Thanksgiving and Gratitude

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Thanksgiving has always been my favorite holiday. I love the simplicity surrounding the  day – it began as a gathering to give thanks for the bounty of the harvest. Today, for many, it has become a day to be thankful for all our blessings.

Sonja Lyubomirsky, the author of The How of Happiness: A New Approach to Getting the Life You Want, says:

“Gratitude is many things to many people. It is wonder; it is appreciation; it is looking on the bright side of a setback; it is fathoming abundance; it is thanking someone in your life; it is thanking God; it is ‘counting blessings.’ It is savoring; it is not taking things for granted; it is coping; it is present-oriented.”

There are real health benefits to expressing gratitude. Lyubomirsky’s research concluded those who are grateful are more likely to be happy, hopeful and energetic as compared to their less grateful counterparts. They also appear to have more positive emotions overall.

So how do we cultivate this gratitude, especially when we are struggling with obsessive-compulsive disorder or other serious health issues? Scores of books and articles have been written on this subject, but maybe taking a look at events surrounding the Thanksgiving holiday can give us some clues:

  • Reaching out to others – As we begin planning for Thanksgiving Day, we decide who to invite: immediate family, good friends, or others who have nowhere to go to celebrate the holiday. Perhaps we remember those who have reached out to us in the past and let them know how much we have appreciated their thoughtfulness.
  • Planning the feast, grocery shop, and cook – This preparation involves mindfulness. Engrossed in the holiday preparation, we are totally focused on NOW and the task at hand, and that can be incredibly calming. An added bonus is when family members join in to help. We spend quality time together, have fun, and create lasting memories.
  • Expressing our thankfulness – Before the meal, many families acknowledge this day of thanks. Some might pray, others might give speeches, or still others might take turns saying what they are grateful for.
  • Watching the children – Joy, hope for the future, and living in the moment (aha, mindfulness!) are just some of the things we experience when we are blessed with little ones at our Thanksgiving table.
  • Giving back – Whether through food drives or volunteering to serve meals at homeless shelters, many of us feel compelled to help others at Thanksgiving.

All such powerful acts of gratitude!

I realize that Thanksgiving  for some families, for whatever reason, is not always a happy time. Families have issues – some more serious than others. But gratitude comes into play in these situations as well. We can acknowledge whatever drama or sadness exists, and still choose to focus on the positive. For example, instead of bemoaning the fact that you have to be in the same room as your horrible brother, be thankful that you still have your horrible brother, and a home where your family can gather.

Whether our lives are negatively affected by OCD or other illnesses or circumstances, it is still possible, and beneficial, to embrace gratitude. Not only on Thanksgiving, but every day of the year.

Wishing everyone who celebrates Thanksgiving a happy, healthy, gratitude-filled holiday!

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Overcoming OCD: A Journey to Recovery – Now Available in Paperback!

I’m happy to announce that the paperback version of Overcoming OCD: A Journey to Recovery has now been released!

You can receive a 30% discount by ordering it directly through Rowman & Littlefield at https://rowman.com/ISBN/9781442239456. Use promotion code RLFANDF30 at checkout for 30% off – this promotion is valid until December 31, 2018. This offer cannot be combined with any other promo or discount offers.

The book can also be ordered through Amazon, Barnes and Noble, Books-A-Million, and other major book retailers.

Another idea: See if it’s available at your local library, and if not, you can ask them to order it! Don’t forget to mention it is published by Rowman & Littlefield, as they are well known in the library circuit.

For those who prefer hardcover books, those are still available as well!

Posted in Mental Health, OCD | Tagged , , , | 8 Comments

The Paperback is Now Available!

I’m happy to announce that the paperback version of Overcoming OCD: A Journey to Recovery has now been released!

You can receive a 30% discount by ordering it directly through Rowman & Littlefield at https://rowman.com/ISBN/9781442239456. Use promotion code RLFANDF30 at checkout for 30% off – this promotion is valid until December 31, 2018. This offer cannot be combined with any other promo or discount offers.

The book can also be ordered through Amazon, Barnes and Noble, Books-A-Million, and other major book retailers.

Another idea: See if it’s available at your local library, and if not, you can ask them to order it! Don’t forget to mention it is published by Rowman & Littlefield, as they are well known in the library circuit.

For those who prefer hardcover books, those are still available as well!

Posted in Mental Health, OCD | Tagged , , , | 2 Comments

OCD and Seasonal Affective Disorder

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Daylight saving time has ended, and winter is in the air. During these darker months, it is estimated that up to five percent of people in the United States suffer from seasonal affective disorder (SAD). SAD is described as follows:

Seasonal affective disorder is characterized by feelings of sadness and depression that occur in the fall or winter months when the temperatures begin to drop and the days grow shorter. The depressive episode is often associated with excessive eating, sleeping, and weight gain. Depressive symptoms begin in the fall or winter and persist until the spring. Women are twice to three times more likely to suffer from the winter blues than men.

Seasonal affective disorder can also impact people during the summer months (“the summer blues”), too, but it is less common. People suffering from SAD either are unable to function or function minimally during the season in which their disorder occurs. Seasonal affective disorder shares several symptoms with other forms of depression including lethargy, sadness, hopelessness, anxiety and social withdrawal.

A recent study published in Psychiatry Research explored the possibility of a connection between obsessive-compulsive disorder and SAD. Study author Oguz Tan and his colleagues at Uskudar University in Turkey referenced past research that indicates the prevalence of OCD is highest in Autumn, and light therapy, which is used to treat SAD, has been shown to benefit some people with OCD. According to the researchers, it has already been established that both SAD and OCD share some of the same underlying neurophysiology involving some type of dysfunction in regards to the neurotransmitter serotonin.

Interesting results of the study include:

  • More than half of patients with OCD have seasonal mood changes
  • Only one-fourth of controls without OCD reported seasonal mood changes
  • The severity of seasonal affective changes does not appear to affect the severity of OCD

Most participants with OCD who reportedly had SAD suffered in the colder months, though there were some subjects who had a more difficult time in warmer weather. For this sub-group of people who had both OCD and SAD, compulsions were also worse during the time of year they were affected by SAD. For those who specifically had SAD during the colder months, the severity of their compulsions directly correlated with the lack of daylight hours.

The scientists have acknowledged that their study has some drawbacks, such as relying on the participant’s self- reporting of OCD and SAD symptoms. They recognize that a better study model might involve measuring people’s OCD symptoms over a longer period of time and noting if and how they fluctuate with the seasons. They believe the connection between SAD and OCD certainly warrants further study, and hope to answer questions such as, “How does SAD affect the prognosis, treatment response, and risk of suicide in those with OCD?”

We already know that OCD is often seen with other conditions, and now we can add SAD to the list. At the very least, it is something to be aware of.

If interested, you can read more details about the study here.

 

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Four Genes Linked to OCD

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Last month (October 2017), a team of researchers from Broad Institute published a study in  Nature Communication which truly delves into the biology of OCD. They used a multispecies comparison between dogs, mice, and humans who suffer from compulsive behavior disorders, and by doing this, were able to identify new genes and biological pathways associated with OCD. The genes in question are involved in synapse maintenance and neurotransmitter signaling, suggesting potential mechanisms at work in the disorder.

Hyun Ji Noh, a postdoctoral associate who led the study, says:

We were seeking ways to take advantage of information from other species in order to inform and focus the study in humans. Each additional species that we looked at gave us more information about possible factors in the brain that contribute to OCD.”

Using genetic associations noted in previous studies of OCD in humans, compulsive behavior in mice, and dogs with canine compulsive disorder, Noh’s team compiled an array of approximately 600 genes that appeared to have some type of connection to OCD. They then designed targeted sequencing panels for these genes and examined them in more than 1,300 cases and 1,600 controls. Their hard work paid off, and the scientists were able to single out four genes expressed in the brain that appear to be involved in OCD in humans. The genes — NRXN1, HTR2A, CTTNBP2, and REEP3, — had variants in either protein-coding or regulatory DNA significantly associated with human OCD. These gene variants disrupt synapse development and also interfere with neural pathways in an area of the brain knows as the cortico-striatal loop, affecting serotonin and glutamate, two terms which are familiar to many with OCD.

The science gets more complicated, and if interested, you can read more details here. But really, what does this actually mean for those with OCD?

Well, the more we know about OCD, the closer we might be to diagnosing it earlier as well as developing new treatment options. While not everyone with mutations in these genes will develop OCD, the researchers believe you are more likely to develop OCD if you do have these gene variations.

And so the exciting research into the mysteries of OCD goes on, and progress, albeit slowly, is being made. I always find it heartening to know there are so many people dedicated to understanding this complex disorder and working hard to help those who are suffering. Not only the research scientists, but also all the dedicated health-care professionals who help those with OCD regain their lives through exposure and response prevention (ERP) therapy.

 

 

 

 

 

 

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Mental Rituals, OCD, and ERP

Five years ago, Seth Gillihan, PhD, wrote a guest post for my blog. Since that time, we have co-authored Overcoming OCD: A Journey to Recovery , and Seth’s own book, Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks: A Workbook for Managing Depression and Anxiety, has been published. Seth continues to work tirelessly in his private practice to help people overcome their OCD. He also has his own blog. His popular guest post resonated with many people, and I think it’s more than worthwhile to publish it once again:

Some of my colleagues and I recently wrote an article about common therapist mistakes in exposure and response prevention (ERP) therapy for OCD. I wanted to highlight one of the sections of that paper that may be helpful to individuals whose compulsions are primarily mental. Mental compulsions typically involve words, phrases, prayers, and so forth that the person says silently in order to prevent a feared outcome, or to reduce the anxiety that the obsession causes (see full article for a list of common mental compulsions). For example, a person might have religious obsessions and may fear that her children will become sick if she has blasphemous thoughts. In response to any blasphemous thoughts or images that come to mind she will repeat to herself a memorized prayer about the greatness of God with requests for protection for her children.

The first step in treating OCD that involves primarily mental rituals is to recognize the familiar cycle of obsessions and compulsions. Just like with observable rituals, mental rituals maintain OCD by providing temporary relief from the OCD-related distress. Some clinicians may fail to identify covert/mental rituals, and people with OCD similarly may have a hard time distinguishing between an obsession and a mental compulsion. When thoughts are coming quickly one after another, some causing distress and some intended to relieve that distress, it can feel like a jumbled mess and the compulsions can be hard to identify. For this reason OCD with mostly or only mental rituals is often mistakenly labeled “Pure Obsessional” (or “Pure-O”) OCD.

The way to tell a mental compulsion from an obsessive thought is to ask what the function of the mental act is: Obsessions increase anxiety whereas mental compulsions are intended to decrease anxiety.

Once a person knows what his or her mental rituals are, it is crucial that the person eliminate them in order to recover from OCD. During ERP the individual must avoid doing mental rituals during exposure—for example, saying ritualized mental prayers to neutralize the fear of harm that comes from doing the exposures.  These kinds of private rituals undermine the exposures and can prevent the person from getting better.

As discussed on an earlier post, ERP for mental rituals requires one to do the opposite of the rituals and allow oneself to have the distressing thoughts like “I’m a devil worshiper,” without any mental rituals to counteract these thoughts. Easier said than done! A lot of the difficulty, of course, comes from the almost automatic nature of the mental rituals; people with OCD often say they do a mental ritual even when they’re trying not to. For this reason the ERP therapist and person with OCD will need to work closely and creatively together to find ways to block the mental rituals.  One solution is for the person with OCD to read out loud material that provokes obsessions (either in vivo or imaginal exposure—see sections 3 and 6 of the article for descriptions of these two techniques) so that the mind is not free to perform mental compulsions. It can also be helpful to say exposure statements to prevent mental compulsions, such as saying “I’m friends with the devil” instead of engaging in a ritualized prayer. Exposure statements should also be used if the person realizes he or she performed a mental ritual—what is often called “spoiling” the ritual.

A final point that we highlight in the article is that it’s usually counterproductive to tell oneself “that’s just my OCD” and similar statements when experiencing an obsession. These kinds of statements play OCD’s game of looking for certainty and trying to find a short-term fix to make obsessions less upsetting. As such, these responses to obsessions often become a ritual, another way to neutralize the anxiety and uncertainty that the obsessions cause. A more effective long-term solution is to answer obsessions with exposure statements that recognize uncertainty: “Maybe I did sell my soul to the devil”; “God might punish me for having that thought.” While I’ve focused here on religious obsessions as an example, these principles apply to any obsessional content.

The bottom line of this discussion is that, contrary to what some people with OCD believe or have heard, ERP can successfully address mental rituals. Armed with knowledge about how to recognize mental compulsions, determination to conquer them, and often with the help of a skilled therapist, individuals with mental compulsions can live more enjoyable and fulfilling lives.

 

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OCD and Computational Psychiatry

There is a relatively new field of research known as computational psychiatry, which focuses on the development of mathematical models to better understand defects in the brain – defects that lead to adverse behaviors.

A new study published in the journal Neuron discusses findings from this type of research into the fundamental processes of OCD. Senior author Benedetto De Martino says:

“Medicine today is very much about decoding the mechanisms in the body. When we are talking about something like a heart valve, that’s a mechanical part that can be clearly understood. But the brain is a computational device that has no mechanical parts, so we need to develop mathematical tools to understand what happens when something goes wrong with a brain computation and generates a disease. This study shows that the actions of people with OCD often don’t take into account what they’ve already learned.”

In other words, what those with OCD know as true does not correlate with how they act.  De Martino uses hand washing as an example. Some people with OCD know their hands are clean, but still they can’t stop washing them. That is a separation of belief and action. It’s interesting to note that the degree of separation between beliefs and actions directly corresponds to the severity of OCD symptoms.

To those of us familiar with obsessive-compulsive disorder, this is not surprising news. We already know that those with OCD are typically aware their compulsions make no sense, but are unable to stop them. De Martino, however, is hopeful that continued studies will be beneficial. He says:

“Just as studying people with lesions in the hippocampus has historically taught us about the inner workings of memory, studying people with OCD can give us new insights into how beliefs and actions are linked.”

Christopher Pittenger, director of the OCD research clinic at Yale University finds the study interesting, but also acknowledges it can be difficult to generalize findings from computerized methodology to the real world. Dr. Pittenger says, “In order to make things trackable, you make them simple.” As we know, the real world is not simple, especially a world with OCD, so it is important to repeat these studies with different types of tasks. You can read here for more details about the study and what tasks were used.

I understand that studying the brain in relation to the disconnect between belief and action has potential value, both in understanding OCD and in treating it. How great it would be if researchers could actually pinpoint the physical cause of OCD and other brain disorders! Still, I have to admit I’ve yet to wrap my head around computational psychiatry for OCD. I think it’s because I’m so used to dealing with the thoughts, feelings, and emotions of those with the disorder, it’s hard to put that all aside and just focus on the science.

The bottom line is we need both – the researchers who work tirelessly to unlock the secrets of obsessive-compulsive disorder, and the professionals, advocates, and loved ones who continue to support those who are truly suffering from the disorder. Together, hopefully, we can beat OCD.

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