OCD, Motivation, and Self-Efficacy

by nitinut freedigitalphotos.net

by nitinut freedigitalphotos.net

Whether we have obsessive-compulsive disorder or not, I think most of us can relate to lacking motivation at times. We are tired, it’s just easier “not to______”(fill in your own blank), we are going to fail anyway, we don’t see the point. We just aren’t motivated to do what we need to do.

In the context of OCD, motivation is likely one of the most deciding factors in overcoming the disorder. Asking for help isn’t always easy, and ERP therapy is hard work. If you’re not motivated, you’re unlikely to be successful, and OCD will continue to rule your life. I’ve written before about recovery avoidance and the role incentives and motivation play in fighting OCD.

In this wonderful blog post (which I highly recommend) titled Self-Efficacy: Turning Doubt into Drive, Anna Cutteridge discusses how those who possess self-efficacy are more likely to be self-motivated in the face of a challenge. She says:

With high self-efficacy, one can attempt goals and conquer stress more readily, and as a result, experience better wellbeing. On the contrary, those who have doubts about their own abilities ruminate on personal flaws, slacken efforts and lose faith in the face of failure – a mind-set that in the long run can act as a brake on one’s ambitions and increase proneness to mental illness. Continue reading

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OCD – Where Does It Come From?

by master isolated images freedigitalphotos.net

by master isolated images freedigitalphotos.net

When my son Dan was first diagnosed (at age seventeen) with obsessive-compulsive disorder, I wanted to learn everything I could about the illness. I also wanted to figure out why Dan developed it. How did he “get” OCD? Is it genetic? Did something trigger its appearance? Was it my fault? Why him and not me?

I remember asking his various treatment providers at the time if a particular event could have triggered Dan’s OCD. Three different health-care providers responded with a resounding, “No.”

I wasn’t convinced. In my mind, OCD made its entrance shortly after a freak accident in which Dan’s friend got hurt. To me, the events were too closely linked to be a coincidence.

In the ten years since I questioned Dan’s treatment providers I have heard many OCD specialists acknowledge the fact that OCD can appear after a particularly traumatic or stressful event. I’m not sure if this is a revised way of thinking, or if Dan’s earlier health-care providers just didn’t know of the connection.

Even more convincing are the testimonies I’ve heard from those who either have OCD or are close to someone with the disorder:

“My son developed OCD right after the death of his beloved grandfather.”

“My best friend died in a car crash and by the next week, I had full-blown OCD.”

“My parents got divorced a few months before I started college far away from home. OCD quickly followed.”

I want to make it clear that I am in no way suggesting that these events caused any individual’s obsessive-compulsive disorder. Certainly many people experience events even more tragic than those mentioned above, and never develop OCD. The general consensus is that if a person has a predisposition to OCD, it is possible that its onset can be triggered by a particular event, usually one that is somewhat traumatic in nature. Of course, what is traumatic to one person isn’t necessarily traumatic to someone else. If you ask an expert about the origins of OCD, you will likely be told that it’s a “combination of genetics and environment.” Recent research supports this theory.

While there is currently no cure for OCD, the disorder is treatable. So does it really matter that there is still so much we don’t know about obsessive-compulsive disorder?

I do think it matters, and I’m thankful for all the researchers out there who work hard to uncover the mysteries of OCD. While genetic components have been identified, and we know OCD often runs in families, we are still far from fully understanding this strange and insidious diosrder. With knowledge and understanding come power, and my hope is that someday in the near future, we will know everything there is to know about OCD, and a cure will quickly follow.

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OCD Studies, Projects, and Hope

by stuart miles freedigitalphotos.net

by stuart miles freedigitalphotos.net

This week is OCD Awareness Week 2016 and you can check out the various activities and events going on here.

Thankfully, there are a lot of people and organizations that work tirelessly, every day of the year, to help those with obsessive-compulsive disorder. Below are a few examples of studies and projects happening now – please check them out as there might be something that could directly benefit you or a loved one.

Firstly…..You might remember that last year, I posted about a study being conducted by Jenna Feldman, a doctoral candidate in Clinical Psychology at Yeshiva University. Jenna is now involved in a different study about OCD and is looking for some help. If you’re interested, check out the information below:

Online Survey about Childhood Experiences and OCD

Please help us with a research survey about OCD treatment and enter a raffle for a $50 giftcard!

If you are an adult (age >18) and suffer from the symptoms of OCD you are invited to complete an online survey about your symptoms as well as certain childhood experiences that some people have. This study is being conducted by the Ferkauf Graduate School of Psychology at Yeshiva University. If you consent to participate in this study you will complete a series of anonymous questionnaires that ask you questions about your childhood experiences and emotions. The survey should take approximately 45 minutes to complete. If you elect to participate you will have the option to be entered into a raffle for one of four $50 gift cards. To learn more about the study please follow the link below:


Secondly…..Please check out UNSTUCK, which has received amazing reviews so far. From their website:

UNSTUCK: An OCD Kids Movie shines a spotlight on kids 6-13 and shows them for what they truly are: OCD experts. The children featured in the film will serve as smart, positive role models offering information and hope to other children dealing with OCD, as well as to their families and communities.

The filmmakers are trying to represent a diverse group of children in the film. If you, or someone you know, has a child under the age of 13 who is African American, Latino, Native American or Asian and has struggled with OCD, please contact Kelly or Chris via their website. In particular they are looking for children who have had some success fighting OCD and can share their knowledge about what OCD is and how to fight it.

And last but not least…..An update from the Pediatric Anxiety and Mood Research Clinic (PAMRC) at the Columbia University Medical Center (CUMC)/New York State Psychiatric Institute:

Our clinic is currently offering treatment for children, adolescents and young adults with obsessive compulsive disorder at no cost through our research treatment program.

Novel Antibiotic Treatment Study (ages 8-20 years)

This NIMH-funded research study assesses the efficacy of minocycline (an FDA-approved antibiotic) for youth who are diagnosed with OCD and who remain symptomatic after an adequate trial of an antidepressant medication. The study will also involve MRS brain scans before and after treatment to assess treatment-related changes in glutamate levels. Our team provides a full diagnostic evaluation and psychiatric care throughout the study.

Ketamine Treatment Study (ages 14-20 years)

This research study aims to determine whether treatment with a low dose of the anesthetic ketamine can rapidly reduce OCD symptoms in adolescents and young adults who remain symptomatic after adequate trials of antidepressant medications and a course of CBT. Eligible participants will receive a full diagnostic evaluation, a one-time low dose of intravenous ketamine, and close monitoring for two weeks following the infusion.

CBT Treatment & Imaging Study (ages 5-17 years)

This research study offers a comprehensive diagnostic evaluation and a full course of CBT to unmedicated children and adolescents with OCD. The study includes MRI scans before and after treatment to assess the function and structure of overlapping neural circuits that support cognitive processes.

Our clinic also offers up to three months of follow-up care (including medication and CBT for OCD) at no cost after participating in one of our OCD treatment studies. For more information, please contact Dylan Braun at 646-774-5793 or braundy@nyspi.columbia.edu.

Thanks once again to all who dedicate themselves to helping those with obsessive-compulsive disorder. You provide those who are suffering with what is needed most –  HOPE!



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When Instincts are Wrong

by stuart miles freedigitalphotos.net

by stuart miles freedigitalphotos.net

This week I’m sharing a post from 2011 (wow, I’ve been blogging a long time!):

I’ve mentioned in at least a couple of my posts that you should trust your instincts when helping a loved one deal with obsessive-compulsive disorder.

Turns out that’s not always true – especially when dealing with family accommodation.

Family accommodation refers to a family member’s participation or assistance in the rituals of their relative with OCD. Some common examples of family accommodation  include reassuring (continually answering questions like, “Will I be okay if I do this or don’t do that?”), altering a family’s plans or routines, and giving in to your loved one’s OCD related requests. By accommodating in these ways, we are basically adding fuel to the fire. While we might help reduce our loved one’s anxiety in the short-term, we are, in the long-term, prolonging the vicious cycle of OCD. Many studies, including this one, conclude that more family accommodation leads to more severe cases of OCD, and more distress among families.

My family and I were as guilty as can be when it came to accommodating, especially before our son Dan began proper treatment. This is where the instincts came in. As a mother, I just wanted to make everything all right and relieve my child’s pain. That was my instinct. So if Dan wanted to sit in a certain seat or eat only peanut butter and jelly sandwiches at midnight, I let him. What harm could it do? Turns out – plenty. By allowing these rituals to continue, I was validating his irrational thoughts, lowering my expectations of him, and giving him no incentive whatsoever to fight his OCD.

A light bulb moment occurred when my husband spent an afternoon shouting basketball scores to Dan in another room because Dan’s OCD would not allow him to view the television. It was at this point that we realized what we were doing was wrong and it was time to go against our instincts. “You want to know the score, Dan?  Then come watch the game!”  was the assertion that began our conscious attempt not to willingly accommodate him. I say “willingly” because it was often hard to know what was OCD related and what wasn’t. When Dan wanted to do errands at  1:00 PM instead of 11:00 AM, was it really because he was busy, or was that just what his OCD was dictating at the time?

We’ll probably never know how much we unknowingly accommodated our son. But it wasn’t a problem for too long. Once Dan began his intensive ERP Therapy and understood more what needed to be done to free himself of OCD’s grip, he made sure to let us know whenever we were inadvertently accommodating him. We worked as a team (though all the very hard work was his) to beat his OCD.

Posted in Mental Health, OCD | Tagged , , , , , | 13 Comments

Anxiety – Avoid or Accept?

by stuart miles freedigitalphotos.net

by stuart miles freedigitalphotos.net

According to the Anxiety and Depression Association of America, 40 million adults in the United States over the age of 18 suffer from an anxiety disorder, making it the most common brain disorder in our country.

Who among us hasn’t dealt with anxiety? While experiencing anxiety certainly doesn’t mean we have an anxiety disorder, most of us know what anxiety feels like. Symptoms vary but often include sweating, racing or unwanted thoughts, palpitations, and a sense of impending doom. Some people think they’re having a heart attack or might actually believe they are dying. It’s a truly horrible sensation and many of us will do whatever we can to avoid feeling anxious.

Maybe that’s the problem.

People are not wired to be happy and carefree all of the time. If we are lucky, we feel that way some of the time, but being human means we will also experience sadness, fear, and yes, anxiety. It is important to note that while feeling anxious is unpleasant, to say the least, it is not dangerous or harmful to us. It is indeed a normal part of life. While anxiety-provoking situations have no doubt evolved over the years (perhaps we now fear a terrorist attack more than a bear attack), our body’s response has not changed.

So instead of trying to rid ourselves of anxiety, perhaps we need to just accept the fact that we will feel anxious at times. When those sensations of anxiety wash over us, we need to allow them in and not fear them or fight them. I know it’s often easier said than done, but with practice, it can be achieved.

Those with obsessive-compulsive disorder might notice a correlation between accepting anxiety and the best way to deal with obsessions. For those with OCD, obsessions are so upsetting that the person experiencing them will do anything to get rid of them. Enter compulsions, which are performed to relieve the distress caused by obsessions. But those who understand their OCD realize that trying to stop thinking about their obsessions, or warding them off with compulsions, only makes the disorder stronger in the long run.

So what is the best way to deal with OCD? Not surprisingly, the same way we should deal with anxiety. Face it head on. Proper treatment for OCD involves noticing and accepting whatever thoughts, feelings, or impulses come your way, and not engaging in compulsions. A good therapist trained in ERP therapy can help.

While we are not able to control how we feel, we can choose how we react to our feelings. Accepting them instead of avoiding them, I believe, will go a long way toward achieving good mental health.



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

Is Thinking about Compulsions a Compulsion?

by FrameAngel freedigitalphotos.net

by FrameAngel freedigitalphotos.net

I corresponded with a young woman with obsessive-compulsive disorder who had participated in exposure and response prevention (ERP) therapy and made some major improvements in dealing with her OCD. However, she still struggled at times and wasn’t quite where she wanted to be – like many with OCD, she was a work in progress.

She had an upcoming vacation planned with her serious boyfriend and was determined that her OCD would not ruin this special time they had planned together. She would not avoid people, places, or things that might make her anxious, she would not apologize for no good reason, and she would not ask for reassurance of any kind from her boyfriend. In short, she was determined to not engage in any compulsions during their vacation. Things would be perfect and she’d have a great time.

My first thought was, “How impressive!” She was doing everything she could to resist her compulsions. But as we communicated more, it seemed to me that perhaps she had become obsessed with not doing her compulsions. And to quell this obsession, she would continuously monitor herself to make sure she wasn’t engaging in any compulsions. Could this check on compulsions actually be a compulsion?

If you’ve lost me, I’m sure you’re not the only one. To say OCD can be confusing is an understatement to say the least.

As it turns out, this woman’s vacation didn’t turn out too well, as she found herself unable to stop focusing on not performing compulsions. Her plan had backfired. Her anxiety skyrocketed, and was not able to enjoy her vacation. Sigh. OCD at its finest (she said sarcastically).

So, what should she have done? As someone without OCD, it’s easy for me to say, “She just should have relaxed, enjoyed the moment, and not been so hard on herself.”  But I know that’s often easier said than done. Still, accepting the fact that she is indeed human, and will slip up here and there as we all do, might have made for a better time.

I don’t believe any of us are perfect, and if we focus on perfection, we are bound to be disappointed. Doing the best we can at any given moment, being mindful and present, is all we can really ask of ourselves. And when the mistakes happen? Well, we can acknowledge and accept them, strive to do better, be kind to ourselves, and move on to the next moment. Otherwise we are just letting OCD win.








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OCD and Cognitive Behavioral Therapy for Insomnia (CBT-I)

by stuart miles freedigitalphotos.net

by stuart miles freedigitalphotos.net

Sleep is often a big issue for those with obsessive-compulsive disorder. In fact, in over five-and-a-half years of blogging, my most viewed post, by far, is OCD and Sleep.

OCD has the potential to complicate anything, and sleeping is no exception. While most of us, with and without OCD, can relate to bouts of insomnia, sometimes issues with sleep can be directly related to obsessive-compulsive disorder.

For example, someone with OCD might be terrified of sleeping because they are convinced they will die in their sleep. So they force themselves to stay awake. Or perhaps there is an obsession directly related to one’s bed or bedroom. When my son Dan’s OCD was severe and he was away at college, he was not able to touch his mattress and therefore couldn’t sleep on his bed. To this day, I don’t know where, how, or if, he slept at night.

If sleep issues are indeed directly related to OCD, then exposure and response prevention (ERP) therapy, the Cognitive Behavioral Therapy (CBT) used to treat OCD, can definitely help.

However, if someone with OCD has sleep problems that are not directly related to their disorder, then ERP is not the way to go; CBT-I is.

Cognitive Behavioral Therapy for Insomnia (CBT-I) , like other forms of CBT, addresses your thoughts and beliefs (which might be flawed), and helps you appropriately change your behavior. Some areas that CBT-I  specifically focuses on include what to do when you can’t sleep, what you do while you’re in bed, sleep restriction, and changing how you think about sleep. After learning about CBT-I many people are surprised that what they’ve done in the past to try to help themselves sleep might actually have made things worse. For example, “sleeping in” to try to catch up on sleep is not generally beneficial, but getting up at the same time every morning is.

Not surprisingly, when we sleep better, we feel better. Any of us who has experienced chronic insomnia knows how sleep deprivation can exacerbate other medical conditions we might be dealing with. OCD is no exception, and I have heard from so many people who state their OCD flares up when they are very tired.

According to Michael Perlis, Ph.D., an associate professor of psychiatry and director of the behavioral sleep medicine program at the University of Pennsylvania School of Medicine, “…treating insomnia concurrently with comorbid psychiatric disorders not only will improve sleep, but also may have a halo effect on those disorders.”

So a by-product of a good night’s sleep just might be milder OCD.

A discussion of sleep and OCD wouldn’t be complete without addressing the fact that some medications commonly used by those with OCD (such as SSRIs) might cause sleep problems. These might be remedied by simply changing the timing of when the medications are taken, or perhaps a change in medication is warranted. This issue,of course, should be discussed with your health-care providers.

For those who battle obsessive-compulsive disorder (indeed for all of us) a healthy lifestyle can result in many benefits. And an important component of a healthy lifestyle is a good night’s sleep. If you suffer from insomnia not directly related to OCD, I highly recommend looking into CBT-I.

Sweet Dreams!


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