Why don’t we do “talk therapy?”

The modern concept of “talk therapy” is born from Sigmund Freud’s psychodynamic theory: the “Talking Cure.” The belief, broadly speaking, was that symptoms of psychopathology resulted from unconscious conflicts or childhood wounds. Thus, processing these conflicts by way of the “insight-oriented” Talking Cure would not only resolve psychologic wounds, but also, and ultimately resolve the pathologic symptoms that were thought to result from them. The trouble is that the vast majority of the outcome-data, nowadays, points in a quite different direction.

Many modern treatments for anxiety-related conditions (including those for Posttraumatic Stress Disorder and Obsessive-Compulsive Disorder) are oriented not primarily to gaining insight into unconscious conflicts that are long-rooted in the past, but to understanding the behavioral dynamic that maintains symptom-severity in the present.

Cognitive Therapy is based upon the idea of the “Cognitive Model,” a very simple concept that proposes that the way people think influences both the way they feel, and the way they behave. But the therapeutic punchline of the cognitive model is that they can challenge their unhealthy thought-processes or perceptions; and as they do, the new thoughts will influence the way they feel and behave.

But, the Cognitive Model is not merely, as it were, a “one-way street.” What we also find is that the way people behave influences the way they think and feel. If you think of the cognitive model as a triangle—and each of the three angles represents either thoughts, feelings, or behavioral choices—the idea is that you can modify the whole “shape” of experience by methodologically changing only one aspect.

The question becomes, Are people generally more able to change the way they think, the way they feel, or the way they behave?

If you really think about it, the answer is obvious. Most anxious people will readily tell you that they can neither stop their intrusive thoughts, nor change the way those thoughts make them feel. But they’ll also readily tell you that they can stop the things they do when they’re anxious; they just don’t want to.

This is where the idea comes-in that we have a lot more power over our anxiety-symptoms than we think we do. Because the way people consistently behave reinforces the way they think and feel. You say, “So what?” That means that compulsions reinforce the OCD. Pull the “C” out of OCD, and the whole system will unravel and fall apart. Good psychotherapy for beating clinically significant anxiety necessarily centers on behavior-change.

This is where talk therapy falls short.

Why do we do exposure therapy?

The short answer is, we do exposure therapy because it is an evidence-based treatment—we know that it works. It helps to facilitate meaningful results within a limited period of time. Like cognitive therapy, exposure therapy is based on the Cognitive Model. While good exposure therapy is comprised of many conceptual and technical “parts,” none is more intrinsic to the process than that of targeted behavior-change. It has been said, “You’re not doing exposure therapy if you’re also doing compulsions.”

It might seem counterintuitive. But think about it: when you stop scratching a mosquito bite, it eventually stops itching. You find through this behavior-change, in fact, not only that the itching-sensation eventually stops, but that it was the scratching-behavior that, all along, was keeping the bite itchy.

OCD - “C” = Ex/rp

So, at Kentuckiana Treatment Center for Anxiety & OCD, we teach our patients to focus on where they have control—behavior-change. Because changing anxiety-related behaviors will necessarily, and correspondingly, mean changing anxiety-related thoughts and feelings. This is what Victor Meyer demonstrated in his 1966 study. His language was a little technical: but the punchline was that when participants consistently prevented their compulsions, or as he called them, “obsessional rituals,” their symptoms began to unravel; and they began to feel better. For the first time in history, people suffering from severe anxiety disorders and OCD made measurable and predictable progress.

But psychotherapists are not magicians. In other words, while the treatment works, patients have to work the treatment.

Exposure therapy nowadays, then, rests on a great deal of evidence. That evidence, in the case of exposure therapy for Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, and clinically significant anxiety-symptoms reaches back to 1966. That’s more than 50 years of research and outcome-data that inform what we do to treat debilitating anxiety problems.

Trust us; we’ve been to therapy thousands of times.

So, what are you waiting for? Let’s get started! Kentuckiana Treatment Center for Anxiety & OCD is located at 100 W. 3rd St., Suite 304 Owensboro, Kentucky 42303

Feel free to check out OCD Straight Talk for more information.