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OCD is OCD and content is not important

 

Understanding Obsessions:

OBSESSIONS ARE THOUGHTS THAT ARE.. 

  • Doubt-inducing; What-If thoughts

  • Anxiety provoking

  • Unwanted, upsetting

  • Repetitive

  • “Sticky”

  • Thoughts you don’t want to have

  • Thoughts that you try to ignore or resist

  • Thoughts that make you feel uncomfortable, anxious, or unsafe

 

If you notice your thoughts have any of the above qualifiers, then IGNORE THE CONTENT (the specific thoughts)

Because these thoughts are "what if" OCD thoughts, then content is ego-dystonic, meaning, completely against who you are as a person. These thoughts reveal nothing about you as an individual. At some point, a specific thought was flagged by you as IMPORTANT, and BAD, that a message was then sent to your nervous system to respond accordingly. Your nervous system now responds with fight/flight/freeze because it thinks that these thoughts are emergencies. 

It is important to know that your body is doing NOTHING WRONG. 

Your body is responding in fight/flight/freeze mode because it is supposed to do so for survival, in response to a threat. The problem is not the body's response. The problem is THE SPECIFIC THOUGHT, which  I refer to as a misfire in the brain. 

Once you understanding this about your OCD thoughts, you can start viewing them as white noise, ignore them, and just keep living life. You can also resist the urge to engage in your mental of physical compulsions. Over time, this sequence will result in habituation (decrease in responsiveness), which means that your brain has now learned that these thoughts are not threatening. 

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Facts about Thoughts: 

A mental event/a link between a chemical reaction in the brain and our awareness of it.  A chemical event occurs, something happens, and then we become aware of that thing  and call it a thought.

 

  • The thought itself is nothing more than a word, a mental illustration/picture.

  • There does not have to be value/judgment on any particular thought. 

  • Thoughts come and go

  • Your brain likely generates approximately 6,000 thoughts/day.

  • Thoughts are not actions.

  • Thinking that the mere fact of having a specific thought makes it more likely that the thought will become an action or event or that merely having the thought is the same thing as the thought coming true/event occurring is incorrect.

  • Thoughts are the things you say to yourself or the images you picture in your mind.

  • Thoughts can fuel emotions and emotions can fuel thoughts; however, it Is possible to simply observe/mindfully note the passing by of thoughts and emotions.

  • Thoughts are not right or wrong, good or bad, positive or negative outright.

  • Labels are often assigned/associated with specific thoughts, but thoughts can merely just exist and be let go.

  • Thoughts are not facts

 

Compulsions Are Physical and Mental Behaviors that…

  • Seem urgent

  • Are objectively repetitive and excessive

  • Are performed to get rid of doubt, uncertainty, and associated discomfort

  • Are experienced as outside of a person’s control or contrary to their will

 

 Mental Compulsions:  Special thoughts, sayings, prayers, numbers, images, and other strategies that you perform entirely, or almost entirely in your mind, as opposed to outward behavior, for the sole purpose of counteracting, dismissing, or preventing obsessional thoughts and anxiety.  

Types of Mental Compulsions: 

  1. Mental avoidance/thought suppression:  attempts to suppress a thought you deem not right/wrong (don’t think of the white bear….). Accepting the presence of thoughts is an important part of recovery.  Letting go of thinking is not the same as actively making the thought go away or pushing it away.

  2. Thought neutralizing: trying to counter a negative/uncomfortable/undesired/feared thought or event with something that you think will offset how horrible/terrifying/despicable/uncomfortable/wrong/inappropriate you perceive the original thought or behavior to be.  Example: you had a random flash/picture/thought of pedophilia or hurting someone. You think this is so horrific (because it is contrary to who you are), that you then engage in compulsive praying, confessions, etc. 

  3. Counting:  Where one feels the need to count to keep something bad from happening, or it can be used as a form of compulsive avoidance, such as when one counts to distract oneself from the presence of other unwanted thoughts.  The compulsion is done in the hope that the obsession/intrusive thought or urge were not going on, rather than accept that the obsession/intrusive thought or urge is occurring. 

  4. Tracing/Tracking (like in contamination ocd; you track someone walking into your house with their shoes to keep track of all of the dirt/contamination)

  5. Mental review: Playing a scenario, event, conversation, etc in your mind, over and over again to check if you did/said something just right, did something wrong, hurt someone, did something inappropriate, etc. 

  6. Emotional checking : checking for confirmation that you love your partner, particularly preset in relationship OCD. 

  7. Self-or Other Reassurance:  Seeking reassurance from self, others, the internet, etc, to elicit commentary that you are safe, that you would never act on the obsessions/thoughts. 

  8. Excessive Checking: Checking of self or others to ensure you did not act on an obsession, or that the obsession came true.  

  9. Confessing: Confessing thoughts, urges, or perceived impulses to harm self or others. Confessing to others your obsessions, because they are intolerable to you, to make sure you don't act on obsessions, etc. 

  10. Mental Analysis: Analyzing why you would never act on the obsessions or urges

  11. Rumination/worry:  Engaging in a repetitive negative thought process that loops continuously in the mind without end or completion. The pattern can be distressing, difficult to stop, and usually involves repeating a negative thought or trying to solve an evasive problem. It can look like worrying about a future event, replaying a past scenario or trying to predict how something will play out. Sometimes it’s just turning the same thought in circles without much variation. Rumination often consumes a lot of time and emotional energy.  People who ruminate will often report that they do not realize they are doing so until a considerable amount of time has passed, and they are uncomfortably far down the rabbit’s hole.

  12. Mental rehearsal:  Involves replaying invented visions of the future, in an attempt to check for the likelihood of catastrophe.  This can also be referred to reverse ruminating, where the focus is entirely on the future, such as an upcoming performance, encounter, interview, or other event that could go terribly wrong. This often is confused with preparing, but is better described as compulsively going over and over something that has yet to happen, in an attempt to relieve discomfort about what could happen. The hope here, is that an individual engaging in this compulsion will achieve certainty that the future event goes precisely as desired, rather than accepting that the future may bring any number of things to the present to be dealt with.  

  13. Memory hoarding: To over-attend to the details of an event, person, or object in an attempt to mentally store it for safekeeping.  The person engaging in this compulsion likely believes that there is special significance to an event/person/object, and therefore, must be recalled/remembered EXACTLY AS IS at a later date. The uncertainty surrounding whether or not he/she/they will be able to adequately reflect upon and evaluate the significance of specific events/people/objects, cause discomfort, which is likely avoided at all cost. 

  14. Compulsive prayer: Saying prayers over and over in your head or out-loud a certain number of times or in a special way. Or saying prayers to "clean" your mind from your "bad" thoughts/obsessions. 

  15. Scenario twisting: Also known as Theorizing or hypothesizing combines reviewing and checking by first replaying an event that did take place and then adding a hypothetical element of the event that could have happened, but did not take place.  Afterwards, an individual may then proceed to analyze how he/she/they would have responded/behaved if the feared scenario had taken place.  The hope is that one will experience certainty that the obsession/urges are not acted upon. 

  16. Mental Rituals: Rituals that include trying  to figure out with certainty if you did, could, or would act on the obsession. 

 

Best Treatment for OCD is Exposure Response Prevention (ERP)

Modified applications of EMDR can also be used

Note: This Clinician is trained in BOTH treatment approaches

  • Exposure Response Prevention (ERP)  involves being exposed to your feared stimuli, while resisting the urge and impulse to engage in a compulsive mental or physical behavior. The goal of repeatedly doing this is to teach your brain that the thought that had been highlighted in the past as very important and significant, is in fact just a thought, and no behavior is needed to address it.

  • Exposure can include but is not limited to the following: imaginal, in-vivo, narrative, written

My Approach to OCD: 

Involves: 

  • Exposure Response Prevention (ERP) + Mindfulness based cognitive behavioral therapy + Self-Compassion

  • ERP can seem very scary for someone with OCD, but it does not have to be

  • You and I can work together to develop a fear hierarchy of all of your feared stimuli/obsessions, and assign a distress value (Subjective Units of Distress/SUD) to each one. In doing this, we will learn which obsessions result in the highest amount of stress, such as a SUD of a 10. 

Treatment will consist of :

1. Learning about what OCD is, including learning to tell the difference between thoughts, feelings, and behaviors.

2. Learning to relate to your physical symptoms in a new way, where you no longer are afraid of your racing heart beat, sweaty palms, troubles with breathing, etc. 

3. We will identify cognitive distortions (thinking errors), such as cognitive fusion, which means you experience a belief that the mere existence of a specific thought alone will result in the thought becoming true in reality. 

4. We will learn about mindful attitudes, such as acceptance, non-judging, and letting go, to best prepare you for experiencing an obsession and tolerating the distress of not engaging in a compulsive mental or physical behavior.

5. My primary job at the beginning of treatment is helping you develop the following skills: Self compassion, mindful observation, objectivity, distress tolerance, affect regulation, and impulse control.

 

6. I will collaborate with you on choosing targets for exposure, using your fear hierarchy.  We will not start our first exposure on something that causes a SUD of 10. Our goal will be to work our way up to a 10.

Working along the hierarchy will help you establish trust in yourself and trust in the process. 

 

At this time, my specialty is the treatment of HARM OCD

On Violent Thoughts: 

Violent thoughts are events that occur in the mind, not bad choices you are making with bad intentions.

 

•Understanding that we do not control what thoughts we are aware of in any given moment allows us to view thoughts with more freedom and less judgment.

•Since we can’t pick and choose our thoughts, we are allowed to observe them in different ways without self-blame. In other words, we are not required to actually hate all violent thoughts in order to be nonviolent, moral people.

  

Hershfield MFT, Jon . Overcoming Harm OCD (Mindfulness and CBT Tools for Coping with Unwanted Violent Thoughts) (p. 20). New Harbinger Publications. Kindle Edition.

 
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