Archives for April, 2010
We received this request and would like to pass it along to anyone interested in participating in this study. Research into the causes of OCD can lead to better treatment. We hope that the research contributes new knowledge about OCD and that those who participate find the experience to be rewarding. Good luck! Dear Drs. Smith and Elliot Thank you for your recent posts on your blog about anxiety and OCD. Many of us have routines or even eccentric superstitions that get us through the day; we read our horoscopes every morning, keep our calendars clean and up-to-date, or pray each night. But for the 2.2 million American adults suffering from OCD, unceasing thoughts and compulsions can get in the way of living. These symptoms of OCD are not mere habits but persistent, distressing and, at times, debilitating impediments.
When people write to us about their problems, we often recommend consultation with a mental health professional. We can answer questions online and give some suggestions. However, we can’t diagnose or treat people without meeting them. So, we refer our readers to other sources of help. However, far too many people tell us that they don't have health insurance, mental health coverage, or the money for co-pays. Sadly, that is the reality today. We expect in the next few years that mental health coverage will become part of all health insurance plans.
A couple of days ago, Chuck wrote about diffusing, a technique to help handle critical comments in a non-defensive way. As he pointed out, strong emotions can clog up clear thinking. When you’re upset, angry, or scared, getting or giving feedback can become more difficult and less effective. Use diffusing when you are on the receiving line of negative feedback. Diffusing involves making something less intense. When you diffuse, you search for a bit of truth in the negative comment and start there. It says that you are at least hearing and considering what the other person has to say. Here’s an example. Jennifer has been having trouble concentrating lately because of anxiety. She worries about her children, her job, and her health. Distracted, she doesn’t always hear what Joe, her husband, is talking about. Joe is beginning to lose patience. He confronts Jennifer, “I seem to be talking to the wall most of the time. Don’t you care about me?”
Anxiety disrupts people’s ability communicate with one another. That’s because intense emotions like anxiety interfere with logical thinking. Thus, overwhelming emotions can trigger black or white, all or none thinking. When the potential for conflict or disagreement arises, anxiety may cause you to think you must “win” the argument. And if you don’t win, you obviously must lose. Unfortunately, such thinking makes you seem defensive in response to criticism and overly aggressive when you need to be critical of someone else. Both responses are based on an unwarranted assumption that people can actually know or “own” truth. But the complexities of human interactions are such that absolute truth is rarely within anyone’s firm grasp. After all, can you not think of numerous times in the past when you’ve been “sure” about an issue and later discovered that you were wrong? I suspect you can.
We have written extensively in this blog and in our books about the strong scientific evidence that supports cognitive behavioral therapy (CBT) as one of the most effective treatments for both anxiety and depression. CBT is so well studied and validated that frankly, we can’t imagine why it shouldn’t be the foundation of most treatment plans. At the same time, we’ve regularly recommended mindfulness techniques such as meditation, yoga, and mindful acceptance to our clients (and we practice what we preach). Mindfulness oversimplified involves focusing on and accepting the present moment. Throughout the years we’ve attended numerous continuing education classes to learn more about mindfulness techniques. Mindfulness is a part of Dialectical Behavior Therapy (DBT), Mindfulness Based Cognitive Therapy (MBCT), Acceptance and Commitment Therapy (ACT) and Mindfulness Based Stress Reduction (MBST). Wow, that’s a bunch of initials.
In my over thirty years in clinical practice, I have run into many challenging problems and issues. These challenges included severe treatment-resistant depression, debilitating obsessive compulsive disorder, and extreme cases of borderline personality disorder among many others. In the vast majority of cases, most clients eventually manage to get much better. But the most vexing issue I have ever dealt with did not involve a diagnosis at all--in the usual sense. It has nothing directly to do with anxiety, depression, eating disorders, or behavioral problems. It is not listed as a symptom of any particular personality disorder. However, before I tell you what it is, I’d like to ask therapists, counselors, and clients what problems they have found to be the most difficult to deal with in their lives. What issues put up the greatest fight when you’ve tried to confront them? What, if anything, has confounded you and left you feeling stuck over and over again? Did you finally manage to move ahead? If so, how did you do it? I’d love to know!
Many of our clients with anxiety also have reported struggles over food. Therefore, we interviewed a colleague who is an expert on eating disorders. Dr. Brenda L. Wolfe is a clinical psychologist who specializes in the treatment of obesity and eating disorders. In addition to private practice, she has published a number of articles and books. Her most recent book reflects her other area of expertise and is called Get Your Loved One Sober which is co-authored with Robert J. Meyers and available from most internet book-sellers.
I don’t know about you, but throughout my life I’ve often regretted giving opinions, thoughts, or advice to others. Most of the time, people don’t want to hear what you have to say or even resent you for telling them what you think. Some people will even directly ask for your opinion and then resist and rebel against what you have to say. For example, when someone asks, “How can I spend less money?” and you tell them, “Stop going out to restaurants; don’t buy stuff that you absolutely don’t need; cut your cable bill (like do you really need 400 channels, internet, a home phone, and a cell phone with internet access?), and write down everything you spend,” you’re likely to get a “Yes, but …” answer. Silence is indeed golden in many situations. You might wonder how, as a psychologist, I can endorse the idea of being silent. Most people think that the job of being a psychologist must involve giving advice all day long. Actually, the opposite is true. The best therapy involves guiding clients to discover their own solutions. That’s because people change when they choose to. And change is more likely when people believe that they have figured out what they want to do on their own. Therapy can provide the shovel, but people have to do their own digging.