#1

[The_root_of_all_evil]

Does the word "grinding" come to mind here?

Sort of, except that grinding has a logical consequence or purpose to it. OCD, not so much.

Does it? Consider it to the person that's doing it. He's obsessing about a series of keypresses, repeated at least 100 times, which can lead to a brief burst of pleasure "DING"...followed by more stress and more repetitions.

And he's going to have to pick a place to complete all these repetitions as well.

CBT then comes in to help the client learn to handle the obsessive thought so that the compulsion is no longer needed.

More difficult here. CBT comes in to understand why the thought appears in the first place, and attempts to pacify that thought.

I disagree totally on this one. The "why" the thought is there is always a combination of learned behavior and beliefs adopted from childhood or adult experiences. CBT does not concern itself with why, thats one of its main differences form odler more tradional forms of therpay. CBT asks if the thought is useful or rational, and then works to replace the thought with a new one, which is then repated until its adopted fully.

This is the real problem, whether the thought needs removing or repairing - and whether it's nature or nurture (two more whole threads that could be done).

But I'd never say "Always" in psychiatry. "Mostly" is the best we can do at the current level of understanding. Sometimes a pipe is just a pipe.

 

[SL33TBL1ND]

It's nice to see some even handed discussion in this area, YOU MAKE GOOD DOCTOR!

 

[khaimera]

Does the word "grinding" come to mind here?

Sort of, except that grinding has a logical consequence or purpose to it. OCD, not so much.

Does it? Consider it to the person that's doing it. He's obsessing about a series of keypresses, repeated at least 100 times, which can lead to a brief burst of pleasure "DING"...followed by more stress and more repetitions.

And he's going to have to pick a place to complete all these repetitions as well.

CBT then comes in to help the client learn to handle the obsessive thought so that the compulsion is no longer needed.

More difficult here. CBT comes in to understand why the thought appears in the first place, and attempts to pacify that thought.

I disagree totally on this one. The "why" the thought is there is always a combination of learned behavior and beliefs adopted from childhood or adult experiences. CBT does not concern itself with why, thats one of its main differences form odler more tradional forms of therpay. CBT asks if the thought is useful or rational, and then works to replace the thought with a new one, which is then repated until its adopted fully.

This is the real problem, whether the thought needs removing or repairing - and whether it's nature or nurture (two more whole threads that could be done).

But I'd never say "Always" in psychiatry. "Mostly" is the best we can do at the current level of understanding. Sometimes a pipe is just a pipe.

To look at in a broad sense, there really is little difference bertween grinding and OCD. Grinding has teh tangivel reward of more XPs or leveling up, which brings pleasure on some level. Where as an OCD compulsion serves to alleviate the anxiety that results from an unwanted and uncontrolable thought or urge.

I still think the "why" is almost[/] never the issue in CBT. Traditional psychotherapy, i.e. psychoanalysis was only concerned with the why of behavior. Research was then performed to show that insight, another word for why, was not sufficient in producing behavior change. Then we got behaviorism and eventually CBT.

Treatment follows the path of recognizing the thought and changing it into a more healthy one. Why the thought appeared in the first place is not a concern. Thats becuase not only will it not be very helpful, but nobody will ever really know the why. We can speculate, but thats as close as we will get at the moment. The why could be based on brain chemistry, genes, experiences, parenting, etc. Cognitive theory maintains that the thought was always a result of how a situation was interpreted. The theory may be wrong, but it would use the word always when explaining its case.

And, to get us slightly back on topic, the tretament of addiction to anything would still involve finding out the thoughts that precede the addictive behavior, and correcting those thoughts. In addition to leanring new coping skill behaviors.

 

[The_root_of_all_evil]

I still think the "why" is almost never the issue in CBT. Traditional psychotherapy, i.e. psychoanalysis was only concerned with the why of behavior. Research was then performed to show that insight, another word for why, was not sufficient in producing behavior change. Then we got behaviorism and eventually CBT.

I'd agree with that, and think it's a bad thing. CBT needs to understand the "why" so it can understand the implications.

Treatment follows the path of recognizing the thought and changing it into a more healthy one. Why the thought appeared in the first place is not a concern. Thats becuase not only will it not be very helpful, but nobody will ever really know the why.

Ah, now big disagreement here. First that the reason for the thought is often very important as it's an underlying thread that produces the disorder. And second that changing a thought is very difficult on a fundamental level and very dangerous. Down that road leads "curing" gay people. (or straights)

And, to get us slightly back on topic, the tretament of addiction to anything would still involve finding out the thoughts that precede the addictive behavior, and correcting those thoughts. In addition to leanring new coping skill behaviors.

But that leaves the patient still with the latent OCD behaviour, which is likely to produce a phobia against the substance that "addicted" them (See most ex-smokers/teetotalers) and leave a latent re-addiction waiting to happen.

If we can work out WHY that thought take place. For instance, it may be that they have associated pleasure with the sounds from the game because of hearing them as a child. Finding out that thought could show therapy (muting the sound while playing), progress (listening to electronica away from the machine) and cure (taking those sounds to their normal life).

That seems to me to be far more helpful overall than correcting the thought by removing those pleasurable sensations. What you've done there is nerve-stapling, to put it the Alpha Centurai way.

 

[Kristoffer Sivertsen]

Nice, I will follow this column!

 

[khaimera]

I still think the "why" is almost never the issue in CBT. Traditional psychotherapy, i.e. psychoanalysis was only concerned with the why of behavior. Research was then performed to show that insight, another word for why, was not sufficient in producing behavior change. Then we got behaviorism and eventually CBT.

I'd agree with that, and think it's a bad thing. CBT needs to understand the "why" so it can understand the implications.

Treatment follows the path of recognizing the thought and changing it into a more healthy one. Why the thought appeared in the first place is not a concern. Thats becuase not only will it not be very helpful, but nobody will ever really know the why.

Ah, now big disagreement here. First that the reason for the thought is often very important as it's an underlying thread that produces the disorder. And second that changing a thought is very difficult on a fundamental level and very dangerous. Down that road leads "curing" gay people. (or straights)

And, to get us slightly back on topic, the tretament of addiction to anything would still involve finding out the thoughts that precede the addictive behavior, and correcting those thoughts. In addition to leanring new coping skill behaviors.

But that leaves the patient still with the latent OCD behaviour, which is likely to produce a phobia against the substance that "addicted" them (See most ex-smokers/teetotalers) and leave a latent re-addiction waiting to happen.

If we can work out WHY that thought take place. For instance, it may be that they have associated pleasure with the sounds from the game because of hearing them as a child. Finding out that thought could show therapy (muting the sound while playing), progress (listening to electronica away from the machine) and cure (taking those sounds to their normal life).

That seems to me to be far more helpful overall than correcting the thought by removing those pleasurable sensations. What you've done there is nerve-stapling, to put it the Alpha Centurai way.

I gotta be honest, I'm loving our thread hijack.

After reading through everything I feel like we may be debating the same points, just using different language. I think when you say the "why" the thought is there, I say that the why is the thought itself. So essentially, if we were working to help someone, we'd be doing the same type fo treatment.

I wish I understood what nerve stapling is. I've never heard that term before.

 

[The_root_of_all_evil]

I gotta be honest, I'm loving our thread hijack.

I don't think it's really a hijack, just a borrowing.

After reading through everything I feel like we may be debating the same points, just using different language. I think when you say the "why" the thought is there, I say that the why is the thought itself. So essentially, if we were working to help someone, we'd be doing the same type fo treatment.

Yeah, sounds a similar way to what I'd said. Just hope that Dr Mark puts his toe in as well.

I wish I understood what nerve stapling is. I've never heard that term before.

It's a wonderful term from the game Alpha Centurai that you use to quell riots. I don't think it's ever mentioned what it is, but it's so evocative.
I believe it's equivalent to a lobotomy/ECT.

 

[khaimera]

I gotta be honest, I'm loving our thread hijack.

I don't think it's really a hijack, just a borrowing.

After reading through everything I feel like we may be debating the same points, just using different language. I think when you say the "why" the thought is there, I say that the why is the thought itself. So essentially, if we were working to help someone, we'd be doing the same type fo treatment.

Yeah, sounds a similar way to what I'd said. Just hope that Dr Mark puts his toe in as well.

I wish I understood what nerve stapling is. I've never heard that term before.

It's a wonderful term from the game Alpha Centurai that you use to quell riots. I don't think it's ever mentioned what it is, but it's so evocative.
I believe it's equivalent to a lobotomy/ECT.

I wonder if DR Mark is reading this thread.

I really like that term, nerve stapling. It does sound like ECT. Which, amazingly, still works.

Anyways, I've enjoyed this discussion and I hope others here have as well.

I'll PM you with some more info.

 

[mkline]

I read all these threads. Glad you guys have had an interesting discussion of this issue.

As with anything, intelligent people can certainly disagree.

I would only add that I have worked with many people with video game problems whose primary issue was not OCD, but I can certainly accept that OCD would be a good way to describe some folks. I still think the addiction model is useful in other cases, if you define addiction not as a disease, but as an inability to engage in an activity in a controlled way leading to significant and serious negative consequences. For some folks, it is easier to acknowledge and take responsibility for the seriousness of their problem if it is defined as an addiction.

CBT is certainly a treatment of choice for OCD and other anxiety disorders, and many of us use CBT principles in lots of the treatment we do, including the treatment of addictions. Other psychotherapy approaches can also be helpful. I find it is often about the personality fit between the therapist and the client. You can do just about anything you want, but if the fit is bad, you likely won't succeed.

I'm all for nerve stapling whenever possible--I have to see if I can get the right staples for my Swingline Model 545--but I suggest ECT only for intractable depressions and some other serious conditions where medicine has proved inadequate.