We have ever worn the watch on the left when you are used to always carry it right and perceive that something is not “in place“? Or to look at a picture and feel the impulse to fix it despite being straight?
These examples are common experiences that help us understand what those who suffer from that pathological condition feels. Experiences a strong sense of discomfort/anxiety because “Things are not in the right way“Or are incomplete. This sensation can become chronic, disabling and can be managed through dysfunctional behaviors, which limit the life of the person.
This condition has been defined Not Just Right Experiences (Njre) And it is certainly a dimension less studied by clinicians and more difficult to understand. In fact, it is not easy to explain this internal, personal sensation, which is activated in front of the most varied stimuli.
What is the Not Just Right Experience
It refers to an unsatisfactory inner sense of imperfection and/or perception that their actions have not been completed appropriately. “A subjective sense that something is not as it should be“.
This experience differs from the perfectionist beliefs or traits that generally have more to do with the need to be perfect in order not to feel inadequate.
Patients who live the condition of Njre have “An inner push that is connected to the desire to feel that things are perfect, absolutely certain, or completely under control“. This in order not to experience the discomfort that would derive in stopping in this condition.
The search for perfection and “completeness“It is unrelated to high standards of performance. It is rather conditioned by an internal, subjective thermometer, to refer to to feel that things are in the right way.
Try the Njre causes significant discomfort in the person and motivates the impulse to decrease or eliminate the internal sensations of imperfection/incompleteness.
This often pushes the individual to engage in repetitive behaviors until he feels free from these experiences. This can create limitations in one’s daily life or to the structure of the vicious circles typical of various psychopathological problems.
Njre and other ailments
In fact, several studies indicate that the NJRE has a possible transdiagnostic nature being associated with various disorders such as depression, generalized anxiety, social anxiety, tic disorders, tourete syndrome and autistic spectrum disorders. Although the research has identified the greater correlations with obsessive compulsive disorder.
Njre and obsessive-compulsive disorder
The most influential cognitive behavioral conceptualizations of the DOC underline the avoidance of the damage as the main cause below the structuring of the symptoms. However, not all patients who present this disorder can identify specific threats (such as fear of creating damage to themselves or others by driving or leaving the gas open etc.).
Simply these patients deny that their compulsions are motivated by preventing feared consequences.
Some patients with DOC engage in dysfunctional behaviors (such as compulsions) to manage and reduce the discomfort given by the internal and widespread sensations that things are not “right“(Njres).
Avoiding or compulsive behaviors help, in the short term, to achieve a state of completeness/perfection, according to internal reference criteria.
These feelings of discomfort would be the consequence of a deficit in the ability to experience emotional experience and sensory feedback that guides behavior. The function of compulsions, in this case, is therefore to reduce emotional discomfort and restore an internal feeling of “rightness“.
Usually the behaviors associated with emotional management are Order rites, symmetry (Place books, clothes, various objects), but also the need to remember/repeat insignificant things. Or taps (knocking on the table), visually imagine forms that give a feeling of being “in place“Etc.
These repetitive behaviors can create the vicious circle of obsessive compulsive disorder, as they lower the feeling of discomfort in the short term, but lead the person to have increasing need for such behaviors and therefore limit daily life.
What is sensitivity to emotions and sensations
As we have seen, the compulsions related to this obsessive disorder subtype are not linked to the need to prevent/avoid a specific threat. They satisfy the need to avoid the feeling of discomfort that the NJRE implies.
Recent research in psychopathology in general, and in the doc in particular, have focused on reactions to emotions and sensations rather than on the experiences themselves. The term “sensitivity” is used to refer to the negative evaluation of emotional states: an emotion can be evaluated as threatening, and this can have consequences on how emotion is managed (Melli, Carraresi, Poli, Marazziti, & Pinto, 2017).
Therefore the tendency to have negative beliefs regarding the NJRE (“I can’t tolerate the discomfort“,”if I don’t do something it will last forever“,”The feeling of incompleteness will become uncontrollable“) Could increase the use of compulsive behaviors and therefore the probability that an obsessive disorder will be structured.
On the contrary, greater tolerance for the Njre would lead to a lower avoidance and smaller number of compulsive behaviors in order to resolve these feelings.
Cognitive-behavioral treatment
The importance of beliefs about one’s emotions and the tolerance of these, explains, in part why patients who cannot identify specific threats associated with their compulsions are less reactive to treatment.
When this first aspect takes over (“If I feel discomfort I will not be able to enjoy things“,”If I feel anxiety I will not be able to stay concentrated at work“) And a difficult relationship with emotions and internal states, the picture is complicated and the treatment also becomes less effective (Melli et al., 2020).
In fact, the intervention that derives from the standard behavioral cognitive approach, called the Exposure and Response Prevention (ERP – Exhibition with response prevention), others must be integrated, borrowed from third generation approaches.
ERP has been widely used in the last 30 years and has become the first choice treatment for the DOC. These are a gradual exposure therapy to avoided anxiety stimuli, with the simultaneous elimination, reduction and modification of the usual anxiety management strategies (avoidance, compulsions, requests for reassurance etc.).
As for the NJRE, the exhibition is not so much to feared stimuli, as to the feeling of discomfort that emerges when we feel that things “I’m not fine”
Integrated treatment
To do this, it is also possible to use therapeutic strategies that could draw from the most general approaches of regulation of emotions and in particular in the training of improving sensitivity to anxiety.
Initially, a psychoeducation phase is carried out regarding the nature of the emotions related to the NJRE (“Emotions have a beginning and an end“,”It is possible to focus despite anxiety“,”You can enjoy your activities despite emotions“).
Behavioral exercises could then be introduced both in session and home, in order to help the patient get used to experimenting with the NJRE, increasing their tolerance and challenging negative knowledge regarding potential consequences.
In addition, also the exercises adapted by the Acceptance and Commitment Therapy (ACT) could also be useful in terms of decrease in the sensitivity to the NJRE.
In general, these could help individuals resist the need to commit themselves to rituals in response to the NJRE and understand their DOC symptoms, thus improving the results and decreasing negative results.
Bibliography
- Melli, G., Carraresi, C., Poli, A., Marazziti, D., & Pinto, A. (2017). The Role of Guilt Sensititivity in OCD Syptom dimensions. Clinical Psychology & Psychotherapy 24 (5).
- Melli, G., Moulding, R., Puccetti, C., Pinto, A., Caccico, L., Drabik, M., J., Sica, C., (2020). Assessing Beliefs About the Consequences of Not Just Right Experiences: Psychometric Properties of the Not Just Right Experience-Sensivity Scale (NJre-SS). Clinical Psychological Psychotherapy.
