- Thread starter Daniel E.
- Start date
David Baxter PhD
Late Founder
This is a not uncommon postpartum reaction, by the way. Fears of not being able to keep the baby safe get turned into fears that the mother may actually want to harm the baby.
Of course, the origin of the intrusive and scary thoughts is the exact opposite: How do I keep my baby safe? But like other thoughts, OCD distorts the original worry and transforms it into something much more disturbing and frightening.
David Baxter PhD
Late Founder
Thank you, @Daniel. This is an excellent series of videos that clearly presents the varieties of OCD, what they mean, and what to do about them, 
Breaking the Curse of Obsessive Thoughts
The obsessions aren't about the remark you think you shouldn't have made, or the crack in the sidewalk, or about the major you have to declare. It's about your neurons misfiring, your brain getting confused, much like I do when I go near a stove. Your amygdala, belonging to the older, reptilian brain that kept us safe from saber-tooth tigers, got triggered by something and is throwing a tantrum. It's stuck, like the Whinny the Pooh keychain that I had that wouldn't stop playing the annoying theme song. Even when I chucked it into the backyard.
Therefore, no immediate action is required from you. You don't have to make things right or do anything to reconcile the situation. No behavior or next step is going to save you from the distress because 99 percent of the obsession isn't based in reality as much as it feels like it is.
The obsessions aren't about the remark you think you shouldn't have made, or the crack in the sidewalk, or about the major you have to declare. It's about your neurons misfiring, your brain getting confused, much like I do when I go near a stove. Your amygdala, belonging to the older, reptilian brain that kept us safe from saber-tooth tigers, got triggered by something and is throwing a tantrum. It's stuck, like the Whinny the Pooh keychain that I had that wouldn't stop playing the annoying theme song. Even when I chucked it into the backyard.
Therefore, no immediate action is required from you. You don't have to make things right or do anything to reconcile the situation. No behavior or next step is going to save you from the distress because 99 percent of the obsession isn't based in reality as much as it feels like it is.
"Aliveness and centered spontaneity...is the paradoxical gift waiting to be unwrapped at the core of compulsion."
~ Christian R. Komor
~ Christian R. Komor
Medications for OCD
Fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, and escitalopram are called selective serotonin reuptake inhibitors (SSRIs) because they primarily affect only serotonin. Clomipramine is a nonselective SRI, which means that it affects many other neurotransmitters besides serotonin. For this reason, clomipramine has a more complicated set of side effects than the SSRIs. In general, SSRIs are usually tried first because they are easier for people to tolerate. Although the SSRIs are not used in combination with each other, an SSRI plus clomipramine can sometimes be used together to combat severe symptoms. The usual effective doses of these medications are higher for OCD than they are for other disorders, like depression, which also respond to SRIs...
Another option is to add another medication as an adjunct to the first. This is usually done if the patient has gotten some improvement from the first medication, but continues to have significant symptoms. There are many choices for adjunct medications, including:
...Laboratory tests are necessary before and during treatment with clomipramine but not with the SSRIs.
Fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, and escitalopram are called selective serotonin reuptake inhibitors (SSRIs) because they primarily affect only serotonin. Clomipramine is a nonselective SRI, which means that it affects many other neurotransmitters besides serotonin. For this reason, clomipramine has a more complicated set of side effects than the SSRIs. In general, SSRIs are usually tried first because they are easier for people to tolerate. Although the SSRIs are not used in combination with each other, an SSRI plus clomipramine can sometimes be used together to combat severe symptoms. The usual effective doses of these medications are higher for OCD than they are for other disorders, like depression, which also respond to SRIs...
Another option is to add another medication as an adjunct to the first. This is usually done if the patient has gotten some improvement from the first medication, but continues to have significant symptoms. There are many choices for adjunct medications, including:
- Adding clomipramine to an SSRI
- An anxiety-reducing medication, such as clonazepam, alprazolam or buspirone, in patients with high levels of anxiety
- A neuroleptic, such as haloperidol or risperidone, especially for people with pathological doubting (a symptom where you do not trust your own senses or need reassurance that you have or haven't done a particular thing), or where tics or thought disorder symptoms are present.
- Lithium, particularly if big changes in mood are a problem
...Laboratory tests are necessary before and during treatment with clomipramine but not with the SSRIs.
https://www.psychologytoday.com/us/blog/the-beginning-the-end/202012/can-new-ocd-treatment-help-where-others-fall-short
I firmly believe all sufferers need a “reason," a “calling," or an “event” that really shakes and pushes them to their personal bottom. A place where they feel that they cannot live this way anymore or feel that they have had enough of all the “bullsh*t.” Once, a sufferer is correctly driven, I believe 99% of the problem is taken care of.
I firmly believe all sufferers need a “reason," a “calling," or an “event” that really shakes and pushes them to their personal bottom. A place where they feel that they cannot live this way anymore or feel that they have had enough of all the “bullsh*t.” Once, a sufferer is correctly driven, I believe 99% of the problem is taken care of.
Overcoming Intrusive Thoughts - YouTube
Recorded April, 2018.
Presented by ADAA members Martin Seif, PhD, ABPP and Sally Winston, PsyD
(authors of Overcoming Unwanted Intrusive Thoughts: A CBT-Based Guide to Getting Over Frightening, Obsessive, or Disturbing Thoughts)
Webinar Description:
Do you have frightening, obsessive, or disturbing thoughts that intrude on your life? If the answer is yes, then tune in to this webinar for some great tools to help you overcome these thoughts.
Recorded April, 2018.
Presented by ADAA members Martin Seif, PhD, ABPP and Sally Winston, PsyD
(authors of Overcoming Unwanted Intrusive Thoughts: A CBT-Based Guide to Getting Over Frightening, Obsessive, or Disturbing Thoughts)
Webinar Description:
Do you have frightening, obsessive, or disturbing thoughts that intrude on your life? If the answer is yes, then tune in to this webinar for some great tools to help you overcome these thoughts.
Introducing Paradoxical Techniques to OCD Clients
Although for most psychological disorders, common factors such as the therapeutic alliance are more important than the particular approach, in the case of OCD there is substantial evidence that cognitive-behavioral approaches are the most effective treatments we currently have.
Although for most psychological disorders, common factors such as the therapeutic alliance are more important than the particular approach, in the case of OCD there is substantial evidence that cognitive-behavioral approaches are the most effective treatments we currently have.
OCD Isn't a Thought Problem, It's a Feeling Problem
Here is the actual problem of OCD. The feeling. More specifically, it is the feeling that makes you engage in compulsive behavior, which subsequently reinforces the OCD cycle. Chasing down and embracing that feeling with a welcoming and accepting posture desensitizes you to the feeling over time. Conversely, if you are unwilling to feel the feeling, but instead rely on compulsions and avoidances, desensitization cannot happen.
Remember, we are able to acknowledge that the trigger is neutral, and has a number of alternative associations. Additionally, we are very capable of telling ourselves why the Feared Story is irrational and wrong. However, we are unable to convince ourselves to not feel something because feelings are largely out of our control.
While not bad or wrong, feeling anxiety in an OCD moment is unwanted. Typically speaking, we say anxiety feels bad, but it by itself is not "bad." It is an unwanted feeling state at the moment you're feeling it. When we ride a roller coaster or see a horror movie, we expect to feel butterflies in our stomach, feel our heart racing, and feel jumpy. You know, anxiety feelings. But in this context, we paid good money for the experience! So, the feeling itself is not bad, just unwanted at that moment and inconsistent with the level of actual risk.
Similarly, when it comes to OCD, sometimes the feeling isn't just anxiety, but sadness, loneliness, anger, apathy, or emptiness...
Here is the actual problem of OCD. The feeling. More specifically, it is the feeling that makes you engage in compulsive behavior, which subsequently reinforces the OCD cycle. Chasing down and embracing that feeling with a welcoming and accepting posture desensitizes you to the feeling over time. Conversely, if you are unwilling to feel the feeling, but instead rely on compulsions and avoidances, desensitization cannot happen.
Remember, we are able to acknowledge that the trigger is neutral, and has a number of alternative associations. Additionally, we are very capable of telling ourselves why the Feared Story is irrational and wrong. However, we are unable to convince ourselves to not feel something because feelings are largely out of our control.
While not bad or wrong, feeling anxiety in an OCD moment is unwanted. Typically speaking, we say anxiety feels bad, but it by itself is not "bad." It is an unwanted feeling state at the moment you're feeling it. When we ride a roller coaster or see a horror movie, we expect to feel butterflies in our stomach, feel our heart racing, and feel jumpy. You know, anxiety feelings. But in this context, we paid good money for the experience! So, the feeling itself is not bad, just unwanted at that moment and inconsistent with the level of actual risk.
Similarly, when it comes to OCD, sometimes the feeling isn't just anxiety, but sadness, loneliness, anger, apathy, or emptiness...
The Power of the Word "Maybe"
How do you embrace uncertainty with respect to OCD-related fears?
Cue to the use of "maybe."
OCD treatment is unique. It involves a specific form of Cognitive-Behavioral Therapy (CBT) called Exposure-and-Response Prevention (ERP), which can be enhanced with the use of Acceptance and Commitment Therapy (ACT) - I know, quite a number of acronyms right there! Everything you've probably learned about treating anxiety is seemingly flipped upside down. Instead of trying to prove just how irrational one's fears are, and provide reassurance that one's worst-case scenarios will not happen, OCD treatment focuses on the "maybe," the uncertainty, the possibility, that ones nightmare scenario, the one they try so hard to prevent through the use of rituals, can actually come true - that "maybe" I will contract a terminal illness one day and die, that "maybe" I will forever be focused on a "just wrong" feeling and never be able to succeed, that "maybe" I will commit a morally wrong act, and that "maybe" my true sexual orientation is not in fact what I think it is.
Scary, isn't it?
The rationale for this approach is as follows: The use of "maybe" is an exposure-based practice to help improve one's tolerance for uncertainty. Now, be mindful that becoming tolerant to the possibility of a fear coming true is not the same thing as saying you want it to come true or that you don't care if it comes true. Acknowledging the possibility of a feared outcome is also not the same as saying there is a 50/50 chance. The goal is not to try and figure out the exact probability of your feared story playing out, nor is it to learn to like it. Instead, the goal is to build a tolerance to it, to make room for the possibility of it showing up one day, vs. fighting with it. As you may know, trying to fight a specific fear - and seek a guarantee that it won't come true - doesn't work. You inevitably find yourself caught in a vicious loop of feeling triggered ---> experiencing high anxiety ---> using rituals to reduce this anxiety ---> getting retriggered ---> experiencing high anxiety ---> using rituals to reduce this anxiety.... and so on. Embracing the "maybe" of your fear, along with the short-term discomfort it will evoke, allows you to finally break this cycle.
Think about all the uncertainties and "maybes" we face every day. We get in our cars and drive to the store knowing "maybe" I can get in a fatal car crash. Our family members go to work and there's that possibility that "maybe" they don't come home. How frightening to think about! Yet, we continue to get in our cars, and our family members continue to leave for work. While these fears may not be highly probable (hence why they are called "worst-case" scenarios), they are still possible. We operate alongside this possibility - the "maybe." We tolerate these uncertainties and make room for them.
The goal then becomes generalizing this skill to core fears driving OCD symptoms. We want to practice the use of "maybes," while refraining from avoidance behaviors, or using any rituals to bring down the discomfort it will initially evoke. The goal is to continue about your day, bringing your discomfort along for the ride, while focusing on more meaningful activities that trying to play the OCD-certainty game (a game that can never be won!).
How do you embrace uncertainty with respect to OCD-related fears?
Cue to the use of "maybe."
OCD treatment is unique. It involves a specific form of Cognitive-Behavioral Therapy (CBT) called Exposure-and-Response Prevention (ERP), which can be enhanced with the use of Acceptance and Commitment Therapy (ACT) - I know, quite a number of acronyms right there! Everything you've probably learned about treating anxiety is seemingly flipped upside down. Instead of trying to prove just how irrational one's fears are, and provide reassurance that one's worst-case scenarios will not happen, OCD treatment focuses on the "maybe," the uncertainty, the possibility, that ones nightmare scenario, the one they try so hard to prevent through the use of rituals, can actually come true - that "maybe" I will contract a terminal illness one day and die, that "maybe" I will forever be focused on a "just wrong" feeling and never be able to succeed, that "maybe" I will commit a morally wrong act, and that "maybe" my true sexual orientation is not in fact what I think it is.
Scary, isn't it?
The rationale for this approach is as follows: The use of "maybe" is an exposure-based practice to help improve one's tolerance for uncertainty. Now, be mindful that becoming tolerant to the possibility of a fear coming true is not the same thing as saying you want it to come true or that you don't care if it comes true. Acknowledging the possibility of a feared outcome is also not the same as saying there is a 50/50 chance. The goal is not to try and figure out the exact probability of your feared story playing out, nor is it to learn to like it. Instead, the goal is to build a tolerance to it, to make room for the possibility of it showing up one day, vs. fighting with it. As you may know, trying to fight a specific fear - and seek a guarantee that it won't come true - doesn't work. You inevitably find yourself caught in a vicious loop of feeling triggered ---> experiencing high anxiety ---> using rituals to reduce this anxiety ---> getting retriggered ---> experiencing high anxiety ---> using rituals to reduce this anxiety.... and so on. Embracing the "maybe" of your fear, along with the short-term discomfort it will evoke, allows you to finally break this cycle.
Think about all the uncertainties and "maybes" we face every day. We get in our cars and drive to the store knowing "maybe" I can get in a fatal car crash. Our family members go to work and there's that possibility that "maybe" they don't come home. How frightening to think about! Yet, we continue to get in our cars, and our family members continue to leave for work. While these fears may not be highly probable (hence why they are called "worst-case" scenarios), they are still possible. We operate alongside this possibility - the "maybe." We tolerate these uncertainties and make room for them.
The goal then becomes generalizing this skill to core fears driving OCD symptoms. We want to practice the use of "maybes," while refraining from avoidance behaviors, or using any rituals to bring down the discomfort it will initially evoke. The goal is to continue about your day, bringing your discomfort along for the ride, while focusing on more meaningful activities that trying to play the OCD-certainty game (a game that can never be won!).
No One Told Me Intrusive Thoughts Could Make Me Feel Unlovable | Made of Millions Foundation
I’m still learning how to welcome doubt, uncertainty and imperfection into a life where previously anything below perfect -- whether it was my academic achievement, my social life, or my ‘goodness’ -- was counted as failure. I’m learning that building up my self-esteem is hard work, and isn’t achieved in a six-week course of CBT after a six-month wait. But I’m also learning how freeing it is to feel the heavy restrictions I’ve placed upon myself slowly start to lift away. I’m learning that true goodness doesn’t lie in a spotless mind but in acceptance, openness and care.
I’m still learning how to welcome doubt, uncertainty and imperfection into a life where previously anything below perfect -- whether it was my academic achievement, my social life, or my ‘goodness’ -- was counted as failure. I’m learning that building up my self-esteem is hard work, and isn’t achieved in a six-week course of CBT after a six-month wait. But I’m also learning how freeing it is to feel the heavy restrictions I’ve placed upon myself slowly start to lift away. I’m learning that true goodness doesn’t lie in a spotless mind but in acceptance, openness and care.
5 Ways to Make Meditation More Accessible to People With OCD and Anxiety
If you attempt to be mindful, then you have succeeded at the exercise even if you did not achieve a sense of mindfulness itself. Rather than approaching meditation from a place of judgment, one actually begins to benefit from meditation by strengthening their non-judgmental skills.
If you attempt to be mindful, then you have succeeded at the exercise even if you did not achieve a sense of mindfulness itself. Rather than approaching meditation from a place of judgment, one actually begins to benefit from meditation by strengthening their non-judgmental skills.
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