Obsessive Compulsive Disorder

OCD is a miserable, often private battle. Most clients describe feeling “stuck”, “ trapped”, or like “a prisoner” in their own mind. Unwanted, intrusive thoughts or images cause significant distress and our natural reaction is to turn that off as fast as possible, so we do various mental or behavioral “gymnastics” to achieve temporary relief…until the next trigger.

I’ve specialized in treating OCD for most of my career as a therapist. I personally suffered with full-blown symptoms in both high school and early college, so when I encountered my first client with OCD after graduate school, I immediately knew what was going on. Like many clients with OCD, this client had been misdiagnosed with Generalized Anxiety Disorder (GAD), and was starting therapy over because their symptoms had worsened. That’s because traditional Cognitive Behavior Therapy (which is great for treating GAD) often becomes compulsive for someone with OCD, as it had for this client.

subtypes

While OCD has the same basic cycle and pattern for everyone, the content varies from person to person. Below are some examples of OCD subtypes:

• Checking OCD

• Contamination OCD

• Counting OCD

• Emotional Contamination OCD

• Existential OCD

• False Memory OCD

• Harm OCD

• Hit and Run OCD

• Hoarding OCD

• Illness OCD

• “Just Right” OCD

• Magical Thinking OCD

• Mental Illness OCD

• Ordering OCD

• Pedophilia OCD

• Perfectionism OCD

• Perinatal OCD / Postpartum OCD

• Purely Obsessional OCD (Pure-O)

• Real Events OCD

• Relationship OCD

• Scrupulosity (Moral) OCD

• Sensorimotor OCD

• Sexual Orientation OCD

• Suicidal Ideation OCD

• Symmetry OCD

That’s a lot I know! It’s not uncommon to identify with several subtypes. But I believe there is power in an accurate label when fighting back against OCD. If we don’t have an accurate label, it’s much easier to internalize the thought as our own, which makes it easier to overestimate the threat or overestimate the personal responsibility in the situation or trigger.

I remember how miserable it was to be plagued by intense thoughts and images that immediately made my anxiety skyrocket, only to be followed by intensely distressful compulsions to avoid or neutralize the fears. It finally got bad enough that I was late to class or work in college because I “had” to go back home to make sure the stove was off or the door was locked. I also ended up in a cardiologist’s office, convinced I was having heart problems. He was wise enough to ask me a few trick questions, and then diagnose me with OCD after a short interview. Everything began to change for me that day. What I thought and felt were threats based in reality I quickly realized were only magnified because my behavior supported the belief in those thoughts. I immediately began stopping any of the compulsions that I could and noticed that the associated intrusive thoughts all of a sudden didn’t seem so meaningful. Therapy helped me with the rest! Fifteen years later, it’s pretty rare that I experience an OCD “flare up”. The skills I learned (and now teach) still work to keep it in check, and I move on with life again. That’s why I’m so passionate about helping others achieve the same long lasting relief. I’m so glad I invested in the work when I did, because I can’t imagine suffering all this time with a treatable issue.

TREATMENT

Exposure and Response Prevention (ERP) is the gold standard treatment approach for OCD. Acceptance and Commitment Therapy (a form of CBT) and Mindfulness is also useful in treating OCD and OCD related disorders. For OCD triggers that have a trauma, or intense shame or disgust based component, EMDR and IMTT are also useful treatments.

Readiness

OCD is unfortunately a “progressive” disorder, meaning that in most cases, if left unchecked, OCD will tend to worsen and morph and grow. Folks often mistakenly believe that their OCD “went away”, only to learn later in therapy that they didn’t realize their OCD had morphed into focusing on another content area that was less distressing (or even an area they thought was helpful for them, like keeping a clean house). And when stressful circumstances reoccur in their lives, so do their full-blown symptoms. OCD never really “goes away”, but it can be well managed with the right therapy. I share this to help motivate you if you are considering treatment for OCD or OCD-like symptoms. As with anything, therapy incorporates motivation building, so you’re definitely not alone in getting “ready”!

Anxiety

Many people with anxiety have gotten used to it and may perceive what they experience as “normal” simply because they’ve habituated to it. Even so, 20% of adults are diagnosed with an Anxiety Disorder at some point in their lives. Difficult to control worries, restlessness, imagining worst case scenarios, and difficulty controlling worried thoughts are common signs of anxiety. While it’s impossible to eliminate all experiences of anxiety in our lives, knowing the signs of a treatable condition can help you keep yours in check.

COMMON SIGNS OF ANXIETY

• Feeling overstimulated (sensory)

• Feeling “short” or irritable

• Frequent “What if” or “Maybe” thoughts

• Teeth grinding

• The need to know anything that could potentially happen; overthinking

• Difficulty concentrating (mind going “blank”)

• Difficulty going to sleep or staying asleep; fatigue

• Frequent stomach, chest, or muscle tension

• Difficulty making decisions (or avoiding making decisions)

• Avoiding unfamiliar or uncomfortable situations

• Others telling you that you appear “aloof” or “distant” (because you’re lost in worried thoughts)

• Difficulty breathing, racing heart, sweating, nausea (or for some, full blown panic attacks)

There are many different types of anxiety besides the generalized type described above that have an additional specific focus:

• Performance anxiety, such as text anxiety, excessive fear of giving presentations, and sport performance related anxiety

• Social anxiety, or fear of judgment, rejection, or embarrassment. Lack of confidence in social interactions, overthinking prior to and following conversations, and desire to avoid social situations.

• Separation anxiety, or fear of being away from a loved one for fear that being away from a them will become permanent

• Illness anxiety (formerly known as hypochondriasis), or fear that nuanced physical symptoms indicate something catastrophic.

• Death anxiety, or fear of death or suffering either for yourself or a close loved one

TREATMENT

Anxiety responds well to a variety of treatments, among which include Cognitive Behavior Therapy (CBT) and Image Transformation Therapy (IMTT). Learning to reframe, and challenge anxious thoughts as well as how to calm and soothe the distressing physical symptoms of anxiety can greatly reduce symptoms back to a level of normalized functioning. Chronic or severe anxiety is best treated with a combination of CBT and IMTT. Disclaimer: Severe or chronic anxiety is commonly misdiagnosed when someone is actually suffering with OCD. It is important to get screened by someone who understands both anxiety and OCD if you think your symptoms may be OCD related. Click here to learn more about OCD treatment.

WHEN TO SEEK CARE

If you are experiencing a few of the above mentioned symptoms, seeking treatment early can optimize prognosis and reduce the length of therapy needed to help you feel better. While everyone feels anxious from time to time, suffering frequently with these symptoms is not something you have to accept.

Fear of Success

I know, it sounds strange at first to be afraid of success (something most of us want), but fear of success is actually very common. Our society is so result, productivity, and goal driven that it’s hard not to have a fear of success get in our way at some point. Left unchecked, fear of success can be a major contributor to avoidance, procrastination, low self-esteem, lowered expectations, and “underperforming” (even if you consider yourself generally successful).

Sometimes, examples are the best way to understand a difficult concept. So I’ll share a bit about the underpinnings of my own fear of success, and how to overcome it.

In middle school, I enjoyed social “popularity”. I fit in with just about anyone I tried to get to know and didn’t experience much rejection. Looking back, I suspect that this social “popularity” had a lot to do with the fact that I was average. I minimized myself in athletics and academics for the assurance that I would “belong”. But high school was a different story. I changed schools and knew no one, so I began focusing on the things I was good at, which was sports and school. I excelled at both, but I was bullied for being “smart”, and was teased by the girls for being athletic. To manage this, I held back by not playing soccer (my best sport) for the school team. This way, no one would be able to ruin the thing I loved the most. Since I went on to play soccer in college, I had to manage my fear of success in a new way (that I definitely don’t recommend)…I became a perfectionist and an overachiever. I felt immense pressure to make the best grades, and constantly predicted that I would fail tests even though I never did because I put way too much work into studying. This drive to “perform” at least assured me belonging with parents, teachers, and coaches - they never rejected me if I succeeded.

I began unraveling and healing these unhealthy habits in my mid-twenties, and more than a decade later, there are still remnants that crop up from time to time. In my career, I have found that the dozens of reasons to fear success tend to fall under two main umbrellas:

• Fear of increased pressure: If you succeed, others will develop new standards and expectations of you. You may fear that others will expect this success to be consistent. You may find yourself wondering, “What if I can’t sustain it?” or “What if I can’t handle the pressure?” This can trigger a subsequent fear of failure, and fear of disappointing others. This category includes a fear of not being good enough, experiencing the “imposter syndrome”, low self-efficacy, fear of increased work or responsibilities, and fear of criticism.

• Fear of social backlash: Let’s face it. When we succeed, sometimes others feel left behind, threatened, or jealous. We may lose friends, outgrow colleagues, or even experience social rejection as a result of succeeding. You may notice you are hiding your success, minimizing your accomplishments, and avoiding the spotlight to manage this fear. Social anxiety or shyness is commonly associated with this fear.

How to overcome fear of success:

1. Focus on the right support network. The right friends will lift you up and want the best for you. Ask your friends for their support. Tell them what it means to you because of what they mean to you.

2. Remember that life is short. Minimizing yourself will only cost you time and a part of a life experience you can’t get back. This could leave you suffering with regret much longer than the time period to face the fear of increased pressure or social backlash.

3. YOU are responsible for setting your own expectations. If you are living your life by the expectations of others you are subject to the fear of increased pressure. So allow yourself to imagine, “If others didn’t expect XYZ of me, or if they expected nothing of me, what would I expect of myself?”

4. It’s important to look at the sources of where this fear could be rooted in your life. Identifying the sources can help you figure out what past experiences need to be healed and explored in therapy. In therapy, you will learn to confront your fear of judgment, fear of disappointing others, fear of criticism, and learn to listen to your own expectations rather than the expectations of others. You will learn how to tolerate and reframe the experience of “failure”, to allow it to work towards your success. Cognitive Behavior Therapy or EMDR can help reframe or update automatic negative thoughts that may have developed from these experiences and are continuing to contribute to present fear of success.

Mindfulness: It's simple, but not easy!

Mindfulness. It’s the buzz word these days. I know I sure say it a lot. But the truth is, mindfulness is simple but far from easy. Here are some reasons mindfulness might not “work” for you:

1. You’re expecting it to be easy, or to “work” quickly. You may be expecting it to do something that it’s not even supposed to do (hint: your brain is not supposed to have zero thoughts). These expectations will lead to not doing it regularly, or not sticking with it long enough to see any potential results. Try this: Do your research, ask your therapist what you should expect from a mindfulness practice. Learn which mindfulness practices are right for you (trial and error), and don’t expect to be “good at it” until you have been practicing regularly for several months. Even then, it’s still hard sometimes. Remember, it’s called a mindfulness PRACTICE because it takes lots of practice!

2. You’re struggling with feeling like a “failure”, or worry that you’re “doing it wrong”. This can make mindfulness not only not work, but downright uncomfortable! Especially when you’re an achievement driven person, slowing down can feel VERY different for our brains. Try this: Instead of engaging with these thoughts, develop a mindfulness about them. Learn to observe these thoughts as neutrally as possible. Label them “failure thoughts” or “worry thoughts” and resume the mindfulness practice. Believing these thoughts will just motivate you to disengage from developing the ability to be mindful. Start slowly in your mindfulness practice (3 minutes for example) and build up to 10 minutes per day.

3. Sometimes, mindfulness can be scary because it requires us to pay attention our bodies. When we have a lot of unresolved trauma (which is stored in the body), or unmanaged anxiety (which manifests in physical symptoms), we can become afraid of our bodies because they’ve been our warning system for so long. Try this: Bring this up with your therapist, and find other supportive calming strategies that don’t require a focus on the body like grounding practices, finding a calm place imagery, or other creative strategies that are supportive.

4. You’re feeling like you don’t have time to fit in a regular mindfulness practice. This is a legitimate concern, we are all super busy with way too many things! Try this: Pair your mindfulness practice with something you do already that doesn’t require a lot of mental engagement, like folding laundry, sitting at a red light, eating your food, or walking to get the mail. Implement the concepts of mindfulness that you learn from meditation into these activities as a way to get in your 10 minutes per day. Also pay attention to when it’s most helpful - is that in the morning with your coffee, or in the evening before going to bed? If you get in a routine, it will be easier to incorporate. As you learn more meditation strategies, you will find it’s possible to be mindful when doing just about any basic task!

What is the difference between immature love and mature love?

The greeks actually have six words to describe love, while we have just one. Crazy right? When we think of love in our language, we know that love applies to many different types of relationships - romantic relationships, friendships, and relationships with our kids too. But they all feel different! Mature love requires both vulnerability and sacrifice, and it takes work to achieve!

I love you because I need you*

This type of love is immature. It says that as long as you serve a purpose or meet a need, you will be loved. Individuals who love this way may have dependent traits, and might seem “needy” or “clingy”. They may be attracted to others who are codependent or who desire to “fix” them. They depend on others more than they should, and may create situations that they can prove to you that you need them; even when perhaps you didn’t ask. This type of situation is “smoke and mirrors” and tricky to spot - you will feel they are meeting your needs, but really, are they? Or are they just creating the need themselves and then filling it? When you ask for something to be different, does anything change?

I love because I am loved*

This type of love is better explained by the greek word, philautia (or self-love). This says that as long as you make me feel good about myself, or as long as you need me, I am capable of loving you. Individuals who love this way are in the relationship to receive rather than give. Those on the receiving end of this type of love may feel they are never good enough and no matter what they do they won’t receive the love they know they deserve. When you ask for your needs to be met, do they somehow change your mind or say they will and then don’t?

I need you because I love you*

This type of love is mature. It says that I allow myself to need you - and this is a vulnerable choice! It takes a lot of trust to make this vulnerable decision to depend on someone and trust that they will show up for us. When they do show up for us, true, mature love is cultivated. 

I am loved because I love*

Love is a commitment. It’s not an emotion. When we make the decision to love - we are both giving to the other person (we are meeting their needs, and to do this the other person is vulnerable enough to allow their needs to be known and met by us) and we are receiving from the other person (they are meeting our needs, and for them to do this, we must be vulnerable enough to allow our needs to be known and met by them). This is a lot of work!! Love is developed over time through lots of actions. 

I know, I know, you’re thinking, “But what about love at first sight?” But that’s not love. That’s excitement & attraction - the honeymoon phase of a relationship is coupled with lots of intense positive emotions of affection, but these dwindle - every emotion, positive or difficult, is temporary. This is why love is a decision involving self-sacrifice for the other and the vulnerability to allow the other to do the same for us.

*Quote from Erich Fromm

Why is it so hard to actually stick to a New Year's Resolution?

We’ve all done it. Set a New Year’s resolution and unintentionally abandoned it soon thereafter. Why is it so hard to keep them? The simple reason: motivation is a finicky thing, and if we take action based on the presence of that, then we are setting ourselves up for failure. Motivation is designed to GET US STARTED; not to keep us going. When we are motivated we feel like we can accomplish anything! But the powerful surge of intense motivation dwindles when the work becomes hard.

So what keeps us going?

The hidden treasure underneath the motivation are our values - the things that are truly important to us, those things we want our life to be defined by. Try asking yourself one thing: when you are not there to overhear, what do you want your family and friends to say about you? Now think about those resolutions. Do they align with that answer? If they don’t, you won’t stick to that resolution very long. If the resolutions do align with your values, NOW you have a fighting chance at holding onto those resolutions.

But it’s more difficult than that. Sticking to a goal is an ACTIVE process. It takes planning, preparation, research or education, accountability, and support! That’s a lot of elements isn’t it? But think about it. Change is difficult, uncomfortable, and something that humans naturally resist. The more we expose our brains to various aspects of something new with repetition, the more chance we have at maintaining it.

Research suggests that it takes around 21 days (or more) to form a new habit and 3 days (or less) to undo it. Feels unfair doesn’t it? Not really though - if you think of how many repetitions your brain has with where you currently stand (prior to implementing any goal or resolution), you will realize it didn’t happen overnight. Establishing anything new won’t happen overnight either.

I remember when I decided to give up drinking Diet Coke. I was drinking 2 a day, and I wanted something healthier (you know, like water). I started by telling my family that this was my goal (accountability). Then I researched what was in Diet Coke and the benefits of drinking more water. I reflected on this research and how it fit in with my personal values so that my decision to do this was based on something real - not just a feeling that would diminish over time. Then I did some planning - I avoided the foods I really enjoyed a Diet Coke with to help me get started, I got a fancy new water bottle, and began figuring out what flavors of tea I liked. Also, I cleared the house of Diet Coke.

The first several months, I craved a Diet Coke at every meal, and particularly with certain foods I felt it paired well with. Around the second month, I noticed I craved it less, but still thought of it often. Six months went by and I only thought of it when confronted with certain foods (like pizza!). Then around 1 year later, when I was reflecting on how I had actually held onto this goal, I realized I hadn’t thought about it much at all. So I decided to reward myself with one. This was a mistake. Not only did it taste terrible, but I actually craved them again for a few days! My brain went right back to what it knew for several years, rather than what I trained it to know for one year. Now, it’s several years later, and I may think of drinking one twice a year at most. I don’t even want one when others drink them.

So set those goals with WHO YOU ARE in mind, tell others about your goal, research your goal and actively plan to let something new take hold in your life. Make a plan to face the temptation to give up and think of how you will feel at the start of 2020 if you are able to look back on this year and say you did it!

Most of us hate change. Here’s why.

It seems fitting to write about change during my own transition from working with a private practice group to doing it on my own. I kept saying that I felt like I was jumping off of a cliff from a perfectly cozy sofa. I talked myself into and out of embarking on this new journey on a daily basis for weeks. Why? Because I’m SUCH a creature of habit. Once I get comfortable, I’m good with it for the long haul.

Mostly, change seems like the enemy because of the emotional discomfort - not necessarily the end result. Of course, everyone can look back in their lives and remember some changes that didn’t turn out that great, but for the most part, there are good things and bad things to the changed state as well as good things and bad things about the way it was before!

It’s all about perspective. Let’s say your partner wants to move into a new apartment. Bigger kitchen, more storage, and a walk in closet! What’s not to love?! (CHANGE. THAT’S WHAT) But ok, seriously, you love the apartment you have now. It’s working just fine. Sure the kitchen feels cramped, but it’s YOUR kitchen. Sure the closets could be bigger, and there could be more room for storage, but there are other ways around that problem. The new place just won’t feel like home. HERE’S WHY: it doesn’t have your stuff in it yet! It has NO memories. You can’t visualize yourself there and your crystal ball is busted so you can’t look into the future to see if it will end up ok. Sticking with the metaphor…think back to when you moved into the apartment you’re in now and how uncomfortable that was!

The deal is that we have to accept that there are pros and cons to BOTH apartments. You’ll focus on what’s wrong with the new apartment so you don’t have to experience change. You feel you can’t tolerate the discomfort of the unknown, when you’ve faced the discomfort of the unknown with success all your life. I KNOW some of you are thinking, “BUT I HAVEN’T”. What about every time you drive to the store? You may do this without even thinking about it. But at one point, it was new. At one time, it felt scary, uncertain, and vulnerable. You even were very aware of the risk of a car accident. But the more and more you did it, you got COMFORTABLE.

BOTTOM LINE: Everyone likes to feel comfortable. The only way you can create that feeling is to do something on repeat. Then, you’ll feel like you’ve settled into a new cozy sofa that you’ll fight to leave in the future! So decide what you want not based on a fear, but based on this question: when I get old, and I look back on this decision (whether it ends up good or bad), do I want to say that I took a risk or not? If your answer is that you wouldn’t regret staying put, then by all means stay put! But if you have a suspicion you would regret not doing something different, then fight through the discomfort, and find out what’s on the other side.