Can We Decide Not to Worry?

close-up of woman

This post first appeared on my blog in September 2013……

I was an anxious child and an anxious teenager. After I graduated high school, I distinctly remember saying to myself, “Enough worrying. You’re going to college. Relax and have a good time.” And I did. I didn’t worry about my grades (a big worry in high school even though my grades were great) or my social life, or anything for that matter. I didn’t slack off; I just didn’t worry. It’s amazing, now that I think of it. How is it that I could stop worrying so easily?

My worrying and anxiety came back with a vengeance after going through a difficult time, and learning a tough lesson. Bad things, horrible things, really do happen randomly, for no obvious reasons. The world is a dangerous place where things can go wrong, and so much is out of our control. And of course at that point in m y life I didn’t just worry about myself, but also my children, my husband, my entire family and my friends. So much stuff and so many people to worry about! When there was a lull in the action, when there was nothing pressing for me to worry about, I worried that there was nothing to worry about. Seriously. I’d get an unsettled feeling and would actually search for things to agonize over. It’s what my brain had become used to – what it craved.

Blogging about OCD and learning more about anxiety and neuroplasticity have helped me through my own journey with anxiety. Over the past years I have again chosen not to worry. It hasn’t been as easy as it was when I was in college, but I’m trying, and it works, most of the time.

Now I’m not for a minute suggesting those with obsessive-compulsive disorder can just decide not to worry. I don’t have OCD, and I know the severity of the worst anxiety I’ve felt is nowhere near what those with OCD experience routinely. What I am saying is it is possible to change the way we think. If I can do it, others can too. Some people can do it on their own, and others might need help. If you have OCD, working with an OCD specialist using exposure and response prevention (ERP) therapy can help retrain your brain. It’s not easy; in fact it can be extremely difficult. But the hard work is worth it and the payoff is huge: less worry, and freedom from OCD.

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OCD, DBS, and Diabetes

brainAs many of us are aware, a good number of scientific findings, such as the discovery of penicillin, have been made by accident.

Well here’s another one to add to the list.

A May 23, 2018 article published in the journal Science Translational Medicine reports a surprising side effect of deep brain stimulation (DBS), which is sometimes used in the hardest to treat cases of OCD. It was observed that an obese man with type 2 diabetes underwent DBS for OCD, and his blood sugar levels improved to the extent that his daily insulin requirements decreased by approximately 80%.

To research further, scientists recruited 14 people who had OCD and had undergone DBS. These study participants did not have type 2 diabetes. The researchers found that the DBS therapy affected the subjects’ insulin sensitivity, and turning the brain stimulators off and on made the levels rise and fall. The metabolic function of the study participants was better when the brain stimulators were turned on, as opposed to when they were turned off.

So what is happening here? Researchers believe that a boost in the activity of dopamine (a neurotransmitter involved in DBS) not only quiets OCD but also improves the body’s ability to process sugar. It is interesting to note that when we eat a lot of sugar, our dopamine levels increase as well.

Previous studies in mice have shown that dopamine released by neurons in the same general decision-making region the researchers stimulated—called the ventral striatum—plays a key role in regulating glucose throughout the body. As part of the research discussed above, the scientists also used optogenetics to stimulate striatal neurons in mice. As the neural cells released more dopamine, the rate at which other cells absorbed glucose from the rodents’ blood picked up.

Whether these findings actually lead to using DBS as a treatment for diabetes remains to be seen. Perhaps future research might lead to even less invasive procedures that target dopamine.

While I wouldn’t say that OCD and diabetes go hand-in hand, I am personally aware of quite a few people, including children, who have both illnesses, and scientists have recognized a connection between diabetes and anxiety disorders.

Sometimes studies raise more questions instead of providing us with easy answers. More research is needed to understand the connection, if any, between OCD and diabetes, so that we can figure out the best way to help those who suffer from these often-debilitating disorders.





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OCD and Psychosis

exhausted (2)

by graur codrin

A version of this post first appeared on my blog in September 2013….

When my son Dan’s obsessive-compulsive disorder became severe, he was in college, fifteen hundred miles away from home. We arranged for him to see a psychiatrist near his school, who called us (with our son’s permission) after he met with Dan. He certainly didn’t sugarcoat anything. “Your son is suffering from severe OCD, and he is borderline psychotic.”

I knew very little about OCD at that time, but I knew what psychotic meant: out of touch with reality. I was terrified. Psychosis made me think of schizophrenia, though that illness was never mentioned. In fact, after I united with Dan and we met with the psychiatrist together, there was no more reference to psychosis.

So what was going on? A post on Psychiatric Times discusses the fact that OCD with poor insight should not be mistaken for a primary psychotic disorder, and a thorough history of the patient is warranted. There is also a good deal of discussion in the article regarding medication, because antipsychotics which are often prescribed in these cases have been known to induce and/or exacerbate symptoms of OCD. In addition, research has shown that these antipsychotics often do not help those with severe OCD who are dealing with poor insight, or borderline psychosis.

The DSM-5 states that OCD may be seen with: good or fair insight, poor insight, or absent insight/delusional beliefs. While many people with OCD realize their obsessions and compulsions are irrational or illogical, this is not always the case. When Dan was first diagnosed with OCD, he did indeed have good insight. But by the time he met with this psychiatrist his OCD had gotten so bad that he was at the point of borderline psychosis. At least at that moment. It should be noted that the insight of those with OCD into their disorder can fluctuate. For example, while calmly discussing a particular obsession and compulsion, people with OCD might realize their thoughts and behaviors are unreasonable. But when they are panic-stricken and in the middle of what they perceive as danger, they might totally believe what they had previously described as nonsensical.

So did Dan have something else going on aside from OCD? Thankfully, no. Once his OCD was treated, any possible issues related to psychosis resolved. This scenario reminds me of his misdiagnosis of ADHD. The same thing happened: When his OCD was treated, his symptoms that had been attributed to ADHD also disappeared.

Certainly there are lessons to be learned from Dan’s experiences. Things are not always what they seem. And in the case of brain disorders, where we’ve categorized certain behaviors as belonging to specific illnesses, we really need to be careful not to jump to conclusions in reference to diagnoses and subsequent treatments. In the case of obsessive-compulsive disorder, maybe the best way to proceed is by treating the OCD first, and then reassessing the situation. Once OCD has been reined in, we might be surprised to find that symptoms typically associated with other disorders have fallen by the wayside as well.




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A Review of Cognitive Behavioral Therapy Made Simple

If you’ve read my book, Overcoming OCD: A Journey to Recovery, you likely remember the clear, concise text boxes written by Seth Gillihan, PhD. At the time, one of the reasons I chose to work with Seth was because of his natural ability to convey often-complicated information in an easy-to-understand manner. He did this without “talking down” to the reader – on the contrary, I think readers felt as if they were having a conversation with a caring friend.

Well, Seth has done it again – for a third time I should say. His successful book Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks was published in October 2016 and his third book, Cognitive Behavioral Therapy Made Simple, is now available.

I’ve read the book and it is everything I expected and more. Seth clearly explains the intricacies of Cognitive Behavioral Therapy (CBT) and how we can all utilize this therapy to help ourselves, no matter what life throws at us. I love how Seth uses real-life examples throughout the book to make these concepts easily relatable. My favorite chapter is “Work Through Worry, Fear, and Anxiety,” and I also appreciate his attention to Mindfulness.

Perhaps the best window into Cognitive Behavioral Therapy Made Simple is through Seth’s own words in the book’s introduction:

Over the past two decades as a student, researcher, therapist, and supervisor, two things have stood out to me about effective treatments. Number one, they’re simple: Do enjoyable activities. Think helpful thoughts. Face your fears. Be present. Take care of yourself. None of these approaches is shocking or complicated. I’ve strived to capture that simplicity in the chapters ahead. When we’re struggling, we typically don’t have the time, desire, or energy to wade through page after page of research findings or study a treatise on the esoteric nuances in the field. We need straightforward options we can use right away.

Number two, they’re not easy. I’ve learned that despite the simplicity of these effective treatments, they still require work. It’s hard to do more of what you love when you’re depressed and unmotivated, hard to face your fears when you’re fighting back panic, hard to train an overactive mind to rest in the moment. That’s where you’ll find the power in CBT—to provide not just a goal to work toward, but manageable techniques and a systematic plan to get you there.

I highly recommend Cognitive Behavioral Therapy Made Simple to all those who are not living the lives they desire due to worry, fear, anxiety or anger. This book, and Seth, will help you move forward – step by step.



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OCD and Death

darknessAs some of us know, obsessive-compulsive disorder can take on many shapes and forms, limited only by the imagination of the person with OCD. In general, OCD likes to attack whatever it is we most value: our families, relationships, morals, accomplishments, etc. In short – our lives.

So it shouldn’t come as a big surprise that some people with OCD are obsessed with death. What better way for OCD to attack what is most important to us than telling us our lives are all for naught as we’re just going to die anyway?

It is not unusual for people to think about death. Personally, the thought comes into my mind often. At times it hits me like a ton of bricks that my time here on earth is limited, and this realization brings up various philosophical questions: What’s the meaning of life? Am I living my life the way I should, or want? Will it even matter that I was here? Is there life, or anything, after death? The list goes on.

I don’t have OCD so I’m usually able to let it all go after a few minutes. I realize the questions I have, for the most part, are unanswerable. I accept the uncertainty and go on with my life. For those with obsessive-compulsive disorder, however, obsessing about death can be torturous. People with OCD can easily spend hours upon hours a day obsessing over various aspects of death and dying, asking the same existential questions mentioned above, and then some. But they don’t stop there. They want answers to these questions and might analyze and research them – again for hours and hours. They might also seek reassurance, either from themselves, clergy, or anyone who will listen. It’s not hard to see that these obsessions and compulsions can literally take up an entire day and overtake lives. It is not uncommon to experience general anxiety as well as depression when dealing with OCD related to death.

So how is this OCD treated? You guessed it – exposure and response prevention (ERP) therapy. While we can’t control our thoughts about death, we can learn how to better react to these thoughts. Exposures might include those with OCD deliberately subjecting themselves to the thoughts they fear, typically through the use of imaginal exposures, while response prevention involves not avoiding or trying to escape these fears, but rather embracing the possibility they will occur. No seeking reassurance. No analyzing, researching or questioning these thoughts – just acceptance of them. In short, ERP therapy consists of doing the opposite of what OCD demands. In time, these thoughts that previously had caused so much distress will not only lose their power, but also their hold on the person with OCD.

Time and time again, we see how OCD tries to steal what is most important to us. Ironically, those caught in the vicious cycle of obsessions and compulsions related to death and dying are robbed of living their lives to the fullest. Thankfully, there is good treatment to help those with OCD learn to live in the present moment and work toward the lives they deserve.



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A Mother’s Day Post

mom and babyOn Mother’s Day I often share this post that I wrote in 2011….

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?

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 might 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 and courage to carry on toward that goal.

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OCD and Perfectionism

 A version of this post first appeared in August 2013:

by stuart miles

Is it a good thing to be a perfectionist? To answer this question, it’s important to understand the difference between adaptive and maladaptive perfectionism. This brief article defines these two types of perfectionism:

Adaptive/Healthy Perfectionism

This type of perfectionism is characterized by high standards of yourself as well as others, persistence in the face of adversity, and conscientiousness. Healthy perfectionism usually goes along with goal-directed behavior and good organizational skills.

Maladaptive/Unhealthy Perfectionism

This type of perfectionism is characterized by excessive preoccupation with past mistakes, fears about making new mistakes, doubts about whether you are doing something correctly and being heavily invested in the high expectations of others, such as parents or employers. An excessive preoccupation with control is also a hallmark feature of maladaptive/unhealthy perfectionism.

Hmm. Fear. Doubt. Control. All symptoms of maladaptive/unhealthy perfectionism. Sound familiar? It’s hard to have a conversation about OCD without including those three words; they are the cornerstones of OCD. It’s not surprising then, that many people who have OCD are also perfectionists. For the purpose of this discussion, the term perfectionist refers to unhealthy perfectionism.

When my son Dan’s OCD was severe, mistakes were not allowed. Procrastinating with schoolwork became the norm and then morphed into him only being able to work at a specific time of day.  He then became tied to the clock for all activities of daily living.  Fear. Doubt. Control. Perfectionism and OCD rolled into one. So many compulsions in OCD are wrapped up in perfectionism. Some people need to reread paragraphs, sentences, or words over and over again to make sure they get it right. Shutting off the stove must be done properly, checking the door lock, or checking anything for that matter, are all compulsions that need to be done perfectly. The list goes on.

Of course, the problem is perfection doesn’t exist, and so those struggling with OCD can never be certain they reread the paragraph correctly, or performed any compulsion perfectly.  Just as the need for control in OCD leads to a life that is out of control, the quest for perfection leads to a life not lived to its greatest potential.

I think most people would agree there is nothing wrong with wanting to excel, and striving to be the best person you can be. That’s different from being perfect. Perfection is an unattainable goal for all of us, as is certainty. A good therapist who knows how to treat OCD will also know how to deal with matters surrounding perfectionism. Those suffering from both issues can learn to accept the imperfection and uncertainty that surrounds us. Indeed, this is something we all need to do to live happy, fulfilling lives.

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