OCD and Distraction

musical notesThis post originally appeared July 15, 2013….

I’ve previously written about my son’s stay at a world-renowned residential treatment program for obsessive-compulsive disorder. After being there for nine weeks, we felt it was time for Dan to come home and prepare to go back to college. He was reluctant to leave the program as well as the staff with whom he’d grown so close, and they encouraged him to stay. Dan kept saying to us, “If I go back to school, I won’t have time to concentrate on my OCD!” Even back then, this rationale made no sense to me. No time to concentrate on your OCD? Wouldn’t that be a good thing? While he was mainly referring to having time to work toward recovery, he also thought this recovery had to be the main focus of his life. My husband and I, on the other hand, believed he needed to get out of the treatment center and back to his life, as scary as that might be. He needed to interact with his friends, engross himself in his studies, reconnect with his family, resume old hobbies and explore new passions. In short, he needed to get back to living a full life, which would help distract him from his OCD.

In this context, I believe distractions are good. But are they always beneficial when dealing with OCD? I don’t think so. Distraction, like avoidance, might become a type of compulsion, a way to counteract the anxiety and fear stemming from an obsession. Indeed, many well-meaning people, including some therapists, encourage the use of distraction by saying things like, “Just think of something else.” For example, if you are dealing with a harm obsession, just switch your thoughts to cuddly kittens or puppies (oh, if only it were that easy to “switch our thoughts”), or perhaps distract yourself through an activity, like listening to your favorite music. Anything to get your mind off that tormenting obsession. Unfortunately, these distractions will offer only temporary relief, at best, and the obsessions will likely return, stronger than ever. Those who are familiar with Exposure and Response Prevention (ERP) Therapy will realize this use of distractions is counter-productive. What OCD sufferers really need to do is to not distract themselves from the anxiety, but to allow themselves to feel it, in all its intensity. In that way it is a true exposure.

So it seems to me there are different types of distraction. Living life to the fullest can provide what I call proactive distractions. Keeping busy takes Dan’s focus off OCD and allows him to enjoy his life. He’s not giving OCD any more of his time than he has to. This is a good thing. But a distraction that’s a direct response to an obsession is what I call a reactive distraction. It is similar to a compulsion in that it reduces anxiety in the moment, but ultimately allows OCD to strengthen.

The same activity might be a proactive or reactive distraction, depending on the circumstances. For example, Dan loves listening to all kinds of music, and he does this regularly for enjoyment. To me, this is proactive distraction. My guess is there were times, when his OCD was more active, that he’d listen to music  in an attempt to suppress the anxiety caused by his obsessions. This would be what I call reactive distraction. Not so good.

I’d love to hear your thoughts on OCD and distraction. As we know, OCD is complicated, and understanding all the issues that surround it isn’t easy. But that’s not to say we can’t keep trying! The more we can decipher OCD’s tricky ways, the better position we’ll all be in to fight it.

Posted in Mental Health, OCD | Tagged , , , , , , , | 10 Comments

OCD and Confessing

by stuart miles freedigitalphotos.net

by stuart miles freedigitalphotos.net

I’ve previously written about my son Dan’s need to apologize. This need was in fact a compulsion – a roundabout way of seeking reassurance. It worked for a long time, until I finally realized I was enabling him by telling him he had nothing to apologize for. OCD sure can be tricky!

Another compulsion that is not uncommon in those with obsessive-compulsive disorder is the need to confess. If your OCD involves harming obsessions, you might confess these thoughts to your sister, who has asked you to babysit your niece and nephew. Maybe she shouldn’t leave her children alone with you? If you had a tickle in your throat while buying cookies at a bakery for said niece and nephew, you might confess that maybe you were sick and you might have possibly touched the cookies, and so maybe the children shouldn’t eat the possibly contaminated cookies.

Confessions related to OCD can run the gamut from something as minor as confessing to ignoring an acquaintance on the street to something as major as confessing that maybe you committed murder by hitting someone with your car while driving. Not only is OCD tricky, but it also has quite the imagination!

So why do those with OCD often feel the need to confess? It is because confessing is just another way to seek reassurance. Just think of what our typical responses might be:

“Of course you can stay with the kids. I know you would never hurt them. And they can eat the cookies too; nobody will get sick.”

“Everyone avoids people now and then. You have nothing to feel badly about.”

“Hit someone while driving? C’mon, you know that’s not true. You would know if you hit someone.”

Those are good responses, right? Well, no. Not when you are dealing with someone with OCD. When we reassure, we strengthen the vicious cycle of obsessions and compulsions.

Those with OCD who have made the above confessions (or any confessions for that matter) are looking to relieve the heavy guilt they feel. For example, someone with OCD might think: “If the children get sick after eating the cookies I brought, it’s not my fault. I warned them.” But alleviating guilt will not help those with OCD in the long run. There are always more feelings of guilt just around the corner.

As with all compulsions in OCD, reassurance seeking also aims to erase any doubt the person with OCD might feel: “She’s right. Of course I would know if I killed someone with my car.” The problem here is the idea of certainty, of no doubt, is elusive and unattainable. There is very little we can be certain of in our world. Those with the disorder have to not only accept, but also embrace, living with uncertainty.

As I mention in this post, OCD can be tricky, and it can have a wild imagination. But it’s not smarter than us. Understanding the role confessions play in perpetuating OCD and then working toward not engaging in this compulsion brings us one step closer to recovery.

 

 

Posted in Mental Health, OCD | Tagged , , , , , , | 7 Comments

A Mother’s Day Post

mom and babyI shared this post last year on Mother’s Day…….

If you ask mothers what they want for their children, most would say, “I just want them to be healthy and happy.”  Truly, isn’t that what we all want?

And so we do everything in our power to make this wish come true. We love, we nurture, we make sacrifices, and we go to the ends of the earth to try to achieve this goal for our children: to be healthy and happy.

But sometimes we come up short. Because as much as we like to think otherwise, so much of life is out of our control. Sometimes our children aren’t happy, and sometimes they are not healthy. And sometimes, as hard as we may try, there is nothing we can do to make things better for them. Whatever type of illness they are suffering from, all we want is for them to be okay.

We are in our own little club, we mothers. I don’t know about you, but anytime I hear a story of sorrow on the news, or read of tragedy in the newspaper, I rarely think of the victim. Instead my first thought is always, “That poor mother.”  Because there is no stronger emotion than the love of a mother for her child, we feel deeply when other mothers are suffering.

And so on this Mother’s Day my wish is for all mothers out there to have happy and healthy children. And if  that’s not where you’re at right now, I wish you the strength to carry on toward that goal.

Posted in Mental Health, OCD | Tagged , , , | 6 Comments

OCD and Procrastination

by stuart miles freedigitalphotos.net

by stuart miles freedigitalphotos.net

When my son Dan’s obsessive-compulsive disorder was at its worst, he would spend hours at a time doing nothing (except obsessing and ritualizing of course), even though he so wanted to successfully complete his freshman year of college. It was frustrating and heartbreaking for me to watch. Why couldn’t he just do his work?

Procrastination in those with OCD is not unusual, and  my guess is there are many reasons why this is true. For Dan at this time, OCD was definitely calling the shots, telling him when and where he could or could not do his schoolwork. Also he is a perfectionist, which is a common trait for those with OCD. But he was dealing with unhealthy perfectionism characterized by fear, doubt, and control. It’s not hard to see how this could lead to procrastination. Mistakes were not an option, and the only way to not make mistakes is to just put off doing the task, or worse, not attempt it at all.

Ahh, avoidance.

Avoidance can be seen as a compulsion in OCD. Someone with OCD might avoid a potentially triggering situation, or at the very least, procrastinate as long as possible until the inevitable must be faced.

Perhaps another reason for procrastination is that many people with OCD have a propensity toward indecision. It is so important to make the right decision that it’s just easier to procrastinate, or even not make any decision at all, which of course brings us back to avoidance.

So how can those with obsessive-compulsive disorder stop procrastinating?

Obviously, getting the right treatment for OCD should help immensely, and is the most important step you can take. Another strategy involves using a timer to inform you it’s time to make a decision or start a task. Or if you are facing a particularly daunting undertaking, you can use a timer and tell yourself you only have to work for ten minutes to start, and then take it from there. You might find that once you’ve started, the task at hand is not nearly as difficult or frightening as you had anticipated. Scheduling a specific date and/or time on the calendar can also be helpful for those who procrastinate. And how about making a list, perhaps even including exactly when something should be done? Many of us love the feeling of crossing things off our lists. All of these suggestions help take the thinking, or ruminating, out of the equation, as timing has been predetermined.

Procrastination wastes precious time that should be spent living the lives we want for ourselves. Of course we all procrastinate now and then, but if it is affecting your life significantly, I hope you’ll get help. We all deserve to be able to live full lives – now, not later.

 

 

Posted in Mental Health, OCD | Tagged , , , , , , , | 9 Comments

After Residential Treatment

by digitalart freedigitalphotos.net

by digitalart freedigitalphotos.net

My son Dan spent nine weeks at a residential treatment program for OCD. When my husband and I decided it was time for him to come home, I was ambivalent to say the least. As I said in my book:

On one hand I was thrilled he’d be home in five days, and on the other hand I was terrified he’d be home in five days.

Many people who attend residential treatment programs for OCD are there because their OCD has become so unbearable that they feel they have no other choice. They are severely debilitated. As I’ve said many times before, Dan entered the residential program in the worst condition of his life. But he wasn’t the only one affected; our whole family also suffered.

Though my husband and I had our share of complaints about the program Dan was attending, there is no question the staff there knew how to treat OCD. In nine weeks Dan went from a young man who could barely function to someone who, for the most part, was able to manage his OCD and was eager to return to his life – the one he had before OCD took over.

But it’s so scary. And not only for the person with OCD. As family members we vividly remember the horror of what life was like before residential treatment. Yes, we can see our loved ones have made strides in treatment, and they do seem so much better, and sure they’ve gone “off-campus” to do all sorts of exposures, and it’s clear they now understand their OCD better than ever….

BUT…what if when they come out of their somewhat sheltered environment and into the real world, they end up back where they started? That is the thought that kept me up nights as we counted the days to Dan’s termination. Perhaps this concern was particularly relevant to us as we decided to remove Dan from the program against the recommendations of his team there. Still, I believe this is a common fear, not only for loved ones, but for the person with OCD who is leaving a safe, supportive environment and venturing back out into the world.

Of course there are things we can, and should, do to maximize the chance of a smooth transition. We can have good health-care providers in place, ready to continue ERP therapy. We can be vigilant about not enabling our loved ones and be sure to keep the lines of communication open. We can remain optimistic and confident that OCD can be beaten, even when dealing with some regression. We can maintain our senses of humor. And we can trust that those who have just gone through this intensive treatment will be better equipped than ever to handle whatever comes their way.

But still….what if?

It didn’t take me long to realize I needed to accept, and even embrace, the uncertainty of the situation, and of life. Sound familiar? This is exactly what Dan learned to do as part of his therapy – those with OCD struggle with the need for certainty, which is simply not attainable.

In Dan’s case, there were indeed many ups and downs once he left residential treatment, but we, like most people, were able to put aside the “what ifs” and deal with everything that came our way, until our son finally beat OCD. If our family could do it, yours can too.

Posted in Mental Health, OCD | Tagged , , , , , , , , | 12 Comments

OCD and Chemical Imbalance

pillsWhile the cause of obsessive-compulsive disorder is not actually known, many professionals and lay people often attribute the disorder to a chemical imbalance. SSRIs, which are medications that affect serotonin, are known to reduce symptoms in a good number of people with OCD. So it is reasonable to deduce that serotonin levels in those with OCD must be out of whack, right?

Well, not necessarily. That explanation is way too easy, and certainly has never been proven. Drugs often help people with all types of illnesses, but how and why they help is not always clear.  And I’m not just talking about medications for brain disorders. There are a number of cholesterol medications, blood pressure medications, anxiety-reducing  medications, rheumatoid arthritis medications – just to name a few – that work to reduce symptoms. Different drugs work for different people, and we don’t always know why. Why does acetaminophen help my husband’s headache but only ibuprofen works for me?

But really, what’s the big deal if we just use an easy explanation of “chemical imbalance” when discussing the cause of OCD, even if it’s just a theory?

Well, for one thing, if those with obsessive-compulsive disorder, or their loved ones, believe their OCD is caused by a chemical imbalance, how will they feel if medication fails to correct this supposed imbalance? Depressed? Confused? Hopeless?

And if we believe that treating OCD is as easy as raising our serotonin levels, we might just be lured into the many scams out there promising a quick fix for OCD. Raise your serotonin levels and be free of OCD ! Ah, if only it were that easy!

As imaging technology advances (PET Scans for example) and more research is conducted, we are discovering that nothing is simple when it comes to OCD. Studies have shown that those with OCD have elevated brain activity in parts of the frontal lobes (particularly the orbital cortex) and the basal ganglia. This is important information that, on the one hand, brings us closer to understanding OCD and its causes, and on the other hand, raises even more questions. Throw in the fact that genetics and environment have been shown to play a big role in the development of OCD, and it is now easier to see how we can’t just attribute the disorder to a chemical imbalance.

So where does that leave us? Well, thankfully, we do not have to fully understand the cause of obsessive-compulsive disorder to treat it effectively. Exposure and response prevention (ERP) therapy, the evidence-based Cognitive Behavioral Therapy used to treat OCD, works. It literally saved my son’s life. So while the experts are busy at work trying to decipher what actually causes OCD, those who live with the disorder can commit themselves wholeheartedly to ERP therapy. Because one thing we do know is that OCD, no matter how severe, is treatable and can be beaten.

Posted in Mental Health, OCD | Tagged , , , , , , , , | 4 Comments

“Just Right” OCD

by jackthumm freedigitalphotos.net

by jackthumm freedigitalphotos.net

 

If you or a loved one has obsessive-compulsive disorder, you know that OCD typically attacks what matters the most to you – your values.

Is a loving relationship the most important thing in your life? OCD will make you question it. Working toward the career of your dreams? OCD might tell you it’s not for you or there’s no way you’ll be successful. Wouldn’t hurt a fly? OCD will try to convince you you’re a danger to others. In my son Dan’s case, OCD stole his joy, his art, and everything else he held dear.

And just when you think you’ve beaten OCD in one area, it shows up in another. I’ve often heard people compare obsessive-compulsive disorder to that whack-a-mole game found in arcades. You whack one mole only to be have another one pop right up. It never ends.

While most people with OCD might be nodding their heads now in understanding, not everyone’s OCD works this way. Those who deal with “just right OCD” experience thoughts and feelings that something is “just not right,” or is incomplete. While on the surface it might look similar to other forms of OCD, its symptoms are more likely to be driven by a vague discomfort or tension rather than the attack on values and ensuing anxiety as described above.

Let’s take the classic example of someone with OCD who washes his or her hands compulsively. In many cases, this compulsion stems from fear of contamination. Perhaps the person with OCD thinks he will spread germs to others or make himself sick if he doesn’t wash, wash, wash. This fear of illness or of causing harm to loved ones is the impetus for the hand-washing compulsion.

Those with “just right OCD” might present with the same hand-washing compulsion, but their obsessions are not related to contamination. Because they are grappling with strong feelings of incompleteness, people with this type of OCD feel compelled to wash their hands until this sense of incompleteness resolves and  everything feels “just right.”

It is interesting to note that those who deal with “just right OCD” are more likely than others with OCD to have a co-morbid condition such as tic disorder. In fact, it can often be difficult to differentiate between “just right OCD” and tics, so a good therapist is a must in getting a correct diagnosis and treatment. Also, not surprisingly, perfectionism and general inflexibility are also often associated with this type of OCD. For more info about “just right OCD” I recommend checking out this IOCDF fact sheet.

So how is “just right OCD” treated? You guessed it. The same way as all types of OCD – with exposure and response prevention (ERP) therapy. While there are many subtypes of OCD, and the disorder can morph from one type to another (remember our whack-a-mole analogy), the bottom line is OCD is OCD. All  kinds of OCD are fueled by doubt and uncertainty, and all OCD sufferers get caught up in the vicious cycle of obsessions and compulsions. But the good news is that, with the help of a good OCD therapist, all types of OCD are also treatable.

 

 

Posted in Mental Health, OCD | Tagged , , , , , , , , | 10 Comments