Seven million children and adults in the United States
suffer from Obsessive Compulsive Disorder.
Don’t suffer in silence.
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Photo Credit: Katvan Studios
Music Score: Sharon Roffman
PSA: Terry Murphy
By Dr. Cynthia Chapman, Carlsbad, California
There are a number of things that make us humans vulnerable to anxiety and worry. But one of the common attitudes among people who deal with anxiety is having a need for certainty.
It is almost as though we are requiring 100 percent certainty that we will encounter zero risk. Well, this is just too much to ask out of life. People with anxiety, phobias, and panic ask questions such as, Can I know for certain I won’t have panic symptoms when I go to that job interview? Can I know for sure that I won’t have to leave if I do go to the interview? Can I know for certain that I won’t feel trapped? Can I know for sure that I won’t cause an embarrassing scene?
If the theory that some people’s brains causes them to feel a strong and inappropriate need for certainty is true, then tackling this problem involves changing those demanding thoughts. So, that means you work to find a way to accept the outcome that you fear. When you have faced this scenario in the past you have probably tried to reassure yourself or get reassurance from someone else. The problem with that is that it’s helpful for about 5 seconds. No amount of reassurance will ever be enough because you still don’t know for certain that whatever you fear is not going to occur. So that nagging anxiety voice will continue to haunt you.
The attitude to aim for instead is, I can tolerate uncertainty. Examples include: “I accept the possibility of a panic attack/plane crash/making a wrong decision, etc., happening.”
For a fear of leaving a situation, you might say to yourself, “I accept the possibility that I might have to leave the restaurant. I imagine that I might feel embarrassed but I’m willing to tolerate that now.”
In the case of fear of a plane crash, you could say, “I accept the possibility that this plane could crash. I’m going to act, think, and feel as if this plane is 100% safe. I accept the risk that I could be wrong.”
Lastly, in the case of fear of a wrong decision, “I accept the possibility that this may not be a perfect decision and I will deal with the consequences that come with it. Yet, I have made a thoughtful decision weighing all the information that I have at this time and therefore making the best decision I’m capable of. I accept and can tolerate that I may be wrong.”
The bottom line is this: When you accept the possibility of a negative outcome, you avoid the need for absolute certainty for your future safety either physically or psychologically. Your responsibility is to lower your risk of problems as much as makes common sense but then to accept the remaining risk that is not under your control.
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Comment from Lori: This difficulty with uncertainty is especially challenging for those with OCD. As Dr. Chapman noted, reassurance seeking or other attempts to gain certainty are only momentarily helpful; and they can perpetuate the vicious cycle of OCD.
Rachael Hatton, Marriage and Family Therapist Intern
New treatment groups for adult OCD, teen OCD, adult trichotillomania, and adult hoarding are now forming in San Diego. These groups will be led by Rachael Hatton, MFTI, under Lori’s supervision. Rachael is a behavioral therapist specializing in treating OCD and related disorders.
The cost includes one individual intake session and 12 weekly group sessions.
To learn more or register, contact Rachael at rmzhatton@yahoo.com or Lori at llrwalker@sbcglobal.net.
Rachael has a master’s degree in Human Development and Family Studies with an emphasis in Marriage and Family Therapy from the University of Connecticut and a bachelor’s degree in Psychology from the University of California San Diego. Learn more about Rachael at www.rhattontherapy.com.
For many years, Obsessive Compulsive Disorder (OCD) was thought to be an exceptionally problematic disorder to treat, and was often misdiagnosed. Traditional psychoanalysis consistently had little impact on the disorder, and other psychotherapies were equally unsuccessful.
However, over the past fifteen years, developments in Cognitive-Behavioral Therapy (CBT) have resulted in a treatment protocol that is especially beneficial for individuals with OCD. In fact, numerous clinical studies conducted over the past fifteen years have conclusively found that CBT, either with or without medication, is dramatically superior to all other forms of treatment for OCD.
Compared to traditional psychotherapy, in which sessions are spent merely discussing the client’s problems, CBT is far more proactive. Working together, both the client and the therapist take active roles in assessing the problem, and in devising concrete, active steps towards alleviating the symptoms.
Using the Yale-Brown Obsessive Compulsive Scale (YBOCS) and numerous other assessment tools, the therapist helps the client create a detailed list of his or her symptoms. This symptom list is then used as the primary tool in a form of CBT called “Exposure and Response Prevention” (ERP), or “exposure therapy.”
Using the symptom list, the client experiments during therapy sessions with exposure to his or her fears, starting with the least anxiety-provoking items from the symptom list. Regular “homework” assignments are given so that the client can continue to challenge symptoms between therapy sessions.
These homework assignments are specifically designed for each individual client, and are an essential part of treating OCD, OC Spectrum Disorders, and related anxiety disorders. They are particularly valuable in helping clients challenge certain symptoms that occur at home, at work, or at school, and that cannot easily be duplicated in the therapy office.
Additionally, a variant of ERP, sometimes called “imaginal exposure,” is frequently used in the treatment of OCD, OC Spectrum Disorders, and related anxiety disorders.
Imaginal exposure involves using short stories based on the client’s obsessions. These stories are audiotaped and then used as ERP tools, allowing the client to experience exposure to their fearful thoughts.
This form of exposure is particularly beneficial for obsessions that cannot be experienced through traditional ERP (e.g., killing one’s spouse or molesting a child). When combined with standard ERP, and other cognitive-behavioral techniques, this type of imaginal exposure can help to greatly reduce the frequency and magnitude of these intrusive obsessions, as well as the individual’s sensitivity to unwanted thoughts and mental images.
Following a structured CBT protocol, the client gradually challenges all of his or her symptoms, and learns new, more productive methods of coping with anxiety. Over time, the individual becomes de-sensitized to previously anxiety-provoking situations and thoughts, and the obsessions and compulsions are eliminated, or significantly reduced in frequency and magnitude.
Using this treatment approach, most clients make dramatic improvement by meeting with their therapist on a weekly basis over a period of just four to six months, followed by two or three “booster sessions.”
After a short time, many clients also become involved in an ongoing weekly OCD therapy/support group. Some clients may also benefit by having a small number of family or couples therapy sessions to address the impact OCD is having on their relationships.
A minority of clients may require a more intensive approach that includes two to three sessions per week or even home visits.
Some individuals with OCD, OC Spectrum Disorders, or related anxiety disorders may also benefit from combining CBT with one or more medications that are sometimes prescribed for these conditions. The goal of medication, or “pharmacotherapy,” is to reduce obsessional anxiety, thereby increasing the individual’s ability to utilize and benefit from CBT.
This is particularly helpful with clients for whom the prospect of exposure therapy is so anxiety-provoking that they are initially unwilling to try CBT. For these individuals, after the medication has begun to reduce their obsessions, it is recommended that they complete a regimen of CBT while continuing the pharmacotherapy.
Medication may also be beneficial for individuals experiencing depression, which is sometimes present in those with OCD and related disorders, or with other psychiatric conditions. But it is important to stress that CBT is the primary treatment for OCD.
Numerous research studies completed over the past fifteen years have concluded that CBT is the most effective treatment for OCD. In fact, in 1997, the Journal of Clinical Psychiatry surveyed over sixty OCD researchers and treatment specialists from across the world in order to determine the best treatment for OCD.
The resulting publication, entitled Expert Consensus Treatment for Obsessive-Compulsive Disorder, described CBT as “the psychotherapeutic treatment of choice for children, adolescents and adults with OCD” and noted that it is “the key element of treatment.”
Despite this endorsement, many clients are tempted to rely on medication alone. But four facts provide a compelling case against the “medication-only” route.
First, analyses of numerous studies comparing CBT and pharmacotherapy have concluded that CBT is more effective in both the short and long-term.
Second, the potential short-term side-effects of these medications are well-documented and include anxiety, insomnia, nausea, diarrhea, difficulty concentrating, and sexual dysfunction. Conversely, CBT has no side effects.
Third, many of these medications have not been fully studied over an extended period of time, and many researchers and clinicians are concerned about the possibility of long-term side-effects, particularly for children, and for pregnant or breast-feeding women.
And finally, studies have shown that when individuals treating OCD exclusively with pharmacotherapy discontinue the medication, as many as 90 percent may experience a complete return of their OCD symptoms. Conversely, those who complete a course of CBT usually have a far lower rate of relapse.
With CBT, the techniques you learn are always with you and provide a set of tools that can immediately be utilized if and when symptoms return.
Reprinted by permission of the OCD Center of Los Angeles
For most, religious beliefs provide moral and spiritual guidance, a sense of purpose, comfort, structure, and community. However, for those with scrupulosity, religion becomes compulsive, joyless and a source of anxiety and stress.
Scrupulosity, a subtype of obsessive-compulsive disorder (OCD), is an over-concern for doing things correctly or perfectly in order to follow religious practices, to please God, or to avoid disrespect from others or from one’s own self.
This form of over-concern and over-responsibility leads to excessive anxiety and guilt. It has been referred to by some as having an excessively tender conscience. There are historical references to scrupulosity among monastic priests as they struggled to please God.
Scrupulosity can include:
Those suffering from OCD are generally aware that their obsessions are irrational and unlikely. With scrupulosity, there is less awareness that the obsessions are of an irrational nature because they are so closely related to their belief system and are intertwined in the individual’s religious life.
This fact can negatively impact the prognosis for treatment success. One’s own well-being and God’s approval are seen as being at stake, thus creating more resistance in the patient. A cooperative effort between a person’s religious leader and therapist sometimes proves to be an effective treatment.
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Lori Riddle-Walker, MFT, specializes in treating OCD and scrupulosity. With degrees in counseling psychology and theology, Lori can provide the special guidance needed to help people with this disorder.