’s my ridiculous OCD thought—it’s meaningless, just a brain glitch. Don’t pay attention to it. You can move on to the next step without getting stuck on this thought." The next step is to "accept" that the result of OCD has occurred. Don’t blame yourself for weak willpower—this is all due to brain imbalance, not your fault. Avoid all negative, critical thoughts, such as: "People with OCD are so awful..." People with OCD must train their minds not to think according to obsessive feelings. We must know that these feelings are misleading. Change your response to OCD symptoms gradually but gently, and try to resist them. What we learn is that even persistent, obsessive feelings are temporary—they will fade if we don’t dance to their tune. Of course, we also remember that when we give in to OCD, it will grow stronger and eventually overwhelm us. We must learn to recognize where these obsessive urges come from and try to resist them. Through the process of executing these four steps, we lay the foundation for self-control. By fighting OCD, we gain confidence and experience the feeling of freedom. We enhance our ability to make decisions. Through persistent affirmation, we change brain chemistry, ultimately achieving true freedom!
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