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Strategic systemic approach and hypnosis

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      OCD is characterized by persistent doubts that lead to anxiety-inducing obsessions and repetitive compulsions. How can we understand this position between doubt and obsessions?

      The hidden power of doubt and its connection to fear, obsession and compulsion

      The psychology of doubt

      Key points

      Doubt challenges rational thinking, creating cognitive and emotional disturbance.

      From a philosophical perspective, doubt is essential to knowledge, but it can lead to decision paralysis and insecurity.

      “The patient no longer fights against his doubts, but for them.” -Jaspers, 1963.

      “Doubt is not a pleasant state, but certainty is absurd.” -Voltaire

      Obsessive-compulsive disorder (OCD) is a complex illness characterized by a cycle of obsessions and compulsions. A central aspect of this disorder is doubt, which triggers a series of protective rituals, profoundly affecting an individual's daily life. OCD can promote doubts that frequently manifest as obsessions, which are persistent, unwanted thoughts that cause significant distress (Abramowitz, Taylor, & McKay, 2009; Nardone & Portelli, 2013; Vitry et al., 2021; Gibson et al, 2016) These doubts can vary widely, encompassing fears about personal health, morality, or causing harm to others. To alleviate the anxiety linked to these doubts, compulsions appear. These are repetitive behaviors or mental acts that an individual feels compelled to perform (Salkovskis, 1999; Nardone and Portelli, 2013). But what is so intriguing about doubt for the human mind?

      The psychology of doubt and the rational mind

      Doubt has profound implications both in the psychology of rational thought and in philosophy . The presence of doubt in the “Western rational mind” manifests itself as a significant source of cognitive and emotional disorders (Descartes, R., 1996). Rational thinking, which generally thrives on clarity, reliability, and logical consistency, is greatly disrupted when confronted with doubt, as is the case in OCD (Gibson, et al., 2016). This disruption comes from uncertainty, which hampers our logical faculties and complicates decision-making processes. The rational mind thus finds itself in a quagmire, struggling without a solid foundation and calling into question our beliefs and our decision-making Gettier, EL (1963).

      Doubt and knowledge

      Doubt has helped shape discussions about the nature of knowledge and understanding, both in psychology and philosophy (Descartes, R., 1996). We often find ourselves questioning our actions and abilities, such as our ability to drive or our ability to cope with serious illnesses. A particular type of self-doubt involves doubting our ability to correctly understand or hold accurate beliefs.

      This type of doubt is common and understandable, given our propensity for error. However, it leads to a paradox when we use our reasoning to question our reasoning ability. Resolving this conflict between our initial belief and our doubt poses an important philosophical and practical dilemma.

      Socrates, for example, was aware of his lack of knowledge about major concepts such as virtue or justice, and this awareness led him to avoid committing to specific beliefs and instead seek opinion others. Our willingness to admit our ignorance opens the way to new learning. On the other hand, Descartes took a more radical approach, questioning everything, even his sensory experiences, to rebuild his belief base from scratch, examining the very roots of his knowledge.

      The simplest examples are those where we reevaluate our beliefs based on new knowledge about our judgment abilities, such as when we acquire a new skill or professional insight. In other cases, the right course of action is less obvious. For example, an eyewitness to a crime, upon learning that eyewitness testimony is unreliable, faces a dilemma regarding how much trust he can place in his memory.

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      The dangers of excessive doubt

      Questioning reality

      Doubt challenges the desire for definitive answers, leading to delays in decision-making or “paralysis by analysis” (Schwartz, 2004), because it prevents firm decisions from being made. Furthermore, the emotional impact of doubt, such as anxiety or insecurity, affects rationality, clouds clarity of judgment and increases frustration. Doubt prompts individuals to critically reevaluate their beliefs, an intellectually engaging but often mentally taxing process, especially when it comes to core or long-held beliefs, leading to cognitive dissonance, where one feels debate with contradictory beliefs, as described by Festinger (1957).

      The methodical skepticism of René Descartes (1996), for example, illustrates how doubt can be used as a tool to dismantle unfounded beliefs, ultimately leading to fundamental truths, as illustrated by the cogito argument (Descartes, 1641). Likewise, the Socratic dialogues emphasize the role of doubt in the pursuit of knowledge, emphasizing the importance of recognizing one's ignorance as a precursor to understanding (Plato, 380 BC), as does skepticism Davis Hume's empirical questioned the reliability of sensory experience and rational deduction, calling into question the very foundations of our understanding of the world (Hume, 1748). Even Nietzsche's perspectivism suggested the inevitability of doubt given the subjective nature of all understanding (Nietzsche, 1887). Others have even presented doubt as a central element of the existential quest for meaning and authenticity (Camus, 1942; Kierkegaard, 1843).

      The dangers of excessive doubt

      While doubt plays a crucial role in rational thinking and the quest for knowledge, excessive doubt can lead to significant difficulties and harmful effects, particularly in the context of psychological disorders such as OCD . This persistent and often overwhelming feeling of doubt can become paralyzing and disrupt a person's ability to make decisions and engage confidently in the world. In cases of OCD, doubt is not simply a philosophical or intellectual exercise; it manifests itself as an implacable and distressing force. It fuels the cycle of obsessions and compulsions, in which the individual is caught in an endless quest for certainty and control over their intrusive thoughts (Abramowitz, Taylor, & McKay, 2009; Gibson, et al., 2016, Nardone and Portelli, 2013). This incessant quest can lead to severe anxiety, impacting mental health and decreasing quality of life.

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      References

      • Abramowitz, J.S., Taylor, S., & McKay, D. (2009). Obsessive-compulsive disorder. The Lancet, 374(9688), 491-499.
      • Clark, D.A. (2004). Cognitive-behavioral therapy for OCD. Guilford Press.
      • Descartes, R. (1996). Meditations on first philosophy. (J. Cottingham, Trans.). Cambridge University Press. (Original work published in 1641)
      • Foa, E.B., Yadin, E., & Lichner, T.K. (2012). Exposure and response (ritual) prevention for obsessive-compulsive disorder: Therapist guide. Oxford University Press.
      • Gettier, EL (1963). Is Justified True Belief Knowledge? Analysis, 23(6), 121-123.
      • Gibson, P. (2019). Advances in effective brief psychotherapy. Lettertec Books.
      • Gibson, P. (2021). Escape the anxiety trap. Strategic Science Books.
      • Gibson, P. (2022). Persuasion Principle. Strategic Science Books.
      • Gibson, P. (2023). The OCD clinic. Strategic Science Books.
      • Goldmann, A. (1999). Knowledge in a Social World. Oxford University Press.
      • Hume, D. (2000). An Inquiry Concerning Human Understanding. Oxford University Press. (Original work published in 1748).
      • Kierkegaard, S. (1983). Fear and trembling. (A. Hannay, Trans.). Penguin Classics. (Original work published in 1843)
      • Kuhn, T. S. (1996). The structure of scientific revolutions. University of Chicago Press. (Original work published in 1962)
      • Nardone, G., Portelli, C. (2007) Knowing Through Changing. Crown Publishing.
      • Nardone, G., and Portelli, C. (2013). Ossessioni compulsioni mania. Capirle e sconfiggerle in tempi brevi. Ponte Alle Grazie.
      • Pittenger, C., Kelmendi, B., Bloch, M., Krystal, JH and Coric, V. (2005). Clinical treatment of obsessive-compulsive disorders. Psychiatry (Edgmont), 2(11), 34-43.
      • Popper, K. (2002). The Logic of Scientific Discovery. Routledge. (Original work published in 1934)
      • Rachman, S. (2003). The treatment of obsessions. Oxford University Press.
      • Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behavior Research and Therapy, 37, S29-S52.
      • Stein, M.B., Forde, D.R., Anderson, G., & Walker, J.R. (2007). Obsessive-compulsive disorder in the community: An epidemiologic survey with clinical reappraisal. American Journal of Psychiatry, 164(8), 1122-1129.
      • Vitry, G., Pakrosnis, R., Brosseau, OG, & Duriez, N. (2021). Effectiveness and efficiency of strategic and systemic therapy in a naturalistic setting: Preliminary results from a systemic practice research network (SYPRENE). Journal of Family Therapy,43(4). https://doi.org/10.1111/1467-6427.12343

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      A team of more than
      50 trainers in France
      and abroad

      of our students satisfied with
      their training year at LACT *

      International partnerships

      The quality certification was issued under
      the following category of actions: Training action

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