Consider your brain’s unconscious mind when you find yourself obsessively worrying about a false memory. Previously, it will have picked up on something and triggered your brain’s amygdala to warn you of danger. As a result, it activates anxious feelings, so you do mental and physical checks to ensure things are safe, albeit unsuccessfully. Specifically, the problem repeatedly comes back to doubt and fearing hypothetical scenarios.
For example, consider Sam, who developed a false memory obsession several months after attending a party. He contemplated for hours on end, thinking he’d caused injury to someone. It’s as if he could see the aggressive scene in his mind but could not quite connect with it. As a result, he anticipated a fearful outcome, such as being arrested and imprisoned.
The party he attended was an actual event that Sam remembers. However, since he could not recall hurting someone there, but felt that he did, he repeatedly asked friends at the party if they remembered. Of course, each person said no. They said he wasn’t aggressive and got a taxi home relatively early.
But Sam had doubts. He worried that what his friends were telling him didn’t fit the facts. Or, more specifically, what he assumed were the facts. Sam mistakenly believed he must have been drunk. Otherwise, he wouldn’t have a hazy memory of doing what he thought he did. In other words, if he were sober that night, he would remember everything, wouldn’t he?
And so, Sam could not rest. As a result, his “need to know” compulsion continued, and friends wondered why he continually asked the same question. Additionally, Sam repeatedly phoned the hospital to check admissions during the night of the party. Also, he began avoiding triggers that reminded him of the party, such as turning down invitations to meet up with friends for a drink.
Before The Obsessional Doubt
Sam’s therapist pointed out that he had no concerns about being aggressive and hurting people before the obsessional doubt. For example, months after the party, his unconscious mind triggered him to question his actions but not before that. He and his therapist discovered the trigger was hearing of a mild-mannered man who was violent at a gathering after drinking too much alcohol. They then discussed how Sam worried he could turn out the same. So hearsay is the trigger that brought on the onset of Sam’s false-memory OCD.
Hearsay is an inference (among other assumptions) that adds credibility to an obsession, even though it cannot make it valid. Either way, Sam continued to think of how he is a mild-mannered person. “If only I hadn’t gone to the party,” he thought. Sam could not get past the idea that he could have turned violent, causing injury to an innocent person. It made him believe that doubt didn’t feature anymore; he just needed to remember.
Therefore, Sam contacted the hospitals again to check if they’d admitted anyone that night, but nothing. Still, images flashed across his mind about what could have happened. He was too afraid to trust that the pictures in his head weren’t genuine. It was so unbearable that imaginary scenarios and fearing the outcome of committing a terrible crime terrified him.
The Brain’s Fear Centre
At this stage, his therapist explained that anticipation of a “what-if” scenario results from the brain’s fear centre releasing adrenalin, causing a fight, flight or freeze response. Or, in other words, a defence reaction. The fear centre is called the amygdala, mentioned earlier. It doesn’t know if a situation is real or imaginary. So it will raise the alarm either way.
Therefore, when Sam’s colleagues ask him if he wants to join them for a drink after work, his amygdala fires up automatically, mistakenly signalling danger. Consequently, Sam turns down their invitation, which is an avoidance compulsion. Then, his amygdala calms down, decreasing his anxiety, but unfortunately, it feeds his obsessive fear.
So what can Sam do?
Sam can train himself to avoid avoidance. So, let’s suppose he agrees to go to the pub with friends. Next, he would focus on nothing negative happening. While doing so, he would utilise response prevention. That means avoiding avoidance. In other words, he would stay at the gathering, drink, and be around people, maybe at a distance to start with. But, in doing so, he would sit with the uncomfortableness of doubt about the earlier false-memory event. After repeating this new action several times, his amygdala will learn that the earlier triggering event has no connection to aggression and harm.
Consequently, it creates a positive association. So then, it will form new memories and Sam’s earlier negative association will fade and his anxiety will increase less the more he does response prevention.
Another thing to consider is that Sam’s fear is irrelevant to the here and now. For example, the inferences mentioned earlier build up in the imagination and create an imaginative story. So when he removes the assumptions, Sam sees the devoid obsession and realises he does not need to do rituals, which helps with response prevention in ERP. By applying these principles, he sees himself as someone who can go out, enjoy a drink and not worry about turning violent, hence, the positive association.
Inferences: Kieron O’Connor & Frederic Aardema: A Clinician’s Handbook for Obsessive Compulsive Disorder. Positive Association: Catherine M. Pittmann, PhD & William H. Youngs, PhD: Rewire Your OCD Brain.