Archives for CBT
A couple of weeks ago, I wrote a blog about believing what you think. The point of the blog was that people have thoughts all of the time that aren’t really true. For example, people who fear public speaking might think that if they speak in front of a group of people their voices might shake and people will think they are fools. Today, I want to discuss feelings. This subject is a bit more complex because you’ve probably been told that all feelings are okay. And that people feel what they feel. Sometimes, that’s true. But feelings can also get in the way of people’s happiness. Let’s start with the feeling of anger. Anger is an emotion that helps people stay safe. Parents’ get angry when someone threatens their children. Anger increases attention to threats. However, when people get angry too often or over small things, anger can become quite destructive.
Obsessive Compulsive Disorder (OCD) involves feelings, thoughts and behaviors. For the vast majority of people with OCD, the feeling of anxiety stands out as prominent. For example, a man with OCD might have an obsessive thought that a doorknob is contaminated and the thought of touching the doorknob causes him great anxiety. He takes a spray bottle of disinfectant and sprays the doorknob, which decreases his decreases. Then he reaches for a Kleenex to give him a barrier from any possible remaining germs. He feels relieved. And that momentary relief feels pretty good; well, that is until the next doorknob appears. The pattern repeats: an obsessive thought, an overestimation of danger or risk, increased anxiety, a compulsive action, and then feelings of relief provided by the compulsive action.
Most days I think about how dog training has influenced my therapeutic style. If you are a client, you have probably heard some of my favorite dog stories. I often talk about how I forgot my training and turned my dog Sadie into a frightened mess of fur whenever a thunderstorm rolled through. It was pretty cute when she was a puppy and would cuddle up next to me for protection. I’d pet her and say whatever silly dog stuff you say to your dog when she’s scared. Now, she weighs well over 60 pounds and when she gets too close between her fur, dog breath, and weight—it’s not quite as cute. Let’s take a look at what I did wrong with Sadie and see what lessons I can learn.
People with difficult feelings like anxiety or depression often believe what they think. This is a common and dangerous trap that most people fall into from time to time. Here’s a phrase that I find myself using over and over with my clients and with myself: JUST BECAUSE YOU THINK SOMETHING DOESN’T MAKE IT TRUE! Simple right? Well, not that simple. We all get into thinking habits like “I’m not good enough,” or “I’ll never find anyone that will understand me,” or “If I touch that doorknob I’ll probably get sick,” or, “If only I could save more money I’d be happy.” If you have thoughts like those you might feel depressed or anxious. Learning to not believe what you think takes practice (and often therapy). But for now, let’s play a game.
People with anxiety disorders worry. They worry about getting sick, running out of money, losing control, becoming embarrassed, making mistakes, getting hurt, hurting someone else, forgetting to do something, and on and on. Anxious worries rarely happen, but sometimes they do. People do get sick, run out of money, embarrass themselves, make mistakes, get hurt, hurt others, forget stuff, and so on. The worries of those with anxiety are reality based. However, anxious people usually inflate the actual level of risk. For example, it is true that cold viruses often linger on surfaces after an infected person coughs, sneezes onto something. If you touch an infected surface and then rub your eyes or scratch your nose, it’s quite possible that you can get sick. However, you probably have touched zillions of things in your life without getting sick. The overall risk is pretty low.
Have you ever awakened at 3:00 am and found your mind racing? You might dwell on making sure you don’t forget some important work issue or start organizing your day to be sure you have time to finish everything you need to. Or then again, your mind might start focusing on thoughts about how horrible it would be to have a lousy night’s sleep. Such thoughts include:
Laura and I sometimes amuse ourselves by noticing how language and expressions gradually morph over time. For example, have you ever taken note of how often people preface something they’re about to say with the single word, “Look!”? I think in the past, folks used to call attention to what they were about to say with “Listen.” Why the change? Go figure (another one of my favorite phrases). And then there’s the ever popular “Seriously?...Really?” I like that one a lot. Why? I really don’t know. It just conveys a tone that I like. Perhaps it’s my sarcastic streak. At any rate, I find myself wanting to say “Seriously?....Really?” pretty often when I confront the thoughts that constantly bombard the minds of people who have obsessive compulsive disorder (OCD).
I recently ran across a Behavioral Intervention Plan (BIP) for an elementary school girl. Behavioral Intervention Plans are often a good idea and can be used to teach students to focus better, reduce their oppositionality, follow rules more often, and become more cooperative. These plans usually emphasize positive interventions (such as rewards and attention) although they also employ negative consequences judiciously, when called for. The original idea behind BIP’s was grounded in something called learning theory. In brief, learning theory proposes that kids will do more of what they are rewarded for and less of what they aren’t. They’re also likely to engage in disruptive behaviors less often if those behaviors result in a loss of something the child likes or if the behavior is followed by a mildly unpleasant consequence. However, some of the BIP’s that I’ve seen in recent years seem to have lost their original grounding in learning theory. The school girl I mentioned (we’ll call her Nicole) had been failing to follow rules, blurting out inappropriate comments in class, banging her head, arguing with the teacher, and sometimes trying to leave the classroom when she shouldn’t. Here are some relevant snippets from Nicole’s BIP:
A couple of days ago, we wrote about exposure. The opposite of exposure is avoidance. We touch on the topic of avoidance fairly often in this blog, but it’s been years since we focused on the topic exclusively. That’s too long because avoidance is arguably the most important thing for you to understand in order to successfully battle anxiety and OCD, or for that matter, most types of emotional disorders. Humans have an understandable desire to avoid feeling distress, anxiety, sadness, and upsets of all kinds. If you’re like most people, when you experience these feelings, you’ll do almost anything to get rid of them. Common strategies include: Abusing substances like drugs or alcohol Distraction Smoking Staying in the house Making great efforts to avoid the triggers for your upsets
We have been writing this blog for a few years. When we started, we decided to call the blog Anxiety and OCD Exposed. It’s been a long time since we have discussed why we decided on that title so we thought that new readers might want some explanation. The term “exposed” may bring up a lot of different thoughts such as: • Finding out that a politician was cheating on his wife • Discovering a dumping ground of toxic waste • The feeling of your hands when you forget to wear gloves in cold weather • A politician taking opposite positions in the same campaign • Not noticing the piece of toilet paper stuck to your shoe • The most effective treatment for anxiety and OCD Research says that overall the best treatment for anxiety and OCD is a method called exposure. When people are afraid or anxious about something, they tend to avoid it. The more they avoid what they fear, the more fearful they become. Exposure helps people face their fears in a gradual way. Most people find that after being exposed to their fear or OCD triggers, over a period of time, their anxiety decreases. The goal of exposure is not to eliminate all anxiety, but to make anxiety manageable.