Thursday, October 20, 2011

OCD Awareness: {The 4 R's}

In his book entitled The Obsessive-Compulsive Trap: Real Help For A Real Struggle, Dr. Mark Crawford outlines what he calls the 4 R's. I think it's a great little memory device in dealing with OCD, so I thought I would share. This is quoted exactly from his book (page 128).


  1. Recognize: This step uses cognitive therapy tools to enable the patient to identify the thinking that is behind the anxiety. In treating OCD, this inevitably results in identifying the obsessive thought, worry, or image and correctly defining it as an irrational obsessive thought.
  2. Resist: This step refers to the RP {Response Prevention} diagram. In this step, the patient is aware of the urge to perform a compulsive behavior. He has been educated regarding the importance of employing RP as essential in breaking the power of OCD and is prepared to resist the urge to perform the compulsive behavior. 
  3. Replace: In step 3, the patient begins the process of modifying the obsessive thought or worry with one that is based on truth.
  4. Re-direct: In the final step, the patient is taught to use the tools mentioned earlier to get through the critical interval of response prevention until the anxiety passes and the pattern of obsessive thoughts followed by compulsive behaviors is weakened. 
What I enjoy about the 4 R's that Dr. Crawford identifies is that it's easy in the moment for a parent to remind a child about their 4 Rs, or the individual can keep a "4 R's" post it note in their cubical at work as a very easy reminder of how to walk himself through the anxiety he experiences. 
In Step #1, Dr. Crawford mentions the need to identify thinking behind the anxiety. Sometimes, this includes one (or more) cognitive distortions. To read about cognitive distortions, click here and here. In Step #3, the individual changes the thought to one that is based on truth. For more information about challenging and changing cognitive distortions, click here

Here are the other posts in this series:

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