Dealing with fetish

Purposeless preoccupations of the mind like the constant worry of the well being of loved ones can be treated by effective behavioural treatment

Published: Wednesday 15 May 1996

SOME people suffer from compulsions like the overpowering need to wash their hands all the time. Such people can lose precious hours of the day preoccupied in their obsessions and compulsions. This malady known as obsessive-compulsive disorder affects approximately five million Americans. A new study recommends psychotherapy sessions for patients suffering from obsessive- compulsive disorder saying that it can produce changes in the functioning of the brain similar to those produced when under medication.

The study on the effect of psychotherapy was conducted under Jeffery Schwartz, a psychiatrist at the Neuropsychiatric Institute of the University of California at Los Angeles, us. "This (study) tells us that effective behavioural treatments can have biological effects, not just psychological ones," says Eric Hollander, director of the obsessive- compulsive disorder treatment programme at the Mount Sinai School of Medicine, Manhattan, Us.

Nine people with obsessive-compulsive disorder were made to undergo brain imaging through a method called PET scans) before and after 10 weeks of cognitive behavioural therapy. One third of the patients did not show any substantial improvement while the other six improved considerably. On studying the PFT scans, it was found that there were two significant changes in the images in the six patients who had shown improvement.

In obsessive-compulsive disorders, four key structures of the brain are locked together. One of the changes in the images observed was the tight links in the activity of these. Says Schwartz, "In patients who respond to treatment, these structures can operate more independently, as is the case of people without the disorder." When these structures become overactive in unison, the disorder occurs.

One of the structures involved is the orbital frontal cortex situated behind the eye socket. This operates as the brain's error detection centre, by alerting the rest of the brain when something is not right and needs to be taken care of. "In obsessive-compulsive disorder, it is hyperactive, so you keep correcting what you think is not right, like checking to see the stove is turned off over and over." explains Schwartz.

Other structures which pass on the similar message are present deep inside the brain and are called caudate nucleus and cingulate gyrus. The 'v set the heart pounding and other actions related to fear. The fourth structure which operates in unison with the rest is the thalamus, which is the brain's relay station for sensory information. When any one of the four becomes metabolically active, the other three follow. In patients who respond to therapy, the activity of the caudate nucleus is found to be reduced, thereby suggesting that the corelation between the four structures can be reversed by cognitive-behavioural therapy alone.

In the therapy the patient is made to relabel his obsessive urge rather than give in to them. "We tell them, instead of saying to yourself 'I have to wash my hands again'tell yourself, 'I'm having an obsessive urge or a compulsion again'," explains Schwartz. Patients are urged to remind themselves time and again that they have a medical problem which makes them behave as they do. And then the), are advised to get involved in any Pleasurable activity which wilt serve as a distraction from the compulsive urge. Thus the urge is diminished by treating it as a mere symptom.

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