Archives for Treatments
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.
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.
I’m sure you know what selfish means and it’s not considered a particularly lovely trait by most people. But what do I mean when I suggest that you become self-less? Typically, the term selfless refers to people who put other people’s needs before their own. Selfless people typically have very little concern for making money, becoming famous, or obtaining a prestigious position. But that definition doesn’t quite fit what I mean by self-less (note I put in a hyphen to distinguish the term from selfless). I think people can and probably should have at least some concern for their own needs in terms of finances, relationships, security, and so on. And sometimes your own needs may even have to take precedence over the needs of others. But people all too often seriously mess themselves up when they become overly concerned about themselves and their egos. They experience exquisite concerns with how they look, what they say, mistakes they make, who likes them and who doesn’t, et cetera. People who worry a lot about their egos judge just about everything that they do. Their internal dialogues consist of an endless loop of self-hate and vitriol with thoughts such as “How could I be so stupid?,” “I hate myself,” “No one could be this dumb,” “I’ll never amount to anything,” “Nobody could ever like me,” and on and on. It’s pretty difficult to feel alright with thoughts like those.
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:
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.
Some kids love school and others are more reluctant. How should parents respond when children complain about school, start to cry about leaving home, or even have a tantrum rather than going to school? If your child has reluctance about going to school, start with the following: Talk to your child about school. Is there a problem going on that you are unaware of? Sometimes kids will not really know why they don’t want to go, it’s just a feeling of unease. But in some cases, kids will identify specific reasons for not wanting to go to school. Common reasons include being teased or bullied by other kids or not understanding some part of the school work.