The crucial time for dealing with OCD is the moment when an obsession strikes. This is the moment of truth. Whether we allow a fearful thought to take hold and stir compulsions, or whether we make progress with the disorder–it all depends on what transpires here. We can give in to the fear, or, with the shred of rational thinking we still have available, we can apply reason to the obsession.
The “LAF” technique*, discussed by psychiatrist Jeff Schwartz in his bestselling book Brain Lock, represents an excellent way to rationally confront obsessions. Over the years, I have constructed a number of easy to remember and clever (so I thought) formulas for therapeutic steps to take at the “moment of truth.” Alas, none of mine ever caught on with my patients as well as that of Dr Schwartz. Can’t beat the acronym. people like to “laugh” at their obsessions.
The “L” in LAF, stands for relabel. It is the first order of business, and perhaps most difficult. Instead of accepting the obsessional fear as an important thought that you should pay attention to,” you relabel it as a destructive, irrational obsession. The “A” stands for reattribute. Rather than regarding the fear as issuing from your own reliable danger-warning system, you reattribute it to a chemical disorder in your brain that is sending a false alarm. You say, “It’s not me, it’s OCD!” The “F” stands for refocus. Once you have relabeled and reattributed, shift your attention to business at hand.
Sometimes, I modify this technique for Christians. In the reattribute step, the obsessional thought can be referred to God rather than to a chemical disorder. That is, you say to yourself: “God is permitting me to suffer this obsessional fear right now so that I can increase my faith in him.” Then, in the refocus step, you say “I’m going to trust this fear to God, and leave in his hands all the possible consequences related to it. Right now, I’m going to get about my business.” Some people, especially those feeling estranged from God, do better staying with the original method. For others, however, the faith centered approach is not only therapeutic, it also promotes spiritual growth.
A couple of points about employing the LAF technique, either version. There must be a strong act of will. We fight OCD through conscious decisions and resolve. The relabel step is especially difficult. OCDers are never certain about anything when an obsession strikes, because they are completely caught up in fear. In the absence of certainty, therefore, you must make the call: “I’m going to assume this is an obsession, and that’s all there is to it.” Then you have to make yourself stick with that decision despite potentially paralyzing doubt.
The refocus step again requires an extra dose of decisiveness. Rather than attempting to fight off the obsessional fear, you need to let it stay there in your mind, and redirect your attention to what you should be doing right now in the present moment. If it’s driving your car, for instance, make sure your hands are placed correctly on the steering wheel, that you’re going the right speed, and so on. If it’s watching TV with your family, pay attention to the program, your interactions with other people, and enjoying yourself.
LAF is a rock solid approach to OCD. I use it with most of my patients. It can be easily augmented with other helpful techniques such as E/RP (exposure and response prevention) and reflecting on obsessions in various therapeutic manners. It works very well for beginners in therapy. It also continues to pay dividends as a key element in effective long-term strategies for dealing with OCD.
*Dr Schwartz includes a fourth valuable step, “revalue.” It is not taken, however, at the moment that an obsession hits, which is the focus here.