This is a systematic way of confronting the violent or any other thoughts in a step-by-step manner. The actual exposure itself is very straightforward.
Sufferers can be exposed to violent thoughts in a number of ways. Instead, they are designed to provoke anxiety by essentially saying that the thoughts are true, that the feared consequences will really happen, and that nothing can be done to prevent them. Ideally exposure should be done whenever and wherever the thoughts occur. Those who suffer from violent obsessions have various types of scripts they write for themselves, and it is important to understand these scripts in order to be able to use them in designing homework assignments.
That will be horrible for my family and me; they will suffer because of what I did and I will suffer knowing what I did to them and to my victim. No one is forced to do anything they are not ready to tackle. If a particular assignment cannot be done in a whole step it may be broken down into smaller steps. Treatment is home-based also known as self-directed treatment and outpatient.
Homework is given weekly in written form and done outside the office with instructions to call if necessary.
Most people have between 4 and 12 different assignments per week. The assignments usually begin with things that are more general and only provoke a moderate amount of anxiety. Over time they gradually become more specific and get people to expose themselves to more and more challenging things.
It is here that therapists are called upon to show their flexibility and creativity. We go wherever we have to go and do whatever it takes to create therapeutic situations that will help the person to confront their thoughts.
Behavioral therapy cannot be done in cookbook fashion. It is usually suggested to the patient at first that there are people out there who are capable of violent acts and who may lose control and act without warning.
The exposure then moves on to suggest that the patient themselves just might be capable of the sorts of things they may be thinking about. From there we move on to confronting the idea that there is a real possibility that they will snap and commit a violent act.
Following this the next step has the patient expose themselves to the thought that they will definitely do whatever it is they are obsessing about, and that it may happen at any time without warning. At this stage, if the patient is particularly doubtful, it may also be appropriate to suggest that they have even done the feared thing recently or in the past.
Moving through these various stages can span a period of months and the whole process can take approximately 6 to 9 months overall. Those with the more serious and debilitating problems may need to come more than once a week or for a longer period. A few of the most serious cases may even need to work within a hospital setting if they are unable to follow treatment on their own although this is much less common and rarely necessary. One good exposure technique is via audio taped presentations of these feared ideas that run several minutes in length and are used several times a day.
Other methods could include reading books or news articles that provoke the violent thoughts, writing brief essays on why the thoughts represent true desires, visiting websites related to violent or sexual offenders, hanging up signs with phrases that evoke anxiety, writing feared words or phrases repeatedly, or voluntarily seeking out real-life situations likely to bring the thoughts on.
With regard to this last technique it can be quite helpful to set up little plays to help the person confront a feared situation in a somewhat realistic way.
One example of this would be the case of a young man who had thoughts that he would stab his father.
We set up a nightly exercise where he would sit next to his father on a sofa watching TV together as the patient held a large kitchen knife in his hand. Probably the most important assignment I ever give patients is for them to agree with each violent thought as it occurs, rather than trying to argue with or analyze them.
They probably get more opportunities to do this assignment than any other. By staying with what you fear you may feel more anxious at first, but you will gradually build up a tolerance to the feared thing. The more total it is, the quicker you will get used to what you have feared and the sooner the fear will subside. This may not be as easy as it sounds, especially in the face of really repulsive violent thoughts. Obviously the real art of doing therapy involves getting people to trust what the therapist is telling them, and that the method will work for them.
They can think the worst of their thoughts, but not feel that they have to react to them. The following list is included to show what some typical behavioral assignments might look like. No list can be complete for all people so this is just a sampling.
Homicidal thoughts are a common symptom in harm OCD , a subset of obsessive-compulsive disorder. Harm OCD causes a person to fixate on thoughts of harming themselves or someone else.
These thoughts can range from violent, sexual, relationship-based and religious, amongst other things. In truth, everyone has these kinds of passing thoughts from time to time. You become extremely distressed and threatened by the fact that you have these thoughts. Soon, the distress becomes so intense that you believe your only choice is to dispel it with compulsive behaviors and mental acts.
One of the key signs of harm OCD is the need to perform certain self-imposed rituals to prevent something bad from happening. Examples include:. Many people with harm OCD try to make their homicidal thoughts go away by avoiding certain situations, including those that trigger thoughts of killing and those that would make it easier to act on violent urges. For example, you might feel like you have to remove all the knives, scissors and other sharp objects from your house in case you might use them to kill your partner.
You might not be able to go near heavy traffic or subway trains for fear of pushing someone in the path of a vehicle. Reassurance-seeking is a common compulsion among people with OCD.
It can involve excessive cleaning, a preoccupation with order or with avoiding certain numbers, or intrusive thoughts. What makes harm OCD a problem is when you take these thoughts or impulses or images to be a dangerous sign.
By contrast, someone with harm OCD who has that thought will become preoccupied with the possibility they will act on the thought. This often turns into a preoccupation with preventing the harm from happening — more on this below. Obsessions are typically thoughts that are unwanted and produce marked anxiety. Often obsessions are about a taboo topic, e.
Harm obsessions are considered to be taboo thoughts, as they typically involve thoughts of harming someone vulnerable, a loved one, or someone clearly undeserving of harm. So why do people have these thoughts? The answer is the same whether or not one has OCD — our minds have all kinds of thoughts.
Some are warm and fuzzy, some are ugly, and most are pretty uninteresting. We cannot control which thoughts come up in our minds. Thoughts are like the content on TV as we flip channels; we have no say over what comes on the screen — all we can do is choose whether to change the channel or not. Ultimately, the thoughts, images and urges associated with harm OCD are insignificant and do not reflect on character.
In fact, a closer look suggests that people with harm OCD are quite unlikely to act on these thoughts. As mentioned above, the thoughts happen for reasons beyond our control. What makes these thoughts into obsessions is the meaning we attribute to them. Trying to suppress a thought typically has the opposite of the desired effect.
For example: for the next 5 seconds, try not to think of a pink elephant. Typically when trying hard to do this, people think of a pink elephant.
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