Preface to first edition 1 Moritz Hauschildt n Detecting and Defusing Thinking Traps Metacognitive Training for Obsessive-Compulsive Disorder (myMCT) Beta-version VanHam Campus Press 2012 (Hamburg) Preface to first edition 2 Preface to first edition Dear Reader, Thank you for your interest in the myMCT - Metacognitive Training for OCD! Why “metacognitive”? You might have wondered if there isn’t a simpler word. If so, you would not be the only one: The publishing company was concerned that a foreign word might scare away the readers. In addition, some of our colleagues did not think that the term was completely appropriate because not only metacognitive techniques are considered in this book. However, a series of reasons were decisive for holding onto the term metacognition (= thinking about thinking). This book deals with specific thinking traps contributing to OCD and teaches ways to diffuse them. It stimulates an examination of our own thinking: which thought contents are normal and which are not, how can I change the contents of my thinking and banish agonizing thoughts? These are all metacognitive questions. The myMCT combines views of various theories, especially metacognitive and cognitive-behavioral approaches, as well as some psychoanalytic assumptions which relate to parental education and coping with negative emotions, particularly aggression. In our opinion, differences among these approaches have been overemphasized in the past. Different terminologies - and sometimes also vanities - have blocked their synthesis. Don’t worry, terminology is kept at bay and the myMCT is written in plain English and not as a science book. photo frame?" of a photo "Meta by {dpade1337} (25/5/09) Metacognition: thinking about thinking! An earlier version of the myMCT was evaluated in 2009. Eighty-six people affected with OCD took part in the study which assessed its effectiveness. More than 60% of the participants indicated that their symptoms were reduced after applying the myMCT. The training group showed a significantly greater decrease (i.e. not due to chance) in symptoms relative to people who did not receive the training (these were sent the manual after the re-assessment). Since that time, there have been a number of additions, some of them proposed by study participants, and it is our hope that these changes have made the myMCT even more effective! This book is mainly directed at those who are affected, but it is also useful as a collection of resources for therapists. 3 100% of the author proceeds from myMCT go to our working group at the University Medical Center Hamburg-Eppendorf (Germany) and support our research on OCD. We wish you much success! Steffen Moritz & Marit Hauschildt by v2" Ampelmann "B Hauptbahnhof (24/5/09) ideengruen Let‘s go! All of the visual material is licensed via creative commons1. We would like to express our gratitude to the artists for making their work publicly available2. The date of the download is listed in brackets. 1 Cover: “Tunnel” by Michael Cavén (26/4/11) 2 If you do not wish that we use your art or photo, please send us an email and we will remove the file immediately. Preface to second edition 4 Preface to second edition Dear Reader, We are happy to present you the updated and expanded version of our self- help manual in English language less than one year after the first edition. For the second edition, we have incorporated comments and suggestions for further improvements from our readers. Thank you! Several of the previous exercises have been optimized while a number of new exercises have been added to the book (e.g., exercises aimed to reduce "magical thinking"/fusing thoughts and actions). Unlike the first edition, written by a single author, we are now two authors. Quite a few exercises were inspired by the "Metacognitive Training for Depression" (D-MKT; Jelinek, Hauschildt & Moritz, 2010), which was co- developed by the second author. The focus of the second edition of the myMCT has maintained the same: Metacognition (= thinking about thinking). The book encourages people with OCD to reflect on their thinking, particularly on those thinking styles or distortions, which contribute to the development and maintenance of OCD. The Metacognitive Training aims to help detecting such "thinking traps" and offers numerous practical examples and exercises how to defuse these traps, in order to acquire a more helpful way of thinking. Just like the first edition, the Metacognitive Training for OCD primarily addresses people with OCD. The collection of exercises resembles a box of various tools (except for the sledgehammer!): Take your time to read and try out which tools fit best to get hold of your OCD. Those tools that seem useful for your specific needs can then be added to your personal toolkit. Wishing you much success Steffen Moritz & Marit Hauschildt Table of Contents 5 Table of Contents I Introduction Goals, Theoretical Background and Structure ……………………. 7 Let´s go! ………………………………………………………………………. 19 II Typical Thought Distortions in OCD #1: Are bad Thoughts Abnormal? ........................................... 22 #2: Do bad Thoughts Lead to bad Deeds? ............................... 38 #3: Must Thoughts Completely Obey my own Will? …………….. 47 #4: Is the World Dangerous? (Overestimation of Threat)…….. 51 #5: Must bad Thoughts be Suppressed? …………………………….. 65 #6: When Feelings Alarm me, is There Actually Danger? …….. 71 #7: Do Obsessions Irrevocably Poison the Thoughts? …………. 81 #8: Am I Responsible for Everything? (Inflated Sense of 87 Responsibility) ……………………………………………………………….. #9: Good is not Good Enough? (Striving for Perfection) …….... 92 #10: Can I Gain Ultimate Truth? (Intolerance of Ambiguity)... 97 #11: Does Brooding Help to Solve Problems? …………………….. 102 #12: OCD is a Brain Disorder – So does That Mean I Can’t do 106 Anything to Change it? …………………………………………………….. #13: Am I a Failure? ……………………………………………………….. 111 #14: Am I Going Insane? ........................................................ 122 III Final Words Practise! ………………………………………………………………………... 127 Feedback ……………………………………………………………………….. 128 Please help uns helping………………………………………………….... 129 Thank you ………………………………………………………………………. 130 Introduction 6 Introduction Goals, Theoretical Background and Structure -7 Let´s go! -19 Introduction 7 Goals, Theoretical Background and Structure Goal of the Training The intention of myMCT is to impart knowledge and coping strategies for thinking traps typical of OCD. Thinking traps are unhelpful ways of collecting and making sense of certain information (e.g. attending to potentially dangerous aspects in the environment rather than to neutral features, thinking that everything must be perfect, or feeling overly responsible for others). They can play a role in causing OCD and its progression. However, not everything that looks like OCD is actually OCD. It is important to distinguish between an inaccurate and unhelpful thinking pattern that contributes to OCD, and habits and behavior that appear compulsive but are appropriate in a certain context and do not produce any psychological strain (e.g., “obsessiveness” in pilots or surgeons when practicing their profession, but not in their personal lives). This training program is divided into a number of units with each unit covering a particular type of thinking trap or distortion. In addition, accompanying or secondary problems, like depression and low self-esteem, are addressed in the final unit as well as common fears of OCD patients (e.g., to suffer from schizophrenia or a severe brain lesion). Although the book is written for people with OCD, some units may also be helpful for people with Obsessive- Compulsive Personality Disorder (OCPD). We will explain the difference later. If you have had treatment for OCD in the past then you may be very familiar with some of the ideas and exercises in this training program. by viZZZual.com "On target" (26/1/09) Introduction 8 How to work with the myMCT Don't work on more than one or two units/thought distortions per day. Be sure to immerse yourself in each unit with the help of the exercises. Please read the questions below and answer spontaneously. Pay special attention to the units for which you have answered core questions with “yes”. Typical Thought Distortions in OCD: Units with Exercises • unit #1: Are bad Thoughts Abnormal? • unit #2: Do bad Thoughts Lead to bad Deeds? • unit #3: Must Thoughts Completely Obey my own Will? • unit #4: Is the World Dangerous? (Overestimation of Threat) • unit #5: Must bad Thoughts be Suppressed? • unit #6: When Feelings Alarm me, is There Actually Danger? • unit #7: Do Obsessions Irrevocably Poison the Thoughts? • unit #8: Am I Responsible for Everything? (Inflated Sense of responsibility) • unit #9: Good is not Good Enough? (Striving for Perfection) • unit #10: Can I Gain Ultimate Truth? (Intolerance of Ambiguity) • unit #11: Does Brooding Help to Solve Problems? • unit #12: OCD is a Brain Disorder – So does That Mean I Can’t do Anything to Change it? • unit #13: Am I a Failure? • unit #14: Am I Going Insane? Introduction 9 This training contains both information to read and practical elements. The practical sections are marked with the following symbols: Pages with a question mark3 ask a question that you should answer for yourself before you read the next page or paragraph, which will provide you with solutions or possible responses. The tool symbol4 represents a practical exercise which helps you to become conscious of your thought distortions and gather new (corrective) experiences. For those practical exercises which are marked with the paper-and-pen- symbol5, you will find worksheets. ! ! Don't cheat! The learning and “aha“ or “eureka” effect of the exercises is much greater if you attempt to work through tasks that are marked by one of these symbols before you continue with the next page or paragraph. Otherwise, something occurs that psychology terms a hindsight bias: new knowledge automatically combines with existing knowledge and gives the wrong impression that it is already well-known. ! Self-awareness and experience are prerequisites for lasting change.