Why "71º & Sunny?"

I consider 71º to be the perfect temperature. Not too cold and not too hot. I also love perfect sunny days. The vast majority of days are not 71º & Sunny and yet, all days were created by God's hand and they are still gifts, even if they don't fit my ridiculous definition of perfection. My struggle with OCD has at times imprisoned me in an impossible attempt to achieve perfection. I'm now learning to love all kinds of days that don't even come close to 71º & Sunny.

Please leave me a comment below. I really want to know what you are thinking!

Wednesday, August 12, 2015

Worry vs. GAD vs. OCD

Another wonderful session that I attended at the IOCDF Annual Conference was led by Martin N. Seif, Ph.D., who is the co-founder of the Anxiety and Depression Association of America. Dr. Seif was a great speaker and he kept us entertained with his witty commentary while sharing some really good material. I thoroughly enjoyed his very informative presentation. Specifically, it was titled, "Worry and Subtle Forms of OCD: When Rational Refutation, Problem Solving, Stress Management, and Coping Skills are Counterproductive."

Dr. Seif's talk gave me a lot to think about, both in regard to OCD, but also in regard to my struggles with Generalized Anxiety Disorder (GAD). Though, to the best of my knowledge, I have never been officially diagnosed with GAD, I'm 1000% positive that I have it. As Dr. Seif put it, there is a continuum of GAD to OCD, where GAD worries are ordinary in content (but overblown), and OCD worries are irrational and can even become quite bizarre. I've often wondered if everyone with OCD might also have GAD. If you tend to worry about bizarre, irrational things, doesn't it follow suit that you would also be worried about normal, every day kinds of things too? If I understood this talk correctly, I think worry looks like the continuum below:

  Regular worry (ordinary content)   GAD (ordinary content)            OCD (irrational/bizarre content)
   Husband's serious illness              Husband's serious illness                                   hit a person
   Ability to pay bills                        Abilty to pay bills                                         I will be arrested
   My child's future/safety                My child's future/safety            My germs will make others sick
My worries toward the left and center of the continuum are ordinary type worries, which most people have. And notice that the worry contents are the same for regular worry and GAD. However, they turn into GAD for me, because my mind tends to blow them up and I do obsess about them. (And I found out, I tend to perform compulsions too.)

Something important to note is that not all worry is neurotic. According to Dr. Seif, (roughly quoting) "if a plan is created and the 'what if' thought is put to rest, then that is productive worry." (That is the worry at the far left of the continuum.) Unhealthy worry is worry that is toxic, and it keeps repeating itself and does not go away. So if I am worried about something of normal content, but after I've done some decent research and put a plan together, but I keep thinking, "Well, what if this happens or what if that happens?" and I can't let the subject drop, I have probably entered the territory of toxic worry. Hmmm . . . almost sounds like OCD. Also, like OCD, the content of the worry (if it is the toxic type) does not matter. Apparently, it is almost never helpful to spend time analyzing the content of toxic worries. Again, that sounds remarkably like OCD.

Ironically, like OCD, GAD and unhealthy worry can have compulsive-like behavior that accompanies it. Believe it or not, even some standard coping skills like "thinking positive thoughts" can become compulsive if they are repeatedly used over and over again in order to lower anxiety. The key here is repetition. Avoidance could certainly be a compulsion here as well. I suspect that rumination and reassurance seeking (in all its forms - whether it is asking others, or over-researching a subject, etc.) may be compulsions, again, if done repetitively.  I suppose making elaborate plans over and over in your mind (like I often do!) in order to deal with or prevent a feared worry from coming true might also be compulsive. Of course, if it is compulsive, any relief would be short lived and would not stop the anxiety. That "what if" would still be present. That is probably the key to identifying unhealthy worry or anxiety.

So how to deal with worry? First I think we need to recognize it. Apparently, worry is thinking, not feeling. I sure often mistake it for feeling. I know I really need to recognize that. Dr. Seif said that we shouldn't engage with the content. The thought will be there, but we don't need to respond to it. In fact, he likened the worry thoughts to having a rude comment yelled at us by a stranger while we are walking down the street. What's the best way to handle that? Well, you hear the comment and of course, you internally acknowledge it and it might be initially upsetting, but it's probably best to not dignify the comment with any type of response, and to just keep on walking. Just like OCD, we need to learn to sit with and tolerate the unpleasant thoughts/feelings.

Interestingly, the treatment sounds awfully similar to the treatment for OCD. It seems to me that the biggest differences between these illnesses are the content of the anxiety producing thoughts, and perhaps the difference in the types of compulsions? From what I can tell, people with GAD (who do not have co-morbid OCD) don't seem to have irrational compulsions like people with OCD do, such as excessive hand washing, or counting, or re-checking things over and over. I don't know, maybe they do? I'm speculating here, but it's almost as if the more irrational the thoughts, the more irrational the compulsions. Just thinking out loud . . .

This workshop was very eye opening to me, as it answered questions that I had had for years. I knew that GAD was similar in a way, but I did not understand just how similar. Ultimately the goal is the same in either disorder - I need to learn to tolerate uncertainty.

Wednesday, August 5, 2015

Scrupulosity And Exposures That Do Not Compromise Faith

At last weekend's IOCDF Conference, I was lucky enough to sit in on a workshop co-led by one of my favorite IOCDF presenters, Ted Witzig, Jr. (FYI, his Christian counseling group has a great website). This year, instead of just talking about scrupulosity, the panel that he was on discussed appropriate ERP's for religious scrupulosity. I was really looking forward to this workshop, and it did not disappoint.

Anyone who is familiar with the treatment for OCD understands that the basic idea of ERP (Exposure and Response Prevention) is to do the opposite of what OCD tells you to do. So if I obsess about Hit and Run OCD (like I did yesterday!) and my OCD tells me to drive back to check the "scene of the crime," proper ERP treatment tells me I should not drive back to check. Do the opposite of what OCD tells you to do. This can be less straightforward though, if your obsessions involve things of a moral or religious nature. However, Dr. Witzig very strongly believes that we do not have to compromise our faith to treat our OCD. I agree.

Here is an example from my own life: For some reason, I developed a fear that someone (in particular, another Christian) would find inappropriate material in my possession and that they would repeat this fact to others in my faith community and that they would all hate me. Here is the crazy part about this - uh, I don't actually have inappropriate materials in my possession! So why I even thought someone would ever find something of an inappropriate nature, well, I guess that just demonstrates how irrational OCD is. I was always anxious about leaving my phone, or iPad, or Kindle behind somewhere to be found by another person. Then one day, I downloaded a book to my Kindle. As I was reading the book, I came across a section that was inappropriate (of a sexual/violent nature, if I recall correctly). I did not know it was in the book before I purchased it, and I certainly would not have purchased it if I had known. Regardless, I had purchased it and it was downloaded to my Kindle and now I was horrified that there was a permanent "record" that I bought this item. This and other similar events caused significant distress for me.

Oh how I love my Kindle!
One of my therapist's suggestions to fight this obsession was to go to a bookstore and purchase (ugh in public!) a "girlie" magazine. It was never in the plan to read it/look at it, but I was just supposed to buy it and throw it out when I got home. Instantly, I had second thoughts about doing this, though I'll admit, I considered going through with it. But I just did not feel right about purchasing such an item and also giving my money to something that I found morally wrong. I summoned the courage to discuss this situation with a member of my church staff (who already knew the basics of OCD because I had previously educated him). He expressed discomfort with that ERP as well. I did tell my therapist that I was really not comfortable with this ERP and the idea was quickly discarded out of respect for my faith. (A good therapist will never force you to do something against your will.)

Ironically, just talking about the situation with one of my church pastors took a lot of the sting out of this whole obsession. It really started to bother me a lot less and I never pursued any more ERP for this issue. But what are some exposures I could have done that would not have compromised my faith? I could have purposely left any of my electronics out in the open for anyone to pick up and peruse and I would have had to live with the uncertainty of what they thought about any material they saw. I also could have done some imaginal scripting in order to raise my anxiety (on purpose) and force myself to sit with the uncertainty of the situation. In an imaginal exposure, I could write out a scenario something like this:

I buy something inappropriate. Someone from church somehow finds out about it. They repeat it to others in my church. Then it gets back to the church staff. Everyone in church now knows about it. They all think I'm a bad Christian. They don't let me serve in any ministries. I get laughed at behind my back. I get looked down on. The staff calls me in to the office to reprimand me. I feel so bad that I end up leaving the church. I lose all my friends. My life falls apart. My family is embarrassed and ashamed. I'm a loser and I'm all alone. God is disappointed and ashamed of me, etc., etc.

On and on the script would go - laying out every terrible consequence that I think could happen because of it. I believe the idea is to read the script over and over again, until finally, it just doesn't scare you anymore. See Jon Grayson's book for some good suggestions on imaginal scripting and how to properly implement this into your treatment program.

These are just two different ways that I could have done an ERP that would still challenge the fears without challenging my faith.

Additional common fears that a lot of Christian people with OCD have are swearing in church, or cursing God. Again, a sufferer doesn't actually have to do these things to get the benefit of ERP. He/she can write out the "what if" scenario that would play out if they actually did the very things that they fear doing. Another critically important ERP is to not avoid going to church or religious functions.

The point is, ERP can be done in a way that doesn't damage the integrity of a person's religious beliefs. It just may take a little creativity. And if there's one thing I know about people with OCD, it is that they are extremely creative.

Sunday, August 2, 2015

Scrupulosity-OCD Conference-Day 3-Post 1

So we made it to the end of the weekend! We're a little more tired, but I think a lot wiser. This morning I attended a Scrupulosity session, led by Kevin R. Foss, MFT, Ted Witzig, Jr., Ph.D., and fellow Scrupulosity sufferer, Colton Berg. There are several things from this session I will be sharing with you in the near future, but I wanted to pass this along. Mr. Foss recommended (and Dr. Witzig seconded this recommendation) a book entitled "Loving Someone With OCD." Apparently it is a good book for sufferers and their families, so I wanted to let you know about it. I will be purchasing it myself.

And now, it is time for me to be present in the moment and just enjoy my seafood lunch at the outdoor cafe here on this beautiful, sunny Boston afternoon. Talk to you again soon!

Oh the scallops and sweet & spicy carrots
were amazing!

Saturday, August 1, 2015

Clint & Joanie Malarchuk: Keynote Speakers-OCD Conference-Day 2-Post 2

I just sat through the keynote speech given by former NHL goalie, Clint Malarchuk and his extremely supportive and loving wife, Joanie. They shared their story of living with Clint's OCD, and his struggles with also living with the trauma of his nearly fatal on-ice injury (on live tv, no less!). It's an amazing story of triumph over incredible odds. Clint recently wrote a book and I've just ordered a copy and I really look forward to hearing his story in more depth.

New OCD Advocacy Program-OCD Conference-Day 2-Post 1

The IOCDF has just launched a brand new advocacy program and you can join! Those who sign the pledge will be heretofore known as OCDvocates. I'm definitely going to look into joining this new program. I'll let you know more as I learn more.