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People with obsessive bad thoughts, for example, of killing their child, experience intense guilt and shame as a result of the thoughts, as if they somehow represent a reality. Such people are often afraid to discuss their thoughts with anyone for fear that they will be thought of as insane or have murderous intentions, yet the mere fact that they feel so guilty at having such worrying thoughts indicates that they are not dangerous people but rather are one of millions of people who suffer in silence from bad thoughts. Such thoughts refer to thinking the most inappropriate things at the most inappropriate times. These thoughts, urges and images almost always fit into one of the following categories: inappropriate aggressive thoughts, inappropriate sexual thoughts or blasphemous religious thoughts. Such thoughts may involve harming an innocent child, urges to jump from a tall building, urges to push in someone in front of an oncoming train or to jump in front of the train yourself. They may also worry about saying or doing things that are contrary to their beliefs, such as shouting a racist remark or having incestuous urges. There are a wide variety of bad thoughts people have, and a number of disorders that can elevate them to serious problems, such as obsessive-compulsive disorder and depression. Millions of people suffer from such thoughts that make them feel like morally bad people as many believe that thinking the thought is as bad as perfroming the act itself, that one day they will act upon these thoughts and that they are closet criminals. However, while the person thinking such thoughts may become guilty, depressed and in some instances, incapacitated, they are highly unlikely to ever act on their thoughts and they remain just bad thoughts. However, while most people will never seek treatment, perhaps because of the embarrassment and shame caused by such thoughts, they can be tamed. Epidemiological stuides around the world suggest that such thoughts may be the most common form of OCD. Those suffering from bad thoughts are often more tormented than people with any other psychiatric disorder and many have contemplated or attempted suicide. Yet they have almost never told another living soul about the disorder, instead suffering in silence.
THE IMP OF THE PERVERSE: The phenomenon of intrusive thoughts has been called 'association by contrast' by the French neurologist Pierre Janet, in which the patient feels driven to do exactly the opposite of what he wants to do. Bad thoughts that are severe, are called obsessions and may cost people the most important things in their lives: they are fearful of being around their children in case they hurt them, some cannot have relationships and some are so paralysed that they cannot perform simple everyday activities such as leaving their house, because of these thoughts. These are obsessions of clinical severity and require treatment.
What Baer (2001) calls 'the Imp of the Perverse' visits everyone from time to time, with two possible outcomes: 1) We give the thoughts little attention and go on with our lives and 2) we are strongly affected by the bad thoughts so that they occur frequently throughout the day and interfere with our lives. Rachman (1978) devised a list of common bad thoughts in healthy college students including thoughts of 'unnatural' sex acts (including sex with animals), thoughts of causing harm to elderly people or blasphemous thoughts during prayers. Intrusive thoughts seem to pepper literature, implying that they have been common throughout history. For example, in the sixteenth century, a woman who admitted to having evil thoughts about harming her husband and children was believed to have been possessed by Satan and only just escaped burning at the stake.
How the Imp selects his thoughts: We are tormented with thoughts of whatever it is we consider to be the most inappropriate and awful thing we could do. Baer (2001) exemplifies this by describing the doctor who worried about mutilating babies with a scalpel and the priest who worried about staring at women's private parts.
Thought suppression: For some people, the way they react to the thoughts can determine whether their bad thoughts will reach clinical severity requiring treatment. Some people may try to deaden the thoughts with drink or make desperate attempts to try and suppress these thoughts and avoid any situations that might trigger them. However, paradoxically, what would be best would be to stop resisting the obsessions and place yourself in situations that trigger the obsessions rather than avoiding them. Allowing yourself to look at whatever you want to look at, letting bad thoughts pass through your mind and recognising bad thoughts as nothing more than thoughts, can cure people of their obsessions. Avoiding almost any situation increases our fears of it. (Symptoms of OCD can be assessed by using the Yale-Brown Obsessive-Compulsive Scale (YBOCS)).
What leads us to suppress bad thoughts? When bad thoughts intrude, many people believe that they are expressing a darker, more violent side to themselves that they didn't know existed, in a manner of Dr. Jekyll and Mr. Hyde. When they first experience violent, sexual or blasphemous bad thoughts, many people believe that deep down inside them is their 'true' self waiting to be unbound- an evil murderer or molester whose appearance is heralded by the appearance of the bad thoughts. For those who reach this conclusion, thought suppression seems to be the only logical approach- that is, to block all attempts of their evil nature from forcing it into their consciousness. We now understand that such methods, along with artificial attempts to suppress the thoughts by drinking or drugs, only makes a bad situation worse. Bad thoughts do not signifiy that you are truly evil deep down and voluntarily suppressing these thoughts will only make them stronger.
THOUGHTS OF HARMING CHILDREN: Why do some new mothers brush off occassional thoughts about harming their infant, while others are tormented and may even come to avoid taking care of their child? If a new mother is suffering from depression, she is more vulnerable to the effects of intrusive thoughts; perhaps her brain is less able to perform its normal function of filtering out bad thoughts such as these, or possibly the negative view of herself that accompanies depression makes her more likely to believe that these thoughts indicate that she is in fact a bad mother. Thoughts of harming one's infant are so common in postpartum depression that in some accounts, this is listed as one of the defining elements of the disorder. Such women have obsessions about putting the baby in the microwave, drowning the baby, throwing the baby down the stairs etc. and such women worry about whether they will end up like Susan Smith who drowned her children in a car. However, according to Wisner such women also fear doing something embarrassing, fear of harming themselves, shouting out obscenities etc. and so these are clearly the thoughts of women worried about doing the most inappropriate thing at the most inappropriate time. These women do not so much have the urge to hurt their baby and know rationally that they could never do such a thing, but more the fear that they might 'lose control' and hurt the child. Often these women will become more obsessed because of how they interpret their obsessions, asking 'Am I having these thoughts because I am a bad mother?' or 'Does this mean I really did not want to have this baby?' Jennings (1999) found that in a study of one hundred clinically depressed women with at least one child under three years of age, 41% admitted to having obsessions about harming their child in comparison to 7% of a non-depressed comparison group. Such thoughts of harm are not restricted to new mothers, nor are they restricted to mothers, but may apply to grandparents, aunts etc. They may not be aggressive obsessions, but rather the fear of molesting one's own children. To demonstrate just how bizarre such obsessions can become in young mothers, Brockington and Filer (1996) tell of one pregnant woman obsessed with sexually abusing the unborn fetus.
Postpartum depression is contrasted with a much more serious disorder called 'postpartum psychosis' in which the new mother loses touch with reality.
HOW CAN I BE CERTAIN THEY'RE JUST THOUGHTS? People may fear terribly about harming another person or sexually abusing a child, even when every bit of evidence suggests they will never act upon such thoughts. Often, people with bad thoughts say they do not feel fit to live in normal society and while this is true for murderers and child molesters, this does not apply to the person tormented by doubt and guilt over bad thoughts. However, patients with intrusive thoughts are unable to draw this crucial distinction. How can they be sure that these are only thoughts and that they will not one day end up like Jeffrey Dahmer? Many people feel like they have committed an unpardonable sin simply by thinking such thoughts, however, exposure therapies such as holding knives and constructing stories based on the fears described can often help, as well as allowing clients to deal with the fact that no one can ever be completely certain that they will not commit the act they obsess about. Discussing certainty with such patients is often a precarious balancing act: most are obsessed with the effort to reach absolute certainty that they can never act on their thoughts- and are tormented by the existence of even the slightest doubt. This is always a losing battle, since we cannot be 100% certain of anything. Therefore, for the question 'How can I be absolutely certain that I will never act upon my bad thoughts?' the only answer is 'you can't.' In fact, the very act of trying to attain perfect certainty is often the worst source of distress for those suffering from violent, sexual or blasphemous bad thoughts. It is not coincidental that the French refer to obsessive-compulsive disorder as 'The Doubting Disease' as patients are endlessly seeking reassurance and futilely seeking absolute certainty.
OCD: Based upon the criteria of the DSM-IV (1994), anyone with intrusive thoughts that interfere with their lives would be diagnosed with OCD which is defined as 'either obsessions or compulsions which are very distressing, take more than one hour a day or interfere with doing work, school or social activities.' Obsessions are intrusive and unpleasant thoughts, impulses or images that are not excessive worries about real life problems for example, perfectionistic, aggressive, sexual, blasphemous, doubting, contammination or symmetry obsessions. These are often accompanied by compulsions: actions that the person feels driven to do over and over again, to reduce distress or to prevent something bad from happening. These may be washing, checking, repeating, praying, touching, hoarding or counting. In almost every culture that has been studied, the prevalence of OCD is at least 2% of the general population, the majority of whom have obsessions only (i.e. Without the accompanying compulsions).
There are crucial differences between people who have intrusive, disturbing thoughts and the infamous people often in the media who have actually committed horrible acts. The very fact that they have never acted in a manner consistent with their thoughts or urges is an excellent predictor they will never act on them. Both psychology and criminology state that the best predictor of future behaviour is past behaviour. Likewise, the mere fact that they feel guilt and distress over their bad thoughts is a powerful indicator that they will not act upon their thoughts as people who engage in criminal acts typically have precisely the opposite emotions from the guilt and shame such patients feel. Even when hooked to a lie detector, psychopaths, sociopaths or simply cold-blooded killers rarely show any physiological reaction. They don't feel guilty or remorseful about even the most horrible acts they perform and typically meet criteria for a diagnosis of Anti-Social Personality Disorder when adults and for Conduct Disorder before they reach the age of 18. Patients with bad thoughts are the opposite of such criminals and are overconscientious and feel intense guilt and tremendous guilt at having such thoughts. Such patients may be diagnosed with Obsessive-Compulsive Personality Disorder which is characterised by overconscientiousness, preoccupation with details or rules and are rigid and stubborn.
The guilt and distress these patients suffer is the result of the orbital frontal cortex which energetically suppresses their bad thoughts. It works to inhibit the thoughts and the associated urges, so patients should be reassured that they will not act on them. The guilt, anxiety and distress caused by unwanted thoughts is the polar opposite of the coolness, lack of remorse and deception which characterises criminals.
Bad thoughts may be dangerous when, instead of experiencing distress and guilt, they are thought to be enjoyable, if the person has ever acted on violent or sexual thoughts or urges in he past, either while sober or under the influence of alcohol or drugs, if the person hears voices, has hallucinations or believes other people are against them or they have uncontrollable anger and find it hard to resist urges to act on aggressive impulses.
WHAT CAUSES BAD THOUGHTS? There are several overlappying theories as to why we have bad thoughts, yet no one theory provides a complete explanation. As far as we can tell, intrusive thoughts have appeared in all cultures and at all times in history, it seems a safe guess that these thoughts are hardwired in our genetic makeup.
EVOLUTIONARY THEORIES: The tendency to have sexual and aggressive thoughts and urges (as well as to engage in these behaviours at appropriate times) has been bred into humans over thousands of centuries, shaping our bodies and minds to help us survive and reproduce. As an example, evolutionary theory predicts that the genes of our ancestors who rarely thought about sexual intercourse would gradually have become outnumbered by the genes of those who thought about sex quite a bit and who, evolutionary theory would predict, produced more offspring as a result. Similarly, males have more aggressive thoughts than females because the males who thought and acted the most aggressively would have tended to become the leaders of their groups and, as a result, would have impregnanted the most females, thus passing on their genes in larger numbers than more docile males.
The evolutionary viewpoint has also been applied to understanding why new mothers might worry about harming their newborn babies. Wisner noted that the more these mothers had violent thoughts about terrible things happening to their infants, the more they also checked their infants to ensure that they were safe. Thus, such thoughts may make the mother more vigilent to the dangers that could befall their children, thereby increasing their children's chances of survival and passing along their genes.
The aggressive and sexual impulses that evolutionary theory predicts were bred into us are thought to be controlled by 'lower parts' of our brains. That is, those parts we share with other mammals. On a more optimistic note, this viewpoint explains that as humans came together in communities, their brains developed structures to keep raw sexual and violent urges under control- that is, to inhibit them. The main role of humans' large orbital-frontal cortex, is to determine whether to act on the thoughts and impulses generated in the lower parts of our brains, or to inhibit acting on them. Evolutionry theory suggests that through this process, we come into contact with the violent and sexual instincts that have been passed down to us over the millennia. Baer (2001) suggests that patients problems with bad thoughts arise when either they cannot accept that such thoughts and urges are part of being human, or they fear that their orbital-frontal cortex will not be able to inhibit these thoughts and urges.
FREUD: Freud emphasised the conflict we are sure to feel when our sexual and violent thoughts and urges (biological remnants of our evolutionary past; the id) clash with newer, tighter restrictions from a carefully regulated society. Freud also theorised that through socialisation, we internalise the social prohibitions of our culture in what he called the superego. Therefore, intrusive thoughts may have been born from this social versus biological clash; that is, the tension between our inbred sexual ad violent impulses and society's strictures against our freely engaging in these behaviours.
THOUGHT SUPPRESSION: While evolutionary and Freudian theories are largely untestable, thought suppression as proposed by Wegner, has the advantage of being testable by experiment and also suggests a treatment approach to reduce bad thoughts. Wegner's theory states that any time we try to force ourselves not to think a particular thought, the thought is paradoxically given more energy. In addition, not only are we unable to suppress the thought, but our attempt backfires by producing a rebound effect in which the thought occurs more frequently after we stop trying to suppress it. Wegner would argue that because of societal taboos, we learn to vigilantly monitor our thoughts and whenever we detect an inappropriate thought, we try instantly to suppress it.
However, though thought suppression clearly plays a role in normal bad thoughts, Baer (2001) states that it is uncertain whether it plays a role in the development of clinical obsessions as Wegner proposes, as, even though nearly everyone engages in some thought suppression for their unpleasant thoughts, only a minority are tormented or paralysed by their obsessions. So, what causes normal bad thoughts to progress from merely annoying to painful and debilitating?
WHY DO BAD THOUGHTS GET OUT OF CONTROL? Research suggests that a psychiatric disorder such as depression, OCD, PTSD or Tourette's syndrome is almost always present in those people suffering from clinically severe bad thoughts Being depressed forces us to view ourselves and the world through dark-coloured glasses and predisposes us to having more thoughts about death and danger. When depressed we often think the worst of ourselves which often leads us to experience normal bad thoughts as evidence that we are worthless, sinful, bad people who are deserving of punishment.
Savage and Rauch (2001) found that sufferers of OCD are often unable to pay adequate attention to events they are not actively focusing upon. OCD sufferers often cannot feel certain that they have not performed an inappropriate action they have thought about because they can't remember not having done it. For example, an OCD sufferer may worry that he has unknowingly molested passers by on the street. When he tries to feel certain that he has not molested, he searches his memory for proof but, not having found it, he becomes even more afraid and, being overconscientious, draws the erroneous conclusion that because he cannot remember not having done it, he must have sexually molested someone. Much research has looked at what goes on in the minds of people when they are having bad thoughts and brain imaging has shown that when they have particular obsessions, specific parts of a person's brain become more active. These include the orbital-frontal cortex, the caudate nucleus and the anterior cingulum, all of which are closely connected with our limbic system, the part of the brain associated with strong feelings. The explains why people usually obsess about things that involve danger of harm or humiliation.
To demonstrate, Dr. Savage gives the example of a woman afraid of knives. If, despite her efforts to avoid them, she sees a knife, this activates the brain's limbic system and she beomes aware of being scared. Then, if due to OCD the parts of her brain previously mentioned are not able to suppress this feeling and keep it from her awareness, then she will probably suffer from obsessions and worries about the knife and the damage it can do. Therefore, while one might worry about harming others, the orbital-frontal cortex and other parts of the brain work hard at inhibiting such urges and the brain activity of an OCD sufferer is the exact opposite of that of a person who acts impulsively and dangerously; in an OCD sufferer's case, the brains automatically inhibit acting upon unwanted thoughts.
Savage (2001) believes that OCD and Tourette's syndrome lie upon a continuum, with the particular symptoms we see determined by which brain systems are malfunctioning. In Tourette's syndrome, the brain's motor networks are primarily affected, resulting in muscular tics, twitches and jerks as well as sounds produced by the vocal musculature. In OCD, Savage believes that prefrontal cognitive networks involved in thinking are primarily affected and so we see more mental symptoms such as obsessive thoughts and worries. In Tourette's syndrome, the urges to do or say inappropriate things are tightly tied into the emotional part of the brain because these acts are all dangerous, provocative or shocking. That is why it is no accident that the words shouted out tend to be those the sufferer might feel most ashamed to shout out. Similarly, alcohol or rectreational drugs such as barbiturates suppress the activity of our brain's frontal cortex whose main job is to control and suppress the primitive aggressive and sexual impulses from the lower areas of our brain. When we drink or do drugs, our frontal cortex is no longer able to do its job properly, making us more likely to act on our impulses. Because of this, for anyone with OCD who worries about doing something dangerous or embarrassing, getting intoxicated with any substance is usually a bad idea.
Savage explains that we see the symptoms of OCD only when both 1) emotional systems of the limbic system and 2) cognitive systems of the prefrontal cortex are malfunctioning. When these two problems coexist, OCD sufferers will place enormous emotional importance on their thoughts, worrying about them excessively. To make matters worse, these two problems are related to problems associated with episodic memory: the ability to create particular past events in your head.
FACING YOUR FEARS HEAD-ON: EXPOSURE THERAPY: When people with intrusive thoughts and who have tried to avoid and suppress such thoughts for a long time are told that the best way to combat them is to face them head-on through exposure, they are often mystified. Extensive research around the world since the 1960s on the use of exposure therapy for OCD has confirmed that repeated exposure of one or two hours at a time without doing any comforts or distractions, are highly effective in reducing obsessions in most sufferers. Such instructions are remarkably effective: two recent neuro-imaging studies at UCLA proved that exposure therapy is the first non-drug treatment to show changes in the brain chemistry of responders that mirror their observable clinical improvements. However, these behavioural instructions rely on the individual's accepting the advice as worthwhile, not harmful and effective.
HABITUATION: Habituation is the key principle upon which exposure therapy is based and the reason it is so effective. Habituation means 'to accustom; to make familiar by frequent use or practice.' Like visiting friends who live beside an airport but who barely notice the noise of planes passing, long familiarity with a situation that initially produces a strong emotional reaction allows us to get used to it and eventually ignore it. Baer (2001) states that if you continue to practice exposure and response prevention, fears and compulsions will almost always decrease, although at different speeds according to the person. Changing our behaviour indirectly changes our thoughts and feelings towards a stimulus. When thoughts are triggered by specific situations, such as taking public transport, going into a kitchen where there are knives etc., patients are instructed to enter into such situations ('in vivo exposure'). This is often accompanied by having the person imagine the feared situations ('imaginal exposure'), often assisted by the use of a tape-recorded description of the feared situation.
In vivo exposure for violent obsessions may involve identifying all the situations that trigger the bad thoughts, followed by systemtatic exposure to these situations, remaining in them even when uncomfortable, such as sitting with the people you fear harming with a sharp object such as a pair of scissors within reach. All the while the patient should be told to expect the thoughts to pass through their mind occasionally but realise that they are not in themselves dangerous. They should try to accept rather than suppress them. In some cases, in order to accelerate progress where it may have been stunted, it is necessary for the patient to expose himself to the very bad thoughts he is most afraid of by writing a script detailing the thoughts that they most fear and recording it to listen to for at least one hour a day. Combined audiotape and in vivo exposure treatment is likely to decrease bad thoughts significantly. However, some people don't respond to exposure therapy or are not willing to attempt it, in which case, other treatments such as cognitive therapy and medication may be helpful.
QUESTIONING YOUR BAD THOUGHTS: COGNITIVE THERAPY: Cognitive therapy, teaching patients how to directly change their thoughts, is primarily for those who are unable or unwilling to undergo exposure therapy. Both have been found to be equally as effective and far more effective than placebo treatment. Teaching patients about their own thought patterns and how to test them for rationality helps many patients to get their bad thoughts under control. Cognitive therapy for treating obsessions is based on the idea that intrusive thoughts are occurrences that everyone experiences. The person who suffers from OCD does not differ from one without OCD in the content of his thoughts but simply in the way he reacts and interprets his thoughts. While most people are able to ignore intrusive thoughts and recognise them as unimportant, the person with OCD pays too much attention to them and interprets them as being very important. He may also underestimate his ability to cope with the intrusive thoughts, thus trying to suppress them and giving them more strength. Such people attribute too much importance to a particular thought (thinking that just because we have a particular thought, it must be meaningful or it might actually happen), think they need to be able to completely control their thoughts, believe a situation is more dangerous than it really is (such people believe that a situation is dangerous until they are guaranteed that it is safe while others assume a situation is safe until it is proven to be danegerous), cannot tolerate uncertainty, are perfectionists and believe they have the ultimate responsibility and power to prevent bad things from happening. In cognitive therapy, the therapist assesses which of these areas a patient is having problems in and then addresses these areas with specific procedures. Just understanding that everyone has violent or sexual thoughts from time to time and that they only differ in their reactions towards such thoughts is relief for a lot of people with OCD as they realise their thoughts have no hidden meaning. Such people's misconceptions and beliefs often leave them vulnerable to interpreting bad thoughts in a way that is destined to lead to anxiety and guilt.
Patients are often taught to recognsise maladaptive apraisals and reactions to intrusive thoughts and taught to develop alternative interpretations of intrusions, assisted by the Socratic questioning technique, for example asking 'is your appriasal of the intrusion helpful right now?' or 'Is your appraisal realistic?' During cognitive therapy, patients may be asked to indulge in thought suppression for a particular object, such as a giraffe, in order to demonstrate the ineffectiveness of this technique. The 'Downward Arrow Technique' helps uncover a patient's underlying beliefs regarding their bad thoughts and demonstrate how the cycle operates. For example, if someone had incestuous thoughts or images, they may think 'these thoughts are disgusting' then 'I need to get rid of these thoughts' then 'I cannot control these thoughts, therefore I might act on them' and finally arriving at the belief that 'I am evil.' The patient may be asked to assess the advantages and disadvantages of controlling the bad thoughts and the advantages of controlling the thoughts are questionned using the Socratic method. This may help the patient to see that thought suppression is a losing battle that is likely to result in further disadvantages. One of the most common beliefs often identified by using the downward arrow technique is that the patient might act on the incestuous thoughts if he is unable to control them. In such cases, the therapist will demonstrate that thinking about something does not increase the probability that it will happen and may conduct behavioural experiments to test this theory. In the past, patients have been asked to imagine such things as dancing nude in the clinic's waiting room to see if this would lead them to actually doing it. Therefore, the patients are treated as scientists collecting evidence that would either support or disprove the hypothesis. The hypothesis may be 'if I think of having incestuous relations with my sister, I will not be able to resist doing it' and the client will gradually come to understand that their theories and predictions do not hold up to the objective evidence: thinking about something does not inevitably make it happen.
Basic beliefs are also questionned. For example, in the above example, the patient's thoughts led to the belief that 'I am evil.' A more accurate reaction may be 'I am extremely worried about acting immorally and hurting someone' and the patient searches evidence which may support or disprove the thought 'I am evil.' Cognitive therapy might precede exposure therapy, particularly for those who are initially unwilling to produce scripts of them acting out the events they are most fearful of. Later, as the patient begins to understand more about his thoughts and beliefs, they may become more willing to do exposure tasks. Indeed, exposure exercises may not work for those who truly believe their thoughts are equivalent to performing the act they think about, and so, in such cases, exposure exercises in which they may be asked to vividly depict them carrying out the act, may be of little help and may cause further anxiety, particularly in the case of blasphemous or religious obsessions.
MEDICATIONS FOR BAD THOUGHTS: Serotonin-reuptake inhibitors (SRIs) are the most commonly prescribed for, and offer the most promise of helping intrusive thoughts if non-drug treatments are not sufficiently effective. These drugs appear to work by making more of the brain neurotransmitter serotonin available to the nerve cells in our brains, thereby reducing a variety of obsessions. Stein and Hollander (1992), in an attempt to directly address the effectiveness of SRI drugs against sexual obsessions, discovered that the greatest improvement was in those people with 'ego-dystonic, intrusive sexual obsessions typical of OCD.' Patients with other types of bad thoughts, such as religious or violent thoughts, have been shown in other studies to respond well to these drugs, but it is not clear whether these drugs assist in some obsessions more than others.
HOW DO THESE DRUGS WORK? A nerve cell is only active when a neurotransmitter like serotonin is present in the synapses. A nerve cell stops transmitting information to its neighbouring nerve cell when it reabsorbs the neurotransmitter from the synapse, ending the transmission. SRIs slow down the reuptake of serotonin, thereby keeping it in the synapse longer so transmission can continue between the neighbouring nerve cells. After a few weeks, this increased serotonin produces changes in serotonin receptors on the surface of nerve cells. It has been hypothesised that these receptors are abnormal in people with OCD and that the changes that SRIs produce in them partly reverses OCD symptoms. However, when activity in the brain's serotonin system is changed, this also changes the activity of other brain systems. Often the best chance of recovery is given with an SRI drug in combination with behaviour therapy: the SRI drug can alleviate depression, improve mood and energy and exposure can help eliminate fears and avoidance of certain tasks or situations, draining them of their strength.
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