HEART program helps with postpartum life

ST. ALBANS- Amy Johnson, Parent Child Center Director at Northwestern Counseling Support Services (NCSS) describes herself as super jazzed when she was pregnant. But when she finally gave birth to a beautiful baby girl named Luna- everything changed.

For the previous nine months she knew how to protect her baby. Johnson had played by the books and done all her research. She had taken childbirth education and infant care classes, she knew how to change diapers, and how she was supposed to burp her newborn. She was prepared for rashes, and sicknesses, and felt ready to bring this tiny human into the world. But when Luna arrived, she realized there was a whole other side of parenthood that she hadn’t prepared for – the mental and emotional shift.

“When I was pregnant I had been showering with my belly to the side, so the hot water wasn’t hitting my belly when Luna was in the womb. I remember doing that after she was born, and starting to cry. When my mother asked me what was wrong I remember saying, ‘I knew how to protect her and keep her safe when she was in the womb, but I don’t know how to do it now,’” Johnson said.

For several months after Luna was born, Johnson struggled with this feeling. She would show up to doctor appointments, painting a look of a healthy baby and mother.

“I would take the postnatal depression screenings at the pediatrician’s office and I just would be like yep, yep, yep, everything’s fine, but inside I had this crippling anxiety that something bad would happen to her,” Johnson said.

Johnson was experiencing a form of postpartum depression, but she didn’t want to talk about it. She was afraid people would think she might hurt herself or her baby. What she didn’t know was that postpartum depression consists of a spectrum, of many different mood disorders, with the majority of cases being nowhere near as severe as postpartum psychosis. In fact, according to Postpartum Support International, psychosis only occurs in approximately one to two of every 1,000 births.

Thirty to 80 percent of all new mothers may experience what’s known as “baby blues”, which includes anxiety, crying, insomnia, tiredness, moodiness and sadness. When these symptoms last longer than three to ten days, the “baby blues” are then classified as postpartum depression, effecting approximately 21 percent of new mothers. Other forms of postpartum depression can take form in panic disorders, obsessive-compulsive disorders, or anxiety disorders.

These types of disorders, Johnson says, are rarely openly talked about when a woman is pregnant or considering pregnancy. She mentions the most she heard when pregnant was the “baby blues” term, which she says comes across as minimizing and benign.

“It’s imperative that families are educated on postpartum depression and other disorders, and their frequency, to aid in de-stigmatizing them and also help families recognize when to seek support.,” Johnson said. “As it is now, people often suffer in silence.”

 

Read more about the HEART program in Friday’s Messenger or subscribe to our digital edition.

What Is Pure O? My Experience With OCD Marked by Intrusive …

Trigger warning: This piece contains mentions of suicidal ideations and descriptions of the intrusive thoughts that can sometimes accompany obsessive-compulsive disorder.

I had my first experience with obsessive-compulsive disorder in the summer of 2017, though I didn’t receive a diagnosis for months. I was on vacation in North Carolina, away from all of my real-life anxieties, but suddenly, it didn’t feel that way. While taking a hot shower after a dip in the ocean, I felt my mind change radically in what seemed like a split second. I didn’t know what was happening or why, but I knew something was incredibly wrong.

Instead of being able to talk myself down from what I thought was a panic attack, my mind spiraled out of control: I’m going to hurt myself. I’m going to hurt somebody else. I’m a monster. I’m a monster. Oh my god.

When I stepped out of the shower, the world spun around me as I grabbed onto the bathroom counter and tried to regain my balance. These new intrusive thoughts were suddenly in the driver’s seat, and the rational Lauren that I had always known didn’t have a voice anymore.

Throughout the next few months, my mental health decreased rapidly. I couldn’t walk anywhere without these new thoughts nagging me to step in front of a car. It was startling. While I knew in my heart that I didn’t want to take my own life or hurt anyone else, my thoughts made me fear that I would someday. During the time before my diagnosis, I couldn’t even spend time with friends or family for fear of letting them in on this new secret I was trying to keep from everyone.

After months of depression due to these intense, harmful thoughts, I decided to give my psychiatrist a much-needed call and schedule a visit. During that appointment, I shook like a leaf as I told her about all the thoughts I had been feeling, completely petrified of what her response might be.

Instead, she nodded her head with understanding. Finally, someone understood what was going on with me. She gave me the answers I had been looking for — I had obsessive-compulsive disorder, and it was an actual mental disorder. Not only was I relieved, but I was also elated.

First of all, what is obsessive-compulsive disorder?

Obsessive-compulsive disorder (commonly known as OCD) affects people of all ages and different walks of life around the world. According to the International OCD Foundation, an estimated 2 to 3 million individuals struggle with OCD in the United States today.

The National Institute of Mental Health says, “Obsessive-compulsive disorder (OCD) is 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.”

What many people don’t know about this mental disorder is that there are several different common “obsessions and compulsions” people with OCD tend to have. These can include washing and cleaning, checking, repeating, harm, and losing control.

Many people only think of OCD as the desperate need to clean everything and keep things organized. In the media especially, OCD is likely portrayed as this one variant, which causes confusion for individuals who haven’t yet been diagnosed. And as I have learned from my own experience, not everyone’s journey with OCD will be the same.

What is purely obsessive, or “Pure O,” obsessive-compulsive disorder?

The OCD I personally struggle with is sometimes labeled by people as “Pure O.” To be clear, Pure O is not a real medical diagnosis, but a term used by many people with OCD who experience intrusive, violent thoughts, but less of the physical compulsions most people associate with the disorder.

‘Brain training’ app developed by Cambridge University could help people who suffer from obsessive compulsive disorder

A ‘brain training’ app developed by Cambridge University scientists could help people who suffer from obsessive compulsive disorder manage the debilitating condition.

Symptoms of the anxiety disorder include things such as excessive hand-washing and fears about contamination.

But just one week of training can lead to significant improvements, according to the Cambridge research team.

Scroll down for video 

A 'brain training' app developed by Cambridge University scientists could help people who suffer from obsessive compulsive disorder manage the debilitating condition. Symptoms of the anxiety disorder may include excessive handwashing and contamination fears (stock)

A ‘brain training’ app developed by Cambridge University scientists could help people who suffer from obsessive compulsive disorder manage the debilitating condition. Symptoms of the anxiety disorder may include excessive handwashing and contamination fears (stock)

What is obsessive compulsive disorder?

Obsessive compulsive disorder, usually known as OCD, is a common mental health condition which makes people obsess over thoughts and develop behaviour they struggle to control.

It can affect anyone at any age but normally develops during young adulthood.

It can cause people to have repetitive unwanted or unpleasant thoughts.

People may also develop compulsive behaviour – a physical action or something mental – which they do over and over to try to relieve the obsessive thoughts.

The condition can be controlled and treatment usually involves psychological therapy or medication.  

It is not known why OCD occurs but risk factors include a family history of the condition, certain differences in brain chemicals, or big life events like childbirth or bereavement. 

People who are naturally tidy, methodical or anxious are also more likely to develop it.

Source: NHS 

One of the most common types of OCD, affecting up to 46 per cent of sufferers, is characterised by severe contamination fears and excessive washing behaviour.

Excessive washing can be harmful, the researchers said, as sometimes OCD patients use spirits, surface cleansers or even bleach to clean their hands.

The they said this behaviour can have a serious impact on people’s lives, their mental health, their relationships and their ability to hold down jobs.

The repetitive and compulsive behaviour is also associated with ‘cognitive rigidity’ – in other words, an inability to adapt to new situations or new rules.

Breaking out of compulsive habits, such as handwashing, requires cognitive flexibility so that the OCD patient can switch to new activities instead.

OCD is treated using a combination of medication such as Prozac and a form of cognitive behavioural therapy – or ‘talking therapy’ – termed ‘exposure and response prevention’.

That therapy often involves instructing OCD patients to touch contaminated surfaces, such as a toilet, but to refrain from then washing their hands.

But they are not particularly effective as up to 40 per cent of patients fail to show a good response to either treatment.

The researchers said that may be in part because often people with OCD have suffered for years prior to receiving a diagnosis and treatment.

Another difficulty is that patients may fail to attend exposure and response prevention therapy as they find it too stressful to undertake.

The Cambridge researchers developed a new treatment to help people with contamination fears and excessive washing.

The intervention, which can be delivered through a smartphone app, involves patients watching videos of themselves washing their hands or touching fake contaminated surfaces.

A total of 93 healthy people who had indicated strong contamination fears participated in the study.

The researchers used healthy volunteers rather than OCD patients in their study to ensure that the intervention did not potentially worsen symptoms.

The participants were divided into three groups; the first group watched videos on their smartphones of themselves washing their hands; the second group watched similar videos but of themselves touching fake contaminated surfaces; and the third watched themselves making neutral hand movements on their smartphones.

OCD is treated using a combination of medication such as Prozac and a form of cognitive behavioural therapy - or 'talking therapy' - termed 'exposure and response prevention' (stock)

OCD is treated using a combination of medication such as Prozac and a form of cognitive behavioural therapy – or ‘talking therapy’ – termed ‘exposure and response prevention’ (stock)

After just one week of viewing their brief 30 second videos four times a day, participants from both of the first two groups improved in terms of reductions in OCD symptoms and showed greater cognitive flexibility compared with the neutral control group.

On average, participants in the first two groups saw their Yale-Brown Obsessive Compulsive Scale (YBOCS) scores improve by around 21 per cent. 

YBOCS scores are the most widely used clinical assessments for assessing the severity of OCD.

The researchers aid that, importantly, completion rates for the study were excellent – all participants completed the one week intervention, with participants viewing their video an average of 25 out of 28 times.

Study co-author Baland Jalal, a Cambridge neuroscientists, said: ‘Participants told us that the smartphone washing app allowed them to easily engage in their daily activities.

‘For example, one participant said ‘if I am commuting on the bus and touch something contaminated and can’t wash my hands for the next two hours, the app would be a sufficient substitute’.’

Co-author Professor Barbara Sahakian, of Cambridge’s Department of Psychiatry, said: ‘This technology will allow people to gain help at any time within the environment where they live or work, rather than having to wait for appointments.

‘The use of smartphone videos allows the treatment to be personalised to the individual.’

She added: ‘These results while very exciting and encouraging, require further research, examining the use of these smartphone interventions in people with a diagnosis of OCD.’

The smartphone app is not currently available for public use because the Cambridge team said further research is required before they can show conclusively that it is effective at helping patients with OCD.

The findings were published in the journal Scientific Reports

Depression & Anxiety Disorders: 2018 Drug Development Pipeline Review – ResearchAndMarkets.com

DUBLIN–(BUSINESS WIRE)–The “Depression
and Anxiety Disorders Drug Development Pipeline Review, 2018”

report has been added to ResearchAndMarkets.com’s offering.

This report provides an overview of the pipeline landscape for
depression and anxiety disorders. It provides comprehensive information
on the therapeutics under development and key players involved in
therapeutic development for post-traumatic stress disorder (PTSD),
obsessive-compulsive disorder (OCD) and depression, and features dormant
and discontinued products.

  • PTSD: There are 38 products in development for this indication.
  • OCD: There are 9 products in development for this indication.
  • Depression: There are 212 products in development for this indication.

Molecular targets acted on by products in development for depression and
anxiety disorders include neurotransmitter receptors such as glutamate
receptors and 5-hydroxytryptamine receptors. Companies operating in this
pipeline space include NeuroRx, Amorsa Therapeutics and Johnson
Johnson.

Scope

  • Which companies are the most active within each pipeline?
  • Which pharmaceutical approaches are the most prominent at each stage
    of the pipeline and within each indication?
  • To what extent do universities and institutions play a role within
    this pipeline, compared to pharmaceutical companies?
  • What are the most important RD milestones and data publications to
    have happened in this disease area?

Key Topics Covered

1 Table of Contents

2 Introduction

2.1 Depression and Anxiety Disorders Report Coverage

2.2 Post-Traumatic Stress Disorder (PTSD) – Overview

2.3 Obsessive-Compulsive Disorder – Overview

2.4 Depression – Overview

3 Therapeutics Development

3.1 Post-Traumatic Stress Disorder (PTSD)

3.2 Obsessive-Compulsive Disorder

3.3 Depression

4 Therapeutics Assessment

4.1 Post-Traumatic Stress Disorder (PTSD)

4.2 Obsessive-Compulsive Disorder

4.3 Depression

5 Companies Involved in Therapeutics Development

5.1 Post-Traumatic Stress Disorder (PTSD)

5.2 Obsessive-Compulsive Disorder

5.3 Depression

6 Dormant Projects

6.1 Post-Traumatic Stress Disorder (PTSD)

6.2 Obsessive-Compulsive Disorder

6.3 Depression

7 Discontinued Products

7.1 Post-Traumatic Stress Disorder (PTSD)

7.2 Obsessive-Compulsive Disorder

7.3 Depression

8 Product Development Milestones

8.1 Post-Traumatic Stress Disorder (PTSD)

8.2 Obsessive-Compulsive Disorder

8.3 Depression

Companies Featured

  • Acadia Pharmaceuticals Inc
  • Ache Laboratorios Farmaceuticos SA
  • Actinogen Medical Ltd
  • Adamed Sp. z o.o
  • Addex Therapeutics Ltd
  • Bionomics Ltd
  • BioXcel Therapeutics Inc
  • Clera Inc
  • Corcept Therapeutics Inc
  • Delpor Inc
  • DURECT Corp
  • Eisai Co Ltd
  • Eli Lilly and Co
  • Embera NeuroTherapeutics Inc
  • FPRT Bio Inc
  • GlaxoSmithKline Plc
  • GliaCure Inc
  • H. Lundbeck AS
  • Kissei Pharmaceutical Co Ltd
  • Lead Discovery Center GmbH
  • Les Laboratoires Servier SAS
  • Lixte Biotechnology Holdings Inc
  • Luye Pharma Group Ltd
  • Mapi Pharma Ltd
  • Medlab Clinical Ltd
  • Meta-IQ ApS
  • Mitsubishi Tanabe Pharma Corp
  • Navitor Pharmaceuticals Inc
  • Neuralstem Inc
  • Neurocrine Biosciences Inc
  • Sumitomo Chemical Co Ltd
  • Takeda Pharmaceutical Co Ltd
  • Trevena Inc
  • VistaGen Therapeutics Inc
  • and many more…

For more information about this report visit https://www.researchandmarkets.com/research/w5czfd/depression_and?w=4

Dr. Phil Kronk: Is obsessive-compulsive disorder a biological brain-based disorder?

For decades, Obsessive-Compulsive Disorder (OCD) was viewed in terms of underlying anxiety. In many ways, it was seen as more of a “mental” problem than a biological disorder. That has changed.

In the latest 5th edition of the psychiatry’s diagnostic manual, OCD has been moved from the anxiety section to one called, “Obsessive-Compulsive and Related Disorders.” What are these related disorders?

They include: Hording Disorder, Trichotillomania (Hair-Pulling Disorder,) Excoriation (Skin-Picking) Disorder and Body Dysmorphic Disorder, which involves a preoccupation with perceived defects or flaws in one’s physical appearance.)

OCD can be found alongside of these other disorders, as well as being closely related to anxiety disorders (which is why it follows the anxiety diagnoses in the diagnostic manual.)

OCD also has a prominent cognitive aspect. First, the amount of insight a patient has about his OCD should be assessed. Secondly, along with medication, OCD is treated by cognitive behavioral therapy, though some choose to use only behavioral treatments.

Why do so, if OCD is a brain-based biological disorder?

Because ongoing research and clinical findings have found that your brain, and its complicated neural circuits, can be changed by either therapy or medication.

But which neural brain circuits are thought to make one develop OCD?

First, I must share that these nerve circuits are considered to cause OCD due to impaired misfiring.

These misfiring’s fail to control responses. The obsessive, impulsive aspects of OCD make one unable to stop initiating actions. The compulsive aspects make one unable to terminate ongoing actions once they are started.

No matter how much feedback the compulsive individual receives, he or she cannot adapt (and change) their behaviors, even after negative feedback. One begins to understand how much mental suffering and despair the patient with OCD can experience.

The nationally known psychopharmacologist, Stephan Stahl, M.D. (and author of over 500 articles and chapters) writes that the balance between the ventral striatum and the dorsal striatum areas of one’s brain may be impaired. In addition to this impaired neural circuit loop, other important inputs from the brain’s hippocampus, amygdala and prefrontal cortex are contributory.

Dr. Stahl writes that drug addiction is also related to the impaired interaction of the ventral and dorsal areas of the striatum.

Others have called the neural circuit from the prefrontal cortex to the caudate nucleus (of the basal ganglia area of the brain) the “worry circuit.”

The neural circuits of someone with OCD have been characterized as being in “brain lock.”

The latest thinking about OCD is that it is not goal-directed behavior to reduce anxiety, but that it consists of “habits provoked mindlessly from a stimulus in the environment.”

Cognitive behavioral therapy uses “exposure and response prevention” treatment. This involves gradual exposure to anxiety provoking situations.

Medication treatment for OCD usually involves one of the SSRI’s, such as Prozac, often at a high dosage, and augmented with an atypical antipsychotic, when needed. Deep-brain stimulation is an experimental treatment.

[This is the third column in a series on OCD this month. Future columns will look at how one ‘experiences’ OCD, as well as detailed explanations of helpful medication and cognitive therapy treatments.]

Phil Kronk, M.S., Ph.D. is a semi-retired child and adult clinical psychologist and neuropsychologist. He has a doctorate in clinical psychology and a postdoctoral degree in clinical psychopharmacology. Dr. Kronk writes a weekly online column on mental health for the Knoxville News Sentinel’s website, knoxnews.com. He can be reached at (865) 330-3633.

‘You are more than your mental illness’: What this woman with OCD wants you to know

From model Gisele Bundchen to TODAY’s Carson Daly, there’s been a lot of discussion about panic disorder and generalized anxiety disorder. But there’s another common form of anxiety that hasn’t been as widely discussed: obsessive compulsive disorder, or OCD.

According to the Anxiety and Depression Association of America, over 2 million American adults live with OCD, a disorder characterized by recurring thoughts and behaviors or compulsions.

TODAY sat down with one young woman with OCD, Nicole Zelniker, 23, to talk about the stigmas around the disorder, as well as what she learned from her coping.

What people often get wrong about OCD

“I think the biggest misunderstanding people have is that it’s just about cleaning or being a clean person,” Zelniker told TODAY. “I feel like a lot of what is portrayed in the mainstream media … is just a person who likes to clean and washes their hands a couple extra times a day or checks the door extra times a day and it’s not really a big deal.”

In fact, you might be able to recall a time someone referred to an individual as “so OCD” because he or she likes to keep things organized or clean. While it may seem harmless, it trivializes the condition and can make a person feel badly about themselves, researchers say.

“When I was younger, I would wash my hands so much that they would bleed … I couldn’t touch things because I was afraid that they were coated in germs and that it was going to be bad for me,” she said. “It was something I couldn’t fully articulate why. But it’s something that your brain does.”

Zelniker was diagnosed with OCD at age seven after her mother saw how it was affecting her at school and at home.

“Because I wasn’t the type of OCD that my friends were seeing in the mainstream media, I actually had a moment where I was maybe in middle school when I told a friend that I had OCD and she was really confused and she told me that I didn’t and she told me that I didn’t know what I was talking about,” Zelniker remembered.

On getting help

“When I was young, I was in and out of therapy. And it hasn’t historically been something that’s worked for me, but it’s worked for a lot of my friends,” she said.

She found that medication, along with lifestyle changes, has helped the most. Making time to unwind after a long day, or on the weekend and curl up with a great novel makes her happy. She also practices self-care by doing things she enjoys like buying smoothies, having quiet time to read or spending time with friends.

“Find a group of people you feel comfortable reaching out to,” she said. Besides strong support from her mom and sister, she credits a college friend with helping her take control of her mental health when she was suffering in college.

“My friend encouraged me to seek out help and get back on medication,” she said.

Researchers have studied how social support helps people, finding that there is indeed a positive, measurable impact across all ages.

“I still now have those racing, obsessive thoughts that kind of feel like they’re ricocheting around in your mind, and that’s something even if I can’t ever get rid of,” she said, “but it’s something I’ve learned to cope with.”

What she wants people to know about medication

While medication isn’t for everyone, and isn’t a one-stop solution, it can drastically help mental health patients. For Zelniker, it’s helped her mange fear.

“When you take a medicine for a physical disease, the whole point is that it helps you with a disease. (Mental health) isn’t any different. It’s beyond your control,” she said.

Advice for anyone struggling

Zelniker hopes young people like herself can help change the culture surrounding mental health.

“Mental health doesn’t define you,” she said. “I am a journalist. I am a New Yorker. I am a woman. I am so many other things than my mental illness.”

“Don’t be afraid to get help.”

Mental illness on the rise in America

SAN DIEGO, Oct. 16, 2018 — Approximately 1 in 5 American adults will experience some form of mental illness in any given year, according to the National Alliance on Mental Illness (NAMI). This accounts for approximately 44 million U.S. adults, or 18.6 percent of the entire U.S. adult population.

According to NAMI, the current number of American adults stricken with a mental illness is staggering:

  • 1 percent live with schizophrenia
  • 6 percent live with a bipolar disorder
  • 9 percent will experience a major depressive episode
  • 1 percent suffer from an anxiety disorder, such as post-traumatic stress disorder, obsessive-compulsive disorder or a variety of phobias
  • 7 million adults suffer from substance abuse, with 40.7 percent having a concurrent mental illness

GEOGRAPHIC LOCATION AND MENTAL HEALTH

The states of Massachusetts, Vermont, Maine, North Dakota and Delaware have the lowest incidences of mental illness in the country, a fact that could be attributed to access to responsive mental health treatment programs.

Having an untreated mental illness could play a significant role in criminal or homicidal behavior, especially if substance abuse or unemployment is also prevalent, according to David Kopel, research director for Independence Institute.

image via https-::pixabay.com:en:board-chalk-psychology-1030589:board-1030589_960_720.jpg

UNTREATED MENTAL ILLNESS CAN LEAD TO CRIME

Admissions to mental hospitals have declined over recent decades, due to decreasing popularity over concerns regarding poor treatment of their inpatients. Conversely, since the 1950s there has been a significant increase within prison populations of inmates with mental illnesses.

According to Kopel, reducing the human and financial costs of violent crimes caused by those with mental illnesses is critical, and “90 days in a mental hospital might avoid the need for 10 years in prison.”

Approximately 15 percent of state prisoners and 24 percent of jail inmates likely have a psychotic disorder, according to the Department of Justice in a story by Ana Swanson and published in the Washington Post.
The ability to provide early identification and intervention for those displaying symptoms that might be indicative of mental illness would be a big step towards compassionate recovery and crime prevention.

Crime in America has become a highly politicized and polarizing issue.
Often, when tragedy strikes, social and political leaders seize the opportunity to bring their viewpoints to the national stage in order to further their own ideology.

As Americans come to terms with the prevalence of mental illness, there is a chance to create sound and realistic policies that move away from historically negative stigma and ideology and move toward both individual and national healing opportunities.

Creating more avenues for appropriate reporting of any suspected mental illness and requiring mandatory, compassionate treatment for those who are diagnosed would be a major step forward to helping solve the country’s current mental health crisis.

image via https-::pixabay.com:en:mental-health-mental-illness-women-1420801:mental-health-1420801_960_720.jpg

There are undeniable gaps in the mental health system that need to be bridged.
Sue Abderholden, MPHA, executive director of NAMI Minnesota, offers the following ideas, which would make crossing the bridge from mental illness to mental health easier, while simultaneously building safer communities.

  • Adequate availability of psychiatrists and mental health providers
  • No waiting lists for community services and inpatient treatment options
  • A 24-hour crisis team in every community
  • Employment and housing options
  • Effective case management and care coordination among mental health professional and organizations
  • Treatment programs for those with dual diagnoses
  • Opportunities for screening and early intervention
  • Unlimited access to mental health treatment

Early identification of a mental illness and access to appropriate treatment options is a sound, compassionate approach towards facilitating individual healing and making American communities much safer.

Until next time, enjoy the ride in good health!

OCD, My Exhausting Best Friend

I obviously need a new best friend.

Most people wouldn’t guess that I’m constantly tortured by disturbing thoughts. I’ve hosted live TV shows and given speeches in front of large audiences. During the LSAT, a few friends from college sat next to me because they said I had a calming energy. They had no idea of the internal storm always raging in my mind.

As far as acting on my thoughts and fears, I don’t: I’m possibly the most boring man on earth. I’m married with kids, don’t drink or get into bar fights. This makes sense. “Themes of O.C.D. have no absolutely no implication about the character of a person,” Dr. Phillipson said.

David Adam, author of the memoir “The Man Who Couldn’t Stop,” told me, “O.C.D. makes everything harder.” His book describes how he confronted his own O.C.D., which involved an intense, irrational fear of contracting H.I.V. We agreed that O.C.D., like all mental health afflictions, is not an artistic muse or creative gift but is ultimately unfair, with no complimentary benefits. Even though he likens his condition to being a recovering alcoholic, Mr. Adam was thankfully able to treat his O.C.D. and eventually write two books after he did a form of behavioral therapy called exposure and response prevention.

This is the most successful treatment for O.C.D., and it involves repeated exposure to the fearful thoughts without giving into the short-term relief delivered by compulsions. The trick is that you can’t outthink the disorder, you can’t outargue it, you can’t outrun it. You have to make the voluntary choice to confront it. It’s like inviting Pennywise the Clown, the demon from Stephen King’s “It” who feeds off your fears, over for a nice cup of tea. For example, if you’re obsessed with germs and contamination, then you have to abandon your compulsions and instead use public toilets and avoid repeatedly washing your hands. You choose to sit with the threat. Eventually, your brain habituates to the threat and is even bored by it, realizing there is nothing to fear.

Dr. Phillipson said people should first choose to forgive themselves for having O.C.D. If everyone had our misfiring brains, the whole world would behave exactly like us. Second, he advised against using negative imagery and instead welcoming our “best friend’s warning” but then choosing to ignore it. “The goal of the treatment is to make the thoughts irrelevant,” he said, “it’s not to make the thoughts go away.”

O.C.D. has exhausted me. I’m tired of suffering. I’m now doing exposure and response prevention, voluntarily exposing myself to my fears. It’s terrifying and often excruciating, like walking through a gauntlet of horrors without a shield or sword, armed only with belief and resolute conviction.

All the while, I’m working to abandon shame and guilt about my mental health disorder and to embrace the “best friend” I didn’t ask for.

Wajahat Ali (@WajahatAli) is a playwright, lawyer and contributing opinion writer.

Follow The New York Times Opinion section on Facebook and Twitter (@NYTopinion), and sign up for the Opinion Today newsletter.

Opinion | O.C.D., My Exhausting Best Friend – The New York Times

I obviously need a new best friend.

Most people wouldn’t guess that I’m constantly tortured by disturbing thoughts. I’ve hosted live TV shows and given speeches in front of large audiences. During the LSAT, a few friends from college sat next to me because they said I had a calming energy. They had no idea of the internal storm always raging in my mind.

As far as acting on my thoughts and fears, I don’t: I’m possibly the most boring man on earth. I’m married with kids, don’t drink or get into bar fights. This makes sense. “Themes of O.C.D. have no absolutely no implication about the character of a person,” Dr. Phillipson said.

David Adam, author of the memoir “The Man Who Couldn’t Stop,” told me, “O.C.D. makes everything harder.” His book describes how he confronted his own O.C.D., which involved an intense, irrational fear of contracting H.I.V. We agreed that O.C.D., like all mental health afflictions, is not an artistic muse or creative gift but is ultimately unfair, with no complimentary benefits. Even though he likens his condition to being a recovering alcoholic, Mr. Adam was thankfully able to treat his O.C.D. and eventually write two books after he did a form of behavioral therapy called exposure and response prevention.

This is the most successful treatment for O.C.D., and it involves repeated exposure to the fearful thoughts without giving into the short-term relief delivered by compulsions. The trick is that you can’t outthink the disorder, you can’t outargue it, you can’t outrun it. You have to make the voluntary choice to confront it. It’s like inviting Pennywise the Clown, the demon from Stephen King’s “It” who feeds off your fears, over for a nice cup of tea. For example, if you’re obsessed with germs and contamination, then you have to abandon your compulsions and instead use public toilets and avoid repeatedly washing your hands. You choose to sit with the threat. Eventually, your brain habituates to the threat and is even bored by it, realizing there is nothing to fear.

Dr. Phillipson said people should first choose to forgive themselves for having O.C.D. If everyone had our misfiring brains, the whole world would behave exactly like us. Second, he advised against using negative imagery and instead welcoming our “best friend’s warning” but then choosing to ignore it. “The goal of the treatment is to make the thoughts irrelevant,” he said, “it’s not to make the thoughts go away.”

O.C.D. has exhausted me. I’m tired of suffering. I’m now doing exposure and response prevention, voluntarily exposing myself to my fears. It’s terrifying and often excruciating, like walking through a gantlet of horrors without a shield or sword, armed only with belief and resolute conviction.

All the while, I’m working to abandon shame and guilt about my mental health disorder and to embrace the “best friend” I didn’t ask for.

Wajahat Ali (@WajahatAli) is a playwright, lawyer and contributing opinion writer.

Follow The New York Times Opinion section on Facebook and Twitter (@NYTopinion), and sign up for the Opinion Today newsletter.

Dr. Phil Kronk: Do you have real worries or obsessive ruminations?

      Worry does not empty tomorrow of its sorrow, it empties today of its strength.” “Corrie Ten Boom

      “Sorrow looks back, Worry looks around, Faith looks up.” Ralph Waldo Emerson

There are enough things to worry about in the everyday world—finances, raising children—without the added burden of having intrusive, unwanted obsessive ruminations.

Such worrisome over-thinking can become all-consuming, emotionally devastating and socially destructive.

Along with compulsive behaviors, such obsessions are part of the diagnostic category of an “Impulsive-Compulsive Disorder.” They are felt to be brain-based and localized in brain circuits that are mis-firing.

As I have said before in past columns, intrusive, obsessive thoughts are similar to a fever. They are a warning sign that something is wrong with your body. The negative feelings that one has about having obsessive thoughts or behavioral compulsions must not make you feel embarrassed, shameful, guilty or socially isolated. They must be acknowledged as being a medical problem that must be treated by a combination of medication and cognitive therapy.

A person with an obsessive-compulsive disorder should seek the help of both a physician and a clinical psychologist.

Obsessive-compulsive disorder often waxes and wanes over time for many who suffer from it. In the short run, cognitive therapy can help quiet the thoughts down. I tell patients it is similar to turning down a radio, so that it blends into background noise.

I always recommend that treatment for obsessive thoughts first involve learning how to relax oneself through progressive relaxation techniques. The next step is to counter the negative messages of the thoughts, by realizing that they are brain-related symptoms. These negative thoughts need to be countered with positive, affirmative statements that you and your therapist work on together.

The goal is to change one’s own relationship to one’s intrusive thoughts. And to learn what are real worries.

Psychologists have written about “real” worries. They involve, for example, bereavement and grief. (In fact, others often tell us that we have been grieving too long. They are wrong!)

PTSD is another diagnostic disorder with worry in its make-up. Its therapeutic relief is complex and not easily done. One must respect the rate at which the victim heals.

Gender Identity Disorder involves another form of over-thinking that needs to be better understood and accepted by the general public. The question, “Am I stuck in the wrong body?” is not easily answered.

Another overwhelming, anxiety-producing thought that patients share is the question, “Is this life I am living real?” or “What if I wake up and find that this is not reality?”

Some fear that they will wake up some day and find that the reality by which they live is not real.

Sometimes, I find that such fearful doubting is due to a significant depression. Sometimes, it is due to an unexpressed past trauma. Sometimes, it is a refusal to look at an upcoming negative life event, such as financial reality.

Obsessive individuals also worry if they are in the right reality. The answer I give them is supportive and non-authoritative. I tell them, no matter what reality you find yourself in, you should try to be happy and secure with the one you find yourself in. Being doubtful is not a reason to feel unhappy.

Obsessive worrying can include “content that is odd, irrational, or of a seemingly magical nature.” Another way to differentiate obsessive worrying from normal, or even other types of anxiety, is by the fact that compulsive behaviors are often present.

As the psychologist, Adam Phillips, Ph.D. is famous for saying, “The past influences everything, but dictates nothing.” I find solace in such a belief in hope. I try to share such a hope for all who suffer from what seems like over-whelming fearful and negative thoughts.

[This is the second column this month on a series about obsessive thinking and compulsive behaving. A future column will look at the impaired brain circuits thought to be underlying this disorder.]

Phil Kronk, M.S., Ph.D. is a semi-retired child and adult clinical psychologist and clinical neuropsychologist. Dr. Kronk writes a weekly online column on mental health for the Knoxville News Sentinel’s website, knoxnews.com. He can be reached at (865) 330-3633.

Let’s Talk About Anxiety

Anxiety in teens and children is increasingly common, and it’s the most prevalent mental health diagnosis among adolescents in the U.S. In spite of that, it’s rarely discussed openly in our community, which largely continues to stigmatize mental health issues. An upcoming screening of a powerful documentary intends to jumpstart a much-needed conversation about anxiety and normalize this common struggle.

On Tuesday evening, October 16, the Parent School Partnership of Yeshivat Noam will be hosting a community-wide screening of the compelling IndieFlix documentary “Angst: Raising Awareness Around Anxiety.” This film is a must-see for parents, educators and others who care for children or teens with anxiety. The film’s goal is to help viewers identify and understand the symptoms of anxiety and encourage them to reach out for help; to destigmatize, normalize and offer hope.

“Angst” engagingly and thoughtfully explores anxiety, its causes and effects and ways of dealing with it. The film features candid interviews with kids and teens who suffer, or have suffered, from anxiety, and what they’ve learned about it. “Angst” includes commentary from mental health professionals, and the screening next week will be followed by a live panel of experts who will field questions and further the conversation.

Many individuals experience an anxiety disorder, but particularly in communities that don’t discuss the problem, those who suffer often feel like their situation is rare or unique. According to the National Institutes of Mental Health, the prevalence of any anxiety disorder (including generalized anxiety disorder, obsessive-compulsive disorder, and specific phobias) in adolescents in the U.S. is 31.9 percent. That means this is an important, if not pressing, topic for many families, including those in our community.

According to Dr. John Duffy, clinical psychologist and best-selling parenting author, “The teenagers in the film describe their suffering with stunning openness, grace and courage…the filmmakers were able to capture what so many of my young clients are suffering in these complicated days: the bullying, perfectionism, panic, obsession, and too often, hopelessness…. Whether you are a teenager, parent, educator or a mental health professional, you simply need to see this movie, and soon. And every school needs to screen this film. It’s that important.”

Chani Oshinsky, a Teaneck resident who saw the film at a private screening this spring, found it eye-opening. “‘Angst’ really helps educate adults so they can validate their children’s or students’ struggles and help them, instead of dismissing or misunderstanding them,” she says.

Notes Dr. Jerry Bubrick, senior director of the Child Mind Center, “In our world there is a stigma attached to mental health disorders. People see anxiety as a personal failing rather than a medical condition; they see it as something to be ashamed of, rather than something to be treated. In reality, anxiety is universal. It doesn’t discriminate—and it’s very treatable. We just need to acknowledge it and talk openly first.”

The firsthand accounts of kids and teens in the film describing their experiences tend to strike a chord with viewers, many of whom have seen their children or students struggle similarly. The film and expert panel on Tuesday will address some of the different ways that anxiety presents in children, which can often be misunderstood by adults, including parents and educators.

Loretta Paley, co-chair of Yeshivat Noam’s Parent-School Partnership, was instrumental in arranging the upcoming screening after she saw the film last year. “I feel that it’s so critical for everyone in our community to see this film, to stop stigmatizing these kids, and to finally understand what they’re going through so we can help them. There needs to be a big change in how we view mental health concerns, and we’re hoping that ‘Angst’ contributes to that change.”

The film and expert panel will take place at Yeshivat Noam Middle School on Tuesday, October 16, at 8 p.m. Admission is free and the event is open to the community. “Angst” is recommended for teens and adults but may be too intense for younger viewers. For questions, please email [email protected]

By Talia Marmon, Ph.D.


Dr. Talia Marmon is a clinical psychologist.

John Green on how he deals with Obsessive-Compulsive Disorder and "thought spirals"

While you may not have heard of the author John Green, be assured that the teenagers in your life have. He is America’s answer to J.K. Rowling, with his mega best-sellers spawning blockbuster movies. Green has become wildly popular thanks largely to his loyal teenage audience. Green is also the rare literary talent who doubles as a podcaster and a YouTube star.

His success stems from his intuitive understanding of adolescents, his ability to meet them on their level and on their devices. To those who consider today’s teens a disaffected tribe, rarely glancing up from their phones and video games, John Green offers a counter narrative.

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Correspondent Jon Wertheim with John Green

Jon Wertheim: Let’s talk about teenagers.

John Green: 60 Minutes’ core audience, I understand.

Jon Wertheim: (LAUGH) It’s trending, uh… well, you know. You write a lot about teenagers.

John Green: Yeah.

Jon Wertheim: Why this cohort?

John Green: They’re doing so many things for the first time and there’s an intensity to that. You know, there’s an intensity to falling in love for the first time and also there’s an intensity to asking the big questions about life and meaning that just isn’t matched anywhere else.

Jon Wertheim: You’ve said before that adults underestimate teenagers.

John Green: Well, I think sometimes teenagers maybe don’t have the language to talk to us in ways that seem compelling to us. And maybe that makes it easy for us to dismiss them or think of them as less intellectually curious or intellectually sophisticated than we are. But I don’t think that’s true at all.

John Green’s books, in the YA — or young adult — genre dominate best-seller lists and while the stories take place in the U.S., They echo worldwide, having been translated into 55 languages.

Jon Wertheim: Lithuanian, Slovenian, Croatian.

John Green: Yeah, yeah It’s really wonderful to have your books travel to places you’ve never been. I mean it’s a weird but really beautiful experience.

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His most famous book, “The Fault in Our Stars,” was a best-seller for more than three years.

And adapted to a hit film in 2014 that grossed more than $300 million. Tinged with tragedy, the story follows two teenagers with cancer who fall in love – heavy, and heady stuff for an adolescent audience.

Jon Wertheim: The subjects you deal with are quite weighty. Death and suicide and cancer. A lot of teenagers haven’t had these experiences per se, but these books resonate with them. How is that?

John Green: Maybe lots of teenagers haven’t had these particular experiences, but I do think they know of loss, and they know of grief, and they know of pain. Maybe the particulars of an experience aren’t universal, but the feelings are.

One reason he connects so well with teenagers? At age 41, Green is still a kid at heart.

His youthful spirit drives more than book sales. It made him a YouTube star.

In 2007, the early days of YouTube, John Green and his kid brother Hank began sharing videos as a way to stay in touch with each other.

In short order, and in lockstep with the growth of YouTube, the Greens’ videos amassed a huge audience, now nearly a billion total views strong. This online video platform in turn fueled John Green’s readership.

Jon Wertheim: They play off each other.

John Green: Yeah. In a way, they’re different sides of the same coin, right? Because what interests me really is the idea of connecting with a viewer or with a reader without having to like actually talk to them and look at them and all that.

This preference, Green said, is the legacy of his own socially awkward adolescence.

Jon Wertheim: Who do you envision are your readers?

John Green: I don’t envision a reader.

Jon Wertheim: You don’t.

John Green: I think in some ways I’m writing back to my high school self  to try to communicate things to him, to try to offer him some kind of comfort or consolation.

Jon Wertheim: Who was that guy?

John Green: I had a difficult time in high school. I wasn’t a very good student and I had a lot of self-destructive impulses and I felt scared all the time.

Jon Wertheim: What were you scared of?

John Green: The short answer is everything.

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He explores those fears in his most recent book, “Turtles All the Way Down,” a best-seller for 50 straight weeks since it debuted at number one. Its theme: obsessive-compulsive disorder, OCD, based on Green’s own. For this book, he obeyed that time honored rule of the craft: write what you know.

John Green: I wanted to try to give people a glimpse of what it is. I wanted to try to put them, you know, at least a little bit inside of that experience.

Jon Wertheim: You use the word “thought spiral.” What does that mean?

John Green: The thing about a spiral is that it– it goes on forever, right? Like, if you zoom in on the spiral it can keep tightening forever. And that for me is the nature of obsessive thought that it’s this inwardly turning spiral that never actually has an end point. So it might be I’m eating a salad and it suddenly occurs to me that somebody might have bled into this salad. Now, they probably didn’t.

Jon Wertheim: This is what you’re thinking?

John Green: But this is what I’m thinking. And instead of being able to move on to a second thought, that thought just expands and expands and expands and expands. And then, I use compulsive behaviors to try to manage the worry and the overwhelmedness that that thought causes me.

Jon Wertheim: So how do you get out of this coil, and how do you break this infinity?

John Green: I have a few strategies. I exercise. That’s probably the biggest thing. Exercise is pretty magical in my life. I don’t enjoy it. (LAUGH) I don’t relish the thought of going for a run but it is very helpful because I can’t think.

John Green lives in Indianapolis, where his life comes short on stress, long on anonymity. He and his wife, Sarah Urist Green, a curator and online art educator, are parents of a son, age 8, and daughter, 5. Sarah began reading his manuscripts when they started dating 14 years ago.

Sarah Green: And I was really nervous because I really liked John, and I knew that if the book was bad it wasn’t gonna work. (LAUGHTER)

Jon Wertheim: The relationship wasn’t going to work. Not the book wasn’t going to work.

Sarah Green: No, no. The book might have worked or not, but I couldn’t be dishonest about, about that and if I didn’t like it, sorry.

John Green: I mean, I’m super glad I didn’t know that at the time. (LAUGHTER) I don’t think I coulda handled that pressure.

Jon Wertheim: Unfiltered criticism.

Sarah Green: Yeah, (LAUGH) yeah.

John Green: Yeah.

Jon Wertheim: John, do you remember when you told Sarah about your OCD?

John Green: I don’t know that it was an event so much as it was a process. And part of getting to know me was understanding that I had problems with anxiety.

Sarah Green: There was never a moment where John kind of sat me down and said, “I have OCD.” Um, it was more of a gradual process– where we were able to kind of put this label on it.  And so I can’t say that I would ever wish it to go away, because it’s a– it’s a part of him.

John Green: I– I’d like it to go away, (LAUGH) for the record.

So much so that, in 2015, fresh off the spectacular success of “The Fault In Our Stars,” Green decided to take a chance and go off the anti-anxiety medication he’d been taking for years.

Jon Wertheim: Why did you do that?

John Green: Well, ’cause I bought into this old romantic lie that– in order to write well– you need to sort of, like, be free from all of these mind-altering substances or whatever. And the consequences were really dire, unfortunately. And– and I– I’m lucky that they weren’t catastrophic, but they were serious. And coming out of that experience I found myself wanting to try to give some sort of form or structure—um, to this fear that I had lived with for my– most of my life.

These John Green fans call themselves “Nerdfighters” – part of a community that now includes hundreds of thousands of members around the world. The Nerdfighters formed in response to green misreading the name of a video game, “Aerofighters.”

Jon Wertheim: What’s a Nerdfighter?

John Green: A Nerdfighter is a person who fights for nerds.

Jon Wertheim: Not against nerds?

John Green: No.

Jon Wertheim: These are empowered nerds.

John Green: Yeah. Obviously we’re pro-nerd. (LAUGH) Really what it’s about is being enthusiastic. Being nerdy is really about how you approach what you love.

Jon Wertheim: Unabashedly.

John Green: Yeah.

Jon Wertheim: All five of you, proud, unapologetic nerds.

Presley: Oh yeah. Yep.

Ben: We take the name with pride.

We met these Nerdfighters last June. They were attending the ninth annual VidCon, a YouTube conference John and Hank Green created to help online video fans and creators meet in person. These five told us they were especially grateful to John Green for writing about his anxiety in “Turtles All the Way Down.”

Becky: It’s reassuring for sure.

Jack: For someone who does experience anxiety, he like, articulates things I could never articulate before. Which both, like, makes me feel seen but also helps me, like, understand and sort of, you know, feel better from different things.

Presley: Yeah, there’s this metaphor of a spiral in the book, and that was one of the most useful things I’ve ever come across in describing my own anxiety. And we use it in the house all time. And being around this community of people that was so loving  really made me grow to be a better person than I would have without it.

Presley at seven years old: I am a homeschooled child… and you all are my favorite teachers.

This was her – Presley Alexander – when she was just seven years old and she first came into the John Green orbit, not by reading one of his books but by watching him on Crash Course, the educational YouTube series that he started with his brother Hank in their manic signature style.

The videos offer lessons in the humanities and sciences with more than eight million subscribers, they are now offered as part of the curriculum in classrooms around the country. On account of his popularity across platforms, Green cuts a figure he never would have imagined when he was a teenager: something akin to a rock star.

Jon Wertheim: I want to know what your high school self would have thought if– if they saw you now.

John Green: Uh, my high school would be very– very happy and excited. (LAUGH) I’m embarrassed to admit. Uh, I wish that weren’t the case.

Hank Green: That’s a great– that’s a great way to put it. I agree completely.

The Green brothers are exceptionally supportive of each other, especially when it comes to John’s OCD – described so vividly in his latest book.

Jon Wertheim: “Turtles All The Way Down.” What was it like for you to read that?

Hank Green: It did help me understand John better. And– and, but– but in general be more empathetic toward people who deal with anxiety and OCD.

Jon Wertheim: What’d you learn about him?

Hank Green: The extent to which sometimes he is at the mercy of his own mind.

Jon Wertheim: But did it cause you to reexamine or reassess moments in your childhood?

Hank Green: Yeah, I mean, there– there have definitely been times in, you know, when John had a less stable life where I think, like, the family was worried about him. You know, those, the– the–

John Green: With good reason. (LAUGHTER)

Lately, there’s a lot less to worry about. With his multimedia, multimillion-dollar empire, John Green is using his pen, his keyboard and his video camera to normalize teenage social awkwardness and also to destigmatize mental illness.

Jon Wertheim: You’ve said that it’s important for young people to be able to see successful, productive adults challenged by mental illness.

John Green: Yeah.

Jon Wertheim: Expand on that.

John Green: Well, I have a really wonderful life. I have a really rich, fulfilling life. I also have a pretty serious chronic mental health problem. And those aren’t mutually exclusive. And the truth is that lots of people have chronic mental health problems, and still have good lives.

Produced by Sarah Koch and Chrissy Jones