Anger and OCD – Getting Mad…

Posted by in ACT, CBT, General, Harm-Related Symptoms, Obsessive-compulsive disorder (OCD), OCD “I hate having OCD! Why can’t these thoughts just stop?!?! How can I be the person I was before?!?!” Many people with OCD are extremely familiar with the anxiety-related aspects of the disorder. OCD is an anxiety disorder after all, so it’s not terribly surprising that anxiety is often core to its experience. But anxiety is certainly not the only emotion that shows up in OCD. I’ve discussed briefly how some people with OCD have symptoms of guilt, shame, disgust, and depression, and how treatment may sometimes need to be modified when these emotions are primary aspects of the disorder. Today, though, I’d like to comment briefly on anger and OCD, which I don’t think I’ve mentioned explicitly in previous posts. Anger can be a powerful force in many people’s OCD. What’s the relationship between anger and OCD? Actually, the relationship between OCD and anger is complex, in that it’s mediated by obsessions, compulsions, or even reactions to developing the disorder. Anger and OCD: Anger as a Trigger for Obsessions Anger is sometimes entwined with anxiety and contributes directly to some types of Pure-O OCD. For example, anger can be a trigger for some people who have harm OCD (e.g., What if getting mad means that I’m capable of harming my family members?). Individuals with violent OCD obsessions may fear becoming angry, because they may fear that it will lead to them “snapping” or losing control. Anger is also sometimes present for those who have OCD with suicide obsessions. For example, “If I feel that I hate my life or am angry with myself, that might mean that I’ll end my own life.” In this context, anger also signals danger and is linked to fear. OCD and Anger: Examples of Anger Triggering OCD Obsessions I felt really mad at my parents, and then I almost felt like I wanted to hurt them. Does that mean I’m a dangerous person? I was arguing with my mom, and I felt an urge to punch her in the face, and I think I actually wanted to. What does that mean? I felt really mad and frustrated at my children, and I wanted to lash out at them. Does that mean that I could actually physically hurt them? I yelled at my kids, and I KNOW I enjoyed it. How messed up is that? Does that mean I really want to hurt them?...
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Contamination OCD – Long Shower Exposures

Posted by in Contamination/Health-Related Symptoms, ERP, General, Obsessive-compulsive disorder (OCD), OCD Long shower times? Just a quick announcement… I’m pleased to announce that with our recent office renovations, we now have a spa-like therapeutic shower room that is perfect for individuals with contamination OCD who have excessively long shower times. This room is ideal for those with contamination OCD who wish to work on shower-based response prevention. For individuals with contamination OCD who take really long showers, we are now able to provide office-based interventions for reducing your long shower times. We’ve had great success with reducing our patients long shower times from multiple hours to a mere 10-15 minutes. Reduce Long Shower Times to Short OCD Shower Times We do this first by developing shower-based response prevention guidelines and modeling non-OCD based shower behavior in-session. We essentially use a shower script to help individuals identify normal shower routines (which, to many of our patients’ surprise, DO NOT include hand-washing behaviors between washing each body part). We practice these routines out of the shower so that our patients can get individualized coaching on these routines. These simulated showers are first performed in our therapy rooms with a therapist, but then are performed in virtual reality (VR) in a virtual model of our office-based shower therapy room. Our shower scripts are then digitized and downloaded to our patient smart phones, and we then have our contamination OCD patients practice these routines in self-directed exposures in their own homes (in their own showers, but without running water). Due to this practice, long shower times start give way to shorter shower times. We also have individuals with OCD complete imaginal exposure. Next, we have our contamination OCD patients practice their showers in-office (with running water) in a spa-like shower room. Although our shower is sterilized after each exposure, the very act of using a public shower is, itself, an exposure. To facilitate these shower-based exposures, we use the same digitized audio script that we used in our simulated exposures to guide the shower. Importantly, we’re also available live via specialized audio technology to coach our patients in implementing this protocol. Patients have full privacy in our spa-like shower room, yet they have the benefit of a live therapist coaching them remotely. In the event that a patient deviates from their script and begins taking a long shower, we can pause the script, get them back on track via coaching, and then resume the...
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OCD Awareness Week 2016

Posted by in General, Obsessive-compulsive disorder (OCD), OCD, OCD - General, OCD - Treatment It’s #OCDWEEK! Help raise awareness and understanding about obsessive compulsive disorder (OCD) and related disorders. Welcome to #OCDWEEK 2016, a week organized by IOCDF to help raise awareness about OCD and related conditions! If you visit IOCDF’s website, you’ll find information about local and online programs and events designed to help increase the general public’s understanding of OCD. When I started this blog a few years ago, the internet was awash in misinformation about the nature of OCD. OCD was (more often than not) described in oversimplified terms, and the popular media largely mischaracterized OCD as a disorder defined primarily on the basis of excessive washing or checking behaviors. If you didn’t fit this mold, it was implied that you didn’t have OCD. I was hoping that, through my writing, I might be able to address some of these misconceptions and bring awareness to some aspects of OCD and anxiety treatment that were often overlooked or poorly understood. For each person with contamination OCD or checking OCD, there was another person with Pure-O OCD wondering, “What’s wrong with me? Am I the only one who has these thoughts?” On the surface, these various manifestations of the disorder can seem quite different, but truly, there are unifying concepts and processes that unite these disparate forms of the disorder and transcend obsessional content. One of the marvelous things about attending an OCD support group is that you can learn so much about your own OCD by simply listening to how other people talk about theirs. Even with radically different symptoms, many people with OCD suffer the same way. They get trapped in the same types of reassurance-seeking behaviors and mental rituals. They fall into similar patterns of avoidance. When you hear somebody else talk about their OCD — especially if it’s a different type of OCD — it can help you see your own OCD with fresh eyes, learn to take your own fears less personally, and ultimately relate to your own OCD in a different way. That’s one of the reasons why I so strongly advocate OCD support groups. Although we have to continue to educate the “I’m so OCD” people of the world, we’ve come a long way. There now exists a veritable army of OCD bloggers and OCDvocates, who have begun to candidly share their experiences with the disorder. They have written about what it’s like to live...
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Group Therapy for OCD: Power in Numbers

Posted by in General, Group Therapy, Obsessive-compulsive disorder (OCD) Group Therapy for OCD Wow. Our first OCD treatment group met yesterday, and IMHO, it was an incredible experience. Thank you to all who attended and showed such courage in standing up to their OCD. I was reminded anew how group therapy for OCD is so different than individual therapy. OCD wants to separate us from others, to shame us, to make us feel hopeless, defective, and guilty… It wants us to define ourselves on the basis of things we can’t control and forget that we are not our thoughts. After all, that’s how it maintains its power over us. Although there is great vulnerability in putting your thoughts out there and saying them aloud in front of others, by doing so, we defy our OCD. OCD lost a few battles yesterday. Let’s keep this war going. For those who missed our group, I hope you can join us next Saturday (8/17) at 1pm for our next session of group therapy for OCD. Upcoming OCD Treatment Group...
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IOCDF Conference, IOP for OCD Program, & Group Therapy for Panic…

Posted by in General, Obsessive-compulsive disorder (OCD), Panic Just a few quick announcements: 1) The 2012 meeting of the International Obsessive-Compulsive Foundation (IOCDF) is just a week away. The IOCDF conference marks the perfect convergence of all things OCD-related. In attendance are some of the best clinicians and researchers in the field.  Many of these individuals will be presenting talks related to OCD diagnosis and treatment. Hundreds of individuals with OCD will also be at the conference, some of whom will be leading workshops and sharing stories of recovery. This year’s roster of presentations looks to be exceptional. If you haven’t registered yet, there’s still time. This year’s meeting will be held in the Windy City: Chicago, Illinois. I’ll be attending–hope to see you there! Also…I may try to be more active on Twitter during the conference.  Feel free to follow me here. 2) I have revamped the description of my Intensive Outpatient Program (IOP) for OCD and have posted an updated summary page on my practice website. This program is not for everyone…but is appropriate for: Local OR out-of-town patients (with any level of OCD symptoms) who wish to complete treatment in the shortest amount of time possible. Individuals who have stubborn symptoms of OCD that have not responded well to traditional outpatient therapy. Individuals with severe symptoms who are seeking an alternative to residential treatment or to psychiatric hospitalization (inpatient treatment). We offer specific programs for adults, kids, and teens.  Click the above link to access the program description. 3) In other news, I’d like to announce that I’ll soon be starting a 6-week, CBT-based group therapy treatment program for panic disorder. This group is designed as an introduction to cognitive behavioral therapy for panic. Although you won’t be panic-free in 6 weeks, you’ll have some of the basic skills and knowledge you’ll need to kickstart your recovery.  Moreover, because this intervention is a  therapy group, you’ll get to work alongside others with similar symptoms. Till next time… Questions? Comments? Will you be at the 2012 IOCDF Conference in Chicago? Sound off...
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Therapy as Science: You + Your Therapist + Scientific Method

Posted by in CBT, General I consider myself a scientist.  I wear this hat officially when conducting research, but I also wear it every time I sit with a patient.  In my research, my science is pretty self-evident: I identify a research question, develop falsifiable hypotheses, and then collect quantifiable data to see whether or not the phenomenon I’m studying behaves the way I think it does. A very similar process unfolds when I work with you in my clinic.  However, from your vantage point, you might not realize it right away.  Nevertheless, we are two collaborative empiricists. Most often, you will define the “research question”.  Usually, this is the very reason that you’re coming to see me.  Sometimes the questions we think we’re asking are not necessarily the ones we should be asking.  For example, questions like, “Why is this happening to me?” are often disguised ways of asking, “How can I change this?”  If that’s the case, I’ll help you refine your question.  Our questions will also be guided by the data you bring to your initial assessment.  These data points include your responses to various questionnaires, as well as other important information we discuss (e.g., current symptoms, symptom history). Next, we’ll develop hypotheses about which strategies are most likely to be helpful for you.  Since I’m an evidence-based medicine kind-of-guy, I’ll let you know what research studies say about the types of interventions that are most likely to be effective for resolving your “research question”. Although not everyone is the same and responds to the exact same treatment protocol, we’ll let science be our guide.  For example, research studies tell us that cognitive behavioral therapy (CBT) is great for reducing symptoms of depression, whereas something called exposure and response prevention (ERP) is particularly good for treating OCD. We will then implement our plan and collect data to make sure we’re moving in the right direction.  These data points include answers to questions, such as: How is your anxiety changing as you are getting more practice with exposure? What are you doing now that you’ve avoided in the past? How does your day-to-day life reflect your personal values? How effective are you at work, at home, and in social situations? How many panic attacks are you having per week/month/year now compared to the past? These are just a few simple questions (there are many, many  more), but as you can see, each...
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Social media (Twitter, Facebook, Google+) in a psychological practice

Posted by in General Lately, I’ve been experimenting with new and better ways of incorporating social media tools into my practice.  Just yesterday, I developed a list of CBT-based exposure ideas for reducing symptoms of OCD, perfectionism, and social anxiety.  What was unique about these exposure ideas was that they were all targeted specifically toward actions one might take online using social media communities like Twitter and Facebook.  Using these very same social media tools, I was able to quickly distribute this content to several different online communities.  Although this face of my practice is virtually brand new, I can already see the power in it.  Although my readership is still small, it’s growing (of course, you could always help it grow faster by following me on Twitter, Facebook, or Google+). The use of social media tools within a professional mental health practice is potentially game-changing.  It becomes simple to disseminate information rapidly, including my blog posts which represent some of the ideas that are foremost in my mind at any given time.  Twitter, Facebook, and Google+ also allow me to interact with my readership in a new and dynamic way, giving me the means by which to get direct feedback and reactions from the larger public.  These tools give me a venue to discuss the ideas that excite me, hear about breaking news on the psychology front, get exposed to new ideas I wouldn’t have considered on my own, and connect easily with others who might either share or disagree with my opinions.  This is powerful stuff, particularly for psychologists who are involved in small private practices. However, the very ease of communication that I so enjoy in one context can become problematic in another, such as when I’m communicating with mental health consumers.  Potential pitfalls include maintaining confidentiality in an online world, explaining to consumers that I can only provide therapy within the context of a therapist-client relationship, finding the time to maintain an active and reciprocal online presence, and keeping abreast of all the rapid technological changes that define (and will continue to define) this medium.  I am cognizant of these issues, and I have informally implemented policies that safeguard against any such problems that might arise. Nevertheless, with these issues in mind, I am in the process of documenting a formal social media policy that will guide my online activities.  Fortunately, I don’t have to invent the wheel; other knowledgeable mental health...
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To tweet or not to tweet (aka, keeping private things private in the Facebook/Twitter era)

Posted by in General There’s an interesting issue I’ve been considering lately. There is a category of folks who openly blog/tweet/post status updates related to their anxiety and other mental health concerns, and there are those who would much rather keep this information private.  Nowhere is this more apparent than on Twitter, where you can get a virtual minute-to-minute (or, in some cases, second-to-second) account of the trials and tribulations faced by individuals throughout their days. Although some people lock down their Twitter accounts and must approve all new followers, I consider Twitter to be a fairly open medium.  On Facebook, however, most people only share status updates with their friends.  Some people make use of Facebook lists, of course, which allows selective sharing of information, but most people I know don’t utilize this feature.   Tools like Google+ seemingly make it easier to broadcast different messages to different circles of friends, which I think lends itself better to blogging about one’s own mental health; however, some inherent privacy issues still remain. There are also other online communities that have been built explicitly around a support-group type model, but despite the large number of members who belong to these sites, most individuals I know don’t frequent them. I am wondering where you stand on these issues.  What have your experiences been like when using Facebook, Twitter, or other communities to talk about mental health topics?  Are you concerned about privacy when using these tools?   Please sound off in the poll below or leave a comment. …or continue the discussion on Facebook, Twitter, or Google+. Thanks! (Given the nature of this topic, feel free to leave anonymous comments with made up names/email addresses if you wish.  Just note that if you use a fake email address, you won’t receive updates when others reply to your comments). [poll...
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Website updates: Research, treatment philosophy, & information sections

Posted by in General I am working on some substantial content changes to this website, which will be rolling out gradually. Just to orient you: 1. My research section has been updated. 2. I have added a section about my treatment philosophy. 3. I am in the process of developing a psychoeducation section for this site.  My goal is to provide basic information about many of the common problems I treat.  These include obsessive compulsive disorder (OCD), social anxiety (social phobia), panic attacks (and panic disorder), generalized anxiety disorder (GAD), phobias, depression, hoarding, body dysmorphic disorder (BDD), trichotillomania (trich), tics, and Tourette’s syndrome (Tourette’s disorder). Questions? Comments? Sound off below. …or continue the discussion on Facebook, Twitter, or...
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