Worry & “What If” Questions

Posted by Steven J. Seay, Ph.D. in CBT, ERP, Generalized Anxiety Disorder (GAD), Obsessive-compulsive disorder (OCD) Anxiety, Worry, & What If Questions If you have anxiety, it’s likely that you wrestle with worry and “what if” questions. Many what if questions are easily recognizable and start with the obvious, “What if…?” Others are more subtle and begin with phrases like “How am I ever going to…?” By definition, what if questions prompt us to solve...
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Scrupulosity & OCD: Religious/Moral Symptoms

Posted by Steven J. Seay, Ph.D. in ERP, Obsessive-compulsive disorder (OCD) Question: I have scrupulosity (religious/moral obsessive-compulsive disorder), and I am triggered by religious posts on Facebook. When I see a religious post, I feel like I have to repost it or God will be mad at me. I also worry about what other people think about these reposts, which then leads me to fear that God will judge me for worrying. Any suggestions for treating scrupulosity (religious...
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Exposure and Response Prevention: An Analogy

Posted by Steven J. Seay, Ph.D. in ERP, Obsessive-compulsive disorder (OCD) Exposure and Response Prevention (ERP) Exposure and response prevention (ERP) is just like a fitness program for your brain. However, instead of shaking up your fitness level, it’s designed to shake up stubborn OCD symptoms. Let’s expand on this analogy. Reasons for Doing Exposure and Response Prevention (ERP) People don’t adopt fitness routines for no reason at all; physical...
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Starting Exposure Therapy: What’s it Like?

Posted by Steven J. Seay, Ph.D. in ERP, Obsessive-compulsive disorder (OCD) For anyone new to exposure-based therapy, such as exposure and response prevention (ERP), there is often much anticipatory anxiety about starting treatment. “What is it? What will it be like? How bad will it be? Can I handle it? Will I be forced to do things I’m unwilling to do?” These uncertainties are typical for most people beginning the process. They’re also...
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Fear of Saliva Swallowing & Choking: Treatment & Symptoms (OCD)

Posted by Steven J. Seay, Ph.D. in ERP, Obsessive-compulsive disorder (OCD), Social Anxiety Question: I have sensorimotor OCD, and I’m suffering from conscious swallowing. My main fear is that I’ll choke or swallow my own saliva whenever I’m speaking or singing. Any tips for how to tackle this fear via exposure and response prevention (ERP)? Great question. Consistent with general exposure and response prevention (ERP) principles, your exposures need to address your...
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OCD: Screaming, Blurting Out Obscenities/Cursing/Profanity, & Other Unwanted Impulses

Posted by Steven J. Seay, Ph.D. in ERP, Obsessive-compulsive disorder (OCD) Question: I’m a teenager and keep having OCD symptoms related to impulse control. I often worry that I’ll lose control and scream or blurt out obscenities. I am especially triggered in quiet public places like classrooms, churches, and movie theaters. I have never actually acted on my impulses and cursed in public, but I still feel very anxious whenever these thoughts occur. Do you...
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Does Non-Avoidance = Exposure? No! Anxiety Disorder Treatment Principles for OCD, Panic, Social Anxiety, & Phobias.

Posted by Steven J. Seay, Ph.D. in CBT, ERP Anxiety Principle of the Day: Non-Avoidance is not equivalent to exposure. Although exposure is predicated upon the purposeful non-avoidance of anxiety-related stimuli, non-avoidance of anxiety triggers is not equivalent to exposure. What is non-avoidance? I liken non-avoidance to being in a particular place at a particular time. Essentially, it involves being in a situation in which your...
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OCD Triggers in Daily Life? Don’t Ritualize. Be Strategic! 3 Tips for Fighting OCD.

Posted by Steven J. Seay, Ph.D. in ERP, Obsessive-compulsive disorder (OCD) Question: I know about ERP, and I understand that OCD symptoms can be reduced by resisting rituals and then habituating to the anxiety brought on by obsessive thoughts. However…what if an obsessional thought requires no ritual? Confused! Great question. I think that in all cases of obsessive-compulsive disorder (OCD), there is some type of ongoing ritual that maintains the obsessional...
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Exposure Therapy’s Most Common Mistake: All Eggs in the Habituation Basket

Posted by Steven J. Seay, Ph.D. in CBT, ERP, Obsessive-compulsive disorder (OCD) Many people have an incomplete understanding of exposure therapy… …be it exposure and response prevention (ERP) for OCD, intentional mistake practice for social anxiety, or interoceptive exposures for panic disorder… This is true for exposure newbies, seasoned exposure veterans, and even some good CBT therapists. This limited understanding is based on the following flawed...
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Sensorimotor OCD & Social Anxiety Differential Diagnosis: “Obsessive Swallowing”

Posted by Steven J. Seay, Ph.D. in ERP, Obsessive-compulsive disorder (OCD), Social Anxiety Reader Question: For the past year, I have been dealing with OCD-related sensorimotor obsessions focused on swallowing. My symptoms started during a class discussion in which I noticed myself swallow. Since then, whenever I am in a lecture or quiet place surrounded by people, I become deeply focused on my own swallowing and worry that others will notice my swallowing and then judge me. I am...
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Treatment for Body-Focused Obsessions & Compulsions in OCD (e.g., Swallowing, Breathing, Blinking)

Posted by Steven J. Seay, Ph.D. in ERP, Obsessive-compulsive disorder (OCD) This post is the last in a series of posts discussing body-focused obsessions and compulsions (aka, sensorimotor, somatosensory, or somatic obsessions and compulsions) in obsessive-compulsive disorder (OCD). This series was inspired by an original article written by Dr. David Keuler for OCDchicago.org. You can access Dr. Keuler’s excellent article here. Ruling out Medical Causes for...
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OCD Treatment (ERP & CBT): Exposure & Cognitive Restructuring

Posted by Steven J. Seay, Ph.D. in CBT, ERP, Obsessive-compulsive disorder (OCD) Question: To what extent would a change of mindset (e.g., changing my expectations for myself) be helpful in recovering from OCD? What is likely to happen if I delay formal treatment with a psychologist and work instead on changing my own mindset? OCD Treatment Components: Cognitive Restructuring + Exposures Regardless of whether or not it occurs in the context of formal psychotherapy, changing...
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OCD Treatment: OCD vs. Me. How do I Tell the Difference?

Posted by Steven J. Seay, Ph.D. in CBT, ERP, Obsessive-compulsive disorder (OCD) Question: Because many of my OCD rituals are related to my professional identity, I’m worried that changing my rituals will somehow change those parts of me that I like (e.g., my personal goals and ambitions). Should I be concerned about this? Early Onset OCD in Kids & Teens (Pediatric OCD) Many people worry that by fighting their OCD, they will lose essential parts of themselves. ...
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Fear, Doubt, Uncertainty, ERP, & the Monster Under the Bed

Posted by Steven J. Seay, Ph.D. in CBT, ERP Everyone I know has, at some point, had to deal with the monster under the bed. Some do it with grace. Others falter. I’ve always been clumsy. I can vividly recall many terrified nights from my childhood, when I would lie rigidly in my bed, utterly paralyzed by fear. Afraid to make the slightest movement, to breathe, to call out for my parents…lest I be detected by IT. The...
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Pure-O OCD (Pure Obsessional OCD): Hidden Rituals

Posted by Steven J. Seay, Ph.D. in ERP, Obsessive-compulsive disorder (OCD) “Pure-O” OCD, or Pure Obsessional OCD, is a relatively less common form of OCD that seemingly differs from classic presentations of the illness.  What distinguishes Pure Obsessional OCD from classic OCD is that in Pure-O OCD, symptoms are predominantly obsessive (rather than compulsive) in nature.  Although individuals with Pure-O OCD frequently experience intense and...
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Exposure & Response Prevention (ERP) for OCD: Treatment Mechanism

Posted by Steven J. Seay, Ph.D. in ERP, Obsessive-compulsive disorder (OCD) Question: How does ERP work?  What mechanism underlies it? Obsessive-compulsive disorder (OCD) is characterized by obsessions and compulsions.  Obsessions are disturbing thoughts, images, or impulses that increase feelings of anxiety. Compulsions (also known as “rituals”) are the strategies that individuals with OCD use to reduce the anxiety associated with obsessions.  Rituals are...
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ERP therapy for OCD: Shifting from destructive to constructive to gestalt notions

Posted by Steven J. Seay, Ph.D. in ERP, Obsessive-compulsive disorder (OCD) Here’s a question for you: Is ERP fundamentally a destructive or constructive process? I think that many people naturally conceptualize it as more of the former than the latter. They conceive of ERP as being the process by which we can “unlearn” or “weaken” maladaptive associations. We learn, through repetition, to no longer be afraid of those things that previously...
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Advanced ERP for OCD: how subtle rituals can limit your progress

Posted by Steven J. Seay, Ph.D. in ERP, Obsessive-compulsive disorder (OCD) As any good psychologist experienced in treating OCD can tell you, the most effective treatment for OCD is exposure and ritual prevention (ERP).  You may also see this type of therapy referred to as exposure and response prevention.  In this case, the semantics are immaterial; the concepts are exactly the same.  ERP is a type of cognitive behavioral therapy (CBT) that is based on the premise...
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OCD guilt, shame, disgust, anxiety & depression: Why treatment sometimes fails (and what to do about it)

Posted by Steven J. Seay, Ph.D. in ERP, Obsessive-compulsive disorder (OCD) OCD isn’t just about anxiety. Although anxiety is certainly a prominent feature of the disorder, clinicians who only attend to anxious symptoms can easily overlook some of its other core features. As a psychologist in Palm Beach, Florida, I work closely with kids, teens, and adults throughout the greater Palm Beach, Fort Lauderdale, and Miami areas on strategies for recovering from OCD. In...
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OCD, ERP, & doubt sensitivity: Shattering the illusion of certainty

Posted by Steven J. Seay, Ph.D. in ERP, Obsessive-compulsive disorder (OCD) Many individuals with OCD hunger for certainty. It’s a craving that often can’t be easily sated. Early conceptions of OCD from the 19th century acknowledged this issue directly, in that OCD was often termed the “doubting disease.” It is this need for certainty, the need to eliminate doubt, that leads many people with OCD to perform repetitive behaviors, which are known as...
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OCD symptoms: the obvious (and the not so obvious)

Posted by Steven J. Seay, Ph.D. in ERP, Obsessive-compulsive disorder (OCD) Turn on your television, and you’re likely to catch at least a fleeting glimpse of obsessive-compulsive disorder (OCD). Many popular TV shows feature characters with OCD (e.g., Emma on Glee, Monk), and it is through this lens that many members of the general population get their first exposure to OCD. Unfortunately, if your understanding of OCD is based solely on depictions in the popular...
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