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