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‘Pax’ Is a Chatbot for People Who Have OCD and Intrusive Thoughts

Aaron Harvey and Rose Bretecher understand what it is like to experience symptoms of mental illness for a long period of time without much education about what is happening or how to find help. That’s why they created Pax, a Facebook messenger chatbot designed for people with intrusive thoughts and obsessive-compulsive disorder. Pax is meant to act like a middle man, according to Harvey, who is the founder of Intrusive Thoughts — the nonprofit behind the app. Pax bridges the gap between realizing something might be going on and seeking actual treatment.

“We both felt that our long journeys to answers could have been cut down significantly if there had been information out there,” Bretecher said.

Pax provides an overview of OCD and is not meant to replace a doctor or therapist. Pax also recommends treatments and lifestyle habits that have helped others. Harvey hopes Pax will empower people to seek professional treatment if needed.

Pax the chatbot

Pax the chatbot

While Google can provide information about obsessive-compulsive disorder (OCD), the information it offers is often much more clinical. Pax, on the other hand, is slightly humorous and conversational while informative about intrusive, obsessive thoughts. Pax uses emojis and gifs to communicate some points, keeping the conversation light-hearted.

Pax OCD bot

Pax OCD bot

When a user connects with Pax, the chatbot lets the user know that they’ll be “exploring” intrusive thoughts and how to handle them. Pax gives many common examples of intrusive thoughts and has videos of people (including Harvey and Bretecher) talking about their experiences.

“The main vision to create Pax was to essentially recreate the experience of sitting down with someone and walking them through how to handle a particular disorder and that’s something you can’t get from a website,” Harvey said.

Pax the OCD chatbot

Pax the OCD chatbot

Both Bretecher and Harvey said they want Pax to show people that they are not alone and provide empathy. There are millions of people around the world that deal with OCD.

“I hope, out of this, people have a little bit more self-love. A lot of people with this condition develop self-hatred.”

While Pax is the first chatbot focused on OCD, there are other mental health chatbots. Woebot provides cognitive behavioral therapy to people via Facebook and checks in with the user daily. Another chatbot, Joy, helps you track your mental health and provides coping strategies for anxiety and depression.

Those interested in chatting with Pax can do so here.

Got a tip for our news team? Send it to [email protected].

Photo via Facebook

What’s the Difference between Obsessive Compulsive Disorder and Obsessive Compulsive Personality Disorder?

Obsessive Compulsive Personality Disorder (OCPD) is a serious personality disorder that is often confused with the more commonly known Obsessive Compulsive Disorder (OCD).  These two disorders sound similar in name, and are often confused with each other, yet they are really two very different and very distinct disorders.

The main distinction between the two disorders is that OCD sufferers perform ritualistic behaviors, and those persons with OCPD tend to be perfectionistic in many areas, causing their relationships with others to suffer greatly.

Obsessive Compulsive Disorder does not damage personal relationships. Obsessive Compulsive Personality Disorder drastically impacts interpersonal relationships, to their detriment.

Definition of OCPD:

This personality disorder is in the Cluster C category of personality disorders, along with anxious or fearful personality disorders, avoidant personality disorder, and dependent personality disorder.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition  DSM-V, OCPD can be diagnosed as follows:

“A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.”  This disorder begins in early adulthood and presents with four or more of the following fixations (American Psychiatric Association, 2014):

  • Preoccupation with details, rules, lists, order, organization, or schedules
  • Perfectionism which interferes with the ability to complete a project because of self-imposed overly strict standards
  • Over conscientious, scrupulous, inflexible in matters of morality, ethics, or values
  • An inability to discard worn-out or worthless items which have lost all value, including sentimental value
  • An inability to delegate tasks to others without the assurance that the other person will strictly adhere to his method of accomplishing the tasks
  • Miserly spending style; money tends to be hoarded for future catastrophes
  • Rigid and stubborn

Definition of OCD

According to the DSM-V, many disorders fit the category of OCD; these include,

Body-dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder.

Obsessive Compulsive Disorder is marked by two distinctive features – obsessions and/or compulsions.

  • Obsessions are recurring and intrusive thoughts, urges, and images, that cause heightened anxiety and distress.
  • Compulsions are repetitive behaviors, commonly involving hand washing, checking, ordering, counting, repeating words silently, or the like.

Common obsessions and compulsions involve themes regarding cleanliness, safety, memory doubts, need for order and/or symmetry, aggressiveness, sexuality, and scrupulousness.

Some Distinctions and Similarities between OCD and OCPD

Treatment:

Treatment protocols for the two disorders are vastly different. Treating OCD involves treating anxiety-caused symptoms, while treating OCPD involves treating a personality disorder. Personality disorders involve characterological deficits, while anxiety disorders do not.

You do not treat a person with anxiety by teaching them how to have improved character; with personality disorders, character is at the core. Well, that is not totally accurate; usually, attachment disruptions are at the core of a personality disorder; attachment issues involving parental lack of attunement and empathy. Cognitive Behavior-type therapies can be used to treat both disorders, but the underlying assumptions are different.

References:

American Psychiatric Association (2014). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association.

Berman, C. W. (2014). 8 Tips on How to Recognize Someone With Obsessive-Compulsive Personality Disorder. Retrieved from https://www.huffingtonpost.com/carol-w-berman-md/obsessive-compulsive-personality-disorder_b_5816816.html

Greenberg, W.M. (2017). Obsessive Compulsive Disorder. Retrieved from https://emedicine.medscape.com/article/1934139-overview

Van Noppen, B. (2010). Obsessive Compulsive Personality Disorder (OCPD). International OCD Foundation (IOCDF) Retrieved from https://iocdf.org/wp-content/uploads/2014/10/
OCPD-Fact-Sheet.pdf

 

Questions arise about what mental health treatment Florida school shooter received as relative reveals he was also …

President Trump has blamed a broken mental health system for Wednesday’s school shooting in Parkland, Florida, but still very little is know about what mental illness the shooter had – if any.

Those who knew Nikolas Cruz described him as a loner with a fascination with guns who was prone to violent outbursts. 

In the hours after the shooting, many speculated that Cruz may have fetal alcohol syndrome based on the structure of his face. But little is known about Cruz’s birth mother since she put him and his little brother up for adoption when he was just two years old.  

Officials said the teen had received treatment at a mental health clinic for a while, but stopped getting help more than a year ago.

The sister-in-law of the teen’s adoptive mother also revealed that he was taking medication at some point for ’emotional difficulties’ but didn’t elaborate on what kind of drugs. 

Nikolas Cruz is pictured above in court on Thursday in Broward County 

Nikolas Cruz is pictured above in court on Thursday in Broward County 

Some prescription medications used to treat depression or psychosis have a side effect of causing murderous thoughts, but it’s unclear if Cruz was taking any drugs at the time or what they were. 

While the side effect of ‘homicidal ideation’ sounds scary, many medical experts say most psychotic and depressed people are not violent, and are more likely to be a danger to themselves or others if they aren’t treated. 

His defense team is currently looking into his medical history, but say they already suspect he suffered from depression and autism. 

Neighbors also hinted at mental illness.

Paul Gold, 45, who lived next door to the family from 2009-2010 told the New York Times that Cruz ‘had emotional problems’ and may have been ‘diagnosed with autism’.

He said he knows that Cruz was sent to a school for students with special needs at one point.

‘He had trouble controlling his temper. He broke things. He would do that sometimes at our house when he lost his temper. But he was always very apologetic afterwards,’ Gold said. 

If he was suffering depression, the loss of his mother or getting kicked out of school could have triggered Cruz to snap and carry out the killing. Lynda is pictured above with out of her two sons above

If he was suffering depression, the loss of his mother or getting kicked out of school could have triggered Cruz to snap and carry out the killing. Lynda is pictured above with out of her two sons above

Amanda Samaroo, whose daughter attended school with Cruz for a time, said her daughter’s friends ‘have said he was known to always be mentally ill and would kill animals’.

In November, Cruz’s adoptive mother died of penumonia, leaving him orphaned. Soon after her death, he moved in with a friend’s family, who say he appeared to be depressed. 

MEDICATIONS THAT HAVE THE SIDE EFFECT OF ‘HOMICIDAL IDEATION’ 

XANAX – used to treat anxiety and panic disorders

ABILIFY – used to treat schizophrenia, bipolar disorder, depression, and Tourette syndrome. It can also treat irritability associated with autism.

PAXIL – used to treat depression, anxiety disorders, obsessive-compulsive disorder (OCD), and premenstrual dysphoric disorder (PMDD).

ALPHRAZOLAM – used to treat anxiety and panic disorder

PAROXETINE – used to treat depression, anxiety disorders, obsessive-compulsive disorder (OCD), and premenstrual dysphoric disorder (PMDD).

ARIPIPRAZOLE – used to treat schizophrenia, bipolar disorder, depression, and Tourette syndrome. It can also treat irritability associated with autism.

If he truly was depressed, it’s possibly the loss of his mother, or his expulsion from school, could have set him off.

Dr Alan J. Lipman, an expert in the psychology of violence at George Washington Medical Center told CNBC that that mass killers typically fall into three categories: a psychotic individual, a sociopath or psychopath and a young male between the ages of 16 and 25 who is depressed and has a fascination with violence. 

The third category seems to check a lot of boxes for Cruz, who frequently posted pictures of his weapons collection and mutilated animals to Instagram. 

Lipman said that the mass killers that are in this category usually are undiagnosed or untreated for their depression. 

Citing reports that Cruz had been in mental health therapy, Lipman said that if he continued treated ‘it’s more than likely this would never have happened.’ 

For depressed shooters, Lipman said there’s usually a triggering event that causes them to break.  

‘This person, who already sees their life as having no value, now feels it’s even more worthless, and they look to express their rage in the most violent way possible,’ Lipman said. 

Those who knew the family say the loss of Cruz’s mother would have been difficult, since she was the only one close to him. 

‘His mother was his entire life and when he lost her, I believe that was it for the boy’s peace of mind,’ Gold said.

‘Who’s not going to be depressed?’ Jim Lewis, the attorney for the family who took Cruz in, said. ‘You’re 19 years old. Your father’s been dead 12 years. The mother’s the one who raised you and all that you’ve basically got in the world in terms of grounding you. And all of sudden she dies of pneumonia.’

While Cruz’s mental health remains a bit of a mystery now, it won’t be for long. 

His defense team have already told reporters that they’re working to get his medical records and may have Cruz undergo a psychological evaluation. Since his arrest Wednesday afternoon, Cruz has not been given any kind of medication for mental health issues.  

His defense attorneys painted Cruz as a victim himself, of a broken system that should have gotten him the help he needs. 

‘He is a deeply troubled young man; a child that has endured significant loss,’ Gordon Weekes, chief assistant for Broward County’s public defender’s office, told reporters Thursday. ‘He fell between the cracks and we have to try to save him now.’

As he was arraigned on Thursday, one of his attorneys, Melisa McNeill, comforted Cruz by putting an arm around his shoulder. 

She told reporters after the hearing: ‘When your brain is not fully developed, you don’t know how to deal with these things. That’s the child I’m sitting across from.’ 

If he is indeed deemed mentally ill, prosecutors will not be allowed to ask for the death penalty in his case.  

Howard Finkelstein, the chief public defender in Broward County, appeared confident that Cruz is mentally ill in an interview with the New York Times.  

‘Every red flag was there and nobody did anything,’ Finkelstein said. ‘When we let one of our children fall off grid, when they are screaming for help in every way, do we have the right to kill them when we could have stopped it?’  

 

Coronation Street star Colson Smith reveals crucial detail in Bethany Platt case that led to Craig’s OCD

Coronation Street actor Colson Smith has revealed the crucial detail that led to his character Craig Tinker’s OCD.

Obsessive Compulsive Disorder is an anxiety disorder where people feel the need to check, perform routines or have certain thoughts repeatedly.

And Colson, who plays Special Constable Tinker in the ITV1 soap, says the catalyst for the disorder in his character was getting a time wrong while giving evidence at the trial of Nathan Curtis who had groomed his now girlfriend Bethany Platt last year.

Craig Tinker at the Nathan Curtis trial
(Image: ITV/Coronation Street)

“It started from the day of Bethany’s trial,” he explained on the ITV1 chat show This Morning.

“What happened there was the catalyst that started this off.

“He got the time wrong and it started with obsession around time. The starting point is he was drawing 24 hour clocks and then it developed into an obsession with even numbers and then the time he was leaving the house.

Craig has developed OCD
(Image: ITV/Coronation Street)

“Now it’s gone into these rituals so it’s slowly grown.”

Colson, 19, appeared on This Morning with OCD sufferer and campaigner Richard Taylor who informed the storyline.

The 25 year old was diagnosed at 15 and had the condition for most of his life without realising.

Richard explained: “For me it came to a head at school where I became worried about touching door handles, walking to and from classes and taking school books home.

He had years of therapy and counselling and is pleased with the way that Corrie is tackling the storyline.

Richard said: “It’s fantastiic. This is a major show that’s going to help so many people. The way Coronation Street has handled it and Colson himself has been amazing.”

After the show Colson tweeted his thanks to Richard, saying: “Thank you to RichBiscuit21 for joining me on This Morning for sharing your knowledge and experience with me over the past few months.”

Craig and Bethany on Coronation Street
(Image: ITV)

And praise poured in from viewers.

One fan tweeted: “So happy ITVCorrie are doing a OCD storyline Richard is brilliant “you either have a diagnosis or you don’t” well said sir.”

Another wrote: “I’ve suffered with OCD for a while Colson Smith it’s really not nice…. People can say it’s weird but it’s not… Well done ITVCorrie for portraying OCD.”

Want to talk about Corrie with other fans? Join our Coronation Street Fan Chat group on Facebook where you’ll also get updates, spoilers and more.

nOCD gets $1M seed round to help people with obsessive …


nOCD, an app created to help people treat obsessive-compulsive disorder, will launch an Android version and add more features after raising a $1 million seed round from early-stage healthcare investment firm 7wire Ventures.

The free app guides patients through exposure and response prevention (ERP) exercises, a type of cognitive behavioral therapy that is especially effective for OCD. ERP carefully exposes suffers to stimuli, including images or situations, that trigger their symptoms and then guides them through exercises to help them manage anxiety and compulsive behaviors. nOCD’s founder and chief executive officer Stephen Smith describes ERP as a “virtual gym.”

Smith began working on nOCD, which launched in 2016 and now claims 80,000 community members across its app and online content, while he was a college student after OCD symptoms began disrupting his life. There are an increasing number of apps focused on mental health, but Smith had trouble finding one that gave him the specific support he needed.

“I was suffering pretty intensely with OCD and mental health apps out there didn’t address OCD specifically. They addressed cognitive behavioral therapy in general, but they didn’t go deep enough. I couldn’t implement treatment because treatment for OCD is very specific,” Smith says. “I wanted to create something that would provide effective treatment and also give users a community and 24/7 support.”

After taking a break from college to focus on nOCD, Smith returned to school at Pomona College. Before graduating last year, he commuted between its Claremont, California campus and nOCD’s office in Chicago.

The lifetime prevalence of OCD among American adults has been estimated to be about 2.3% and the World Health Organization has described it as one of the most disabling conditions because of OCD’s impact on work and quality of life.

Even though it’s effective, ERP therapy can be difficult to find and hard to afford. nOCD was created to address barriers to treatment, like not getting enough guidance outside of medical appointments (which can cost hundreds of dollars per session) or confusion over how to complete exercises. Its users can also track their progress in the app, share access to that information with healthcare providers and connect anonymously with other OCD sufferers for support.

nOCD’s seed round brings its total raised, including angel funding, to $1.25 million. The app is currently available only on iOS, but its new funding will be used to develop a version for Android. The startup also plans to add more features based on user feedback, including tools that make ERP easier to understand for people who haven’t tried it before. It recently added Larry Trusky, who previously served as vice president of development at Allscripts and chief technology officer of Zest Health, as its new CTO and chief operating officer.

While many self-help mental health apps have launched over the past few years, nOCD might be a precursor of the genre’s future, in which startups create resources tailor-made for specific conditions.

“Most mental health conditions need specific treatment, not just OCD,” says Smith. “It’s not unique in that sense, but the tech industry tends to condense them into one. Our platform treats patients in the middle of an episode. They hit an SOS button and get exposure and response prevention-based support. The whole principle is to accept uncertainty and if you can do that, obsessions and fears decrease in frequency over time.”

Featured Image: Manuel Breva Colmeiro/Getty Images

nOCD gets $1M seed round to help people with obsessive-compulsive disorder

nOCD, an app created to help people treat obsessive-compulsive disorder, will launch an Android version and add more features after raising a $1 million seed round from early-stage healthcare investment firm 7wire Ventures.

The free app guides patients through exposure and response prevention (ERP) exercises, a type of cognitive behavioral therapy that is especially effective for OCD. ERP carefully exposes suffers to stimuli, including images or situations, that trigger their symptoms and then guides them through exercises to help them manage anxiety and compulsive behaviors. nOCD’s founder and chief executive officer Stephen Smith describes ERP as a “virtual gym.”

Smith began working on nOCD, which launched in 2016 and now claims 80,000 community members across its app and online content, while he was a college student after OCD symptoms began disrupting his life. There are an increasing number of apps focused on mental health, but Smith had trouble finding one that gave him the specific support he needed.

“I was suffering pretty intensely with OCD and mental health apps out there didn’t address OCD specifically. They addressed cognitive behavioral therapy in general, but they didn’t go deep enough. I couldn’t implement treatment because treatment for OCD is very specific,” Smith says. “I wanted to create something that would provide effective treatment and also give users a community and 24/7 support.”

After taking a break from college to focus on nOCD, Smith returned to school at Pomona College. Before graduating last year, he commuted between its Claremont, California campus and nOCD’s office in Chicago.

The lifetime prevalence of OCD among American adults has been estimated to be about 2.3% and the World Health Organization has described it as one of the most disabling conditions because of OCD’s impact on work and quality of life.

Even though it’s effective, ERP therapy can be difficult to find and hard to afford. nOCD was created to address barriers to treatment, like not getting enough guidance outside of medical appointments (which can cost hundreds of dollars per session) or confusion over how to complete exercises. Its users can also track their progress in the app, share access to that information with healthcare providers and connect anonymously with other OCD sufferers for support.

nOCD’s seed round brings its total raised, including angel funding, to $1.25 million. The app is currently available only on iOS, but its new funding will be used to develop a version for Android. The startup also plans to add more features based on user feedback, including tools that make ERP easier to understand for people who haven’t tried it before. It recently added Larry Trusky, who previously served as vice president of development at Allscripts and chief technology officer of Zest Health, as its new CTO and chief operating officer.

While many self-help mental health apps have launched over the past few years, nOCD might be a precursor of the genre’s future, in which startups create resources tailor-made for specific conditions.

“Most mental health conditions need specific treatment, not just OCD,” says Smith. “It’s not unique in that sense, but the tech industry tends to condense them into one. Our platform treats patients in the middle of an episode. They hit an SOS button and get exposure and response prevention-based support. The whole principle is to accept uncertainty and if you can do that, obsessions and fears decrease in frequency over time.”

Featured Image: Manuel Breva Colmeiro/Getty Images

JOHN ROSEMOND: Sometimes, less words can help more

As a good daddy is supposed to do, I would remain in her bedroom, explaining and reassuring, upwards of thirty minutes until she gave the “all clear.” Sometimes, however, my sleep therapy wouldn’t stick, in which case she’d wake me up in the wee hours of the morning to tell me that her anxiety disorder with obsessive-compulsive and phobic features (ADOCPF) was preventing her from sleeping. I eventually figured out that I was spending four to six hours a week trying to talk her out of being sleep-phobic and belatedly realized that my well-chosen words weren’t working. In fact, her fears seemed to be worsening, which strongly implied — horror of horrors – that I wasn’t a parenting expert after all.

Shortly thereafter, I figured out that her condition was worsening not because I had yet to figure out the magic words that would restore her mental health, but because I was talking at all. My talk-talk-talking effectively validated her fears. Why, pray tell, would I be talking at all if her fears didn’t deserve a lot of serious attention?

So, I stopped talking. The next time Amy told me, tearfully, that she was afraid of going to sleep, I said, “Yeah, I know. That sort of fear is not unusual at your age. I’ve said all I have to say, Amy. I don’t have anything to add. You’re going to have to either learn to live with it or put an end to it. I’m not helping, obviously. So, my princess, I love you (kiss, kiss). See you in the morning!” Exit Daddy, stage left.

Amy was none too happy with that turn of events. She continued trying to engage me in her fears for a week or so. She would begin bawling as I left her room, for example. She may have even yelled, “You’ll be sorry if I’m dead in the morning!” Children are, after all, soap-opera factories. I, however, stayed the course. It was not an easy thing to do. Had I abandoned my child? Was I a covert sadist, a sociopath even? Parental self-doubt is a deceptive thing.

Several weeks passed before I noticed that Amy’s demons seemed to have released their grip on her. When I tucked her in, she made no attempt to get me to hang around, talking in vain. It occurred to me that the very thing no psychologist-in-good-standing would recommend had been key to Amy’s recovery.

That experience led me to begin recommending to other parents my “no-talking cure” for childhood fears. They had, I would point out, said everything there was to say about the fears in question. They were repeating themselves as if their children were dense. They were on a constant search for magic words that don’t exist. Furthermore, and unwittingly so, their talk-talk-talking was verifying that the child’s fears were serious, deserving therefore of much parental consternation and, therefore, ever more talk-talk-talking. And around and around they went, until they stopped talking.

Every time I’ve recommended my new, amazing, ironic and most peculiar cure for ADOCPF – obsessive fears of all sorts, mind you – it worked. And it continues to work to this day, which is one reason of many why I do not believe – with rare exception – that young children should be allowed to engage in one-on-one (as in, private) conversations with therapists. Having been trained to talk to children, I don’t. In the case of irrational anxieties/fears, said conversations are likely to lend significance to something that is nothing more than a product of a child’s rather overactive and random imagination. Contrary to the standard (and unproven) psychological narrative, the fears in question do not represent “issues” in a child’s life that said child cannot safely express or lacks the words with which to express. They are literally meaning-less. Therefore, the less attention they are given, the better.

Family psychologist John Rosemond: johnrosemond.com, parentguru.com.

Here’s when to worry about worrying

If you’re worried sick about the red “check engine” light that just flashed on your car’s dashboard or the speech your boss just asked you to give at next month’s regional conference, you’re engaging in normal, everyday worrying. You may be able to borrow money from a relative to fix the car and, when your talk is over, you’ll breathe a huge sigh of relief and move on.

But if you have worries that overwhelm your mind and cause you to become anxious, invading your thoughts and sometimes producing unpleasant physical symptoms, you may have an anxiety disorder. Anxiety disorders are diagnosed if worries are long lasting (six months or longer) and interfere with normal activities and ability to enjoy life.

The constellation of anxiety disorders affects 40 million adults in the United States, or one in six people. Anxiety is one of the most frequent complaints that prompt a doctor’s visit. And it comes in multiple forms.

Generalized anxiety disorder involves feeling excessively anxious over an extended period of time, affecting your ability to focus at work, school and in everyday situations, often having a negative effect on personal relationships.

Generalized anxiety has many possible symptoms, including: feeling stressed and emotionally on edge; finding it difficult to concentrate; persistent and excessive worry, despite knowing you worry too much; becoming easily exhausted and irritable; headaches, stomach aches and unexplained pain; excessive sweating; feeling breathless and faint; needing to go to the bathroom frequently.

Adults may worry excessively about their job, finances, health and their children.

Obsessive compulsive disorder: Needing to carry out specific rituals over and over and being bothered by repeated unwanted thoughts such as sex or religion are signs of obsessive compulsive disorder. Repeated hand washing until hands are chapped and raw, obsessively checking that the door is locked or the stove turned off, or organizing your work in a specific order and needing to restart the sequence if the order is interrupted can consume hours of every day.

Performing the ritual may bring temporary relief, but the need to repeat it resurfaces, creating an anxiety loop that leaves you exhausted and consumes your life.

Panic disorder causes sudden and intense fear, despite the fact that there is no apparent threat. Panic attacks cause multiple physical symptoms, including a racing heartbeat, shaking, sweating and shortness of breath. Many people fear they are having a heart attack and are overwhelmed by a feeling of impending doom.

Fear of losing control and of another attack occurring causes many people to avoid places where panic attacks have occurred in the past, often leading to social isolation.

Social anxiety disorder involves fear of social situations. Fear of being judged by others, of making a fool of oneself publicly, or of offending others causes those with social anxiety to avoid social interactions. Physical symptoms include blushing and sweating when around others and feeling nauseous and shaky. People tend to have a hard time making and keeping friends and to isolate themselves.

If you have anxiety that is interfering with your peace of mind and quality of life, make an appointment with your doctor or a mental health professional. Your doctor will do a health history and a physical exam to see if there are any physical problems causing your symptoms and may refer you to a mental health specialist, either a psychiatrist or a psychologist.

Although there is no cure for anxiety disorders, they can be treated, most often with cognitive behavioral therapy, medication or a combination of the two. Self-help techniques such as meditation and mindfulness are also often effective.

Cognitive behavioral therapy teaches patients to change negative thought patterns and learn new ways of reacting to anxiety-producing situations. Patients learn to identify, confront and neutralize negative thoughts

Anti-anxiety drugs include benzodiazepines, which are considered first-line treatment for GAD. Antidepressants are also effective in treating anxiety. The beta-blockers propranolol and atenolol are most effective in treating the physical effects of anxiety: they slow the heart and help control shaking and blushing.

Anxiety disorders are common. If you are worried that you might have one, make an appointment with your doctor or a mental health professional.

Rupp is care coordinator for Long Term Care Authority of Enid Aging Services.

Are You Looking to Buddhism When You Should Be Looking to Therapy?

Some 30 years ago Jack Engler published an influential study based on his experience as both a Buddhist meditation teacher and a clinical psychologist. He had discovered over the years that many people who come to Buddhism are looking for the kind of help they ought properly to seek in psychotherapy. “With the ‘triumph of the therapeutic’ in Western culture,” he wrote, there is a tendency in mindfulness meditation to “analyze mental content instead of simply observing it.”

In more recent years this conflation between Buddhist practice and psychotherapy has only deepened. Books tracing associations between the two traditions have proliferated, and the use of mindfulness meditation in a therapeutic setting has become commonplace. Indeed, pristine, unassailable mental health is often assumed to be the ultimate goal of all study and practice of the dharma.

The problem, however, is that it isn’t. And when, as it happens, an accomplished Buddhist meditator struggles with severe depression or anxiety—symptoms of a clinically diagnosed psychological disorder—it can be especially difficult for students to understand. Writing after the death of the Canadian Buddhist teacher Michael Stone, who had struggled with bipolar disorder, the Scottish Zen monk Dogo Barry Graham reflected on would-be students who were disappointed to hear that what treats his own mental health issues is not meditation, but Prozac. “Some were upset when I told them to see a doctor before they attempted meditation practice,” he wrote on his blog.

We run the risk of conflating the ultimate goal of Buddhist practice with an altogether conventional, secular understanding of mental health.

At this point there can be little doubt that a great deal of personal suffering has been alleviated through the judicious application of mindfulness meditation to the various maladies of the psychosocial self. Such success in employing mindfulness as a therapeutic instrument has granted scientific credibility to an ancient form of Buddhist ritual activity—a credibility that cannot help but influence our understanding of the benefits and goals of traditional Buddhist spiritual practice. For precisely this reason, it’s essential that we appreciate the critical difference between how mindfulness is used in the context of modern psychotherapy and how this same meditative technique has traditionally functioned as an indispensable element of the Buddhist path to enlightenment (nibbana). If we fail to grasp this distinction, we run the risk of conflating the ultimate goal of Buddhist practice with an altogether conventional, secular understanding of mental health.

Both Buddhism and psychotherapy are directed toward the problem of human suffering, but nibbana—the goal of Theravada Buddhist practiceand the therapeutic goal of “mental health” are grounded in two distinct understandings of the nature and scope of human suffering. While psychotherapy aims at the alleviation of symptoms experienced as extrinsic or peripheral to the patient’s underlying core sense of self, Buddhism addresses a form of suffering (dukkha) considered intrinsic to the experience of the personal self as an independent agent defined by its capacity to analyze and think, to judge, choose, act and be acted upon. Buddhist teachings associate these two forms of suffering with two distinct but interrelated truths about the self and its world: the first is “conventional” truth (sammuti-sacca), which governs day-to-day, practical affairs, where appearances are all that matters; and the second is “ultimate” or “absolute” truth (paramattha-sacca), which reveals the illusory nature of these same appearances.

The practice of psychotherapy is, accordingly, dedicated to a method of healing that leaves the conventional structure of self-as-agent intact as the focal point of attention, whereas Buddhist spiritual practice engages in a sustained, methodical dismantling of our customary preoccupation with self-centered experience.

One way to illustrate the subtle but profound difference between these two forms, or levels, of suffering is through reference to the clinical condition known as obsessive-compulsive disorder (OCD). OCD is defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as the presence of obsessions, compulsions, or both. Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, and in most patients cause marked anxiety or distress. Compulsions are repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession, as an attempt to reduce or mitigate the accompanying anxiety. Unfortunately, as DSM-5 explains, compulsive acts “are not connected in a realistic way with what they are designed to neutralize or prevent”; consequently, they serve only to increase the individual’s distress.

The discomfort experienced by an OCD patient is triggered by thoughts that are unambiguously experienced as alien to the patient’s core sense of self. Even in the most serious cases, when the unwanted thought arises—say, a compulsion to wash one’s hands for the tenth time in an hour—the patient is aware that her hands are not actually dirty. That is to say, in people suffering from OCD some part of the conscious mind remains aloof as an impartial spectator, aware of the compulsive thought but not identified with it. This feeling of being compelled, against one’s will, into an intimate alliance with thoughts and desires not my own is referred to technically as “ego-dystonic thinking”—a defining symptom of obsessive-compulsive disorder.

Ego-dystonic thinking is not peculiar to OCD patients; to some extent, it’s a familiar dimension of everyone’s mental life. Although most of us are deeply identified with our thoughts most of the time—“I think, therefore I am”—nevertheless under certain circumstances we know what it is to experience a thought as intrusive, or to reflect in such way as to distance ourselves from thoughts that cry out for attention. Unlike the OCD patient, even when an intrusive thought persists, most of the time we can resist the siren’s call to action.

For example, let’s say I’m going out of town for several days. Before leaving my home, I carefully go over a checklist of things that need to be done, making sure that the thermostat is adjusted correctly, that lights and stove are turned off, and so forth. I go over the list several times, until I’m sure everything is in order. But then, sitting in the car with the engine running, I’m seized by an urge to go back inside and check one more time. A critical difference between the normal experience of ego-dystonic thoughts and the pathological experience of the OCD sufferer is that I do not experience such thoughts as a source of unbearable anxiety, much less as an irresistible summons to act; rather, I can sit back and simply watch the urge come and go.

Jeffrey Schwartz, a research neuroscientist in the Department of Psychiatry of UCLA’s medical school who specializes in the treatment of OCD, discovered a way to turn his patients’ severely ego-dystonic thinking into the means of their cure. He noted early on that OCD’s “intrinsic pathology is, in effect, replicating an aspect of meditation, affording the patient an impartial, detached perspective on his own thoughts.” Drawing on his personal experience with the practice of mindfulness, Schwartz painstakingly taught his patients how to drive a wedge between the intrusive thought and the simple awareness of that thought, effectively widening the gap between, on the one hand, the patient’s subjective sense of self and, on the other, the unwanted urge, which is viewed as not mine. He calls this first step “relabeling” the thought. The second step is to “reattribute” the obsessive thought, consciously recognizing it as a function of pathological brain circuitry. The patient then “refocuses,” shifting his attention away from the obsessive thought toward a thought felt to be consonant with his core sense of self. Finally, he “revalues” the original obsessive thought, assigning it no power or authority over his (now) clearly separate identity as a healthy person.

Schwartz’s technique works. A significant percentage of patients undergoing his therapeutic regimen have found partial or even total relief from their symptoms. The anxiety generated by obsessive thoughts is lessened, and with the lowering of this anxiety, the need for associated compulsive behaviors is no longer present.

Notice that mindfulness meditation is only employed here temporarily, in the initial stage of Schwartz’s regimen. Having achieved adequate distance from the disturbing thoughts and urges, the patient moves seamlessly from simply observing them as they arise, unbidden, to actively judging such thoughts as pathological, and finally to consciously choosing a way of thinking and acting consonant with the “healthy” or “normal” desires of the core self experienced as a volitional agent engaged in purposeful action.

But what if literally every thought were experienced as “painfully amplified”? What if the entirety of one’s mental and emotional life were to be experienced as insistent, discomfiting, and intrusive?

Such is the human condition seen from the point of view of an advanced Buddhist meditator. Here, for example, in this passage from the postcanonical Abhidhammattha Sangaha, we find a description of how mindfulness is used as a tool for cultivating insight (vipassana) into the painful nature of ever more refined states of concentration (jhanas):

Consider the monk who, aloof from sense desires, enters and abides in the first jhana: whatever occurs there of form, feeling, perception, mind or consciousness, he sees wholly as impermanent phenomena, as ill, as a disease, a sting, a hurt, an affliction, as something alien, gimcrack, empty, not the self. 

—trans. E. M. Hare

According to the first noble truth, one of the four foundational principles of Buddhist thought, a level of anxiety or suffering is woven into the very fabric of our thinking, feeling, sensing, and perceiving, a primal discontent inherent to even the most exalted states of concentration and bliss—not to mention the ceaseless mental turmoil present in normal, “healthy” ego-centered experience. To imagine that this deep-seated malaise could somehow be eradicated while still preserving one’s habitual preoccupation with these same basic structures of thought, feeling, and sensation is to fail to grapple with the ultimate truth about human suffering.

Buddhist teachings remind us that we will never achieve real or lasting satisfaction by adopting a different, better way of thinking or acting.

From the Buddhist point of view, therapeutic programs designed to make the ego happier or more comfortable are geared toward the relatively superficial or “conventional” notion of suffering. Buddhist teachings remind us that we will never achieve real or lasting satisfaction by adopting a different, better way of thinking or acting. The effort to find happiness in this way may bring relief from the more extreme forms of anxiety to which the personality is subject, but it is nonetheless based on an endlessly replicating fantasy charged by an unquenchable, obsessive thirst that serves only to perpetuate the ego’s compulsive activity and its attendant suffering. is is the very definition of bondage to karma, the engine of a chronic existential disease. The insatiable yearning to analyze and discriminate, judge and choose—and thereby to control or shape the self in the image of its constantly shifting desires—is the elemental force of dukkha in its most basic form. It is the inescapable plight of the self.

This brings us to the central concern of Theravada Buddhism, and to mindfulness meditation as the primary means for stepping away from the whole project of searching for happiness by judging and choosing, rejecting some things while accepting others.

As a tool for cultivating insight into the inherent suffering of the ego, mindfulness meditation opens up a field of awareness disassociated with any form of volitional activity. To maintain a deep, sustained practice of mindfulness is to consistently disidentify with the experience of self as willing agent, to let go of the obsessive need to discriminate, judge, and choose. Such practice leads to the ultimate annihilation of our incessant thirst (tanhakkhaya), the utter peace and freedom of nibbana: “Here, monks, I say there is no coming, no going, no standing still; no passing away and no being reborn. It is not established, not moving, without support. Just this is the end of dukkha” (Udana 8.1, trans. Peter Masefield).

In principle, what the unconditional peace and freedom of nibbana asks of us stands in stark contrast to our conventional desires: either let go of the self and its world without reservation, or embrace them both wholeheartedly, just as they are. The first is the expression of insight or wisdom, the second, that of boundless empathy and universal compassion. Either way, the point is that with the realization of nibbana, attention is no longer dominated by the obsessive, anxious need to discriminate between what is acceptable and what is not, and the associated compulsion to act on the basis of such distinctions. This need defines both the self and its suffering; by contrast, an uncompromising disidentification with the volitional self and its tortured particularity is the hallmark of Buddhist practice. This is where psychotherapy and Buddhism part ways in their interests and methods.

At the time of Engler’s study 30 years ago, those undertaking Buddhist practice to solve psychotherapeutic issues—and, according to him, there were many such people—often suffered from various clinical disorders characteristic of an ego that had been traumatized and arrested in the course of its development. They were frequently searching for a way to avoid the developmental tasks essential to the formation of a functioning ego; Buddhism was particularly attractive to them because of its core teaching of no-self, mistakenly perceived as a “shortcut solution to the developmental tasks appropriate and necessary to their stage of the life cycle.” However, what they found in Buddhist practice was, ironically, nothing but an endless hall of mirrors reflecting their own fears and desires.

“My impression,” Engler wrote in his groundbreaking study, “is that narcissistic personalities represent a sizable subgroup of those individuals with borderline levels of ego organization who are drawn to meditation.” For this type of personality, the ideal of enlightenment or nibbana offers a unique attraction:

This [ideal] is cathected as the acme of personal perfection with eradication of all mental defilements (kilesas) and fetters (samyojanas). In other words, it represents a purified state of complete and invulnerable self-sufficiency from which all badness has been expelled, the aim of all narcissistic strivings. For this kind of personality, “perfection” often unconsciously means freedom from symptoms so they can be superior to everyone else. The second attraction is the possibility of establishing a mirroring or idealizing type of narcissistic transference with spiritual teachers who are perceived as powerful, admirable beings of special worth in whose halo they can participate.

Notice how the perspective of Engler’s narcissistic meditators parallels the perspective of Schwartz’s OCD patients: both groups experience particular thoughts as alien and painful to a core self that seeks to regain control of its psychological integrity through asserting its power to judge and then to choose and act on what is considered to be in its own best interest. In this case, however, the goal—idealized as “the acme of personal perfection . . . complete and invulnerable self-sufficiency”—is conceived in terms both unrecognizable to psychotherapy and antithetical to the basic principles of Buddhist doctrine and practice. The two traditions have become hopelessly conflated, to the detriment of both.

This conflation has its roots in a prevalent assumption, namely, that bare observation—the essence of mindfulness practice—has no power or value unless it can somehow be harnessed to the attainment of a goal that serves the purposes of the ego. Consider, for example, how Schwartz himself described the revelation that led him to apply mindfulness meditation to the treatment of OCD: “But perhaps, I thought, the impartial spectator needn’t remain a bystander. Perhaps it would be possible to use mindfulness training to empower the impartial spectator to become more than merely an effete observer.”

In the current environment, where the practice of mindfulness meditation is routinely detached from the broader context of Buddhist doctrine, even among Buddhist practitioners we’re much more likely to find the ultimate, liberating goal of nibbana confused with a conventional version of mental health. The problem Engler so skillfully documented 30 years ago is increasingly likely to occur and at the same time is increasingly less likely to be appreciated for what it is. Given this situation, his research is, arguably, even more germane now than when it was first published.

Let’s be clear: mindfulness meditation has proven to be an effective component in psychotherapeutic programs aimed at achieving the secular or (to use the Buddhist term) conventional goal of mental health. is in itself is an accomplishment of indisputable value. But mindfulness meditation in its “ultimate” application—as a Buddhist practice aimed toward realization of nibbana—is not concerned with shaping a functional ego. It is, rather, a way to disidentify with both health and illness, happiness and sorrow, pleasure and pain. To disidentify, that is, with the unavoidably painful nature of even the most refined varieties of self-centered experience.

As practiced in the traditional Buddhist context, mindfulness is not a powerful, spiritualized form of psychotherapy, a device for fine-tuning the ego—much less a strategy for achieving “complete and invulnerable self-sufficiency.” Although in an abridged form it can be legitimately harnessed to the business of healing the self of a range of mental and emotional disorders, as an essential component in the Buddhist path to nibbana, mindfulness is not about becoming a happier, better person. It’s not about “happiness” at all—at least not if “happiness” is understood as the fulfillment of desire. Mindfulness is, rather, about wisdom rooted in insight, renunciation, and unqualified self-surrender.

This is not a message easily appreciated by a society awash with self-help books promising the fulfillment of one’s desires through some sort of spiritual or psychological adjustment. It is worth remembering, though, that even in ancient India the search for nibbana was not for everyone. There was, from earliest times, a clear division in the sangha between lay and monastic practitioners. And even within the monastic community there was a recognition of what might be termed levels of interest and commitment.

If we are to avoid distorting Buddhist doctrine and practice in such a way that we risk sacrificing its ultimate promise of liberating insight, then it is vitally important that we draw a clear and careful distinction between the traditional goal of nibbana and modern psychotherapeutic definitions of mental health. In doing so, we need to pay close attention to the ways in which the ancient Buddhist mental discipline of mindfulness is being used and the purposes to which it is being turned as it is assimilated into what the American historian and social critic Christopher Lasch once called “the culture of narcissism.”

One of the most prominent and elegant of all Chinese Buddhist texts is the Hsin Hsin Ming, a poem attributed to the third patriarch of the Chan school. Its opening lines are traditionally considered to capture the essence of Buddhist meditation:

The Supreme Way is not difficult
If only you do not pick and choose.
Neither love nor hate,
And you will clearly understand.
Be off by a hair,
And you are as far from it as heaven from earth.

—trans. Master Sheng Yen

Temple

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