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The basal ganglia continually monitor what is going on in the cerebral cortex, which is the thinking part of the brain and where information is processed.
The brain’s relay system (thalamus) is responsible for sending and receiving motor and sensory signals (apart from smell) to and from the cerebral cortex.
Because the basal ganglia are thought of as being sticky in obsessive-compulsive disorder (OCD), it shows why the thalamus relays repeated information back and forth to the cerebral cortex.
The repeated information thus becomes obsessional and carries a sense of threat. Repetitive actions to neutralise obsessive thoughts are known as compulsions. For example, when Mr X regularly prays for forgiveness for having blasphemous-intrusive thoughts (obsession), he is doing a compulsion.
The reward he gets for doing the ritual is anxiety relief, but it doesn’t last long. It’s because after doing it, he gets doubts and thinks he needs to pray again just in case God hasn’t forgiven him. The hippocampus, the memory part of his brain, reminds him that the praying compulsion is the “solution”.
Unfortunately, the brain’s memory contributes to retaining old connections, including a person’s faulty interpretation of an obsession. But the good news is that the brain can also form new connections. It is known as neuroplasticity, meaning the erroneous connections can be modified.
Before I explain how it works, think of several crossing points in the brain whereby messenger cells meet and transport information to and from each other. Recall how the thalamus loops OCD messages to and from the thinking part of the brain. It uses these crossing points (synaptic connections) to do this.
So, how does the brain form new connections?
Well, let’s take Mr X’s situation as a further example. What he would have to do is change his thinking errors associated with the obsession. He can do this with cognitive therapy (CT) and back it up with exposure-response prevention (ERP).
For instance, one of his thinking error is, ‘Because I’m having blasphemous-intrusive thoughts, God will abandon me and I’ll go to hell’. In CT, he would change this to something on the lines of, ‘I will allow the unwanted blasphemous thoughts to come and go without attaching meaning to them’. Additionally, he would agree to resist the compulsions related to the obsession like resiting praying for forgiveness. By not yielding to compulsions, it means his basal ganglia become less sticky because the rational part of his brain (the cerebral cortex) plus the thalamus begins reciprocating the corrected information.
In short, CT and ERP help Mr X’s brain decode and correct blasphemous-intrusive thoughts, and as a consequence, the obsession weakens. With practice, the threat factor diminishes (in the above example, the mistaken threat is the fear of being abandoned by God). What’s more, the weakened obsession decreases the urge to ritualise and as a consequence, Mr X can disengage more easily from thinking and doing the things that at one time had him caught in a loop.
And there is your healthy neural change.
Read more about the biology of OCD in my book “Desire-Intrusive Thoughts: What To Do When Sexual, Religious, and Harm Obsessions Carry Unwanted Arousal”.