The 2nd annual OCD Southern California conference is in Irvine on Saturday, March 25th. It’s a wonderful opportunity to meet leading clinicians and researchers, get great information, and have the opportunity to interact with others who deal with Obsessive-Compulsive Disorder.
This year’s keynote speakers are Jonathan Grayson, Ph.D., of the Grayson L.A. Treatment Center for Anxiety & OCD, and Ethan Smith, National Spokesperson for the International OCD Foundation. For more information and to register, go to:
The music is pumping, the class is full, and the energy is palpable in the room. Fitness trainer and indoor cycling instructor Wendell Mitchell moves through the rows of students.
“Get comfortable being uncomfortable!” he calls over the music, and the students respond, each giving a little more than they thought they could a moment ago.
The anxiety therapist in me delights in what is happening here. He directs students to do what’s difficult – what’s outside their comfort zone – and they do it. Each knows on some level that the only way to get to where they want to be (weight loss, endurance, energized, etc.) means having to push themselves through some level of discomfort. They know that it won’t be given; it has to be earned. “No pain, no gain” is the familiar gym mantra.
“This is just like anxiety treatment,” I think to myself.
In anxiety treatment, the therapist instructs and encourages the patient to act outside of
their comfort zone, to do something different than they might already be choosing to do. By taking these steps forward, anxiety is something that one can learn to manage and to thrive with. Yet many people fear what treatment for anxiety will be like. Just the mention of standing up to your fears is enough to keep many away from the treatment that could open the door to a much better life.
What Does He Know?
I’m intrigued by how Wendell is able to get so much out of his students, and I wonder what it is that he knows that benefits his fitness students, and applies so well to anxiety sufferers. I sit down with him to talk one sunny day. It’s clear from the start that, in the nearly twenty years he has been in the fitness industry, he has developed a passion for changing lives. I wonder with him how he is able to inspire motivation in his students – and what nuggets I might take from this into my treatment of anxiety sufferers.
He is quick to point out that the motivation must come from each individual themselves, and not from any goal he might have for them.
“They need to find what their motivation is for being here,” he says, noting that he encourages students to think about why they are in class.
I quickly draw a parallel to anxiety treatment. A person seeking treatment must know their “Why?” Why are they in treatment? It is the job of therapist to instruct the patient in successful techniques and to nurture that inner motivation – that “Why?” – and keep it in sight throughout treatment. Without a “why,” there is no compelling reason to get better. In fitness, the motivation might be to live a healthier life. With anxiety, the motivation might be to be able to do things a person has been wanting to do, but has felt too afraid to try.
Wendell also explains to me that something happens when a person decides to push themselves, even just a little. There’s a recognition that they did something that they previously thought they could not – and that tends to trigger even more motivation.
“It’s empowerment,” he says. “Most people walk away feeling unstoppable.”
Again, I draw a parallel to anxiety treatment. When a patient does something that they previously thought they couldn’t, there is an incredible feeling of empowerment. And this empowerment tends to help propel a person forward. The memory of that success can be a great motivator.
With anxiety treatment, just as with fitness training, finding your “baby steps” is key. Rarely does a fitness student or anxiety patient start with the most difficult task. If you’ve never taken a 45 minute indoor cycling class before, you probably wouldn’t expect to be a top performer in class on your first day. And if you’ve never stood up to a particular fear before, you most likely wouldn’t expect to stand up to the scariest thing right off the bat.
“You need to figure out where their baby steps are,” says Wendell, when discussing taking the trip up the fitness ladder. Then you can “celebrate the little small victories.”
When it comes to anxiety treatment, the same is true. A person chooses the steps that feel manageable to them as they work their way toward conquering a fear. Each step is a cause for celebration.
Most people begin a fitness routine knowing it will be tough work. As Wendell likes to say, “this is a workout, not a cookout, folks.” Any patient I ask about getting fit or getting good at something that involves fitness (from cycling to hiking) can tell me that it is more than just showing up and going through the motions. It takes hard work, and if one does the work, they will see improvement, and what seemed difficult at first gets easier. The same is true for anxiety treatment. It takes hard work facing your fears, learning new ways of coping, and pushing through challenging exposures. Yet the payoff is seeing what seemed insurmountable before become more manageable – maybe even easy. And just like in fitness, you get to do it at your own pace. Pushing yourself harder means more progress; going a little slower means more measured progress.
The key is “being willing,” says Wendell when he talks of progress in fitness. A person has to be willing to push themselves toward a goal. If they do, they may find themselves somewhere unexpected.
“I didn’t think I could do it, but here I am. I’m not gonna like it, but I’m gonna do it again.”
With anxiety as it is with fitness, if you push yourself, practice, and repeat – willingly – you may find yourself soaring to places you never imagined. Get comfortable being uncomfortable.
This week is OCD Awareness Week (#OCDWeek ) Many people with and without OCD wonder whether OCD is treatable The answer is that there are very effective treatments available for OCD. Children, teens, and adults alike may feel hesitant to begin treatment for their OCD. I often think that there is no better way to face one’s own challenges than to hear about how someone else faced theirs. With that, I must share a blog post I read this morning.
This post is by 16-year-old Ellen, a teen who has worked hard, not only to challenge her own OCD, but to raise awareness around the globe. She is an inspiration.
The 21st annual OCD Conference, presented by the International OCD Foundation, begins this Friday in Los Angeles. This extremely valuable conference is an excellent resource for individuals with OCD, their family, friends, therapists, researchers, and anyone who has any interest in OCD at all. What makes this conference so special is that professionals, people with OCD, and others from the general public all intermingle and share information and perspectives. A person who has experienced OCD has as much to offer as a professional who is doing research and treatment. People who attend the conference generally take note of the inviting atmosphere and the ease of interacting with individuals from all different backgrounds.
This year, I will have the honor of participating in two presentations at the conference, and co-leading a support group. If you are in, or near, the Los Angeles area, this is one conference worth checking into. For more information. look at the IOCDF’s conference website: http://www.ocd2014.org/
I am preparing to head to the annual conference of the Anxiety and Depression Association of America (ADAA). I look forward to conferences like this one because they provide inspiration for the work I do and the opportunity to interact with the latest information and the great minds that are working on treatments for anxiety and depression. This year, I am fortunate to be able to present at the conference on a topic that is of great interest to me, since I work with a good number of children and teens: Engaging Parents in Children’s Anxiety Treatment. Because I think this is such an important subject, I’d like to share some of what I will share with the professionals at the conference here.
Through my practice, I’ve come to believe that parents are a very important ingredient when it comes to treating children who are struggling with anxiety disorders. Why? Well, first, it is generally parents who spend the greatest amount of time with their children and who are the “experts” on the child. As a clinician, I know that I have a great resource to tap into in the form of the parent. Who better to help me understand how this person spends their time, how they react to things, what they are sensitive to, etc.? Certainly I can often obtain a good deal of information from talking to the child or teen him or herself, but the outside perspective a parent provides is beyond valuable.
Next, working with anxiety requires a good deal of understanding on the part of the person with anxiety and their immediate support system. A big part of overcoming anxiety disorders is education. I spend a lot of time helping the people I work with to really understand how anxiety works and how to challenge it. The better educated someone is, the better they are able to make good choices for dealing with their anxiety. If a child or teen goes home to a parent who is well-educated in the ways of anxiety, that child stands a much better chance of finding success and support in defeating their anxiety.
Third, dealing with anxiety requires a lot of active work outside of session. Learning to defeat an anxiety disorder means a child or teen has to go home and practice, practice, practice. For that practice to be effective it has to be done regularly, with a good understanding of the purpose, and with a sound rationale. If I send a young person home to do practice that makes sense to no one but him or her, then the task is much more difficult. Without that support, a the chances the practice will happen decrease greatly, and treatment is going to progress much more slowly. If a parent who understands the work to be done is there to provide support and direction, then the work is much more likely to be done, and treatment is much more likely to move along.
Finally, once treatment ends, if a parent has participated in treatment, the child or teen is not alone in his or her knowledge and understanding of anxiety and its ways. Anxiety is a natural part of life and when it pops up a good plan is necessary to deal with any of the more difficult challenges it may present. When a parent has participated in treatment with a child, that child has an ally in identifying anxiety when it tries to disguise itself in the future. The parent might even recognize the signs and tricks of anxiety before the child or teen does. Parent and child can form a team to use the tools learned in treatment and put anxiety back in its place. They may even potentially prevent the need to return for treatment.
These are some of the reasons that I believe parents are an important part of the treatment team. Because of this, I try to let both parent and child know how important a player each is in the treatment process. In a future post, I will talk about some of the challenges parents face when they have a child who struggles with anxiety.
This week (October 14-20, 2013) is International OCD Awareness Week. Since promoting OCD awareness is a particular passion of mine, of course I’d like to seize on the opportunity to do a little educating. Just what is OCD? How does it present? Is it treatable?
Let’s start with a little background about how many people have OCD. It is generally thought that 1 in 100 adults has OCD and 1 in 200 children. That’s 4-5 children in the average elementary school, and about 20 in a medium-sized high school. Sadly, though, OCD is often under-recognized. The International OCD Foundation notes that it often takes between 14 and 17 years from the first onset of symptoms until a person gets access to effective treatment. Awareness of what OCD is can help to change that.
Simply put, OCD involves obsessions and compulsions. Obsessions are intrusive, recurring thoughts that are unwanted by the individual. They are associated with uncomfortable feelings and they interfere with important, valued activities. Compulsions are behaviors or mental actions a person engages in to try to feel better or to make the obsessions go away. Avoidance of things or situations that trigger obsessions can also be a compulsion. Compulsions only provide temporary relief. Common obsessions include fear of being contaminated, fear of causing harm to others, fear of losing control and fear of committing a moral offense. Common compulsions include excessive washing and cleaning, constant checking that nothing was done to harm others or that no mistake was made, mentally reviewing events, repeating movements or activities until they are “just right,” seeking reassurance and confessing.
OCD can be extremely agonizing for those suffering from it – and for those who care about them. It can result in lost productivity, lost opportunities and general misery. There are, however, effective treatments that exist. According to the International OCD Foundation, the key elements of treatment for most people with OCD are “one or more of the following: a properly trained therapist, Cognitive Behavior Therapy and medicine.” The Cognitive Behavior Therapy that has demonstrated the most effectiveness for OCD is called Exposure and Response Prevention. It basically involves confronting the thoughts, situations, etc. that make the person anxious and then making a choice not to engage in compulsions. While this may sound a little unnerving, the end effect is that the person learns to tolerate uncomfortable feelings and learns that they naturally lessen on their own.
A little while ago, I took a walk in a park that was along the cliffs of the Palos Verdes Peninsula. The day was clear and the view was beautiful. Except one thing kept popping up that disrupted my serenity. It was a sign that read, “DANGEROUS CONDITION. DO NOT CLIMB ON OR OVER RAILING. DON’T EVEN THINK ABOUT IT!”
“Gee, thanks,” I thought to myself. I looked to my companion. “You know, I wasn’t even thinking about climbing over the railing and now I can’t get it out of my head.”
Indeed, my companion was having images of climbing on or over the railing, as well. As if one warning weren’t enough, this same message was repeated on signs all along the cliff’s edge. They were far enough apart so that, just as the image began to fade, we were admonished once again to “DON’T EVEN THINK ABOUT IT!”
“That sign is an OCD sufferer’s nightmare,” I commented.
Indeed, one of the hallmarks of Obsessive-Compulsive Disorder (OCD) is intrusive thoughts and images. They are unwanted by the person, they cause distress and they won’t go away. What’s more, they play themselves over and over in the person’s head. It is these thoughts that make up the “Obsessive” part of OCD.
“Why Can’t You Just Stop Thinking About It?”
These are the words that many OCD sufferers hear from their well-meaning friends and loved ones – that is, if they are courageous enough to actually share that they are having unwanted, intrusive thoughts. In fact, most people with OCD will tell you that they already have tried to stop thinking about it. They may have put great effort into trying to make the offending thoughts and images go away. So often, though, it seems that the harder they try, the stronger the thoughts. How can this be?
Well, the sign I spoke of above is a good illustration of why it is difficult (if not impossible) to just stop thinking about something. Imagine it is you walking along the railing and the sign warns you, “DANGEROUS CONDITION. DO NOT CLIMB ON OR OVER RAILING. DON’T EVEN THINK ABOUT IT!” Now, try it. Don’t even think about climbing over the railing. Whatever you do, do not think about climbing on or over the railing. You’re not thinking about it, right? Do not think about climbing over or on the railing!
If you had images in your head of climbing on or over a railing, you are not alone. Our mind works so that when we struggle to try NOT to think about something, we tend to only think about it more. I will sometimes challenge people in my practice not to think about a white rabbit. Usually, they immediately begin to smile. That’s because they get it. That white rabbit popped into their head as soon as I said anything about it – and they realize the futility of trying to not think about it.
So, why can’t the person with OCD just stop thinking about an unwanted thought or image? Because our minds just do not work that way. It seems that we may do better if we simply do not try to fight away those unwanted thoughts, and instead go with them. We may just find that, when we do not fight with those thoughts, they begin to fade away on their own.
If someone in your life is strugging with OCD, remember that they cannot simply stop thinking about their intrusive thoughts and make them go away. There is, however, real help for managing these thoughts. Your support and understanding about how very difficult it is to get unwanted thoughts out of their head may be that person’s first step toward getting help and moving in a positive direction.