WHY DO YOU DO THAT THING YOU DO?

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WHY SHOULD YOU GIVE UP ON OCD?

DR RAJ PERSAUD CONSULTANT PSYCHIATRIST

drraj.persaud@googlemail.com

www.drrajpersaud.com

One of the weaknesses of the typical psychiatric approach to disorders like Obsessive Compulsive Disorder (OCD) is that it requires sufferers to take part in difficult tasks. For example exposure and response prevention means that if you believe your hands touched something dodgy, and you are now contaminated, then you must resist the urge to wash.

The problem is that this kind of resistance to perform the normal impulse which alleviates stress, is very very hard. Indeed it tends to cause more suffering in the short term than the usual strain of the OCD illness itself.

This brings us to the key question of motivation. Some are motivated enough to accomplish difficult tasks whilst others don’t have the drive to overcome such obstacles. CBT, the current treatment of choice in the NHS requires a great deal of motivation.

While there are techniques that include Motivational Interviewing, which involves helping to clarify goals, psychiatry is much much weaker in how to help with motivation, than it is on outlining what you have to do in order to recover. The map up the mountain is clear, but how to galvanise yourself to actually perform the hike?

The other reason this is tough is that in the short run treatments like exposure and response prevention make you feel worse than just continuing with the illness. Yet the illness in the longer term destroys lives.

One flaw at the heart of the current psychiatric approach might be to rely too much on extrinsic motivation as opposed to intrinsic. We will explain what we mean by intrinsic as opposed to extrinsic motivation later on in more detail. Suffice it to say that whenever you do something for external reasons ie you are paid to do it, then this is for extrinsic reward.

A study just published by Mark Muraven at the University of Albany entitled ‘Autonomous Self-Control is Less Depleting’ in the Journal of Research in Personality, has found that having to endure resistance to an impulse ie to eat tasty cookies is achieved with more success in terms of longer term self-control if your motivation is more intrinsic as opposed to extrinsic.

For example, individuals who took part in his and similar experiments, who were asked not to eat chocolate chip cookies were subsequently less able to regulate their emotions and failed to persist as long on a frustrating task as compared to individuals who were asked not to eat radishes. Not wanting to eat a radish is done for intrinsic reasons. Radishes are intrinsically less rewarding to eat as opposed to chocolate chip cookies.

The key implication for the treatment of OCD is that we need to become much more aware of why we are taking part in treatment or why we want to get better in the first place. Is it because of external reasons? In other words is it because primarily it will please those around us? Or for intrinsic reasons – we want to do so for the intrinsic pleasure and relief of not suffering from OCD in the longer term.

A better way to explain and explore intrinsic and extrinsic motivation is to look at the issue in relation to the problem of how to motivate people to exercise more in order to lose weight.

Michelle Segar, Caroline Richardson and other colleagues based at the University of Michigan in the USA have just published some fascinating research on how to get middle aged women, who are not used to exercising, to get off their butt and burn that fat.

The researchers took a sample of over 150 women aged between 40 and 60 years old and followed them up for a whole year, to find out what it was that predicted which women would actually achieve weight loss as a result of increased activity over the longer term.

It’s easy to start losing weight by getting a bit more active, but we all know that the call to go jogging at 6AM in the morning rapidly begins to lose its allure after just a few weeks. The trick is not just to start more exercise but to keep it up for the rest of your life.

The researchers were particularly interested in studying this group as they revealed in their recent research paper that its women over 50 years old who are generally found to be the most sedentary in the Western World. Yet increased activity in this group is particularly crucial as it wouldn’t just assist dramatically with weight control. Indeed there are a whole host of conditions that women are particularly prone to as they age which would all be especially prevented by more exercise.

The list includes osteoporosis, intellectual decline culminating in dementia, depression, and breast cancer, among many others. Exercise, even gentle activity to the extent of a walk a day has been shown to be helpful in warding off these serious and common conditions that lie in wait of women as they get older. 

Segar, Richardson and colleagues in their research were particularly drawn to the question of how to motivate middle aged women to get going and start exercising regularly, not just because this sector of the population probably needed to most, and yet were doing it least, but for other reasons as well.

In particular the researchers pointed out that middle aged women are frequently busy with other commitments, like looking after their family and juggling the 101 things that women do, so that there were significant practical barriers for these women to take up more exercise.

On top of that the researchers wondered whether the typical exhortation to women to exercise because it was ‘good for you’ and would ‘help you lose weight’ were actually motivating, or could instead be de-motivating.

This may seem surprising but psychologists have focused on a new idea in motivational theory, which is that we can do things for intrinsic or extrinsic reasons. Extrinsic reasons include going to work because you are paid to do it. In other words you don’t go to work for the utter unadulterated joy of it. If the money was removed and you now had to decide to venture into the office for the sheer pleasure of it, or do something else, chances are when dealing with extrinsic rewards, you will tell the boss to take a running leap.

When it comes to intrinsic motivation this means you are doing something precisely because you are drawn to the activity for intrinsic reasons. For example you probably enjoy going to the cinema for the fun of it – there is no external reason for doing it. If on the other hand your boyfriend wanted you to go and see the latest gruesome ultra-violent car chase movie, when your taste is more romantic comedy, then if you went along in order to keep the peace; so you are now going to the cinema for extrinsic reasons.

The point the researchers were making with this study is they wondered whether it was better to get women to eat healthily and exercise more for intrinsic reasons rather than extrinsic ones. It would be more motivating for the women if they were encouraged to see exercise as something they would enjoy and benefit from in terms of daily well-being ie to do it for intrinsic reasons, rather than the usual approach of health experts. This is instead to emphasise the extrinsic rewards ie weight loss and less illness risk.

The researchers also saw a crucial link between the women deciding to exercise and also to take more control over their lives. Because women of this age tend to put themselves at the mercy of the demands of everyone around them, this means they put themselves last. In order to pragmatically make room in the day for more exercise this also meant the women had to put themselves first, and take more personal control of their lives. This meant the women would have to take more initiative than perhaps they were used to.

It also meant that the women had to ask some deeper perhaps even uncomfortable questions about what they wanted their lives to be fundamentally about. If it was simply to serve others, then of course their own well-being and health would take a back seat and suffer as a result.

The researchers contended that the best way to motivate women was to appeal to what they really wanted in life. If they wanted more of a sense of well-being and control over their lives then doing more exercise was a key

part of this. The exercise was worth doing because it intrinsically would be associated with feeling better rather than doing it in order to wait for benefits like weight loss.
The researchers were interested in the idea that the way to get women doing more exercise and as a result losing weight was paradoxically to change the key motivation away from simply doing exercise in order to primarily lose weight. This was part of the research project because of the previous puzzling research finding that women who have weight related and only body shape physical activity goals end up participating in less physical activity than those having non–weight-related body shape goals over the longer term.

Bottom line – do the exercise because its fun than because of fat – and magically enough you tend to lose more weight in the longer run.

Indeed the final finding of this study was that women with Weight Loss and
Health Benefits goals participated in significantly less physical activity a year later after the study had begun, than those with Sense of Well-being and Stress Reduction goals.

Doing the exercise for the intrinsic benefits of a general sense of well-being leads to longer term adherence over years as opposed to simply exercising because you want to lose weight.

Whether you agree with this research or not the fundamental point is that the reason you do something is kind of crucial in determining whether you succeed or not. Doing something because everyone else thinks it’s a good idea is seldom as motivating as doing it for your own personal reasons. Find a good and personally powerful reason to do something and this is half the battle. The rest is surprisingly easy.

REFERENCES

TYPE OF PHYSICAL ACTIVITY GOAL INFLUENCES PARTICIPATION IN HEALTHY MIDLIFE WOMEN Michelle L. Segar,  Jacquelynne S. Eccles and Caroline R. Richardson.  Women’s Health Issues, Volume 18, 281–291.

Autonomous self-control is less depleting Mark Muraven Journal of Research in Personality, Volume 42, 763–770

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