It is unfortunate that our schools do not teach us that our brains are comprised of many systems, some of which operate with considerable independence from the others. The independence of these systems is reflected in the way individuals suffering from OCD respond to episodes of extreme anxiety. Like all human beings, those with OCD have a strong basic survival instinct and are likely to experience great distress at the prospect of leaving a perceived threat unresolved. However, when what they experience as a threat is actually a function of their OCD (and therefore, is essentially the product of misfiring brain circuitry), they still react to this perceived threat as if their very lives were in danger. A conflict of independent systems also can affect those who do not have OCD. For example, a person may have the goal of exercising, but when the opportunity to do so presents itself, she may find herself thinking, “I’ll begin tomorrow.” Similarly, when tempted, someone whose goal is to save money may find himself thinking, “Yes, but this sale is so tremendous! Look at all the money I’d be saving!” The point is that we can only make disciplined and values-based choices that challenge instinctive or self-defeating urges when we are mindful of the contradictory agendas presented to us by our brains.

To date, the focus of my writing has been on educating sufferers and professionals alike about the various forms of OCD and the methods of behavioral treatment I have found to be effective. In contrast, this article attempts to identify the essential qualities within the patient that contribute to the success or failure of treatment. In my discussion of this subject, I will give considerable attention to such concepts as agency, mindfulness, and autonomy. Agency can be defined as the faith we have in our capacity to respond effectively to challenges in our lives. Mindfulness is the non-judgmental awareness of an experience in real time – that is, as that experience is unfolding – and an acknowledgement of our responsibility for the choices we make and/or the beliefs or perspectives we endorse in relation to that experience. The willingness of patients to be accountable for the choices they make has a profound effect both on the recovery process and the achievement of their goals in life. And finally the term autonomy refers to the choices and actions of the “Gatekeeper,” the “I” or “me” who, based upon his or her goals and values, makes the final decisions on matters of importance to the individual.

Continued...