Maladaptive beliefs are thoughts, interpretations, and assumptions about the world that—according to cognitive models of emotion—get in the way of our functioning by leading to extreme distress, avoidance behavior or some other time-consuming behavior that disrupts functioning.
An example would be the tendency to overestimate threat or the belief that thinking about doing something awful is the equivalent of actually doing it. It is not exactly clear what leads to these beliefs. Probably some combination of learning history (modeling, reinforcement) and biological factors.
Your treatment methods for OCD and other anxiety disorders include Cognitive-Behavioral Therapy (CBT). I have always been interested in this approach as it gives the patient some control over their treatment and progress. Are there shortcomings to this method of treatment?
Sure. While CBT is the most effective treatment we have for OCD, there are limitations. The main one is that it takes a lot of hard work and practice to overcome a problem like OCD. One has to be willing to confront their fears and resist their rituals. While most people are able to do this with the help of a skilled therapist, it’s a challenging task. In the end, the person who does muster up the courage to do CBT usually learns that the anxiety wasn’t as bad as they’d feared, that it doesn’t last forever, and that the consequences they were afraid of are much less likely than they had presumed.
The most effective form of treatment for OCD seems to be Exposure Therapy. This technique has gotten some bad press on occasion with those who implement it unethically. How can clinicians reinforce the effectiveness of the treatment and still reassure the patients?
Yeah, I am not a fan of the TV shows that dramatize exposure. It is not typically done that way, but we all know how the press likes to manufacture drama! I think explaining to people how exposure works is very important. Providing a rationale helps the person understand why a therapist would use exposure. Also, explaining that the therapist-patient relationship is similar to the relationship between someone wanting to learn how to play an instrument like the piano, and the teacher. The piano teacher never forces the student to do anything they don’t want to. But the teacher knows how to teach piano and, hopefully, the player is willing to do the work and practice necessary to learn, even if it requires lots of effort. No one can force you to practice the piano, but you can’t become a good player without hard work and practice. Same is true for getting over a problem like OCD.
Based on your findings, how important are friends and family members’ roles in the lives of those learning to live with OCD and other anxiety disorder?
Great question. We involve friends and relatives as “support people” and as surrogate therapists. We often find that relatives provide the wrong kind of “help” by accommodating to anxiety/OCD symptoms. For example, they might help with avoidance or compulsive rituals because they feel that they are keeping their love one from becoming anxious or otherwise upset. It’s one way that relatives or partners/spouses might show how much they love and are concerned for the anxious person. But unfortunately, this keeps the person from getting over the problem. So, in cognitive-behavior therapy we work with significant others to learn how to help the person confront, rather than avoid, their anxiety (after all, anxiety is not dangerous). We teach significant others how to help with exposure and response prevention, how to end accommodation, and how to work together to face fear, rather than avoid it. It’s extremely important to have the right kind of support—assertiveness, rather than giving in to anxiety; and certainly not hostility.
What would the layman find most surprising about your research?
I guess it would be surprising to learn that we want people to “lean in” to their anxiety. Anxiety and fear can be uncomfortable, but they are not dangerous, and our research shows that the best way to overcome excessive anxiety is to learn how to be better at having anxiety, rather than trying to be better at making anxiety go away. Anxiety and fear are the kinds of things that just get worse the more you try to fight them. So, the goal is to stop fighting and make anxiety your friend. Think about it—anxiety (or the “fight-flight response”) is a necessary part of human survival. It’s a life-saving part of our biology that helped us survive (and still does) situations in which we perceive a threat. Something like that would never harm us (it wouldn’t make sense), even though many people with anxiety/OCD (and their loved ones) are afraid of experiencing anxiety.
With all the funding in the world, what would be your white whale of research? Is there something you are secretly curious about but haven’t had the chance to explore yet?
I would like to be able to do a longitudinal study following people from childhood through adulthood and looking at how strongly various biological and environmental factors predict the development of anxiety and OCD. There are lots of theories about this and that gene, virus, or environment as playing a role in these problems, but very little longitudinal research; and very little research looking at how these factors might interact. This would be my dream study.
What advice would you give to a student thinking of specializing in your field?
The most important thing a student can do is to get experience with conducting research. The training programs that produce the most competent and successful clinicians and scientists (on average, of course) require that you have research experience in order to be a competitive applicant. So, volunteer in a research lab, do an independent study or senior thesis, and become familiar with the various conceptual models, research paradigms, and assessment methods. Finally, read as much as you can on the topic!