Archives for Psychotherapy
Many people have problems that occur repetitively, disrupt their lives and seem completely out of control. Sometimes we’re asked if these problems are examples of obsessive compulsive disorder (OCD). And indeed, there are some similarities to OCD. Nevertheless, these problems are not considered to be in the same category. So what are we talking about here? Specifically, we’re referring to the category of emotional disorders known as Impulse Control Disorders. The similarity to OCD is seen in the fact that impulse control disorders, like OCD, are repetitive and very difficult for the person to bring under control. Furthermore, like OCD, they greatly disrupt and impair the sufferers’ lives.
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.
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.
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.
As you no doubt know, bad things happen to good people from time to time. There’s no rhyme or reason for it and it’s not particularly fair, but such things do happen. Sometimes these events are quite awful such as serious traumas or illnesses. And when these things happen out of the blue, people often experience a huge wave of difficult feelings. Emotions such as great upset, distress, anger, and despair are quite typical and frankly, normal at these times. It’s also pretty typical to find yourself railing about the unfairness of it all and the fact that you don’t deserve what’s happened. When these thoughts and feelings occur, generally the person will take on a new role in life—that of a patient or even a victim. And friends, healthcare providers, therapists, and family generally pick up the appropriate role of helpers.
So, Laura responded to my blog on Six Reasons for Not Treating Your Anxiety or OCD with one of her own blogs that may have helped you rethink your “treatment interfering beliefs” in a more productive way. If so, you’re ready to move ahead, right? Well, not quite. I think it’s also wise to take one more important step. Specifically, I’d like you first to consider accepting where you’re at, problems and all. That’s right; evaluate yourself as acceptable and OK as you are. Realize that you didn’t ask to have problems with anxiety and OCD. Rather, you have these problems for lots of good reasons. You may have had genes that tilted you in this direction. Or perhaps you experienced one or more traumas. Maybe your parents were overly critical and overbearing. On the other hand, maybe they couldn’t provide the structure you needed as a child. Perhaps you grew up in an unsafe neighborhood. People acquire anxiety and OCD for these reasons and many more. They pretty much never become anxious because they “wanted” to have these problems. Yet, many clients judge and evaluate themselves very harshly just because they have some problems that they didn’t ask for in the first place. They see themselves as weak, incompetent, and horribly flawed. Thus, they tell themselves that they absolutely MUST overcome their problems. In addition, they should do so quickly and completely.
A couple of days ago, Chuck wrote about why some people either believe they can’t get better or decide not to get treatment for their anxiety or OCD. Some readers had other ideas like having no money or not having access to good cognitive behavioral therapy. Here are six ideas for overcoming such obstacles to change: Money. Many people lack the financial resources for getting help. Some people can’t afford therapy at all, others have medical insurance that doesn’t cover mental health in a comprehensive way. Try contacting the nearest college or university. Most colleges have psychology clinics that have well supervised upper level students or graduate students work with clients in order to gain experience. Costs for such services are often modest and most use a sliding scale. Community mental health agencies also use sliding scales to charge for services.
A couple of days ago, Laura wrote a blog on how anxiety can morph into panic. Many people experience episodes of mild to moderate panic here and there—a few of the common triggers for such episodes include looming deadlines, upcoming parties, and presentations to work groups. However, some people experience panic at a much more intense level, to the point that they actually develop a full blown Panic Disorder. True panic attacks of this sort involve anxiety and fear of stunning intensity. The actual attacks usually peak within ten minutes and slowly fade, but it’s common for people to actually think they could die during one of these attacks. Common symptoms of these attacks include: Profuse sweating Rapid, irregular heartbeat Shortness of breath or sense of suffocation A sense of unreality or detachment Fear of impending death without any real basis Nausea Fear of losing control or “going insane” Trembling and shaking Chills and hot flashes Dizziness When such attacks reoccur, the person worries about future attacks, has considerable concerns about the meaning of the attacks, or changes his or her behavior in order to avoid attacks, the odds are that a Panic Disorder is in play. Frequently, but not always, people with Panic Disorder also have Agoraphobia (fears of being in places that would be difficult or highly embarrassing to leave or escape from), but that’s a topic for another blog.
When children are afraid of something, adults often reassure them. Many kids are afraid of the dark or of monsters under the bed. This fear usually starts sometime around preschool and is a great way to delay bedtime or to keep a loved one hovering around the bedside. Many millions of parents, with good intentions, have said to their scared kids, “Don’t worry, there’s nothing to be afraid of.” Most scared kids willingly accept their parents’ reassurance. They might get an extra hug or a night light or one more bed time story. Gradually, they outgrow their fears. But some kids don’t easily grow out of their fears. They may just be prone to anxiety or sometimes they get too much attention from their caring parents. These kids’ fears may get them extended routines of reassurance such as long rigid rituals that must be performed each night before they sleep. And many exhausted parents give up and extend an invitation to their frightened children to sleep with them in their beds.
Social phobia is more than shyness. It involves intense worry about being with people you don’t know, or fear of unfamiliar situations. People with social phobia worry about being judged or evaluated for their actions. And they predict that those judgments will be harsh, negative, and humiliating. They understand that their concerns are greater than warranted, but find themselves overwhelmed with strong feelings of fear. These fears lead to avoidance of people or situations that make them uncomfortable—not to mention terrified. Children and teens with social phobia don’t answer questions in school even when they know the right answer. They don’t want to seek attention and can seem distant, unfriendly, and sometimes even arrogant to others. As adults, they may avoid speaking up at work, making presentations, being socially interactive, and being assertive. It’s understandable that those with social phobia are often underachievers—at school, at work, and in relationships. People with social phobia usually don’t seek treatment for their condition. That makes sense, because they tend to avoid attention of any kind and rarely ask for help. They don’t want to make a call to a mental health professional or seek a referral from their medical provider. Those with social phobia may lead restricted, lonely lives because of their condition.