Thread by @KhalilCenter

Part 4 is NOW LIVE!

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Today we welcome back Dr. Hooman Keshavarzi (our founder + Exec. director) and Dr. Fahad Khan (Deputy and Clinical director). Last week Dr. Hooman introduced the TIIP model. Today’s session will go deeper into exploring the model, + we will be looking at OCD from an Islamic lens

The presence of obsessive thoughts are very common among people. But, what is Obsessive-Compulsive Disorder (OCD)? Obsessions are unwanted, repetitive thoughts. Emphasis on UNWANTED. Someone with OCD dislikes having these thoughts however it's very difficult to control.

OCD is made up of #obsessions and #compulsions. In order to be diagnosed you don't have to have compulsions, but that's almost always the case.

A compulsion is a strong urge to carry out a ritual. A person w/ OCD often thinks that“If I do x, then I have control over my anxiety"

There is a 1-2% prevalence of clinical OCD in the general population. Young adults are at a higher risk.

#OCD is often accompanied with with other mental disorders (comorbidity) eg., depression.

What are some obsessions a person may have? Obsessions can include (not limited to) exaggerated fears of contamination from contact with people/items, fear of accidentally/intentionally committing an act that may be harmful, or committing an act that is sexually inappropriate

However, today we will talk more about #scrupulosity which is more related to morality and religiosity. Shaytan may put in the doubt and a person with OCD will have to battle that urge.

OCD and Obsessive-Compulsive Personality Disorder differ from each other. One with OCPD may check if the door is locked however a person with OCD will do that frequently, over and over again.

People with #OCD may engage in covert compulsions. Examples include mental reviews, mental checks, scenario bending, reverse ruminating, counting/mental chanting, thought neutralization, self-punishment, compulsive prayer.

Let's talk about #OCD scrupulosity. What we call waswasa in Islamic tradition, we would call it OCD scrupulosity in modern learnings. Eg., A person with OCD may engage in compulsive prayer. This can be a form of thought neutralization, in order to counter the sinful thoughts.

With #OCD scrupulosity there may be an avoidance of religious acts. Eg., Performing prayers or making wudhu can become a hard task. They may avoid prayer because the idea of coming to pray and make wudhu is very challenging for them.

On the other hand, Someone with #OCD scrupulosity may
increase religious acts: they pray to alleviate the immense anxiety and distress they feel.

For example, repeating the same surah over and over again while praying. It's an abnormal method of praying.

Waswasa vs. Ilham. Shaytan plays on the weakness of people. Shaytan whispers suggestions, thoughts. The thoughts that come from shaytan are called waswasa. Good thoughts that come from angelic sources are ilham.

Wasawasa is a fear of one's own thoughts. They react with some compulsions. The problems aren't the thoughts, it's the reactions to the thoughts.

Waswasa becomes a vicious cycle - When a person with OCD becomes aware of these thoughts, it causes distress + physiologically arousal + puts them in a hyper-vigilant state that drives the obsessive reaction designed to extinguish the feared consequences conjured up in their mind

What is the #TIIP conceptualization of OCD Waswasa?Dominant aspects of the human psyche involved in OCD are the aql and nafs that have an accompanying impact on emotions and spiritual well-being.

For example, A person with #OCD scrupulosity may think: "my wudu is only acceptable if it is done with perfection. If I have any doubt, it is important for me to go back and do the wudu again." They (their nafs) becomes addicted to this repetitive behaviour.

As a result, in the moment the nafs is satisfied by the repetitive behaviour even though it is causing them overall pain in the long term. The nafs says "Right now I make myself feel good and afterward I can feel bad ". Afterward, is usually when the person comes for treatment

What is TIIP treatment of #OCD-waswasa? It includes 1) cognition (talim) - restructuring designed to restore balanced thinking. 2) nafs (mukhalafah) systematically desensitizing the patient to experienced subjective distress

TIIP treatment of #OCD-waswasa also includes 3) ruhani (zikr) instilling hope in Allah, and 4) emotion - breaking tension between internal critic/experiencer

In treatment of #OCD-waswasa how do we counter the compulsive thought? We reverse the negative attribution bias by this principle: Certainty is not lifted by doubt. Certainty is only lifted by certainty.

For eg., certainty is a statement. Certainty is a 100% confident statement that "I broke my wudu because I passed gas". It is a statement of surety.

Anything short of certainty is a doubt. For eg., using words like maybe, possibly, what if... Therapists can draw attention to these terms their clients use. Anything that comes after “what if”… is nullified.

We cannot think our way out of #OCD. We cannot control our thoughts, we can only control our reactions. One way to stop the reactions/compulsions we draw attention to the origin of the thought.

For eg., a person may repeat prayers because they feel the first one was not accepted. So, a therapist can tackle that by drawing attention to the first time they prayed.

Therapist: Where did the thought about the first prayer come from?

Client: It is a commandment from Allah

Therapist: The second time you prayed, where did the thought come from?

Client: it came from waswasa

Therapist: Okay, so if it came from waswasa which is from shaytan then whose command did you listen to?”

Client: Oh no! I was following Shaytan!

Once the client realizes the second prayer was for shaytan they will then realize that by repeating prayers they are more unsafe (prayer is not accepted).

Another helpful thing to incorporate in sessions: objective measures.

Exposures in sessions are needed. These tasks can induce pain. For example: spending 15 minutes making wudu → spend 10 minutes by next week. Through keeping a log you can see the things that are changing.

A big thank you to today's presenters: Dr. Hooman Keshavarzi and Dr. Fahad Khan for today’s session on TIIP treatment of OCD in Muslim patients! And a big thank you to our organizers, and our attendees!

Tune in next week for live updates on session 5.