A New Way of Treating OCD (A Non-Exposure Based Way)
The New Kid on The Block
For years we have known that ERP (exposure and response prevention) is the gold standard treatment for OCD. I have been using ERP with my clients for years, and many have been able to get their life back using this approach.
But the truth is, the research says that only 60% of clients will get better with ERP. So then what? Do those individuals just live with the suffering that OCD has caused them? Should they just give up? Accept that this is as good as it’s going to get?
Hell no. There has to be more. And luckily, there is.
For the past 9 months, I’ve been seeking ongoing training and consultation with hundreds of other OCD therapists across the country on a therapy called Inference Based CBT.
Is it new? Sort of, but not really.
What is Inference Based Therapy (ICBT)?
Inference Based Therapy has been around since the early 2000s. It has undergone many randomized controlled studies comparing it to ERP, and the data has shown to be just as effective as ERP.
This is great news. This means that we have more than one way to effectively treat OCD.
ICBT is a cognitive therapy for OCD. ICBT aims to resolve “inferential confusion.” Which is when someone confuses imagined possibility with reality.
ICBT works “upstream” by addressing the doubt (or what if?) that set the OCD into motion.
By working upstream, when you can resolve the doubt, then the anxiety and compulsions do not occur.
ICBT looks at what is behind the doubt. There is a reasoning process you use with obsessional doubts that you don’t use with normal doubts. You reason differently in OCD situations than every other area of your life. We teach you how to see the difference.
ICBT says that intrusive and obsessive thoughts do not occur by random, there is a story behind them. The story is absorbing and takes you behind your senses.
ICBT aims to help people return to trusting themselves and their senses.
What I love about ICBT
I’ve been using ICBT with the majority of my clients with OCD for the past 6 months. I still consider myself a beginner but many of my clients feel like this makes so much sense. It’s also common for some of my clients to feel confused. Because this is very different than what they were previously learning through an ERP approach.
This was my experience in learning ICBT too. It has (and still does) take a lot of work to see how this approach works.
I love how well rounded this model of therapy is. In ERP, there is no real in depth discussion about how a person came to become so consumed with their worries. And in ICBT, we really help people understand this and I have seen this be so validating to my clients to have a deeper understanding of themselves.
I love how interactive it is. We use games and exercises to apply the concepts so that clients can arrive at these conclusions on their own.
And mostly, I love having an additional treatment option for clients. Exposure will still be a treatment I use in my practice but when a client isn’t making progress or isn’t ready to try ERP, it’s nice to have other ways of helping them regain their life.
Questions about ICBT? Send me an email at jenny@stateofmindtherapy.com
Written by Jenny Matthews, LMFT, LADC
Jenny is a therapist that specializes in helping over-thinkers and worriers get relief from anxiety so they can be more productive + do what matters + be present with their loved ones.
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How You Can Change Your Relationship With Anxiety and OCD
Created by Bryan Piatt
Bryan is a practicum provider that specializes in helping people get untangled from obsessive thoughts and worries so they can live more freely in a life they love.
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How To Support an Anxious Flyer
Traveling with someone anxious about flying? Check out this article on Travel and Leisure Magazine that Jenny contributed to for helpful tips on how to support your loved one.
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How to Handle Big Feelings
Dropping Anchor: A Helpful Tool for Handling Anxiety, Panic, and other big feelings
Dropping anchor is a tool from ACT (Acceptance and Commitment Therapy) that can be really effective for any big feelings-anxiety, anger, shame, etc.
The 3-part excercise is meant to help you gain more control over your actions (instead of freezing up, ruminating, or lashing out). This exercise also helps reduce the impact or power of the big feelings.
Please note, the goal is NOT to eliminate the big feelings or difficult thoughts. When that becomes the goal, we can easily get hooked further by these experiences.
Remember this acronym: ACE
It stands for Acknowledge, Connect, and Engage
Check out the exercise below. If you prefer to practice this exercise through audio, check out this recording I made that will walk you through it.
Acknowledge your thoughts and feelings
Notice them with curiosity and without judgment. It helps to say them in a matter of fact way, like “here is worry,” or “I’m noticing a racing heart.” You can also be more vague such as “here are difficult thoughts/feelings” or “I’m noticing pain.”
This part of the skill is critical. Many other strategies like grounding, deep breathing are good at getting you connected with your body but they are also aimed at distraction. The acknowledge part of this skill is helping you to not avoid or distract, by naming your experience you are actively accepting it and creating distance from it.
Come back into your body
Do any small movement to reconnect with your body. Have a gentle stretch. Wiggle your toes and fingers, walk, or shift in your chair.
While doing this movement, continue to practice acknowledging your thoughts and feelings (so this doesn’t become a distraction technique).
Engage in the world
Now it’s important to refocus and engage with an activity. The purpose of this exercise is to help you be able to take effective action, even if you are experiencing difficult thoughts or feelings. This can be done in several ways:
Actively notice the environment you are in right now. Name something you can see, hear, smell, touch, or taste.
Take note of where you can put your attention next to make the most of this situation. Maybe that means returning to some work you were doing. Taking the dog for a walk. Or maybe engaging in a game with your kids.
Dropping Anchor Audio Recording
When practicing a new skill, it can be more effective to listen and be guided through the exercise instead of reading instructions. So I made an audio recording that you can use to listen to when you are practicing this skill. After awhile, you won’t even need the recording, the skill will become natural to you.
Written by Jenny Matthews, LMFT, LADC
Jenny is a therapist that specializes in helping over-thinkers and worriers get relief from anxiety so they can be more productive + do what matters + be present with their loved ones.
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How to Overcome Your Fear of Flying
5 Strategies to Help You Overcome Your Fear of Flying
Get Started with Our Flight Anxiety Toolkit
What’s Your Core Fear of Flying?
Your afraid of this behemoth machine crashing?
You’re afraid of turbulence breaking the airplane apart?
You’re afraid of flying into a thunderstorm and crashing?
You had a panic attack on the airplane last time and you’re afraid that the panic will return?
You’re claustrophobic, so the slightest idea of sitting in this tiny cylinder would drive you mad?
You’ve seen media stories of passengers losing control on the airplane and trying to escape out of the emergency exit and now you’re afraid that could be you?
You have a history of health anxiety and the idea of being too far away from a hospital is keeping you from boarding that airplane?
Why Do You Want to Fly?
Is it something else? If so, dig deep to see if you can extract your core fear.
I yearn to participate in a family vacation (without having to drive alone)?
I yearn to apply for a job that requires air travel?
I yearn to tap into my adventurous side and see the world?
I yearn to break away from the shackles of fear and develop confidence in myself?
Is it something else?
3. take action
If your fear is centered around not understanding how airplanes operate or weather/turbulence related fears, commit to learning how airplanes work.
If your fear is FEAR OF FEAR, try to become more mentally flexible with scary, uncomfortable thoughts, feelings, memories, and bodily sensations:
Practice using your attention muscle (that thing you use to read and communicate) to not engage with all of the “What if’s” that pop into your awareness. Learn more about attention vs. awareness and rumination here.
Increase your willingness to FEEL ANXIETY and not try to push it away, fight it it, or pull you into more avoidance or rumination.
Remind yourself why you’re willing to expand your comfort zone and face your fear. (I want to be able to get away in the winter months, I want to visit my relatives, etc)
4. Anxiety is uncomfortable but not dangerous
Remind yourself that after you face your fear, you will learn that fear is simply an emotion that can’t harm you. You will also learn that fear loses its power after you face it head on!
5. Seek Additional Support for Your Fear
Overcoming fear is not easy, and you don’t have to do it alone. Having a professional, like a therapist that specializes in treating anxiety disorders and phobias, that can walk you through this challenge can be a game changer.
A therapist can help you create an individual plan to how to work on facing your fear. Therapists can be great for accountability if you know you have a tendency on letting avoidance take over.
At State of Mind Therapy, our therapists are skilled at treating flying anxiety. We work with clients one-on-one and have digital courses that you can join to give you the tools you need to overcome your fear.
Scheduled a free 15 minute phone consultation to get started working with one of our therapists at State of Mind Therapy.
How Rumination May Be Keeping You Prisoner to Anxiety/OCD
Let me guess.. It feels like there’s a never ending NASCAR race in your mind - the cars being racing thoughts that produce scary thoughts, images, memories, and catastrophic predictions. Your mind keeps SPINNING, SPINNING, SPINNING! Eventually, it makes you feel like a prisoner to this endless race that you never even signed up for.
We get it. And we can help.
As clinical mental health therapists, we often see people struggling with - what we often hear as, “overthinking.” Our clients tell us that they just can’t relax because their mind is in constantly spiraling out of control and they can’t stop the SPINNING! But the truth is - they are doing something and they are most likely doing it without even realizing they’re doing it. This is a process called rumination. When working with us, clients are often surprised how much they’ve actually been ruminating without even knowing it!
What is rumination?
Professionals in the field have often suggested that mental rumination is thinking about past or future life events.
It’s often been said that when we are ruminating about the future, we are dealing with anxiety - and when we’re thinking about the past, we are in the arena of depression.
I believe most therapists continue to be in alignment with this definition of rumination.
However, this definition has recently been vastly expanded, and thankfully so - because we are now seeing at least one reason why people continue to find themselves stuck in their anxiety, panic, and OCD recovery.
What most people with an anxiety disorder or OCD don’t understand is how much their rumination contributes to their anxiety symptoms as well as their reluctance to engage in their exposure treatment plan.
The mental health research field has begun to realize that more attention needs to be focused on how a sufferer is engaging in rumination. Dr. Michael Greenberg is also a specialist in the field of anxiety and OCD. Dr. Greenberg has established a very detailed list of ways he’s seen clients ruminate - see if you can relate below.
Ways We Can Ruminate:
Trying to figure something out
Directing attention/monitoring thoughts and feelings
Keeping ones guard up (mentally)
Pushing away thoughts, trying to not let thoughts enter ones awareness
Using mindfulness or ‘bad distraction’
Engaging in self-talk
Rumination is a Choice (but often feels like it’s not)
Many of our clients will tell us “I overthink, worry, or obsess.” But actually, what they are really saying is that they are engaging in rumination (but they don’t know it).
Obsessions are when a thought shows up automatically. which is something we have no control over.
A compulsion is effortful. So when you engage with the thought using any of the 6 examples listed above, you are actively directing your attention towards it (compulsion).
Rumination keeps people stuck because they don’t realize their mental behavior can be a mental compulsion. Clients often feel like rumination is something they don’t have control over, but I’m here to tell you otherwise.
Let me provide an example of why this is an unhelpful behavior and how it may be keeping you prisoner to your mental health disorder.
Let’s say that Johnny Doe has been diagnosed with health anxiety OCD. Johnny’s core fear is that he has an illness, but nobody is able to come up with a diagnosis. Johnny recognizes that he has minimal evidence of a medical issue, but his fear is very convincing and overwhelming. Johnny has also been medically cleared numerous times by medical professionals, but he’s still partially inclined to believe that he’s contracted some sort of illness (even thought there’s zero objective evidence of an illness).
Because Johnny tends to experience obsessional thoughts about being sick or having an underlying condition that is not being addressed, he may begin to engage in various forms of rumination, such as directing attention/monitoring, trying to figure it out, and self-talk.
Monitoring may include scanning their body for any type of abnormality (skin defect, noticing minor aches and pains, tickle in throat, weird sensation, etc.).
Johnny may also try to “figure it out” by engaging in research throughout the internet (Dr. Google) - hoping to find an answer to their feared/hypothesized illness.
Or Johnny may try to figure it out by thinking about all the toxic substances he has recently been exposed to as a means to hopefully solve the mystery of his “illness.”
Johnny may also use positive self-talk compulsively, by saying something like, “I’m going to be ok” or use excessive prayer in his mind in hopes that this will prevent his illness from continuing.
Johnny is utilizing rumination as a means to establish a sense of safety or protection against a (most likely) mentally fabricated, phantom illness. However, what this behavior is actually doing is maintaining his high anxiety state.
Now you may ask, “well what if there is a problem?” or “why is it a big deal to do this!? “
Fair question!
However, there’s a reason why Johnny is seeking out mental health treatment: he is suffering with anxiety and struggling to live a normal life.
Now Johnny could continue to find answers by visiting more specialists, spending more time on the internet or more time monitoring his body for more evidence of illness, but this all comes with significant costs:
Time
2.Energy
3. Worsening anxiety
4. Conflict with relationships
5. Avoiding going to places that trigger anxiety
Important note: Ironically, Johnny is doing a bunch of rumination because he feels like he needs to do it - so he can then hopefully feel better/safe. However, once Johnny sees what he is doing, he realizes that he’s actually worsening and fueling his anxiety/OCD.
So what do we do once we have come to understand that rumination is a compulsion and something you actually do have control over?
We must let the thought be there, and not direct our attention to the feared thought that’s in our awareness!
Attention vs. Awareness
Attention is the mental muscle you use to read a book, engage in communication, solve a math problem, watch a movie, notice the sunset, etc.
Awareness is anything that you notice in your mental periphery.
For example, as I type this sentence, my attention is directed toward my screen and keyboard.
But in my awareness I notice that I can hear my neighbor’s ridiculously loud leaf blower, I can hear birds chirping, and I can hear the sound of the blustery wind whooshing through the trees.
Attention and awareness are two very discrete attributes of the brain.
However, it’s worth noting that there is no distinct line where attention and awareness meet.
But that’s ok - once you begin to practice re-directing your attention, you will notice the difference between the two.
So The Point Is…
Johnny does have some degree of control of where he directs his attention.
The hard part of course is resisting the strong urge to direct attention to the fear of a possible illness (but trust me, with practice you can do this).
It’s also important to note that people with anxiety/OCD disorders are also often afraid of experiencing their current emotional state forever.
Often, people believe that their anxiety will stick around FOREVER if they don’t continue to direct attention towards their perceived problem. However, that’s typically not the case.
Often what we see in our clients is - if they are successful at not continuously ruminating and are able to maintain some control of their attention - after 2-3 days they begin to notice improvements in their anxiety symptoms as well as a reduction in the urge to ruminate.
Some therapists may argue that this approach is distraction. But actually, it’s not.
This is actually an exposure exercise because we’re not allowing ourselves to pursue certainty - or in other words, we’re exposing ourselves to uncertainty by not answering the questions/fears of the mind that’s demanding answers. It is here (bathing in uncertainty) where we need to be in anxiety and OCD recovery.
Additionally, once an individual gets practice having more control of their attention muscle and they’re no longer engaging with unhelpful thoughts screaming in their awareness - we find that exposure exercises (intentionally triggering one’s anxiety in a particular context) are often less anxiety provoking!
Putting All Of This Into Practice: The Choice Point
Once you have determined that your obsession or fearful thought is not rational or helpful, you’ve arrived at the choice point.
Here there are two choices: continue to direct your attention towards the phantom threat by continuing to ruminate, or, you can redirect your attention through these steps:
Aknowledge and label the thought once it enters your awareness (ex. “I’m noticing a thought and fear related to my health anxiety”). Note: you don’t need to do this every time
Open up and make space for the emotion to enter your mind and body with radical acceptance and compassion towards it
Direct your attention to anything else or simply to nothing - as long as it’s not directed to the feared/obsessional thought or feeling
Let the feared/obsessional thought or feeling camp out in your awareness as long as it needs to without fighting or resisting it
You’re human - so you will slip up - just notice that you did slip up and direct your attention back away from the unhelpful thought or feeling
If you find yourself still really anxious - you’re probably ruminating - time to check-in with yourself by asking, “Am I ruminating right now? How am I directing my attention to this thought?”"
Repeat
That’s it.
Not engaging in rumination is hard work. we get that. So if you are struggling with this, don’t give up. This doesn’t mean your brain is broken, you just need to keep at it.
The human mind has been evolved to notify us of any sense of danger. The mind is like a problem-solving, analytical, judgmental, catastrophic thinking machine. And it does this really well!
The problem with this default mechanism is that sometimes it sends out a false alarm to our conscious mind (where we notice thoughts).
Fortunately, humans have the ability to notice this alarm, which often presents as various physical or mental symptoms: increased heart rate, sweating, racing thoughts (what if’s), predicting the worst case scenario, and plenty more!
Once we are able to notice the fear signal, we can decide if this notification is helpful or unhelpful - and then we can direct our attention towards whatever we want (even if it’s towards nothing).
How State of Mind Therapy Can Help With Rumination
Let’s be honest - it can be hard to put these skills into practice.
With the help of an anxiety or OCD therapist, you can learn about the ways in which you ruminate and set up a plan for practicing effective skills.
To get started, schedule you free 15-minute phone consultation to determine if we would be a good match to help you gain freedom from anxiety and OCD.
Written by Justin Matthews, LGSW
Justin is a therapist that specializes in helping individuals get relief from anxiety and OCD by teaching them how to be more flexible with their unhelpful thoughts so they can spend more time doing what matters.
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[Video] 5 Minute Guided Mindful Break For When You Feel Overwhelmed
When you feel stressed, anxious, and overwhelmed it can help to take a break to regain a sense of peace so you can focus and be present in the world around you.
Written by Jenny Matthews, LMFT, LADC
Jenny is a therapist that specializes in helping over-thinkers and worriers get relief from anxiety so they can be more productive + do what matters + be present with their loved ones.
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Response Prevention Tips to Help You Stop Engaging in Compulsions & Rituals
We know that overcoming OCD isn't easy. And you have probably tried to reduce or stop engaging in compulsions many times and found it to be really difficult. In this post, we want to share some tips with you about ways to prevent yourself from engaging in compulsions.
First of all, why is this important? I'm sure you have many of your own personal reasons why you want to stop. No matter what is motivating you, it can still be really hard. The important thing to remember, is that if you don't stop the compulsions then you just keep feeding the OC cycle and will stay stuck.
Stopping compulsions isn't as simple as just deciding to stop (you already know this though!)
There are some strategies that can help you be more successful. There is no right or wrong way, so you may want to experiment with different ones and find out which ones helps you the most.
Delay the compulsion: if it's hard to completely stop a compulsion, then make a plan to delay it. Give yourself a specific time and set the timer. Increase the delay by a few minutes over time.
Do it wrong: If your compulsion involves doing something in a particular order or a particular amount of time, you can choose to do the compulsion in the incorrect way (ex: touch 5x instead of 3x)
Do something that is active and brings joy: this sounds like distraction, and in some ways it is (more about the difference later). But when you are just starting out, it's hard to know what to do when you are choosing not to do a compulsion. And if you are just sitting there and feeling really uncomfortable, then you might be more likely to engage in ruminative, worried thinking which won't help you either. We want to work on helping you be able to function with anxiety, which will help you resist rituals in the future. So pick something you will do instead, maybe it's picking one cute puppy video and sending it to a loved one, playing a game of tag with your kids, or complete a sudoku / crossword puzzle. Pick a specific amount of time you will do this activity so that you have a clear way to measure your success.
Write a script: grab a note card or place to jot notes in your phone. Write down all the reasons you want to get better. What would your life be like without OCD? Write down any encouraging or motivating phrases. If you are struggling with resisting the urge, take out your note and read it. This may give you just what you need in that moment to resist, even if it's just for a few minutes.
Try responding with uncertainty. Examples include: "maybe" or "we'll see" or "what's done is done."
If one of your compulsions is to seek reassurance from others, make sure they know how to respond so that if you are unable to resist asking for reassurance than they can help you by not giving you the answer.
Written by Jenny Matthews, LMFT, LADC
Jenny is a therapist that specializes in helping over-thinkers and worriers get relief from anxiety so they can be more productive + do what matters + be present with their loved ones.
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Exercise: "I Notice I'm Having The Thought"
When you have constant what if thoughts it can be hard not to pay attention to them.
We love to teach our clients how to create more distance between their thoughts and them so that you aren't running on auto-pilot anymore.
If you have more distance from your thoughts, it's easier to see them for what they are (streams of ideas in your head) and not get hooked by them.
Try this exercise to help you get more distance:
“I’m having the thought” exercise
Write down a thought that hooks you with anxious feelings
Say that thought 10 times, how does that make you feel? (rate it from 1-10)
Now say same thought, except add “I’m having the thought” in front of it
Now add “I notice I’m having the thought.”
What did you notice about the difference between the first, second, and third change? If you found it helpful, we recommended that you practice this skill daily to help you be able to use this tool more easily.
You might find it helpful to have a log, journal, or note section on an app to keep track of your progress.
Written by Jenny Matthews, LMFT, LADC
Jenny is a therapist that specializes in helping over-thinkers and worriers get relief from anxiety so they can be more productive + do what matters + be present with their loved ones.
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Our Favorite Books for Help with OCD
Learning all you can about OCD can make a big difference in your recovery. By reading self-help books, you can increase your understanding of how OCD works, feel less alone, and learn helpful strategies to deal with OCD.
There are so many great books available today to help you on your journey. We wanted to share a few of our favorites with you.
These are not affiliate links, just ones we think are great.
Freedom from Obsessive Compulsive Disorder by Jonathan Grayson, PhD
The Mindfulness Workbook for OCD by Jon Hershfield, MFT
Overcoming Unwanted Intrusive Thoughts by Sally Winston, PsyD
ACT Workbook for OCD by Marisa Mazza, PsyD
Written by Jenny Matthews, LMFT, LADC
Jenny is a therapist that specializes in helping over-thinkers and worriers get relief from anxiety so they can be more productive + do what matters + be present with their loved ones.
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State of Mind Therapy in Bloomington can help. Click the button below to sign-up for your free 15 minute phone consultation today.
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How to Stay In The Present Moment
Our minds drift to many different places throughout the day. What should I eat? Did they like my presentation? I need to remember to call the doctor. And so on.
It's normal for minds to drift.
But if you have a mind that is prone to worry thoughts, then you can find yourself distracted often which makes it hard to do the things in life that matter most to you, like focus on your job, enjoying time with you family and friends, and working towards your goals.
Although it's normal for minds to drift, we can work on strengthening our ability to stay in the present moment through attention training. We can do exercises for our mind, just like we may exercise our body through running or lifting weights. Below are two ways to help you strengthen your ability to return to the present moment. (Remember, the goal isn't to never drift, because that's just what minds do. Your goal is to get better at noticing when you drift and bring yourself back to the moment)
Attentional Training in Two Ways
Self-focused Attention
This is where you notice thoughts, feelings, and sensations that are occurring inside of you. The point isn't to try and control them or make them go away, but instead notice them without judgement. For instance, you may say "I notice my heart racing" or "here's anxiety." By doing this in a matter of fact way, we stay curious and in the present rather than pulled into a story our mind tells us.
Task-focused Attention
You can practice staying present in the moment through an everyday task, such as washing the dishes. While doing this task, you can focus on:
Touch: what does the water feel like? What is the temperature like?
Sight: What catches my eye? What colors or patterns do I see?
Hear: What sounds do I notice?
Smell: What smells do I notice?
Taste? what flavors do I notice? what is the quality of the flavor? Strong? Mild?
Written by Jenny Matthews, LMFT, LADC
Jenny is a therapist that specializes in helping over-thinkers and worriers get relief from anxiety so they can be present with their loved ones.
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5 Ways to Handle Setbacks
It's not uncommon for people to make great progress on handling stress and anxiety to then really struggling. Sometimes the struggle is small and sometimes is a major setback. Here are some tips to help you get through tough times like these:
Remember that your progress can never be unlearned. Even if you have a setback, it likely won't be as difficult as it was back before you got the help you needed. You will bounce back much sooner because of the previous knowledge and changes.
Evaluate changes in your life. Was there something that contributed to this setback? Life changes and stressors can often cause setbacks. If you can identify a contributing factor, it can help you to assess what you need to help you get back on track.
Have you been taking care of yourself? If we are not meeting our most basic human needs that can be enough to impact mental wellbeing. You can remember the acronym HALT (Hungry? Angry? Lonely? Tired?) to help you check-in with yourself.
Go back to therapy. Even if you haven't seen your therapist in awhile, it can help to go back and work through the setback. Reviewing your skills and getting support can go along way. Even just one session could be enough to get you back on the right track.
Remember that you are human. Setback are not a sign of failure. They are common. Life is stressful so setbacks are bound to happen from time to time. We can't stop it but we can learn from it. And you will get stronger each time.
Written by Jenny Matthews, LMFT, LADC
Jenny is a therapist that specializes in helping over-thinkers and worriers get relief from anxiety so they can be present with their loved ones.
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The One Thing Families Should Stop Doing
OCD impacts individuals and their loved ones. You may need your loved ones to reassure that nothing bad will happen or maybe they participate in compulsions so they can make you feel better.
In OCD treatment, it's important to learn about all the ways you try to get rid of anxiety or other distressing feelings to add them into your response prevention plan. One important piece to consider is ways your family participates in this.
This is called family accommodation. This means any changes your family member(s) does to prevent you from being triggered or to make you feel better.
Examples of Family Accommodation
Participating in compulsions by changing clothes when they get home, handwashing, or showering
Saying "you won't get sick from that."
Changing their work schedule or other activities because of your compulsions
Why Family Members Should Stop Accommodating OCD
They are reinforcing the message that your fear and anxiety are "bad" and can't be handled
It is impacting their life by creating anger, frustration, burn out, anxiety
The accommodations make your OCD worse in the long-run
How to Reduce Family Accommodations
It's best to do this together as a team
Sit down with your loved ones and educate them about family accommodations. Many times families don't know that this is harmful and/or don't know how to stop. They can think they are helping you.
List all the accommodations they do and make a plan on how to start to remove them
Give your family permission to remove one accommodation at a time so it's not so overwhelming
Written by Jenny Matthews, LMFT, LADC
Jenny is a therapist that specializes in helping over-thinkers and worriers get relief from anxiety so they can be present with their loved ones.
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How Should OCD Be Treated?
One of the most common things we hear from clients who come to us for OCD treatment is that they have done years of talk therapy without much improvement.
This doesn't mean talk therapy isn't helpful. Many people find it helpful to talk with someone about their feelings and get validations. But most people with OCD will not see improvement in their symptoms by talking alone.
In fact, much of the time talk therapy can involve "co-compulsing" with the therapist by analyzing thoughts, seeking reassurance, and making meaning out of thoughts by looking for hidden traumas.
It's important for you to know that there are treatment approaches for OCD that have been backed by research. And this may come as a surprise to you, but most therapists have no idea how to use this treatment approach.
The majority of graduate school programs for therapists do not include training on OCD assessment, diagnosis, and treatment. Therefore, the only therapists that can adequately treat OCD are ones that have sought more specialized training.
What is the most effective treatment approach for OCD?
Research has shown that Exposure and Response Prevention in the most effective way of treating OCD. There are some additional treatment approaches proven to be helpful as well. A combination of medication has also shown to improve OCD symptoms. There is also a growing amount of research on the use of Acceptance and Commitment Therapy (ACT) for the treatment of OCD (which blends very well with ERP!)
At State of Mind Therapy, Jenny and Justin use both ERP and ACT in treatment of anxiety disorders and OCD.
What is ERP?
ERP stands for Exposure and Response Prevention. In its most simple form, it means to gradually expose yourself to your fear while not engaging in any behaviors that may serve to reduce your anxiety.
When you engage in an anxiety reduction behavior, you reinforce the need to keep doing the behavior. This prevents you from learning that anxiety is safe and tolerable. And it can make your world a lot smaller by keeping you from doing the things you love in life.
ERP helps you to change the relationship you have to the feared stimuli. Its helps you to be more flexible with how you respond and makes you better able to handle difficult thoughts and feelings.
We know it can feel scary but it's worth it.
You can check out some related videos here that we did on this topic:
How to Effectively Treat OCD (video)
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Emotions: Friend or Foe?
Many of us (including myself) never received education about what emotions are and their purpose. However, the truth is - scientists continue to struggle to meet a consensus on what emotions actually are. Russ Harris, an Acceptance and Commitment Therapy pioneer has been so kind to gather the current data regarding emotions, and here’s what he’s discovered: scientists in the field of emotions have agreed on two conclusions about what emotions are:
An emotion is a complex network of neurological, cardiovascular, musculoskeletal, and hormonal flux within the body.
This physical process prepares us to react.
Most of us notice these physical changes as “butterflies” in our stomach, a “lump” in our throat, clammy hands, or watery eyes. When we experience these physical sensations, we sometimes have an urge to take action.
For example, if one is preparing for an upcoming speech, one may begin to feel various anxiety symptoms days leading up to the event (muscle tension, thoughts of failing, sweaty palms, difficulties concentrating, body temperature changes, etc.).
These physical sensations may urge us to behave in a certain manner (avoidance around preparing for the speech or nudge us to get off our butt and get prepping). The key here is that we may or may not act on these urges to react.
Ultimately, we have a choice (avoid or prepare).
In other words, we can still dictate our overt behavior (actions), even when we can’t control how we are feeling. So if a co-worker pissed you off, you may have an urge or desire to scream at them or maybe even give them a good wack! Many of us let the urge pass and do our best to be civil during the confrontation, but some of us may choose to react and engage in a behavior that leads to severe consequences - but remember the choice is yours.
The ultimate aim here is to be authentic to ourselves and to honestly acknowledge to ourselves how we are feeling, accept those feelings, and at the same time act in a way that mirrors who we want to be seen. So how can we use emotions as allies? It begins with understanding what they can do for us.
What Emotions Do
Our emotions can serve 3 main purposes: communicate, motivate, and illuminate.
Emotions communicate by allowing others to see your facial expression, body posture, physical movement, breathing pattern, and vocalizations (expressing your feelings). Unless of course we decide to “hide our feelings” by “putting on a happy face,” for example. This can be helpful or not so helpful - it depends on the situation (more on this in a future blog post).
Emotions motivate us to run or hide (fear response). Anger may urge us to stand our ground or to fight our enemy. Sadness may urge us to take a pause, reflect, isolate, and rest. Guilt may urge us to make things right with someone if we compromised trust in a relationship or in society. Love motivates us to be caring and nurturing.
Emotions illuminate the importance of safety, defending our territory, maintaining boundaries, fighting for what is right, grieving, how we treat others and the importance of repairing social bonds, and the importance of intimacy, connection, bonding, and many more.
How to Effectively Use Your Emotions
Emotions can offer a palette of wise data if we’re willing to tap into it, and if at the same time we’re able to differentiate a helpful or not so helpful emotion. Often, people become anxious or depressed because they’ve become so good at not noticing when the emotion rises, not being able to name the emotion and link it to a thought or situation, and then ultimately engage in avoiding the emotion. Many also do this on autopilot, which can hinder one’s self-awareness surrounding their mental illness. So let’s start practicing noticing what’s showing up (emotion), name it, and determine if there’s any wisdom to gain in the emotion, and then redirect your attention back to what matters in that moment.
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How to Be the Architect of Your Life
The Common Struggle
I see many clients who are struggling with anxiety, depression, or OCD who come to me after numerous attempts to fix their mental health symptoms. Many of these individuals have become their own expert in mindfulness and have been doing a great job at allowing their anxious thoughts and physical symptoms to just be (acceptance), but they continue to not find relief from their malaise. Some of them have also committed to going to a Yoga class, increased their physical activity, switched from coffee to chamomile tea, and on and on.. While some of these changes can be occasionally good, often it can lead us down to a path to engage in activities with the hope that it gets rid of something (anxiety, OCD, depression). Suffers do these types of things because that’s what our culture tells them to do when you are mentally ill. However, when we engage in control efforts to get rid of a symptom we don’t like, we fall into a continued trap of anxiety or depression.
Often when someone has been suffering with a mental illness for sometime, they’ve begun to avoid things in their life that use to bring them meaning, purpose, and joy. When someone begins to avoid activities such as building and maintaining relationships, engaging in the workforce, being playful, tinkering with their hobbies, being adventurous, etc., their lives become small, boring, lonely, and simply unsatisfying. In other words, one can become very isolated from their values, which in itself can create human suffering.
Using Values to Build A Meaningful Life
So what do we do when we’ve mastered mindfulness and attempted activities that are suppose to cure us of our disease but have only failed to do so? In Acceptance and Commitment Therapy (ACT), we engage in a values exercise called “Flavor and Savor.”
How To Identify Your Values
Pick 2-3 values that stick out to you instinctually. Choose from the list of values below (This is the flavor part of the exercise).
Pick a value that you feel you crave (like how you feel when your stomach growls for your favorite food).
It’s important you don’t pick a value that you feel like you should have, or that culture or religion says you should have.
What does this value means to you?
Acting on Your Values
Write out 2-3 sentences about how you will ACT on this value.
Create a SMART goal in order to make acting on our values a little more realistic.
For example, one of my values is growth. What growth means to me is to continuously pursue opportunities to expand my knowledge in business, my therapy practice, my role as a father, and my photography skills. A couple of ways that I ACT on this value is by creating a goal to read books about photography and books on the latest science around mental health, and then incorporate this new knowledge into my sessions with clients or in my photography process.
After you have practiced picking a value (flavoring), at the end of the day reflect on how it felt to intentionally incorporate this value into your day (savoring). You may have noticed a big difference in your day, or maybe you didn’t. Have no fear if you didn’t notice anything, but then try choosing another value to practice incorporating into your day. For more about the difference between values and goals, check out this great video: Values vs. Goals.
Here’s a list of values to start from, excerpted from Brene’s Brown’s book, “Dare to Lead”:
Written by Justin Matthews, LGSW
Justin is a therapist that specializes in helping individuals get relief from anxiety and OCD by teaching them how to be more flexible with their unhelpful thoughts so they can spend more time doing what matters.
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How to Unhook From Thoughts Using Mindfulness Meditation
Justin Matthews, LGSW will show you how to use mindfulness to learn how to accept and allow thoughts in 2 minutes
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Common Sub-Types of OCD
Many people think OCD is characterized by symptoms of excessive handwashing, counting, checking, and having things be "perfect." Although these are indeed symptoms of OCD, it is a limiting description of the possible ways OCD presents itself.
Why are sub-types helpful for OCD?
Because the symptoms of OCD are not widely understood, many people are still under-diagnosed with OCD. And this means people are not recognizing it and likely not getting treated...especially the most appropriate type of treatment. So by identifying sub-types and talking openly about them, more people may get the help they really need. Many of our clients with OCD had thought they were "just weird" or "had anxiety." There is relief in knowing there is an explanation and name for your symptoms.
The downside of sub-types for OCD
Although sub-types are helpful in some ways, it can common with some issues too. It's important for people to know that these subtypes are not separate diagnoses. They are under the OCD diagnosis. It can actually be a slippery slope to over-identify with a subtype because it can make people more susceptible to relapse. For instance, if you are focused on your symptoms of Harm OCD, you could make great improvements in therapy but years down the road OCD could come back in a different theme, such as sexual orientation OCD, you could struggle with applying your previous skills to this theme because it "feels different." This is why it's important in treatment to not focus too much "on the content" of what OCD says, but instead understanding the ways it can play it's game and suck you in. This way, no matter what theme shows up, you can use your skills
Common Subtypes of OCD
Contamination OCD-fear of getting sick, fearing of spreading illness, fear of disgust, fearing of becoming a "dirty" person
Responsibility/Checking OCD-fear of items (like appliances) being left on, items being unlocked or properly secured
Just Right OCD-excessive awareness of something not being symmetrical, unease when completing routine activity, concerned an item doesn't belong somewhere
Harm OCD-fear of snapping and harming others or yourself, fear of acting on intrusive thoughts, fear of being responsible for a tragedy caused by an error you made, fear of hitting someone with a car and not knowing it
Sexual Orientation OCD-fear of living in denial of your sexual orientation
Pedophile OCD-fear of snapping and becoming a pedophile, fear of touching a child inappropriately, fear of being in denial of being a pedophile
Relationship OCD-fear of not really loving significant other, fear of partner leaving
Scrupulosity/Moral OCD-fear of interpreting scripture incorrectly, concern about words/symbols being a sign of condemnation, fear of being judged for not following religion perfectly
Hyperawareness OCD-excessive awareness of involuntary bodily processes such as breathing, swallowing, blinking, etc.
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Asking to be cured of OCD is for dead people
Wait, I can’t be completely cured of OCD?
Let’s begin by first acknowledging that OCD SUCKS!! There is a reason you are looking for help, and I’m guessing it’s because you’re suffering and becoming sick and tired of being sick and tired. Trying to get rid of obsessive thoughts through compulsions is exhausting. And it makes your world smaller and smaller. The suffering is often evident once OCD begins to rob you of your time, relationships, work performance, and simply just makes you feel very uncomfortable under your own skin. However, asking to be completely free of OCD can only be achieved once you’re 6 feet under. I know, that sounds dark and dramatic - but it’s true. OCD is a chronic disorder, which means it cannot get better without treatment. When I tell my clients that I can’t completely cure them of their OCD, I often see their body posture almost collapse. But the truth is - there is no magic Men in Black device that can delete our thoughts and memories - they’re now in our repertoire. HOWEVER, there is hope - so please stay with me.
How Acceptance and Commitment Therapy (ACT) can help treat OCD
Exposure and Response Prevention (ERP) has been (until recently) the only gold standard for treating OCD. However, there is a new treatment in town, and it has not only been shown to be just as effective as ERP, but also incredibly influential with helping people design a life that is more rich and meaningful. This treatment is called ACT. I describe how ACT works by having my clients visualize a glass of water that is about 25% full of water, but also completely saturated with salt. I explain that the water represents their lives and everything in it that brings them meaning and joy, and the salt is their OCD symptoms. During this exercise, I confess that I can’t remove that salt, but what I can do is help my clients fill their glass with more water, which decreases the significance of that salt in their lives. I also teach my clients skills to help them deal with that salt more flexibly as we move forward together -filling their cup with more purpose, meaning, and value.
Do you use ERP to Treat OCD?
Yes. ERP is certainly still very useful and I incorporate ERP into my practice. I like to describe working within ERP and ACT as a marriage - each model having their own unique benefits that contribute to the treatment process. For more information about ACT’s usefulness with treating OCD, please go here: https://iocdf.org/expert-opinions/expert-opinion-what-is-act/
My role as a therapist in treatment for OCD
I describe myself as more of a coach than as a “healer.” I often use a metaphor (I use metaphors a lot!) to describe my role in treating someone with OCD. Here we go, let’s begin by imagining two mountains that are right next to each-other. These mountains represent “life.” Life is hard and it is much like climbing a mountain. Mountains can be incredibly dangerous to climb if you don’t have the right tools to help you get to the top. So now imagine your mountain being right next to mine, and let’s pretend that we can magically hear and see one another. The benefit of this circumstance is that I know some tips that can help get you up this mountain, and maybe even enjoy this climb. I can give you strategies for feet placement, how to sharpen your pick axe, I may even see an alternate route up that you can’t see from your perspective, or I may see an avalanche racing your way before you do. Assuming I don’t slip and face my own adversity on my mountain (hey, I’m human too!), I can coach you up your mountain with the help of scientifically-proven skillsets. I may even have us pause occasionally, and just take the time to enjoy the scenery up there, because that’s important too!
What I’m trying to say here is that I’m not this magical healer that is just basking in the sun on top of my mountain - free from any anxieties or curve balls that life throws at us. I’m just like you, a normal human trying to climb this mountain we call life. And the truth is, this mountain only ends when the credits to our story begin to roll. So let’s make the most of what we can out of this adventure.
Written by Justin Matthews, LGSW
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"I know I need to sit with anxiety...but HOW?"
It sounds so simple, right?
As you start to learn about the strategies that help and don’t help with anxiety, you’ve likely come to learn that running from discomfort is only making matters worse.
So everything you have been learning tells you to not avoid, distract, or do a compulsion but to “sit with anxiety” instead.
I get this isn’t easy. If it was, you wouldn’t be avoiding in the first place.
I find that there are important skills I need to help my clients learn in order to effectively “sit with” anxiety. So here are my tips on how to “sit with anxiety.”
My 5 Tips on How To Sit With Anxiety
Be curious about what your body is doing
Close your eyes to really allow yourself to be present with your mind and body. Do a scan of your body and notice where you are experiencing sensations. Just name the sensation you notice in a matter of fact way. For example: “I notice chest tightness” or “here’s nausea.” Draw an imaginary circle around that area.
Acknowledge the sensation for what it is
When we feel anxiety in our body, we can begin to interpret these sensations for real danger. If you find your mind doing this, remind yourself “this is just a sensation” or “here is discomfort.”
Be curious about what your mind is doing
Close your eyes once again and notice what your mind does. Is it giving demanding threats? Is it spinning with a bunch of random thoughts? Is it desperately trying to focus on something else? You don’t have to do anything here, just sit back as if you were sitting in the chair of a theater and watching a show.
Be gentle
Sitting with anxiety isn’t easy. You need to give yourself relentless grace and encouragement for doing something difficult. No judgment allowed here. Tell yourself “this isn’t easy” or “I can do hard things.” Beating yourself up for having anxiety is not helpful in moving you forward, so commit to being more kind to yourself. If you had a close friend who began to panic, would you say “what’s wrong with you?” I doubt it. So don’t tell yourself that either. Treat yourself like you would treat a friend.
Remove temptation
If you are working on sitting with anxiety without avoidance or compulsions, you may want to modify your environment to make it more challenging to access those. For instance, if you are working on reducing handwashing, remove extra soap or hand wipes. If you are working on not checking the rear view mirror, flip it up or cover it. If you seek excessive reassurance (online or with loved one), leave your phone/computer and go for a walk so can’t research the internet.
Practice, practice, practice
If you are working on relating to anxiety differently, then these skills are crucial to your success. If you are doing exposure therapy, then you are moving towards situations that make you uncomfortable all the time.
If you are struggling to sit with the anxiety, then you will likely abandon the exposure exercise quickly and end up avoiding the situation (or doing a compulsion).
If you are struggling with “sitting with anxiety”, then I would recommend practicing these skills on a regular basis before doing exposures. If you only practice these skills during times you are highly anxious then it may make it more difficult to sit with the uncomfortable feelings.
If you need help with applying these skills, then you may want to think about starting therapy for anxiety or OCD. Our therapists are trained in using the most effective strategies for treating anxiety disorders and OCD.