2017 OCD Conference

Another year, another amazing OCD conference.  I am always so proud to be a part of this wonderful community.  This year I was fortunate to be the affiliate representative for OCD North Carolina and, for the third consecutive year, I facilitated a support group for parents of adult children suffering with OCD.  As usual, I am floored by the resiliency of the OCD sufferers that I meet and inspired by the dedication of the researchers and clinicians who work tirelessly towards better treatment outcomes.  

OCD Walk 2017

Come on down to Duke University's East Campus for the 2017 OCD Walk on June 10th 2017 at 9:30am.  As part of the IOCDF 1 Million Steps 4 OCD walk, OCD North Carolina will be hosting the very first awareness walk to take place in NC.  We have organized four walks - the Triangle, the Triad, Wilmington, and Asheville - over the course of two weekends.  We are really excited to build community, spread awareness, and raise money for an awesome cause!

To register or donate, please go to the link below:

https://www.crowdrise.com/OCDNorthCarolinaWalkinNCTriangle

Self-Control

 Click the image to read "Self-Control Is Just Empathy With Your Future Self" in The Atlantic.

Click the image to read "Self-Control Is Just Empathy With Your Future Self" in The Atlantic.

Researchers at the University of Zurich have found that a part of our brain - the right temporoparietal junction - is not only responsible for empathy, but also has a role in modulating self-control.   

"Empathy depends on your ability to overcome your own perspective, appreciate someone else’s, and step into their shoes. Self-control is essentially the same skill, except that those other shoes belong to your future self—a removed and hypothetical entity who might as well be a different person. So think of self-control as a kind of temporal selflessness. It’s Present You taking a hit to help out Future You."

I imagine that this could potentially have some interesting clinical implications.  For example, if we engage in activities that might foster empathy - such as volunteering or immersing ourselves in different cultures - might that also help to enhance self-control?  If we work on being compassionate to others, will we then have a greater ability to treat our future-selves with that same kindness?  It will be interesting to see the future directions of this research.  

OCD & Hockey

Hockey fans will know that one of the most exciting moments in a game of hockey comes at the end of the game, with one team hopelessly trailing.  In the expiring moments of the game, the trailing team will often pull their goalie.  It's a huge risk - the goal is undefended - but at this moment of the game, there is nothing to lose.  The trailing team will not win by playing defense; they must play offense.  And so, they bring an additional player onto offense and hope against hope that they can score (this does actually work, by the way).  

OCD hopes that you never think to pull the goalie.  It depends on you always playing defense - responding to fear, discomfort, uncertainty.  OCD says 'jump' and you oblige.  As long as you play by these rules, you can never win.  The odds are always, always in favor of OCD.  If you want the odds back in your favor, you have to pull the goalie and go on offense.  When OCD says "your hands are dirty", you don't wash them; you get them dirtier.  The risk is greater; it's scarier.  But we know exactly what happens when you play by OCD's rules.  If you choose to go on offense, you give yourself a shot.

"Just Relax..."

 Click the image to read "Relax! You'll Be More Productive" by Tony Schwartz.  

Click the image to read "Relax! You'll Be More Productive" by Tony Schwartz.  

When it comes to anxiety, the well-intentioned advice to "just relax" often falls quite short.  It's not that simple.  This article provides some more tangible ideas that may help to curtail perfectionism and anxiety.  The over-arching idea: less can sometimes be more.  Counterintuitively, the best results can sometimes be found, not by constantly working, but by taking care of yourself and allowing some time to relax.  Carving out time to exercise, sleep, take breaks, and even vacation can all lead to increased productivity.

 

OCD and Why “Normal” Doesn’t Matter

It seems that a week doesn’t go by without hearing one of these phrases (or some similar variation) from my clients:

My mom said that she would shower after being in a crowded bar, too.
My friend said that it’s normal to double-check that the car is locked.
My girlfriend told me that she would also be grossed out by touching a toilet seat.

These kinds of phrases can serve many functions.  They can be hopeful pleas to avoid adding yet another behavior to the long list of compulsions to be targeted in treatment.  Or perhaps they are a furtive attempt to engage in a compulsion under the guise of something else, a sneaky tactic employed by a sufferer who is not yet ready to confront OCD.  Maybe these phrases are the work of the OCD itself – convincing the sufferer that they should bend to its wishes without delay. Or maybe, they are a last-ditch effort to find some semblance of normalcy in an otherwise chaotic and uncertain world.  Perhaps they are even accurate assessments of what an ‘average’ person might do.  

When my clients bring one of these phrases into session, I invariably offer the same response: I don’t care. It doesn’t matter.  

These are words that are not heard too frequently in therapists’ offices (hopefully), but in this particular instance, I stand by them and believe them.  It’s not that I don’t care about the client or empathize with the distress that they find themselves in; it’s simply that the concept of “normal” is utterly irrelevant to the treatment of their OCD.  

Do individuals with OCD engage in behaviors that might be considered abnormal or excessive? Of course. In fact, behaviors which are “clearly excessive” are described in the DSM-V diagnostic criteria under its definition of the term compulsion.

But here’s the real question: is excessiveness (or normality) the sole component to determining if a particular behavior is compulsive? Absolutely not.

But here’s the real question: is excessiveness (or normality) the sole component to determining if a particular behavior is compulsive? Absolutely not.  

The DSM-V offers some additional guidelines under its diagnostic criteria, one of them being that compulsions “are aimed at preventing or reducing anxiety or distress”. That is to say that it is not simply the frequency with which someone engages in a behavior, but also the function of the behavior itself. Is that behavior a means of modulating an unwanted emotion? Does it reduce anxiety? Does it prevent a person from having to experience anxiety? If you can answer yes to these questions, you have yourself a compulsion.  

Let’s revisit the toilet seat example above.  As a practitioner who guides clients through Exposure and Response Prevention, I have a certain familiarity with toilets.  For those unacquainted with this treatment modality, ERP is an evidence-based practice which falls under the umbrella of Cognitive Behavioral Therapy (CBT).  It is a process by which individuals with OCD expose themselves to triggers, evoke anxiety, and then practice allowing that anxiety to run its course without altering it in any way.  By doing this, we allow our brain to have a corrective experience, showing our brain that it does not need to do anything (read: compulsions not necessary!) in order to get through the experience of anxiety. For individuals with contamination obsessions, I often find myself in the bathroom touching toilets.  Let’s ponder a few questions:

Do I enjoy touching toilets?  No.
Is rubbing a toilet and then rubbing my clothing and body a “normal” thing to do?  I don’t think so.  
Would I rather not be touching a toilet?  Yeah, probably.  
Does this experience spike my anxiety?  NO.  

Aha!  This is the important part!  It doesn’t matter if your friend, your mom, or everyone on your basketball team avoids touching toilets.  Chances are, these people are not touching toilets because it’s maybe a little unpleasant or because they have no reason to rub all over a toilet (unless your friend is an OCD therapist)…but if you have OCD and your anxiety is the reason for your avoidance – that’s a compulsion.  It does not matter if the behavior is considered normal or abnormal; if the function of the behavior is to reduce or prevent anxiety, that is a compulsion.  If you are an OCD sufferer, your barometer of compulsive behavior is not normality or the behavior of others, but rather, the barometer is your anxiety itself.  If you’re truly interested in stamping out your OCD symptoms, forget ‘normal’ and let your anxiety be your guide.

It’s Not What You Know

Several years ago, my father-in-law approached me with a proposition: he needed a companion to knock off an item from his bucket list. This particular item was his greatest fear and was something that he felt strongly about conquering in his lifetime. Knowing that it was something I had done once before, he felt I would be a good candidate to provide some support.

Much to my wife’s chagrin, her father and I decided to jump out of a plane together on a sunny morning in May 2010. This being a somewhat momentous occasion, we splurged for the additional documentation – there are pictures and video of the whole ordeal.  In the years following this experience, one of those pictures has always stood out to me.

All novice skydivers are required to begin with a tandem jump; that is, an experienced skydiver is strapped to your back.  In one particular picture, there is a stark contrast between my face and the face of the instructor.  On my face: sheer terror.  On his: indifference.  

  On my face: sheer terror.  On his: indifference.  

On my face: sheer terror.  On his: indifference.  

Let’s think about why this difference might exist; why two people jumping out of an airplane might have such differing responses.  Being afraid of falling from 14,000 feet seems like a perfectly reasonable fear, and yet, my cohort was able to do so with minimal ostensible fear.  What could I have done differently that might have yielded different, calmer results?

Our brain is programmed to activate our fight/flight response when it determines that there might be danger...In order to reprogram this response and to eliminate these false alarms, it is necessary to give our brains a corrective experience; that is, to show it (not just tell it) that we’re okay.

One of the most common interventions that I see when people try to combat fear is an effort to rationalize. Many people believe that, by using logic, reasoning, statistics, etc., they will be able to cast off some irrational fear and begin anew, with clear, fresh, anxiety-less perspective.  Countless air travelers have, no doubt, been reminded of the relative safety of air travel as compared with car travel… and yet fears of flying persist while millions of motorists drive in cars without a second thought.  In 1975, beaches across the country were full of swimmers terrified of an imminent shark attack, as portrayed in Jaws, despite the statistical rarity of such occurrences.  And of course, the knowledge that the risk of death in any given skydive is a minute 1 in 100,000 does absolutely nothing to ameliorate the fear that accompanies a skydive.  Why is that?  Well, it’s because the difference between me and the other skydiver is not what we know; it’s what we’ve done.  

Our brain is programmed to activate our fight/flight response (also known as anxiety or fear) when it determines that there might be danger.  Sometimes this response is activated too easily or in times when no real threat is present.  In order to reprogram this response and to eliminate these false alarms, it is necessary to give our brains a corrective experience; that is, to show it (not just tell it) that we’re okay. This particular part of our brain is not especially concerned with statistics or rationality; instead, it learns through experience. This is why professional skydivers, after thousands of jumps, extinguish much of the initial fear that accompanies jumping out of plane.  This is why flight attendants who ride airplanes daily, are non-plussed when the plane hits a patch of turbulence.  And this why the bulk of us get in our cars every day without fear, despite the statistical risk that accompanies it.  

It’s hard to leave this habit behind. In most instances, our ability to rationalize is adaptive.  It helps us to make sense of the world and to calculate the best paths in our day-to-day lives.  When it comes to irrational fear and anxiety, we’re better off forgetting these habits and instead, focusing on providing our brain with the experience it needs to make the appropriate tweaks.  Our brains are incredibly adaptive and they can learn a lot when we give them the opportunities that they need.  So the next time you feel that twinge of anxiety, leave the rationalization and reassurance behind; instead, take a risk and give your brain a corrective experience.