Four Steps to Manage Obsessive-Compulsive Disorder

When I was a young girl, I struggled with obsessive-compulsive disorder. I believed that if I landed on a crack in the sidewalk, something terrible would happen to me, so I did my best to skip over them. I feared that if I had bad thoughts of any kind, I would go to hell.

To purify myself, I would go to confession and Mass over and over again, and spend hours praying the rosary. I felt if I didn’t compliment someone, like the waitress where we were eating dinner, I would bring on the end of the world.

What Is OCD?

The National Institute of Mental Health defines OCD as a “common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.” OCD involves a painful, vicious cycle whereby you are tormented by thoughts and urges to do things, and yet when you do the very things that are supposed to bring you relief, you feel even worse and enslaved to your disorder.

The results of one study indicated that more than one quarter of the adults interviewed experienced obsession or compulsions at some point in their lives — that’s over 60 million people — even though only 2.3 percent of people met the criteria for a diagnosis of OCD at some point in their lives. The World Health Organization has ranked OCD as one of the top 20 causes of illness-related disability worldwide for individuals between 15 and 44 years of age.

Whenever I am under considerable stress, or when I hit a depressive episode, my obsessive-compulsive behavior returns. This is very common. OCD breeds on stress and depression. A resource that has been helpful to me is the book Brain Lock by Jeffrey M. Schwartz, M.D. He offers a four-step self-treatment for OCD that can free you from painful symptoms and even change your brain chemistry.

Distinguishing Form from Content of OCD

Before I go over the four steps, I wanted to go over two concepts he explains in the book that I found very helpful to understanding obsessive-compulsive behavior. The first is knowing the difference between the form of obsessive-compulsive disorder and its content.

The form consists of the thoughts and urges not making sense but constantly intruding into a person’s mind — the thought that won’t go away because the brain is not working properly. This is the nature of the beast. The content is the subject matter or genre of the thought. It’s why one person feels something is dirty, while another can’t stop worrying about the door being locked.

The OCD Brain

The second concept that is fascinating and beneficial to a person in the throes of OCD’s torture is to see a picture of the OCD brain. In order to help patients understand that OCD is, in fact, a medical condition resulting from a brain malfunction, Schwartz and his colleagues at UCLA used PET scanning to take pictures of brains besieged by obsessions and compulsive urges. The scans showed that in people with OCD, there was increased energy in the orbital cortex, the underside of the front of the brain. This part of the brain is working overtime.

According to Schwartz, by mastering the Four Steps of cognitive-biobehavioral self-treatment, it is possible to change the OCD brain chemistry so that the brain abnormalities no longer cause the intrusive thoughts and urges.

Step One: Relabel

Step one involves calling the intrusive thought or urge exactly what it is: an obsessive thought or a compulsive urge. In this step, you learn how to identify what’s OCD and what’s reality. You might repeat to yourself over and over again, “It’s not me — it’s OCD,” working constantly to separate the deceptive voice of OCD from your true voice. You constantly inform yourself that your brain is sending false messages that can’t be trusted.

Mindfulness can help here. By becoming an observer of our thoughts, rather than the author of them, we can take a step back in loving awareness and simply say, “Here comes an obsession. It’s okay … It will pass,” instead of getting wrapped up in it and investing our emotions into the content. We can ride the intensity much like a wave in the ocean, knowing that the discomfort won’t last if we can stick in there and not act on the urge.

Step Two: Reattribute

After you finish the first step, you might be left asking, “Why don’t these bothersome thoughts and urges go away?” The second step helps answer that question. Schwartz writes:

The answer is that they persist because they are symptoms of obsessive-compulsive disorder (OCD), a condition that has been scientifically demonstrated to be related to a biochemical imbalance in the brain that causes your brain to misfire. There is now strong scientific evidence that in OCD a part of your brain that works much like a gearshift in a car is not working properly. Therefore, your brain gets stuck in gear. As a result, it’s hard for you to shift behaviors. Your goal in the Reattribute step is to realize that the sticky thoughts and urges are due to your balky brain.

In the second step, we blame the brain, or in 12-step language, admit we are powerless and that our brain is sending false messages. We must repeat, “It’s not me — it’s just my brain.” Schwartz compares OCD to Parkinson’s disease — both interestingly are caused by disturbances in a brain structure called the striatum — in that it doesn’t help to lambast ourselves for our tremors (in Parkinson’s) or upsetting thoughts and urges (in OCD). By reattributing the pain to the medical condition, to the faulty brain wiring, we empower ourselves to respond with self-compassion.

Step Three: Refocus

In step three, we shift into action, our saving grace. “The key to the Refocus step is to do another behavior,” explains Schwartz. “When you do, you are repairing the broken gearshift in your brain.” The more we “work around” the nagging thoughts by refocusing our attention on some useful, constructive, enjoyable activity, the more our brain starts shifting to other behaviors and away from the obsessions and compulsions.

Step three requires a lot of practice, but the more we do it, the easier it becomes. Says Schwartz: “A key principle in self-directed cognitive behavioral therapy for OCD is this: It’s not how you feel, it’s what you do that counts.”

The secret of this step, and the hard part, is going on to another behavior even though the OCD thought or feeling is still there. At first, it’s extremely wearisome because you are expending a significant amount of energy processing the obsession or compulsion while trying to concentrate on something else. However, I completely agree with Schwartz when he says, “When you do the right things, feelings tend to improve as a matter of course. But spend too much time being overly concerned about uncomfortable feelings, and you may never get around to doing what it takes to improve.”

This step is really at the core of self-directed cognitive behavioral therapy because, according to Schwartz, we are fixing the broken filtering system in the brain and getting the automatic transmission in the caudate nucleus to start working again.

Step Four: Revalue

The fourth step can be understood as an accentuation of the first two steps, Relabeling and Reattributing. You are just doing them with more insight and wisdom now. With consistent practice of the first three steps, you can better acknowledge that the obsessions and urges are distractions to be ignored. “With this insight, you will be able to Revalue and devalue the pathological urges and fend them off until they begin to fade,” writes Schwartz.

Two ways of “actively revaluing,” he mentions are anticipating and accepting. It’s helpful to anticipate that obsessive thoughts will occur hundreds of times a day and not to be surprised by them. By anticipating them, we recognize them more quickly and can Relabel and Reattribute when they arise. Accepting that OCD is a treatable medical condition — a chronic one that makes surprise visits — allows us to respond with self-compassion when we are hit with upsetting thoughts and urges.

The Dangers of Cyberchondria

We’ve all done it, or at least most of us have. I know I’m certainly guilty of it. I’m talking about turning to the internet for answers to our health concerns.

Just type in our (or our loved ones) symptoms and away we go. That rash we have? Turns out it could be anything from contact dermatitis to cancer. Which is it? Not sure? Well, search some more. There is always another website to check. And as many of us know, these searches can be never-ending.

Excessively scouring the internet for answers to our health concerns is known as cyberchondria. One in three people, among the millions who seek health information in this manner, report feeling more anxious after searching for answers than before. Yet they keep searching even as their worry escalates. Cyberchondria has the potential to disrupt many aspects of a person’s life and studies have even linked it to depression. Those with cyberchondria tend to either avoid going to their doctor, or go too much — both out of fear.

What drives people to engage in a behavior that often makes them feel worse than before?

Thomas Fergus, a psychology professor at Baylor University, links cyberchondria to a dysfunctional web of metacognitive beliefs, which are really just thoughts about thinking. We all have these types of belief systems. For example, it is considered normal to believe that deliberating over a challenging problem will lead to a satisfying solution. In cyberchondria, however, metacognitive beliefs morph into a mental trap — people search online health content incessantly.

Dr. Fergus and Marcantonio Spada, an academic psychologist at London South Bank University, have shown that these metacognitive beliefs in cyberchondria overlap somewhat with those of anxiety disorders. People with health anxiety, for example, hold maladjusted views about the role worry plays in maintaining their emotional and physical well-being. It is these same sorts of dysfunctional belief systems, Fergus says, “that send people with cyberchondria back for long sessions at the computer.”

In 2018, Fergus and Spada published research that, not surprisingly, links cyberchondria with features of obsessive-compulsive disorder (OCD). People with OCD perform compulsions to ease their anxiety, and those with cyberchondria engage in ritualistic searches for health information to dispel their anxiety. In both cases, people will only stop when they feel certain that all is well. As many of us know, online health content is too vast to allow us to be certain about anything. In fact, certainty is not actually attainable when it comes to most aspects of our lives.

So how can we escape the vicious cycle of cyberchondria? Appropriate therapies for anxiety disorders such as Cognitive Behavioral Therapy (CBT), mindfulness, and even antidepressants might be helpful. In addition, metacognitive approaches that encourage people to question the value of going online to relieve their anxiety can be beneficial.

There is another solution to spending countless hours on the internet trying to figure out your latest ailment. Go see your doctor for a proper diagnosis — once. Then you can use the other therapies mentioned to learn how to not only stop searching for answers, but to also learn to accept the feelings of uncertainty that are inevitably connected to our health.

Child and Adolescent Anxiety May Be Associated With Later Alcohol Use

Child and adolescent anxiety is positively associated with later alcohol use and disorders, according to research published in Addiction.

The systematic review of 51 prospective cohort studies from 11 countries included publications from PubMed, Scopus, Web of Science, and PsycINFO that were published in English, involved human participants, investigated anxiety exposure in childhood or adolescence and alcohol outcome, and included at least 6 months of follow- up. Study sample sizes ranged greatly, from 110 to 11,157 participants, exposure ages ranged from 3 to 24 years, and alcohol outcomes ranged from ages 11 to 42 years.

Across the 51 studies, 97 associations were categorized by anxiety exposure, including generalized anxiety disorder, internalizing disorders, miscellaneous anxiety, obsessive compulsive disorder, panic disorder, separation anxiety disorder, social anxiety disorder, and specific phobias. Alcohol use outcome was categorized by drinking frequency and quantity, binge drinking, and alcohol use disorders.

Evidence for an association between anxiety and later alcohol use disorders was found in the narrative synthesis. However, the association between anxiety and later drinking frequency and quantity as well as binge drinking were inconsistent. The discrepancies were not explained by type and developmental period of anxiety, follow-up duration, sample size, or cofounders.

While the data suggests an association between child and adolescent anxiety and later alcohol use disorders, researchers state that the evidence is “far from conclusive of a positive association between anxiety during childhood and adolescence and subsequent alcohol use disorder.” Further research will be necessary to investigate this potential association.

Reference

Dyer ML, Easey KE, Heron J, Hickman M, Munafò MR. Associations of child and adolescent anxiety with later alcohol use and disorders: a systematic review and meta‐analysis of prospective cohort studies [published online March 19, 2019]. Addiction. doi:10.1111/add.14575

Super Awesome Science Show: The science of spring fever


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We’ve all heard about spring fever, although medically speaking, it’s not really an illness. Instead, it refers to a change in our behaviour that happens to align with the changing of the seasons. On this week’s Super Awesome Science Show, we explore some of the science behind these changes and offer some perspective on how to deal with the consequences.


READ MORE:
Spring sniffles — Are you suffering from allergies or the common cold?

Our first guest may know a reason for the effects of spring fever: we are being exposed to more light. Kathryn Roecklein, an associate professor of psychology at the University of Pittsburgh, reveals the effects of sunlight on our brains and how the change in seasons may alter how we act. She also reveals that we may no longer see such a dramatic shift due to our continual exposure to artificial light.

The change of the seasons also means a rise in certain mental health concerns. Statistics have shown spring brings with it a rise in suicides and greater unhappiness in some people. We speak with Jon Abramowitz, a professor of psychology at the University of North Carolina and an expert on coping with anxiety and obsessive-compulsive disorder, who reveals the truth about living with these problems and how to cope.


WATCH:
Spring fever has hit the school

In our SASS Class, we explore one of the stereotypes of spring fever – the urge to find new mates. Our guest teacher is Maryanne Fisher. She is a professor of psychology at St. Mary’s University but she is better known as the relationship doctor. We discuss the process of trying to find a new mate and how this can be complicated by competition. She also reveals that looking back to the 18th century may help people figure out how to win at love today.

If you enjoy The Super Awesome Science Show, please take a minute to rate it on Apple Podcasts and be sure to tell a friend about the show.

Thanks to you, we’ve won a Canadian Podcast Award as Outstanding Science and Medicine Series. Thank you all very much for helping us keep this show AWESOME!

Contact:

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Guests:

Kathryn Roecklein
Web: http://psychology.pitt.edu/people/kathryn-roecklein-phd
Twitter: @roecklein

Jon Abramowitz
http://www.jabramowitz.com/
Twitter: @DrJonAbram

Maryanne Fisher
http://www.smu.ca/future-students/relationship-doctor.html
Twitter: @ml_fisher

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Overcoming scrupulosity with God’s mercy – and a therapist

Ignatius of Loyola, Alphonsus Liguori and Therese of Lisieux are only a few of the saints who suffered from scrupulosity on their path to sainthood. Their desire to follow God wholeheartedly became a double-edged sword, as they often experienced great guilt and restlessness for doubting whether many of their actions were sinful — when they were not. Such struggle often kept them from enjoying life.

If you struggle with scruples, don’t let them keep you from celebrating God’s blessings in your life. Here’s what you can do about them.

Psychologists have found in this malady — still very common in our day — a close connection with obsessive-compulsive disorder (OCD), and some suggest a joint priest-therapist approach when helping a person overcome this disorder.

“Obsessive Compulsive Disorder is an anxiety disorder… Typically, the form that it takes is that people have one or more areas of fear. They are worried about something bad happening, and they engage in behaviors that we call ‘compulsion’ in order to decrease the anxiety that results from these fears,” explained Elizabeth Higbie, a Licensed Clinical Social Worker at St. Raphael Counseling in Denver.

OCD can manifest in many ways, she explained. The classic examples include those of people with an obsessive fear of contamination who engage in the compulsion of handwashing, or of people who need to have everything in order as a compulsion to some other fear.

But it can also manifest in other areas, such as in the fear of harming others.

“Scrupulosity is a manifestation of OCD, and I think it is a unique manifestation because we have to consider the role of spirituality,” she added.

“[In scrupulosity] there’s an obsession that I’m not in a state of grace, that I’m not pleasing to God,” explained Father Scott Bailey, Pastor at Risen Christ and Chaplain at St. Raphael’s Counseling. “A scrupulous person really believes that they’re always guilty of serious sin. Even if their heart is in the right place, if they desire to know God above everything else, they have this anxiety that they’re making the wrong choice, that they’re not pleasing to God… While it’s a spiritual reality, there is also a large psychological element to it.”

Such guilt often comes from the difficulty of distinguishing temptation from sin.

People with scrupulosity tend to see God as a punishing God who is out to get them or waiting for them to mess up.”

Father Bailey explained: “A temptation comes to our mind, it’s appealing to us, but if we refuse to engage in that thought, then it just remains a temptation. [Yet] sometimes the scrupulous person thinks that because they have the thought to do this tempting thing, that they are in sin.”

People also experience scrupulosity in the form of real anxiety around things that are not large moral issues.

“You might find this in the person who commits himself to some particular spiritual practice, like praying the rosary every day. It’s a wonderful thing to do, but if they miss a day, then they suddenly are in concern that they are in serious sin… or that they didn’t pray the rosary with the attention it deserved,” he added. “It’s hard because maybe there are legitimate things in there, like realizing we could do a better job of praying, but it doesn’t mean that we are displeasing to God.”

Common compulsions of people who struggle with scrupulosity include going to confession very often because they think they’re in a state of mortal sin, and “priest hopping” because they don’t want the same priest to listen to their confession repeatedly.

Overcoming scrupulosity

Although Higbie assures OCD is a complex disorder — since people are often genetically predisposed to it and others can acquire it from a history of trauma — she guarantees there is hope: “I think people who get into these patterns can become very hopeless and it can feel very overwhelming and out of control. So, to remember that there is hope and that treatment really can help.”

Both Father Bailey and Higbie highlight the importance of recurring visits to both a spiritual director or confessor and a mental health professional to overcome this struggle.

For the psychological aspect of this reality, Higbie recommends finding a Catholic therapist, since scrupulosity cannot be treated as any other type of OCD.

“We have to manage [scrupulosity] a little bit differently than we manage other types of fears,” Higbie said. “Frontline treatment for [OCD] is something called ‘exposure and response prevention therapy’ (ERP). So, if someone is afraid of contamination, an exposure might be having them use a public restroom or not washing their hands… where they actually have to face their fears and not [fall into] other compulsive behaviors.

“If we’re going to treat scrupulosity, we have to take a bit of a different approach because, obviously, as Catholic therapists, we’re not going to recommend that someone engage in mortal sin and then sit with it… Instead, I typically take a modified approach where if somebody is questioning, for example, whether they have committed a mortal sin, the exposure might involve sitting with the uncertainty of whether or not they may have committed a sin, and not rushing to confession at the first impulse or fear.”

Another recommended measure is committing to one confessor or spiritual director, who can aid with the spiritual aspect of scrupulosity.

You’re not hopeless, you’re not beyond repair. The Lord is going to continue to walk with you and be with you.”

Other than helping the person make the commitment of not going to confession every two or three days, a priest can also help correct the distorted understanding of God that is common in people with this struggle.

“People with scrupulosity tend to see God as a punishing God who is out to get them or waiting for them to mess up. There’s this constant fear of condemnation… They do not think about the mercy and love that we know is available to us,” Higbie explained.

“A part of the spiritual healing is healing who I am before my God,” Father Bailey added. “Can I see myself as loved by God the father? Maybe that means that I see myself like the prodigal son in Luke 15… being embraced by the Father.”

Higbie assured there are many priests in the archdiocese who are “well-versed” in scrupulosity and encouraged those struggling with it to not be afraid to talk to one and find a Catholic therapist.

“OCD is very common, and I would venture to say that it’s fairly underdiagnosed,” Higbie concluded. “I think there’s a lot of people that don’t think of OCD or they think of it in just the traditional ways of handwashing, contamination or order; but they don’t think or know about the different ways it might manifest.

“If you find yourself having significant anxiety that requires you to do specific behaviors in order to reduce that anxiety, it might be good to seek out some professional support in assessing whether or not you would be suffering from OCD.”

“This could be the best encouragement: Remember that Jesus is actually with you and he’s actually helping you,” Father Bailey concluded. “You’re not hopeless, you’re not beyond repair. The Lord is going to continue to walk with you and be with you.”

For professional help with scrupulosity or OCD, visit straphaelcounseling.com.

10 Questions Is All It Now Takes to Recognize Obsessive-Compulsive Disorder

LOS ANGELES, April 12, 2019 /PRNewswire-PRWeb/ — Obsessive-Compulsive Disorder, more commonly referred to as OCD, is a debilitating neuropsychiatric disorder that affects approximately 3% of the population.

Characterized by unwanted, pervasive thoughts and accompanying ritual behavior, OCD brings about great anxiety and distress when not properly diagnosed and treated right away.

OCD doesn’t go away on its own and has no cure. But even as sufferers of OCD are plagued by uncontrollable repetitive impulses and behaviors that control their lives, there are many available management options today, including therapy and medication.

OCDTest.com, created by a team of professionals dedicated to helping people with OCD find effective treatment for their condition. In addition to a compilation of helpful and informative resources, the site has a free online diagnostic tool available to help the millions of sufferers identifying the condition early.

“Recognizing there are few options online for people around the world to get help for OCD, we wanted to provide a solution for people to understand if the condition is present in their lives,” says the team from OCDTest.com.

According to the International OCD Foundation, the average time someone with OCD to get treatment is seven to ten years. “Our goal is to shorten that time by helping people understand that they have the condition and provide education so they will get treatment sooner.”

The free online diagnostic tool on OCDTest.com was designed to “support as many people as possible, from as many countries as possible,” with the express goal of identifying Obsessive-Compulsive Disorder at the earliest opportunity, while providing a better understanding of this condition, and helping individuals find effective OCD treatment.

Unlike most other websites offering free OCD test, OCDTest.com utilizes the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the gold standard test utilized by OCD specialists.

Individuals with obsessive-compulsive disorder are thus able to utilize the same test an OCD therapist would without going to an OCD treatment center.

The team from OCDTest.com stresses, however, that in order to get a true OCD diagnosis, it is recommended seeing a properly accredited medical doctor, psychiatrist or OCD specialist.

“For those of you that just found out you have OCD, never forget that this condition is treatable. You don’t have to live in anxiety, fear, doubt, or shame.”

In addition to the free online diagnostic tool, OCDTest.com has useful guides, a blog with helpful articles, a directory of treatment centers and OCD advocates, and other quality resources.

“We recognize that there are still some nations and countries that don’t have local resources. We have done and continue to do all that we can to help support these individuals in finding the help that they need.”

Understanding OCD
In a 2018 study by the World Health Organization, obsessive-compulsive disorder has become the fourth most common psychiatric condition and the 10th leading cause of disability around the world.

Due to a lack of awareness and access to proper treatment and support, however, it still takes the average person 7 to 10 years between onset of symptoms and being able to access effective treatment.

People afflicted with OCD are caught in a cycle of obsessions and compulsions. Obsessions are intrusive, unwanted, and pervasive thoughts, triggering fear, doubt, and anxiety in sufferers. The compulsions are a need to find relief from the discomfort and distress brought about by the obsessions.

Relief, however, is only temporary, as sufferers go through the obsessions once more, and so the compulsions, unfortunately, serve to reinforce and strengthen the original obsessions. Those afflicted with OCD soon find that they can’t ignore, think, or will their way out of these repetitive thoughts and behaviors that control their lives.

With obsessions and compulsions feeding off and reinforcing each other, OCD thus becomes a vicious cycle.

This is why most treatment goals for OCD are focused towards breaking this cycle– retraining the brain to help control the symptoms and increase mindfulness with the least amount of medication possible.

Getting treatment as early as possible is the best course of action for anyone suffering from OCD. A holistic approach is also greatly encouraged, setting up patients for success by eating healthy food, exercising, and getting enough sleep, and giving as much emotional support as possible through family, friends, and people who understand OCD.

About us:
OCDTest.com provides unbiased and informative resources to help educate about OCD. Our free tool can guide you through the process of identifying OCD treatment. For further information, please visit: https://ocdtest.com

 

SOURCE OCDTest.com

Compulsive tidying can lead to throwing away everything you own

You’ve KonMari-ed your drawers, cleared your cupboards of clothes you haven’t worn in the last month, and made your living room match the minimalist one you found on Pinterest.

There’s nothing more to do, but you don’t feel satisfied. You want to keep clearing, decluttering, paring back until you have nothing left.

You look around and objects feel like they’re looming large, suffocating you simply by existing.

This is compulsive decluttering – ‘the opposite of hoarding’ – also known as obsessive-compulsive Spartanism; being unable to handle mess.

You want to live a life that’s as minimalist as humanly possible and experience intense stress when confronted with unnecessary physical items.

The behaviour isn’t officially recognised as a medical disorder, or even as a symptom of OCD, but online many of those dealing with anxiety disorders share their experiences of feeling trapped by the presence of objects.

In a time when decluttering is a trend and the whole world is tidying up, admitting that you’ve cleared out every possession from your home is more likely to attract applause than cause for concern.

But how can you know when your decluttering has crossed the line from normal tidying to something compulsive?

Amelia, 26, was diagnosed with obsessive compulsive disorder last year, and feels compulsive decluttering offers an explanation for her previous behaviour.

‘I walk into my parents’ house and see piles of books, tens of coats loaded on to hooks, and cupboards filled with more mugs than two people could ever use,’ she tells Metro.co.uk. ‘It automatically makes me feel overwhelmed and like I’m about to have a panic attack.

‘My inability to live with that much clutter was a big part of why I moved out, and why I was so irritable with my parents.

‘I think people would be surprised that I feel so uncomfortable with clutter, because I’m naturally quite a messy person. I prefer doing big tidies rather than day-to-day stuff, so you’ll spot piles of clothes on my floor most days, then a spotless place once a week.

‘My compulsion is more apparent when it comes to those big tidies. I suddenly want to throw absolutely everything away, even if it has a purpose or it should have some sentimental meaning. I don’t feel connected to my stuff and its presence feels claustrophobic. I’ve thrown away photo albums, diaries, and gifts from friends and family because I just have a sudden need to get it out of my space.’


Emotional relationship with clutter/why some people find it so hard to throw things away
(Picture: Ella Byworth for Metro.co.uk)

Amelia says that when she started to read books on minimalism a few years ago, she noticed herself being too cutthroat with what she discarded.

‘I’d ask myself if I really needed a laptop, pots and pans, and all these bits of art I’d picked up when travelling,’ she tells us.

‘I brought it up in therapy and realised a big part of what was going on with my self-esteem. I felt like I didn’t deserve to have anything, that if I depended on things I was making myself vulnerable.’

Natalie, 30, has a similar relationship with stuff, finding comfort in clearing out her possessions. She’s been diagnosed with an anxiety disorder.

She tells us: ‘At uni my friends would say to me – ‘where is all your stuff?’ – but I was like – what else do I need?

‘All the stuff I have has a purpose, I use it. If I find something I haven’t worn or used or looked at in more than a few months I will happily throw it away.

‘I have moved house a lot in the last ten years – every time I move I see it as an opportunity to get rid of more things.

‘I think this comes from the traumatic times when I have attempted to move house using bin bags and public transport. Horrific.’

For Natalie, decluttering doesn’t feel like a problem. Clutter does.

When she’s in an area surrounded by mess, she feels restless and stressed out.

‘I can’t relax until the area I’m in is tidy,’ she says, ‘which means sometimes I come home from work and will just immediately start tidying – without taking off my coat or shoes, because I know I can’t sit down and read or put the TV on if I can see messy stuff in my peripheral vision.’

When she declutters, she feels a sense of calm.

‘Decluttering sprees are one of the most relaxing activities I can do,’ Natalie explains. ‘It makes me feel so productive and when I lug those giant bin bags of useless shit out of my house I feel instantly lighter.

‘I can go into my bedroom with a plan to declutter one drawer and emerge four hours later having thrown away 80% of my possessions.’

Aimee, who also has anxiety, says that decluttering helps her feel as though she’s in control: ‘Before a recent flight (I’m a nervous flier), I cleaned my flat from top to bottom.’

That’s not the case for Amelia, who describes her decluttering missions as an ‘out of control spree’.

‘It’s not enjoyable at all,’ she says. ‘It’s a compulsion and once I’m in it I can’t stop, even when I know I’ve gone too far. I’ve tidied for hours then sat down and still felt tense and restless, which then turns into other compulsions like checking switches or compulsive skin picking.’

Psychologist Lorna Mograby, of Counselling Directory, explains that compulsive decluttering can come from the pressure of perfectionism and feelings of guilt.

‘Clutter can cause extreme anxiety to the point that they need to get rid of it right away,’ she tells Metro.co.uk. ‘The perfectionist mentality would mean that the person has such high expectations as to the standard of tidiness of their environment that that they take decluttering to an extreme level – often getting rid of useful items they may require later or even throwing away gifts.

‘As we live in a society that advocates minimalism and criticises consumerism, an individual might feel guilt at the amount of possessions they have.


How being unable to decorate the places we live is affecting us Metro illustrations (Picture: Ella Byworth/ Metro.co.uk)
(Picture: Ella Byworth/ Metro.co.uk)

‘Also getting rid of items might give them a feeling of being in control of their lives. Maybe they feel they have not been able to exercise much control in their lives previously.

‘Belief that certain items have been contaminated and need to be thrown away might also trigger this condition and provide the sufferer with some relief – albeit temporary!’

That’s the trouble with any compulsive disorder – while the behaviour might make you feel safe and soothed for a moment, that feeling quickly disappears. Then you have to either continue with the compulsion or find another one to chase some relief.

Then there are the practical effects of compulsive decluttering. There’s the obvious issue of throwing away things that you may later need, such as important documents of items that can’t be replaced.

Aimee tells us that a previous ‘purge’ of her wardrobe left her ‘scarred’: ‘I got rid of loads of clothes a few years back. I still think about some of those items.’

Natalie has had the same issue, telling us she regrets chucking ‘boxes, instructions, receipts’.

‘My instinct is to throw any things like this away instantly – only to find that I need to return an item and I don’t have any of the paperwork,’ she explains. ‘Also clothes. I love creating space in my wardrobe but I am definitely too brutal. I will go to find that sparkly vest I haven’t worn in a while and then realise I chucked it – but now I have a new skirt that goes perfectly with it.’

The behaviour can also cause issues with friends and family who don’t have the same drive to clear their personal space.

Amelia still struggles to visit her parents’ house, while Aimee has found herself offering to tidy her desk neighbour’s stuff before because it was ‘getting’ to her.

If a compulsive declutterer is in a relationship with someone with similar views on minimalism, living together can be plain sailing, but problems arise when the urge to clear leads to the discarding of things someone else deems meaningful. Differing levels of tidiness can be tricky in any relationship, but when someone clutter puts you unbearably on edge, what can you do? And from the other person’s perspective, is it fair to let them lead on the tidying, despite knowing it may be an unhealthy compulsive behaviour?

The key, as with any mental health issue, is to find the line between standard behaviour and patterns of action and thought that are damaging physically and mentally.

Lorna explains that the border between ‘just being tidy’ and compulsive decluttering can be tricky to see, but it comes down to how the person is feeling.

One person’s treasure is another person’s trash, so it’s not as simple as declaring that an object is something that shouldn’t be chucked away, and defining someone’s behaviour based on what exactly they’re discarding.

Lorna says a sign tidying has gone to far is ‘when the need to be tidy reaches an extreme level and an individual is even throwing away useful items, possessions they like or gifts, because they believe that their environment if becoming cluttered.’

‘Warning signs include when the individual experiences excessive anxiety and the quality of their life is affected, when they are consumed by feelings of guilt at the amount of their possessions, or they believe that something negative is attached to that item,’ says Lorna.

‘If a person becomes totally consumed by thoughts of clutter and they think about little else, or, if the person already has a mental health condition, such as depression, anxiety or experience other forms of OCD, [these are causes for concern].’

Psychologist Catherine Huckle echoes this, adding that a sign that decluttering could be a symptom of OCD lies in a person’s thought patterns, and what they’re trying to achieve by clearing out their personal space.

‘When someone feels that they have to declutter and remove items from their home it is a compulsive behaviour, and often follows an obsessive thought pattern,’ says Catherine. ‘The thoughts could vary enormously but could range from a sense that if they have too much stuff they’ll be burgled, there’ll be a fire and they won’t be able to escape, through to the idea that if they have too much stuff others will view them as slovenly, messy or dirty.

‘Decluttering in this context might mean limiting items that come into the home, clearing things immediately after they have been used (for example putting packets straight to the bin outside), throwing out half used items like shampoo or soap bottles, having rigid rules about where and how items are stored and tidying [or] removing items that others leave lying around or that they bring into the home.’

Having a resistance to clutter is common. As Catherine explains, a lot of us feel a need to declutter because of the ‘extra cognitive burden’ excess possessions can have. When you have an anxiety disorder, this can cause overload.

Obsessive compulsive spartanism happens when the threshold for mess and clutter drops below the norm and troubling thought patterns linked to possessions emerge.

‘It becomes more than “just being tidy” when there is a high level of distress associated with mess, when it preoccupies thoughts and when it impacts on your ability to function,’ says Catherine. ‘In practise this might mean becoming very anxious if someone makes a mess in your home orbeing unable to stop thinking about the bottle that’s been put back in the “wrong” place.’

Continuing to declutter isn’t the solution to that sense of unease – it’s a temporary answer that fades quickly and can leave you sitting in an empty room without a mattress to sleep on.

So what are you supposed to do when your need to tidy goes too far?

It’s not as easy as watching a Netflix special or learning a new folding technique, unfortunately. As with any mental issue, professional help can be a lifeline.

CBT has good evidence of being helpful for obsessive compulsive behaviours, while exposure and response prevention therapy could help with feelings of fear when confronted with clutter.

Catherine recommends that while pursuing therapy, a declutterer can take small steps to challenge their urge.

‘This might be practising leaving things in a different place, and noticing how anxiety rises, reaches a peak, and eventually falls,’ she explains. ‘This is called habituation and over time it means that we experience less and less anxiety in response to the same changes. Having a success with a small change can help to motivate and give confidence to try bigger changes.’

Get a throw cushion that fulfills no purpose, but you love regardless. Keep hold of something that brings fond memories when you look at it. You don’t have to submerge yourself in clutter or turn your back on tidying entirely, but it’s vital to learn that you are allowed to have things you care for.

MORE: Why you have so many tabs open

MORE: Why clutter has the power to break up your relationship

MORE: Why do lads do such unquestionably stupid things?

One of the Most Effective Treatments for Obsessive-Compulsive Disorder: Part 2/2

This is the final post in the series on obsessive-compulsive disorder (OCD)—a psychological disorder associated with obsessions (recurring thoughts, urges, etc) and compulsions (repetitive behaviors in response to obsessions).1 Today I conclude my discussion of exposure and response prevention (ERP), which is one of the most effective treatments for OCD.2

Introduction

Last time I used the example of someone named Charlie who had germ-related obsessions; for instance, Charlie found taking out the garbage highly anxiety-provoking. After creating a fear hierarchy (see picture), Charlie began his gradual exposure to anxiety-causing situations on his list.

Exposure and response prevention (ERP) requires one to stay in the obsession-related stressful situation until anxious feelings dissipate. During and after exposure, the individual must refrain from engaging in compulsions and other forms of avoidance (e.g., distractions).

But what if, unlike for Charlie’s obsessions, there are no exposure exercises for your obsession? For instance, if you obsess about running over an animal when driving, or going to Hell for being a bad person, how can you practice real-life exposure?

One solution is imaginal exposure.

Imaginal exposure

To illustrate, consider Jessica obsessions. Often when Jessica feels very angry and enraged, she obsesses about the possibility of one day becoming a murderer. The thought makes her highly anxious. Various treatments have not helped, so her therapist has suggested imaginal exposure. Because the thought of murder is so upsetting, Jessica creates a hierarchy for her imaginal exposure, and begins with exposing herself each day to anxiety-provoking thoughts lower on the hierarchy first.

For instance, Jessica spends 45 minutes each day imagining that, in a fit of rage, she punches a stranger in the face at a bus stop.

Before she begins practicing imaginal exposure, Jessica writes a script in which she includes her feelings, thoughts, and behaviors at the scene. Jessica’s script is very detailed. For instance, she tries to visualize the scene as she punches the person at the bus stop, the victim’s look of horror and pain, the pouring of blood from the victim’s nose and mouth, the faces of bystanders who are terrified and shocked, the sound of sirens approaching, two police officers approaching her with their guns drawn, being pushed into the police car while crying, and so on.

Jessica uses this script to create an audiotape, and listens to the tape each day until her anxiety about the situation dissipates. In the coming weeks she will move to more anxiety-provoking situations, and eventually to visualizing murder.  No matter the step, Jessica needs to focus on those aspects of the situation that makes her most anxious, and stay with those feelings for as long as necessary.

The logic of ERP

It is important to remember that ERP makes no promises; bad things (be they murder, suicide, catching a rare disease, etc) may occur. But the likelihood of such events is very low.  So with the help of ERP we can learn to live our lives not in constant fear of rare events. The goal is experiential learning; that is why we need not an intellectual lesson but repeated exposure to our thoughts, feelings, bodily sensations, etc.

Refraining from performing the rituals and compulsions during exposure is necessary because if you perform your usual rituals you will not learn that the thing that triggered your fear (e.g., imagining yourself as a notorious killer) is not really dangerous. Nor will you learn that you have the ability to manage your feelings of anxiety, and that your anxiety will go down on its own even without you performing the compulsions.  

If you are receiving therapy, you probably know that your therapist is not going to force you to do the exposure portion—or physically prevent you from doing the compulsions. Your success depends on your willingness to face your fears. You need to really believe this form of therapy is the way toward lasting change. You need to make a commitment.

Concluding thoughts

OCD can gradually tighten the circle around you until your life is extremely limited. This happens gradually enough that you may not see all that you have lost. Therefore, one way to motivate yourself to face your fears or to try ERP, is by comparing the consequences of being disabled by OCD versus having it under control. To do so, try brainstorming about negative consequences of OCD—its effects on work, intimate relationships, choice of activities, etc. Then think about positive consequences of not being limited by OCD:

Where would you go? What activities would you try? How would you spend your day?

And when live a fuller life, what feelings might you experience? Will you feel happier and more confident? Well, try and find out! But there is a high likelihood that when you are able to think about your fears logically, you will have more experiences and many of them will be positive.

**Please note that this information is meant only for educational purposes, and is not intended to be a substitute for professional medical advice or treatment.

References

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

2. Strauss, C., Rosten, C., Hayward, M., Lea, L., Forrester, E., Jones, A. M. (2015). Mindfulness-based exposure and response prevention for obsessive compulsive disorder: study protocol for a pilot randomised controlled trial. Trials, 16, 167.

Obsessive compulsive disorder: when you can’t stop doing what you’re doing – WLS

HOUSTON — Obsessive compulsive disorder, also know as OCD, only affects about two percent of the population, but symptoms are usually severe. Clinical trials are targeting new receptors in the brain and that might mean positive news on the medical horizon. Obsessive compulsive disorder is a chronic, mental disorder, where thoughts you don’t want become behaviors that you can’t stop.

OCD severely impacts quality of life. Just ask the expert, who is also a patient.

“I’ve lived with OCD since childhood, I was diagnosed when I was 12 and have been in treatment ever since,” said Elizabeth McIngvale, PhD, an Assistant Professor at Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences.

She used to ask her mom if it was okay that she touched something in school, “Then it transferred into a lot of contamination rituals, spending a lot of time in the shower. Fearing I hadn’t done something enough, I wasn’t clean enough. I was going to contaminate other people.”

OCD is rooted in fear which feeds the anxiety and brings about the unwanted behavior.

Psychologists used cognitive behavioral therapy in some cases, as well as traditional anti-depressants aimed at serotonin and dopamine brain messengers. But researchers are now seeking something new, glutamate in the brain, a neurotransmitter that sends signals to other cells.

Eric Storch, PhD, McIngvale Endowed Chair and Professor in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College Of Medicine said, “Some recent information suggests that there might be a third messenger that naturally occurs called glutamate. Thereby have improved response to anti-depressants.”

And, for McIngvale who might only get several minutes a day without intrusive thoughts, it’s clearly critical to find a better way.

“I can understand someone’s pain and I can truly believe with all my belief system, that they can get better,” said McIngvale

The study of this new drug is being conducted at 59 centers across the country. And, McIngvale has also started the Peace of Mind foundation, dedicated to providing help with OCD.

Can CBD Reduce Anxiety?

The World Health Organization (WHO) ranks anxiety as the sixth largest contributor to global disability today. Anxiety is prevalent throughout the world, where an estimated 1 in 27 people suffer from an anxiety disorder.

We all experience anxiety sometimes. But for those with an anxiety disorder, anxiety can persist and get worse over time. Anxiety disorders include conditions like post-traumatic stress disorder, panic attacks and social anxiety. The reasons behind anxiety disorders are diverse, but they can all be equally detrimental to your life.

Cannabidiol (CBD), a constituent of the Cannabis sativa plant, is emerging as a potential treatment for anxiety disorders. Evidence is growing that CBD is able to reduce anxiety in many different situations. CBD also lacks the psychoactive effects of regular cannabis and won’t make you high, which makes it appropriate for most people to use.

On a cellular level, CBD interacts with various receptors known to regulate fear and anxiety-related behaviors. This helps to calm the fear and anxiety signals your body sends to your brain. Research has shown CBD can specifically help with the following anxiety-related disorders.

Portrait of a young man looking anxious.

1. Post-Traumatic Stress Disorder (PTSD)

You can experience PTSD symptoms for a few months or many years after a traumatic event. Symptoms can be debilitating, and may include serious behavior changes, avoidance of social situations or reminders of the trauma, or negative mood swings. CBD has been shown to reduce many of these symptoms of PTSD, as well as help people let go of persistent fear memories.

2. Social Anxiety

A study published in the Journal of Psychopharmacology scanned the brains of volunteers with social anxiety disorder before and after a single, 400 mg dose of CBD. Certain areas in your brain are known to become more active when you feel anxious, whereas other areas reduce their activity.

In the volunteers who received the CBD, their brain scans showed significantly more balanced brain activity, which is typical of regular, healthy brain function. The volunteers also reported feeling less anxious in general.

Related: I Tried CBD Oil for My Anxiety. Heres What Happened.

3. Travelling

Anxiety surrounding travel is another area that can impede your life. It can prevent you from taking trips you dream of, pursuing education, or even traveling to visit family and friends. And those with anxiety may use alcohol or prescription medication to help them get through a trip. But CBD can offer another alternative.

In a survey by Remedy Review, travelers who took CBD prior to flying reported that they were more than 50 percent less likely to use alcohol or prescription medications to help relieve their anxiety and stress prior to and during the flight. And, overall, 97 percent of respondents said CBD made their travel experience better.

4. Public Speaking

Speaking publicly is a common anxiety-provoking situation, which is why various studies have looked at the effect of CBD in those asked to speak in front of a group. Most studies have found that taking CBD prior to a public speech significantly reduces the speaker’s anxiety, cognitive impairment and discomfort during the speech. CBD also helps reduce anxiety and worry prior to the speech.

Interestingly, research also found that the dose amount of CBD is important. In one study, volunteers who were asked to speak publicly were given doses of either 100 mg, 300 mg, or 900 mg of CBD prior to speaking. Those who had taken the 300 mg dose reported feeling less anxiety during the speech, but those who had taken the lower and higher doses had no apparent benefit.

5. Obsessive-Compulsive Disorder (OCD)

The effects of CBD on obsessive-compulsive disorder are not well-researched in people, but a study with rats and mice showed that the animals had reduced obsessive-compulsive behavior after receiving a single dose of CBD. Due to the general anti-anxiety effects of CBD, it’s predicted to help with OCD in humans as well.

6. Panic Attacks

A 2017 review of studies on CBD’s anti-panic effects concluded that CBD is promising for the treatment of panic disorder (PD). Current pharmaceutical drugs for treating PD come with various side effects that can cause people to stop using them, which often results in a relapse in PD symptoms. Evidence suggests that CBD does not induce dependence or abuse in those who take it on an ongoing basis. It also appears that CBD maintains its effectiveness over time, unlike many current psychiatric drugs where people can develop a tolerance to them.

If you’ve ever struggled with an anxiety disorder, speak to your doctor or other health professional knowledgeable about CBD about the possibility of supplementation. Discuss if CBD would be appropriate for your individual situation, as well as what dose may be appropriate. Research has shown that more is not better, so make sure you’re taking the right amount. And if you decide to try CBD, always buy it from a certified supplier to ensure the highest quality.

Related on Care2

 

Treating kids’ phobias in three hours, and OCD in four days

New studies seem to support that very short, intense cognitive behavioral therapy (CBT) may be as helpful as traditional CBT treatment schedules in helping kids with anxiety disorders like OCD. And when I say short, I’m talking about three hours of treatment for phobias and four days of therapy for obsessive-compulsive disorder. According to a meta-analysis by Thomas Ollendick, director of Virgina Tech’s Child Study Center, and Stockholm University professor emeritus Lars-Göran Öst, as described in Scientific American, “with the quicker therapies, 54 percent of patients were better immediately post-treatment, and that rose to 64 percent on follow-up—presumably because they continued to practice and apply what they had learned. With standard therapy, 57 percent were better after the final session and 63 percent on follow-up.” I’m sure mileage varies tremendously between individuals but cognitive behavioral therapy absolutely works and if there’s a more efficient way for kids (and adults) to learn the techniques and then actually use them to get relief, that’s fantastic news. From Scientific American:

The details vary, but the quick treatments have some common features. They generally begin with “psychoeducation,” in which patients learn about their condition and the catastrophic thoughts that keep it locked in place. In Bergen, this is done in a small group. With children, the lessons may be more hands-on and concrete. For instance, Ollendick might help a snake-phobic kid grasp why the creature moves in a creepy, slithering way by having the child lie on the floor and try to go forward without using any limbs.

A second part usually involves “exposure and response prevention,” in which patients confront in incremental steps whatever triggers their anxiety: perhaps shopping, for agoraphobics, or having dirty hands, for people with OCD. With support from the therapist, they learn to tolerate it and see it as less threatening. Patients leave with homework to reinforce the lessons. Parents may be taught how to support a child’s progress.

Brief, intensive and concentrated cognitive behavioral treatments for anxiety disorders in children: A systematic review and meta-analysis.(Behaviour Research and Therapy)

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David Pescovitz

David Pescovitz is Boing Boing’s co-editor. On Instagram, he’s @pesco.

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