Four Steps to Manage Obsessive-Compulsive Disorder

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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.

Four Steps to Manage Obsessive-Compulsive Disorder

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8 Things Autistic People Wished You Knew about April

This is an interesting article I found on: www.psychcentral.com

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Every April, autism takes a center stage in global awareness. All around the world, well-meaning, good-hearted people “Light it up blue” for Autism Awareness Month, and they decorate their social media with the puzzle piece frames and the jigsaw rainbow awareness ribbons.

And, every March, autistic adults are already dreading April. Many of them report feeling traumatized by previous Aprils. They begin to mentally prepare for what is ahead, feeling powerless to stop it. They’re bracing themselves for what is on the horizon.

What autistic people wish their neurotypical allies knew going into April:

  1. We really don’t want or need awareness. To most neurotypical (non-autistic) people, awareness of autism is to be aware of a disease, to regard it with a somber recognition of how serious a problem autism is and how fervently a cure is needed. It doesn’t conjure the reverent solidarity that breast cancer awareness does for survivors, the bereaved, and their loved ones. Instead, it means that the world comes together to talk about the tragedy of autism.
  2. Most of us do not want a cure. The vast majority of autistic adults do not want a cure, nor do they see autism as a disease. It is simply their way of existing, perceiving, and being. Autism is inextricable from the identity and perception of the autistic person, and a “cure” would mean to erase from them what is their core self and what their divergent minds can contribute to society. Most of us are quite proud to be autistic.
  3. We wish you’d see us outside of the medical disability model. The medical model pathologizes our innate traits. We may develop on a different curve, have different strengths and weaknesses, and relate differently from the majority of the population, but those traits aren’t inherently negative. Our traits are interpreted in the most negative way because they are not what “most people” do. We express empathy differently, but a lack of eye contact or verbal expressions of emotional solidarity do not mean we lack empathy.
  4. We are offended by puzzle pieces, “Light it up blue,” and Autism Speaks. Autism Speaks has dominated the world’s narrative about autism. They are a fundraising monolith, and their information distribution campaigns rank at the top of search engine results around the internet. The focus of their campaign was originally to scare the world into realizing how important it was to find a cure and to eradicate autism and to implicate vaccines as the culprit. They have continued to deny autistic perspectives, and only a minuscule portion of their many millions in donations actually goes to helping autistic people (often less than 1%). Essentially, donations go to marketing puzzle pieces and the international “brand” Autism Speaks has created. They are responsible for the puzzle pieces and the “Light it up blue” campaigns. For a more detailed breakdown and alternative charities to support, click here. We ask that you share autistic-authored posts and articles in April and hashtag them #redinstead.
  5. We prefer identity-first language over person-first language. This means that we prefer to be called “autistics,” or “autistic people,” or “aspies” (if that’s how one identifies) as opposed to “person with autism” or “person with Asperger’s.” But, every individual’s preference should be respected.
  6. We are great at self-advocating, and we wish you’d learn about autism from autistic people. There are thousands of blogs, websites, organizations, and informational resources out there produced and managed by autistics. The autistic community is a thriving, tight-knit juggernaut of change and advocacy, and they uplift other marginalized populations by focusing on intersectional human rights outside of the neurodiversity paradigm. They’re fierce defenders of children and dedicated scholars and researchers. They can be found on social media by searching the hashtag #actuallyautistic. The Aspergian is a collective of autistic writers, or you can read more of my blogs here at PsychCentral.
  7. Autism doesn’t end at age 18. Most people tend to think of autism as a childhood disorder, but an autistic person is autistic every day of his or her life.
  8. Function labels are deeply offensive and inaccurate. When someone is autistic, it has been socially acceptable to comment on how high- or low-functioning he or she is. The truth is, autism is invisible, and a person’s struggles cannot be measured by how a person seems to be performing. Often, “function” comes at great price to the autistic person, meaning that they have to hide or “mask” their innate traits and behaviors to appear more “normal.” You can read all about function labels by clicking here.

Autistic people need neurotypical allies to be more than just aware of autism, but to accept our differences and see our strengths and our weaknesses as unique to the individual. We need your help to find our way into the conversation about autism, which means sharing articles by autistic people and supporting autistic organizations. We need employers and schools to accommodate for our neurological profiles, and individuals to understand how we relate differently.

So, let’s make April “Autism Acceptance Month” and shift the focus to autistic people as thinking, feeling, valuable human beings. By reading this article, written by an autistic person, you’re off to a great start as an ally.

8 Things Autistic People Wished You Knew about April

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On Stage on the Spectrum

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About three years ago, I got an email publicizing a drama school called the Center for Applied Drama and Autism, C.A.D.A. I was instantly interested. A year before, my 10-year-old son Tommy had been diagnosed with autism. I had always wanted him to get into acting because I’d acted as a child, having been in shows such as Gypsy and Fiddler on the Roof at local dinner theaters. Tommy seemed as though he would be a natural because he had the ability to memorize scripts (he was an avid scripter; people who are autistic often are), and he was very funny.

The school was in downtown Akron, about fifteen minutes away from our home. I signed him up. Soon, one Saturday a few weeks later, we entered an old building on Main Street and searched for the acting studio. Down a staircase we went and soon we found ourselves in C.A.D.A.

Tommy was going to take improv. Improvisation classes, we would learn, are good for autistic people because they help them to be better communicators (learning to think on their feet) and ultimately find their own voices. These classes were also fun.

We’d done traditional social groups at centers for people on the spectrum, but these had turned out to be unsuccessful because they lacked vital context and purpose. Acting encouraged the participants to be social, but also to be creative, making up narratives and scenarios.

The first day at improv, Tommy and his classmates warmed up doing an exercise called “Zip, Zap, Zop,” in which they passed energy to each other. Then, they did an exercise called “Mirrors,” in which they mimicked each other as if they were looking in a mirror. Then came a game called “Bus Stop,” where they pretended to be waiting for a bus in a character of their choosing. Soon, they would be acting out fairy tales and even learning Shakespeare.

Tommy took to it. There was only one problem. Well, really two problems. The first was that there was a very loud service bell that people rang so that they could get in the building which was often locked. This service bell unnerved Tommy. He had sensory issues, so the bell was a hindrance in his play. The second problem was that I got cancer, and Tommy fell apart. While I was getting treatment, we had to stop going to drama for a time. But I survived cancer, and then, something else wonderful happened. C.A.D.A. moved! No more service bell. C.A.D.A. relocated to what is known as their blue box theater in Akron, where they currently reside.

Now in 2019 at the blue box theater, Tommy takes improv from Ruben Ryan and Brandon Meeker. He goes every Saturday. And he’s getting good. He can sustain a scene and create original dialogue that is purposeful and entertaining. Improv helps him stay in the moment, to be in the moment, completely engaged and fascinated with people and life. This is saying something for someone on the autism spectrum, who might often be disengaged and out of touch.

So whose brainchild is C.A.D.A.? C.A.D.A. was co-created by Wendy Duke, a drama teacher for over 40 years, and Laura Valendza, an actor and intervention specialist.

C.A.D.A.’s philosophy is as follows:

Our goal is to meet our students where they are now, and without coercion, help them to recognize their own abilities and gifts through empowerment and making connections. We do not wish to change the uniqueness of each student, but rather help each one deal with social and emotional situations that will occur throughout their lives.

We do this via individual and collaborative applied drama techniques such as theatre games, improvisation, role play, character study, voice and body work, mask work (commedia dell’ arte), and Play Back Theatre. Additionally, we encourage creativity and originality through student created puppet plays, playwriting and video production. Visual art, dance and music are all key components in theatrical productions and give our students an opportunity to expand their artistic gifts and interests.

What does all this mean? For a parent of a child on the spectrum, it means that my kid can study acting at a world-class acting school right in our own little Akron, Ohio.

Recently, Tommy was asked to be a “co-star” at C.A.D.A. This means that he will work with a class of younger students as sort of a mentor/helper. Tommy’s father and I couldn’t be more thrilled. Tommy has gone from a timid pre-teen who was frightened by everything, including a loud service bell, to a full-fledged teenage actor in a leadership role.

If your child has autism, you might consider enrolling him or her in acting classes in your hometown. I’m sure acting courses can benefit your child. These classes have made all the difference in Tommy’s life.

On Stage on the Spectrum

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To Others Who Have Experienced Trauma as Children

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Most of us have real anger and suffering living inside us. Perhaps in the past we were oppressed or mistreated, and all that pain is still right there, buried in our store consciousness. We haven’t processed and transformed our relationship with what happened to us and we sit there alone with all that anger, hatred, despair and suffering. If we were abused when were young, every time our thinking mind goes back over that event, it’s like we’re experiencing the abuse all over again.– Thich Nhat Hahn

The #MeToo movement, including Dr. Ford’s testimony on the Senate floor in 2018, was an eye-opener for many of us. Even though I personally had experienced sexual assault and figured others had too, I was not prepared for the staggering number of brave women and men who publicly came forward to share their experiences of pain and violation. I also wasn’t prepared for the amazing feeling that this movement could actually change the climate that our daughters and sons grow up in.

By the time most of us reach adulthood, we have experienced some form of trauma, ranging from heartbreak to the more intense physical, sexual, and emotional abuse. Though the actual trauma may have been experienced decades ago, often there are hidden tender and hurting spaces in its wake.

Healing is a lengthy process, even years after the event, things can happen that “trigger” a traumatic response. That is, current events in our lives that are not directly related to the trauma we experienced can evoke a reaction that is more intense than the situation at hand deserves. What happens when we are overreactive is that we are no longer in the present. However, by being aware of when we are triggered, and working on maintaining our calm and presence, we are, in fact, helping our children and ourselves.

Psychologists who study the long-reach of trauma will note that when your child enters the age that the parent was when they experienced a traumatic event, a deep part of them will relive the experience. This is beyond a simple remembering of the event — it is as if we’re actually re-experiencing the trauma. This is critical to keep in mind so that we are not blind-sided when the kids reach that age in which we experienced a significant loss or abuse.

I believe the human system is built this way so we can heal unresolved issues from our earlier wounding. It also may be a survival mechanism, in that our hypervigilance helps us protect our children by warning them of dangers in their environment. However, like most automatic survival mechanisms, these processes can take on a life of their own. That is why it’s critically important to use these uncomfortable situations as opportunities to set the course for the next generation. To harness the hidden power in these circumstances by becoming aware of when you’re triggered and before stepping into overreaction, use the trigger as a signal to get centered.

How do you know when you’re triggered? For me, all of a sudden I feel overly anxious, overly angry, or conversely, like I want to withdraw and hide. I examine whether or not a real danger is evident. In nearly every single case of being triggered, there actually is no real danger (if there is, please address it immediately and maybe even get backup help).

If there is no real danger, this is the critical moment. Breathing deeply and naming feelings “worried, scared, agitated”, can lead to healing. Yes, it’ll reduce the likelihood that you’ll act from the wounded place, but it will also help you soothe the hurting places. As if you were a loving parent to yourself, nurturing and healing the wounded places.

I’ve noticed that being kinder to myself reduces the likelihood that I’ll act out from the painful residue of the trauma. It’s an act of cultivating unconditional friendliness towards ourselves. We embrace the scared and vulnerable parts of ourselves, instead of pushing the challenging emotions away through reacting or overreacting.

When I am in a triggered phase (which when it is really bad, can last for most of a day and even span a couple days), I start my day by talking to the wounded little girl inside of me. I place a hand on my heart and on my abdomen (the Grounding Hand Posture), and I tell my younger self that I (the adult protectress) am here now. I comfort those wounded places within me with the knowledge that I am present and in charge, and that I will guide the hurt parts of myself with my mature wisdom, with strength and with kindness.

By emotionally taking care of ourselves through tending the emotional wounds and anxieties, we are less likely to act from the painful residual trauma. And we begin to remove the fear of our own emotions, which only serves to separate us from our self and those we love.

Use your triggers as an opportunity to deepen your friendship with yourself. Call upon your courage, which you likely have in spades. You’ll be more connected to the reality of the present moment. This, in turn, will increase the likelihood that your actions will arise from the most centered part of you.

Compassionately paying attention to ourselves has added benefits — of interrupting the transmission of trauma between generations, and of drawing any lingering shameful feelings out of the darkness and into the light. These earlier challenging experiences can become our opportunity to embrace ourselves with unconditional friendliness, to change the social climate that our children grow up in, and to powerfully reclaim our truth as we stand in solidarity.

To Others Who Have Experienced Trauma as Children

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Don’t Force Gratitude

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In his book What Happy People Know, Dan Baker argues that you can’t be in a state of appreciation and fear, or anxiety, at the same time. He explains:

During active appreciation the threatening messages from your amygdala [fear center of the brain] and the anxious instincts of your brainstem are cut off, suddenly and surely, from access to your brain’s neocortex, where they can fester, replicate themselves, and turn your stream of thoughts into a cold river of dread. It is a fact of neurology that the brain cannot be in a state of appreciation and a state of fear at the same time. The two states may alternate, but are mutually exclusive.

Other studies have also highlighted how gratitude can buffer you from the blues, protect you from illness, and heal your neuroses.

You Can Be Depressed and Grateful

While I believe gratitude can definitely contribute to emotional resilience and promote wellness, I disagree with Baker that you can’t be depressed and grateful at the same time.

Why? Even in my most severe depressive episodes, I was always cognizant of my blessings and appreciated the good things in my life. In fact, a section of my daily mood journal is dedicated to listing all the things I am grateful for each day. This exercise helps to create new grooves, or neural passageways, that lead to healing; however, it doesn’t have the horsepower to abort the brain entirely and start from scratch with a purely optimistic outlook.

Gratitude isn’t always the magical antidote that positive psychologists and celebrities like Oprah claim it to be.

When Gratitude Backfires

Sometimes gratitude can actually backfire, explains Dr. Margaret Rutherford, a psychologist in private practice in Arkansas. For persons with Perfectly Hidden Depression (PHD), a kind of depression where someone creates the façade of everything going well in his or her life, showing gratitude only contributes to the problem.

In her blog When Gratitude Backfires, Dr. Rutherford writes:

When [gratitude] has an intense, driven, being on a treadmill quality, with the speed slowly being turned up, and up, and up, and up. It can be tremendously self-destructive….It’s not that it’s insincere. It’s very real. But the giver is in pain that she or he isn’t talking about, and showing gratitude becomes a performance itself. The gratitude backfires.

Don’t Fake It

We’ve been told to fake it until we make it, but forced gratitude doesn’t seem to be any help to depression. In one study published in the Journal of Personal and Emotional Psychology in January 2001, two researchers at the University of California in Berkeley inspected yearbook photos from 1958 and 1960.

They distinguished genuine smiles from false smiles (the two smiles activate different muscle groups). Thirty years later, the students with the genuine smiles were found to be faring much better than those with the fake smiles: The genuine smilers had more satisfying marriages, greater feelings of well-being, and so forth.

Mindfulness and Emotional Agility

For those of us who battle chronic depression, I think it’s important to know that 1) we can be grateful and depressed at the same time, and 2) it’s okay not to be grateful. For me and for many others I know, it is much more helpful to approach feelings and thoughts with mindfulness — simply acknowledging them in a loving way and trying to stay present in the moment — or with emotional agility, allowing ourselves to feel our emotions, than to force any kind of optimism or positive psychology.

Gratitude may come.

And it may not come.

Either way, we are okay.

Don’t Force Gratitude

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OCD Treatment: More Important Than School or Outside Activities?

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Obsessive-compulsive disorder (OCD) is an often misunderstood and complicated illness. It can latch on to anything that is important to us, and has the potential to totally devastate lives.

Still, so many people believe it is nothing more than excessive hand washing and the desire to keep things tidy. This could not be further from the truth. For the purpose of this post, I’ll be referring specifically to OCD in children.

When OCD makes an appearance in a family, it often brings about fear and confusion. For one thing, obsessive-compulsive disorder manifests itself differently in everyone. Truly, there is no end to the ways it can present itself in addition to the stereotypical compulsions mentioned above. A few examples include eating issues, refusal to leave the house, irrational fears of certain people, places, or things, and the inability to complete previously easy homework assignments. You name it, it just might be OCD.

Which leads us to the next issue that faces parents of children with OCD — getting a proper diagnosis. Misdiagnosis is common, which of course leads to the wrong treatment. Even when OCD is properly diagnosed, the right therapy, exposure and response prevention (ERP) therapy is often elusive. What’s a family to do?

For those lucky enough to receive a proper diagnosis and referral to good treatment, you’d think the children would be on their way to recovery. However, that is not always the case – I’m hearing from more people than ever who are in this situation. While various forms of intensive treatment (intensive outpatient, partial hospitalization programs, or residential treatment centers) are often recommended for their child, many parents are concerned that a commitment to intensive treatment will disrupt their child’s life. For example, Kate loves dance and she’ll miss some classes and the recital, Jake will miss a good chunk of fourth grade if he does a particular ERP program, and Ashley will miss a few social events and have to tell her friends what’s going on (or lie).*

Obviously, the children discussed in the above paragraph are not totally debilitated by OCD. Not yet, anyway. And it very well could be that they are balking at the idea of treatment. For children who can’t leave the house, or are not able to function to any extent in their daily lives, the decision to seek treatment is typically easier — they have already hit bottom. But many parents of children who are teetering on the edge don’t seem to want to take away the few things that still make their children happy, or “normal.”

As an advocate for OCD awareness and proper treatment for over ten years, I cannot stress the importance of getting the right help for obsessive-compulsive disorder sooner rather than later. OCD rarely gets better on its own, and once entrenched, is harder to treat. So, for all those out there who might be in this situation, please get your child the right help as soon as possible. Friends and activities will come and go. Even missing a significant amount of time in school can be made up. But a child who grows into a young adult with untreated OCD might very well be so disabled by the disorder that he or she can’t even hold down an entry-level job. Getting good treatment now will free your child from the grips of OCD and allow him or her to go on to have a wonderful life.

*These are not their real names.

OCD Treatment: More Important Than School or Outside Activities?

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Finding Your Yes: A Powerful Strategy for Shifting from Negative Habits to Positive Ones

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Try this short experiment and say the following statements to yourself: I want to stop eating junk food. I want to stop yelling at my kids. I want to stop worrying about things I can’t control. (Feel free to substitute behaviors that might be more relevant in your life).

Notice how this feels in your body when you say these things to yourself. Do you feel tight and constricted or more open and expansive? Do you feel motivated and energized to change these habits, or do you tend to feel stuck, closed off, or perhaps even some sense of guilt or shame?

Now try these statements out (and again feel free to change them to fit the behaviors that are relevant in your life): I want to commit to making food choices that support and nourish radiant health and wholeness. I want to parent my kids so that they feel deeply supported and valued; I want to fully engage in as many precious, present moments of my life as possible. Notice how this feels in your body as you say these things, and ask yourself the same questions as above.

Chances are, these first and second statements have a different feeling tone for you.

To simplify this experiment even further, you might say the word “no” out loud several times and notice what happens in your body. Now say the word “yes” several times. For most people, the first has a feeling of resisting or rejecting something, and it feels constricted and closed, whereas the second has a feeling of embracing or moving toward something that is more energizing, open and hopeful.

Focusing on the “Yes”

According to the work of researcher and health psychologist Kelly McGonigal, focusing on what you can say “yes” to, choosing a value-based commitment that reflects something important to you in your life, and taking a positive action toward something, are more effective ways to change behavior than trying to say no to something or trying to stop engaging in a behavior you are unhappy with. In other words, committing to what you want is more powerful than trying to resist something that you don’t want.

As simple as this shift may sound, it is a new idea for many people, especially when it comes to wanting to change difficult behaviors. It is human nature to want to resist, push away, and fight against what is unpleasant or undesirable. In addition, it is common to be self-critical and to beat ourselves up when we aren’t able to stop engaging in an unhelpful behavior. We sometimes think that if we are hard on ourselves this will help us stick to our goals. According to researcher Dr. Kristen Neff, the research is quite compelling to support the power of self-compassion over self-criticism, as a vehicle for behavior change.

I know for me, during my teen years and into my early college years, I struggled with a very unhealthy relationship to food and a negative body image. I would binge eat, and then try to punish myself by restricting my eating. I would berate myself and feel shame when I couldn’t stick to my goals of eliminating junk food and losing weight. Then one day, I read a book that completely shifted my focus and how I was approaching my goals. It was a book about the benefits of aerobic exercise and it sparked my interest in becoming healthier and stronger by adding a positive behavior instead of trying to eliminate a negative one.

As I moved toward incorporating this new behavior (exercise) into my life, my struggle with food began to fall away. I was no longer battling myself and focusing on constantly saying “no” throughout my day; instead, I was saying “yes” to something that I found meaningful and that I enjoyed. When I look back at other big changes in my life, they too involved saying “yes” to something rather than saying “no” and trying to stop myself from doing something (which often didn’t work).

Finding Your YES

So I invite you to ask yourself what you might say YES to in your life today. Instead of trying to stop something that isn’t working, what might you add into your life that encompasses a value that is deeply important to you? For example, instead of trying to stop binge watching TV or playing on your phone at night, you might focus instead on adding in 30 minutes of quality time with your children or partner or friends each night, and notice how that shifts your experience with TV.

Here are a few questions that you can ask yourself to get started:

  1. What do you want to say yes to, go after, create or cultivate in your life?
  2. What is your WHY? Why is this important to you? How does it connect to your deepest values about how you want to live your life?
  3. What can you do today, and what small, specific and committed actions can you take each day that are consistent with your long-term values (from question 2).
  4. How might your inner dialogue (that voice in your head and the things you say to yourself all day long) support your long-term goals and be self-compassionate when you are struggling? In other words, imagine what you would say to a good friend who was trying to say “yes” to something in their life and at times experiencing setbacks, that would be supportive and encouraging. Try to speak to yourself that way.

Finding Your Yes: A Powerful Strategy for Shifting from Negative Habits to Positive Ones

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12 Ways to Keep Going with Depression

This is an interesting article I found on: www.psychcentral.com

See credits below.


About once a week I hear the same question from a reader, “What keeps you going?” The short answer is lots of things. I use a variety of tools to persevere through my struggle with depression because what works on one day doesn’t the next. I have to break some hours into 15-minute intervals and simply put one foot in front of another, doing the thing that is right in front of me and nothing else.

I write this post for the person who is experiencing debilitating symptoms of depression. The following are some things that help me fight for sanity and keep me going, when the gravity of my mood disorder threatens to stop all forward movement.

Find a good doctor and therapist.

I have tried to beat my depression without the help of mental health professionals and discovered just how life-threatening the illness can be. Not only do you need to get help, you need to get the RIGHT help.

A reporter once referred to me as the Depression Goldilocks of Annapolis because I have seen practically all of the psychiatrists in my town. Call me picky, but I am glad I didn’t stop my search after the third or fourth or fifth physician because I did not get better until I found the right one at Johns Hopkins Mood Disorders Center. If you have a severe, complicated mood disorder, it is worth going to a teaching hospital to get a consultation.

Be just as choosy with your therapist. I have sat on therapy couches on and off for 30 years, and while the cognitive behavioral exercises were helpful, I didn’t begin making real progress until I started working with my current therapist.

Rely on your faith — or some higher power.

When everything else has failed, my faith sustains me. In my hours of desperation, I will read from the Book of Psalms, listen to inspirational music, or simply yell at God. I look to the saints for courage and resolve since many of them have experienced dark nights of the soul — Teresa of Avila, John of the Cross, Mother Teresa. It is of great consolation to know that God knows each hair on my head and loves me unconditionally despite my imperfections, that He is with me in my anguish and confusion.

A substantial amount of research points to the benefits of faith to mitigate symptoms of depression. In a 2013 study, for example, researchers at McLean Hospital in Belmont, Massachusetts, found that belief in God was associated with better treatment outcomes.

Be kind and gentle with yourself.

The stigma attached to depression is still, unfortunately, very thick. Maybe you have one or two people in your life who can offer you the kind of compassion that you deserve. However, until the general public offers persons with mood disorders the same compassion that is conferred on people with breast cancer or any other socially acceptable illness, it is your job to be kind and gentle with yourself. Instead of pushing yourself harder and telling yourself it’s all in your head, you need to speak to yourself as a sensitive, fragile child with a painful wound that is invisible to the world. You need to put your arms around her and love her. Most importantly, you need to believe her suffering and give it validation. In her book Self-Compassion, Kristin Neff, Ph.D., documents some of the research that demonstrates that self-compassion is a powerful way to achieve emotional well-being.

Reduce your stress.

You don’t want to give into your depression, I get that. You want to do everything on your to-do list and part of tomorrow’s. But pushing yourself is going to worsen your condition. Saying no to responsibilities because your symptoms are flaring up isn’t a defeat. It is act of empowerment.

Stress mucks up all your biological systems, from your thyroid to your digestive tract, making you more vulnerable to mood swings. Rat studies show that stress reduces the brain’s ability to keep itself healthy. In particular, the hippocampus shrinks, impacting short-term memory and learning abilities. Try your best to minimize stress with deep-breathing exercises, muscle-relaxation meditations, and simply saying no to anything you don’t absolutely have to do.

Get regular sleep.

Businessman and author E. Joseph Cossman once said, “The best bridge between despair and hope is a good night’s sleep.” It is one of the most critical pieces to emotional resiliency. Practicing good sleep hygiene — going to bed at the same time at night and waking up at a regular hour — can be challenging for persons with depression because, according to J. Raymond DePaulo, Jr., M.D., co-director of the Johns Hopkins Mood Disorders Center, that’s when people often feel better. They want to stay up and write or listen to music or work. Do that too many nights, and your lack of sleep becomes the Brussels sprout on the floor of the produce aisle that you trip over. Before you know it, you’re on your back, incapable of doing much of anything.

Although pleasing our circadian rhythm — our body’s internal clock — can feel really boring, remember that consistent, regular sleep is one of the strongest allies in the fight against depression.

Serve others.

Five years ago, I read Man’s Search for Meaning by Holocaust survivor and Austrian psychiatrist Viktor Frankl and was profoundly moved by his message that suffering has meaning, especially when we can turn our pain into service of others.

Frankl’s “logotherapy” is based on the belief that human nature is motivated by the search for a life purpose. If we devote our time and energy toward finding and pursuing the ultimate meaning of our life, we are able to transcend some of our suffering. It doesn’t mean that we don’t feel it. However, the meaning holds our hurt in a context that gives us peace. His chapters expound on Friedrich Nietzsche’s words, “He who has a why can bear almost any how.” I have found this to be true in my life. When I turn my gaze outward, I see that suffering is universal, and that relieves some of the sting. The seeds of hope and healing are found in the shared experience of pain.

Look backwards.

Our perspective is, without doubt, skewed during a depressive episode. We view the world from a dark basement of human emotions, interpreting events through the lens of that experience. We are certain that we have always been depressed and are convinced that our future will be chock full of more misery. By looking backwards, I am reminded that my track record for getting through depressive episodes is 100 percent. Sometimes the symptoms didn’t wane for 18 months or more, but I did eventually make my way into the light. I call to mind all those times I persevered through difficulty and emerged to the other side. Sometimes I’ll take out old photos as proof that I wasn’t always sad and panicked.

Take a moment to recall the moments that you are most proud of, where you triumphed over obstacles. Because you will do it again. And then again.

Plan something fun.

Filling my calendar with meaningful events forces me to move forward when I’m stuck in a negative groove. It can be as simple as having coffee with a friend or calling my sister. Maybe it’s signing up for a pottery or cooking class.

If you’re feeling ambitious, plan an adventure that takes you out of your comfort zone. In May, I’m walking Camino de Santiago, or The Way of Saint James, a famous pilgrimage that stretches 778 kilometers from St. Jean Port de Pied in France to Santiago de Compostela in Spain. The anticipation of the trip has fueled me with energy and excitement during a hard stretch of my life.

You need not backpack through Europe, of course, to keep moving forward. Organizing a day trip to a museum or some local art exhibit could serve the same purpose. Just be sure to have something on your calendar other than therapy and work meetings.

Be in nature.

According to Elaine Aron, Ph.D., in her bestseller The Highly Sensitive Person, approximately 15 to 20 percent of the population is easily overwhelmed by loud noises, crowds, smells, bright lights, and other stimulation. These types have rich interior lives, but tend to feel things very deeply and absorb people’s emotions. Many people who struggle with chronic depression are highly sensitive. They need a pacifier. Nature serves that purpose.

The water and woods are mine. When I get overstimulated by this Chuck E. Cheese world of ours, I retreat to either the creek down the street or the hiking trail a few miles away. Among the gentle waves of the water or the strong oak trees in the woods, I touch ground and access a stillness that is needed to navigate difficult emotions. Even a few minutes a day provide a sense of calm that helps me to harness panic and depression when they arise.

Connect with other warriors.

Rarely can a person battle chronic depression on her own. She needs a tribe of fellow warriors on the frontline of sanity, remembering her that she is not alone and equipping her with insights with which to persevere.

Five years ago, I felt very discouraged by the lack of understanding and compassion associated with depression so I created two forums: Group Beyond Blue on Facebook and Project Hope & Beyond. I have been humbled by the level of intimacy formed between members of the group. There is power in shared experience. There is hope and healing in knowing we are in this together.

Laugh

You may think there’s nothing funny about your depression or wanting to die. After all, this is a serious, life-threatening condition. However, if you can manage to add a dose of levity to your situation, you’ll find that humor is one of the most powerful tools to fight off hopelessness. G.K. Chesterton once said, “Angels can fly because they take themselves lightly.” That’s what laughter does. It lightens the burden of suffering. That’s why nurses use comedy skits in small group sessions in inpatient psychiatric units as part of their healing efforts. Humor forces some much-needed space between you and your pain, providing you a truer perspective of your struggle.

Dance in the rain.

Vivian Greene once said, “Life isn’t about waiting for the storm to pass, it’s about learning to dance in the rain.”

When I was first diagnosed with depression, I was sure that the right medication or supplement or acupuncture session would cure my condition. Ten years ago, when nothing seemed to work, I shifted to a philosophy of managing my symptoms versus curing them. Although nothing substantial changed in my recovery, this new attitude made all the difference in the world. I was no longer stuck in the waiting room of my life. I was living to the fullest, as best I could. I was dancing in the rain.

References

Rosmarin, D.H., Bigda-Peyton, J.S., Kertz, S.J., Smith, N., Rauch, S.L., & Björgvinsson, T. (2013). A test of faith in God and treatment: The relationship of belief in God to psychiatric treatment outcomes. Journal of Affective Disorders, 146(3): 441-446. Retrieved from https://www.sciencedirect.com/science/article/pii/S016503271200599X

Hildebrandt, S. (2012, February 6). How stress can cause depression [blog post]. Retrieved from http://sciencenordic.com/how-stress-can-cause-depression

Frankl, V.E. (1959). Man’s Search for Meaning. Cutchogue, NY: Buccaneer Books.

Aron, E. (1996). The Highly Sensitive Person. New York, NY: Carol Publishing.

12 Ways to Keep Going with Depression

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Welcome to the Bipolar Club

This is an interesting article I found on: www.psychcentral.com

See credits below.


One of my best friend’s nephews was recently diagnosed with bipolar disorder. He’d been in mental distress for about a year and was self-medicating, so this didn’t come as a surprise to me. In a way, it was a relief because the kid could finally get the right help he needed. I’ve had bipolar disorder since 1991 (and probably before that.) I told my mother that my friend’s nephew was diagnosed.

“Mom, you know Peter’s nephew, Jonathan?”

“Yes,” she said.

“He was diagnosed bipolar.”

“Oh, no!” she said with a horrified look on her face. I might as well have told her that he’d passed away.

I have to say, her reaction surprised me. I didn’t know that she viewed the disease with the angst that she did. But she’s been the mother of a daughter who’s been bipolar for almost 30 years. In many ways, it must be harder to stand by and watch a close loved one go through the roller coaster of this illness than to have it yourself.

18-year-old Jonathan’s diagnosis was certainly no big deal to me. It wasn’t the deal breaker that it appeared to be for my mother.

My friend Peter called me. “Would you talk to Jonathan?” he asked.

“You mean about bipolar disorder?”

“Yes.”

“Sure.”

“You’re the most successful bipolar person I know.”

“Wow, what an honor!”

“No, truly.”

“Well, thank you.”

“You’re more successful than most people I know, never mind the bipolar.”

What could I say? The illness took its toll in years gone by, but today, I was in recovery, had a job, was raising a child, had a good marriage and a freelance writing career, had great friends. I’d finally come into my own. I guess I was a good role model for a newly diagnosed person.

I planned out what I would say to Jonathan.

  1. Take your medication. If you don’t take your meds daily, your life will be shit. (Sorry, about my language, but there’s no better way to say it.)
  2. See a psychiatrist and a psychologist. The psychiatrist will handle the medication, and the psychologist will talk to you and help you cope with this often debilitating disease.
  3. Be careful whom you tell. Not everyone is comfortable with mental disorder. If you spread the word haphazardly, you might lose friends and keep from making new ones.
  4. Don’t mix street drugs and alcohol with your prescription meds.
  5. Plan for your future. Don’t quit school and lie low for a few months or a year. You might never get up. Dig in and get a degree, then a job, then a place to live, etc.
  6. Be happy that they found out what was making you crazy. You’re one of the lucky ones. There’s nothing worse than undiagnosed severe mental health issues.
  7. Rely on your family and true friends for support.
  8. Exercise, exercise, exercise. (This is something that I need to start doing. I don’t always practice what I preach.)
  9. Believe it or not, this malady will make you a strong, better person.
  10. Sometimes, you’ll feel like giving up. Don’t give up.

The above is a list of ten things I’d like to tell Jonathan, but I could go on and on. I think I’ve covered the major issues.

As far as my mother and her horror of Jonathan’s bipolar diagnosis, I have to realize that, again, she’s been experiencing my pain all through my disease process. Now that I’m in recovery, she can display how she feels about bipolar disorder.

I will do my best to help Jonathan. I’ve been down this road before.

It’s not a road I would have chosen, but it’s my road, the road that has characterized my life.

Welcome to the bipolar club, Jonathan. You’ll be fine. You really will. Don’t let the diagnosis get you down.

Welcome to the Bipolar Club

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The Value of a Relapse

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Utter the seven-letter word relapse in recovery circles and the room grows silent. Why did it happen? How did it happen? How much sobriety did she have? How long did she stay out? If a person had years of sobriety accrued, it is expected that the clock be reset – as if they had never stopped drinking. Call me a rebel, but this is too black and white for my taste. While I realize the need to recognize and commemorate consecutive days of sobriety, recovery from addiction is rarely straightforward or neat. More often than not, it’s a messy, ongoing journey of learning and coping and healing that includes its share of falls. Relapses are a sometimes-necessary part of the adventure. In fact, I’m glad mine happened. Here’s why.

My five-day experiment

The summer before last I experimented with alcohol after 28 years of sobriety. Having quit drinking before I was legal, I always questioned whether or not I was truly an alcoholic. Maybe, I thought, my binge drinking between the ages of 15 and 18 were merely a form of high school rebellion. It seemed a valid question. I couldn’t relate to many of the testimonies in twelve-step group meetings because I hadn’t really lost anything as a result of my drinking, except for some pride after initiating a stupid cat fight under the influence.

One July evening after everyone had gone to bed, I stared at the Heinekens in the fridge. Maybe I am normal, I thought to myself. Maybe I can have the occasional cocktail and join the fun. So with shaking hands, I pulled one out of the fridge, opened the bottle, and reacquainted with my long lost friend.

Nothing terrible happened. I stopped at one. So the next night I tried it again. For the first 48 hours of my experiment it seemed as if I had joined the ranks of the social drinkers. Hallelujah! However, by day three, I began to obsess about my next drink. On day four, I smuggled a six-pack of Coors Light into a park to drink alone. On day five, I considered stopping by the liquor store to buy a bottle of vodka to keep in the trunk … you know, in case I needed a fix.

The next day, by coincidence or divine intervention, a friend who is a recovery alcoholic stopped by the house during his run. He has never done this before or since. I confessed to him the details of what I was up to and he told that he was picking me up for a meeting the next day.

A bathroom break, not a start over

“Is there anyone here with 24 hours of sobriety?” the meeting chair asked at the end. I wasn’t sure whether or not to raise my hand. As the folks in the room saw it, I had about 26 hours of sobriety. However, by my standards, I had been sober 28 years and one day. I went with their math and waltzed sheepishly to the front of the room to claim my chip.

That day was an important milestone for me. I haven’t drank since. However, I wasn’t celebrating a day of sobriety. I was commemorating all the wisdom and perseverance and courage that had kept me sober for over a quarter of a century. All the sweat and hard work of the 28 years of sobriety that preceded my 24-hour chip were on display in that moment. Nothing was lost. I don’t believe a person starts over if they pick up a drink. I view it more like a bathroom break, where you look at yourself in the mirror and ask, “What the hell am I doing?” and then resume your place in line to get a table.

Progress is uneven

Perhaps some people have linear recoveries. They drink. They stop. They find happiness and peace. But I have yet to meet such a person. The recovery patterns for most of us entail a dance of up-and-down movements, right-to-left adjustments, a pirouette and a plié – with the hope that we are moving forward. Much like a walking labyrinth that guides you out before in, recovery is typically more spiral or circular than it is square. Just when we think we’ve encroaching on home base, we are thrown out to left field.

“Progress, not perfection” rings true with all of my addictive behavior. I don’t have to get it down the first time, the second time, or even the 52nd time. Gradual baby steps towards the goal of serenity and peace are enough. On those days when I engage in codependent behavior or reach for something to relieve my pain, I remind myself that it’s not the fall but the rebound that counts. Healing consists of catching myself and trying over and over and over again, sometimes as many as 50 times a day. It’s the journey and effort that matter in recovery, not a perfect score card.

Lessons of a relapse

Relapses teach us invaluable lessons if we are open to learning. For example, before my experiment, I regarded my decision to stop drinking much like I did eliminating gluten and sugar from my diet. My relapse demonstrated the seriousness of addiction, that sobriety is a life-saving action, not a healthy choice. Abstaining from a cocktail isn’t in the same category as foregoing a brownie or piece of bread. For addicts, alcohol hijacks your brain, whispering false promises in your ears. If you’re not careful, the self-destruction can erode all aspects of your life.

My relapse also taught me that abstinence isn’t about willpower and discipline. It has nothing to do with personal character or emotional resilience. Recovery is about humility, about admitting powerlessness and relying on other people and a higher power for strength and guidance. The healing power is found in the shared experience of others, in tapping into a community of support.

The pain underneath the addiction

I dare say that my relapse was life-transforming in that it forced me to discover what was driving the addiction. I began intensive psychotherapy and probed more deeply into every aspect of my life, asking the question, What’s going on here? My soul-searching efforts resulted in a stronger sense of self. As a result I can better identify the pain that makes me susceptible to addictive behavior.

I’m certainly not saying relapse is all good. Some people can’t get clean again after they start drinking or reengage in an addiction. It is a risk, for sure. However, if you are able to end your addiction and return to recovery, relapse can open the door to a better understanding of your addiction and, therefore, to a stronger recovery. I don’t believe you start over if you pick up a drink. I believe you pause and begin again with a new perspective.

The Value of a Relapse

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