Understanding rOCD

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Some other old notes

Hi everyone,

I was doing some Spring cleaning (not Spring yet) and found some old notes from my therapy and mindfulness sessions. They really helped me to understand rOCD and what the first steps are in getting better. Here they are:

  • OCD looks for areas of rigidity, where we are not very flexible in our beliefs and targets them.
  • Short term goal. When we have an rOCD thought – “this is an OCD thought about…”. Start labelling thoughts.
  • Long term goal . We should slowly start to include possibility statements in our self-talk. For example ” I really do not want to break up, my world would end” vs. “It wouldn’t be great, it would hurt but it could be possible”. This shows OCD that we are not afraid of it and once we take away the target, it will have less strength. This also brings flexibility to our thinking.
  • Our goal is to be able to observe thoughts without evaluating and judging them or analysing them.
  • Do not fight it. Give permission to come in but do not get involved with the thought.
  • When anxiety is a dominant emotion it is very difficult to feel everything else. Learn to recognise anxiety feelings.
  • I know it is OCD because once I seem to find comfort in a thought, and “solved” my problem mentally, another contradictory thought comes up to discredit the first.

My favourite - Thoughts are not facts!

You can’t stop the waves but you can learn to surf.John Kabat-Zinn

 

Some old notes

Imp-of-the-mind-cover

 

Hi everyone,

It has been really crazy lately. Loads of emails to reply to (I will reply to everyone when possible), busy at home and extremely busy at work.I have been going through some old OCD notes in preparation for the final draft of the rOCD book and found something really good that I just had to share. These notes are taken from one of the best OCD books that I ever read. The book is called “The Imp of the Mind” – you can find it on Amazon here.

Here are some of the notes:

What is the imp
The word “Imp” is taken from a title of a poem from Edgar Alan Poe “The imp of the perverse”. It describes the natural tendency that our brains have to think and being attracted to evil. Pierre Janet called this “association by contrast” whereas patients feel driven to do the exact opposite of what they want to do.
Bad thoughts happen to everyone. Some people just seem to cling to these more strongly thus in time developing obsessions. These bad thoughts tend to be the most inappropriate things to think at the most inappropriate times. What you consider the most awful or shameful thing to do is normally the subject of these thoughts.

Thought suppression and Rebound effect
The more you try to get rid of something, the more you are aware of it. That is why thought suppression is not a very effective technique. Fighting or avoiding situations where these thoughts might occur is only likely to increase the intensity and frequency of these thoughts. A rebound effect might also occur after we give up on suppressing thoughts i.e. thoughts come to the mind at a higher frequency than before suppressing them. After we abandon control of these thoughts, they become less bothersome and are less noticed.The more you try to avoid situations that trigger unwanted thoughts, the worse your problem will become.

OCD and depression
It appears that depression impairs the normal functioning of the brain and this results in the patients being more vulnerable to bad thoughts. Interpreting these bad thoughts in a wrong way can also lead to further depression. It also appears that people with depression are more 5-6x more likely to have bad thoughts than people without depression (based on a study done on post-partum patients). When we are depressed we tend to think the worst of ourselves.
Some patients with bad thoughts seem to report that these started when everything in life started to go well and happiness was “reached”. Almost like the mind has come up with something to worry about and ruin things.
One of the biggest fears seem to be that of loss of control. That you would snap and do something that you would not normally do.
Sexual obsessions seem to be present in more than 1/4 of people with OCD. Self-medication sometimes occurs in the form of alcohol and drugs to try and deaden the obsessions.

Absolute certainty vs. enough certainty
There seems to be a need to feel certainty absolutely before being able to move on.The slightest doubt is a tormentor. The very act of trying to attain perfect certainty is often the worst source of distress. This is why the French call OCD the “doubting disease”. Part of the success consists in stop checking for reassurances.
What is like to feel absolute certainty and how will you know you have achieved it? Nobody knows and even if you could, your brain will tell you that it is not because it is too good to be true. Hence people are tormented by doubt caused by a need of feeling certain.

There is no such thing as absolute certainty, but there is assurance sufficient for the purposes of human life.

John Stuart Mill

Common cognitive error for people with OCD:

  • attributing too much importance to thoughts
  • thinking that they need to be able to control thoughts (or are capable of doing so!)
  • exaggerating the danger of a situation
  • intolerance of uncertainty
  • perfectionism
  • excessive responsibility

Can’t shake it…

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Hi everyone. I have finally started working on the book. Working and helping taking care of a newborn baby takes a lot of time but it is well worth it!

I have picked some emails that I had not yet replied from rOCD sufferers and realised that there was something that I did not cover… “NOT JUST RIGHT EXPERIENCES” in OCD. Or NJREs as it is shortened.

From this link: http://www.ncbi.nlm.nih.gov/pubmed/12732376

Individuals with obsessive-compulsive disorder (OCD) frequently report uncomfortable sensations of things not being just right (“not just right experiences”; NJREs) and a need to ritualize until they quiet these sensations.

Imagine this – You started your rOCD recovery, things are starting to improve and you are obsessing a lot less. But there seems to be an issue – something kind of feels “off”, something is quite not right. You can’t pinpoint what it is. But it is there. What does this mean? How can you “fix” this feeling?

As with all feelings, there is nothing you can do change them straight away. Your experience in that particular moment is your experience. Nothing more, nothing less. By this I mean, there is no need for interpretation or trying to associate this phenomenon with some other things.

CBT teaches us that you can change the way you feel by changing the way you think. I think this is partly true. However, there are some processes that you can influence and others that you can’t. If you feel cold or hot – no amount of “thought changing” is going to fix this. I believe it is the same with NJREs. These are so characteristic of OCD that it becomes futile and tiring to try and change them. We should focus instead on changing what we can e.g. develop better mindfulness and acceptance habits.

The other thing with NJREs, is that they are a “great” way for our brains to bring us back to old rumination habits. Which in turn worsens our OCD and slows down our progress. So the best course of action is just to ignore them, resist the temptation of engaging and do something else.

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Antibiotics

When doctors treat infections, have you ever considered why in most cases they prescribe a course of antibiotics that could last more than a week? And you have to take them more than 2 or 3 times a day?

The simple answer is that in order for the drugs to be effective, they have to reach an x dose for an x period of time. So just taking the medication once, will not do any good. Starting one day and forgetting about the rest will do no good either. The reason for this is that once you take the drug, your body will do its best to get rid of it  (in most cases through the urine, sometimes through your breath if it is alcohol!).

So again, for a drug to be effective it needs to be taken at regular intervals for a certain period of time. How does this apply to rOCD?

There is no emergency medication. If you are not taking your daily dose of anti-rOCD “medication”, do not expect for things to be any different. Sure, in some cases rOCD will fly under the radar because your mind is busy with something else or because of any other reason. But when stress knocks at the door and things do not go as planned then rOCD will come out to haunt you. Until treating rOCD becomes a daily priority in your life, do not expect much improvement. The good news is that 15-20 minutes a day will do wonders. The bad news is that it will take some time and effort to get there. The choice is yours.

Introductions

imagesHi everyone,

It has been a busy couple of weeks but I am now back writing some posts. I have noticed that many more people have joined the blog subscription roll since I moved it to a .com domain. And many more people are e-mailing me asking similar questions. I will always reply to any emails, even though it might take me some time to do it due to the large number of people emailing me and work and family commitments.

Having said that, I would like to give out some general pointers that will be useful if you want to move forward:

1-  Take responsibility

It is your responsibility to look for ways to get better. Giving this responsibility to someone is not going to work. There are no miracle answers when it comes to rOCD. Just hard work. There are a lot of resources on this blog that will help start with this.

2- Take action

At a certain point you will have to stop thinking and start doing. Seeking for medical advice is a very good start. Seeking for a therapist can sometimes be tricky but it will be very useful. If you can’t afford any of these,  look into mindfulness practice. However, this is not a substitute for professional intervention.

3- You have to find the answers for yourself 

Many people tell me their story and ask me if I think it is rOCD or just “falling  out love”. My experience is that this is something that does not help very much. If I say it is rOCD, there will always going to be “what if’s” this and that. So I kind of stopped answering this question and just try to help people help themselves. A word of caution on this one – most often there is nothing wrong with the relationship but the problem lies with your own anxiety. If you want some clarity of mind, you will have to “fix” your anxiety first.

4- If you want to get better

If you really want to get better do not treat rOCD like flu or measles. That it will go away by itself. From all the people that I have spoken with so far there are always good periods where rOCD appears to disappear but it eventually comes back. You will have to commit yourself to daily change if you really want to see some progress. It is hard to retrain yourself and your brain in the beginning, but it will get a lot easier if you persist.

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Tip #29 Q&A

Some of you have emailed me asking some very pertinent questions in regards to ROCD. Most of the questions overlapped between individuals. As someone pointed out in a previous post, it could be beneficial to have access to the same “answers”. So here is a general summary or overview of my answers based on my own experience with ROCD:

How do I know it is truly ROCD and not me falling out of love with my partner?

This is one of the questions that I have been asked the most.

First, I always  like to stress that I am not a qualified mental health professional. I am just someone that went through a long period of ROCD and “recovered” from it. I like to make this clear because this is the right thing and fair thing to do. Ultimately, I encourage people to look for professional help if they can afford it or point them to books and other literature that helped me along the way. I think it is important for each of one of us to take personal responsibility for our recovery.

Second, the important bit is the OCD bit. Not the “R” bit. Everyone in a relationship at certain times will question the quality and truthfulness of the relationship. It is a NORMAL thing to do. Especially, if the relationship is under stress. The difference between a “normal” person and ROCD person is that in the ROCD sufferer the questioning becomes an obsession. The “normal” person is able to resume switch off the questioning. The ROCD sufferer can’t. So if you are obsessing about your relationship and this is impacting your thinking, feeling, etc then most likely it will be ROCD.

Third, there seems to be a huge misconception that the level of love in a relationship should remain static. Somedays, you will feel tired and unable to feel much love. Other days you will feel exactly the opposite. If our idea of being with the right person is based purely or mostly on the way we feel than we have fallen into the Hollywood trap – find the right person and you will be forever happy without any work from both parties.

Fourth, being in the “right” relationship is more about being the right person than being with the right person. If you share most of the same values, are both willing to work towards your happiness and there is no abuse in the relationship, most likely you are already in the “right” relationship. Again, this is more a choice than anything else. You can both decide to be happy. Growing apart is more about not nurturing the relationship than not being with the “right” person.

Why can’t I stop questioning or thinking about my relationship?

This is the obsessive side of the disease. It is not easy to switch off. Sometimes it will require medication, other times just therapy. It seems to increase or get worse when people are depressed or anxious. So improving from ROCD will most likely require improving from depression and anxiety.

Why can’t I feel the same way anymore when I want to feel the same again?

Over-thinking has a funny effect on the brain. Your emotions get depleted. It is much harder to feel something. When we feel depressed it is very hard to feel anything else. We just feel down. The other side of the coin is that the more you want to feel something, the more aware you become when it is not there. So this just reinforces the cycle of not being able to feel because you are raising your anxiety.

So to start feeling something again, we need to stop wanting feelings to be there when we expect them to be there and stop the over-thinking.

Why is it difficult for me to accept that I have ROCD?

OCD is also known as the doubting disease. Once we seemed to have found an answer, our brain will try to find an exception to our answer. This is what the brain does when it is anxious. It looks for possible signs of danger.

How can I get better?

Getting better will require medical advice to know if you need medication. Therapy to learn the right tools on how to cope with ROCD. And most importantly, COMMITMENT on your behalf not to give up. Sometimes finding the right medication and right therapists happens in the first instance, sometimes later. I was lucky enough with my medication as I did not have to switch to anything else. Not so lucky with my first therapists but managed to learn something useful from all of them.

Why can’t I feel sure about it one way or the other?

Wanting to feel certain is part of any type of OCD. It torments the sufferer and drives the condition. I like this quote:

There is no such thing as absolute certainty, but there is assurance sufficient for the purposes of human life.

John Stuart Mill

Will I ever feel normal or recover from ROCD?

Yes, if you are able to move from focusing on the problem to focusing on possible solutions.

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Tip #24 What we should learn through ROCD

“The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths. These persons have an appreciation, a sensitivity, and an understanding of life that fills them with compassion, gentleness, and a deep loving concern. Beautiful people do not just happen.”

Elizabeth Kubler-Ross

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Tip #22 Some links worth visiting

This week, I have decided to give everyone a break from this blog and recommend some other links.

The first link is related to ROCD research that is going on in the  psychological community. It is about a group based in Israel led by Dr. Doron. They have done extensive research on the causes and mechanics of ROCD. They also have a questionnaire relating to ROCD diagnosis available. Not sure if they intended to use it to diagnose ROCD patients or not but it looks pretty simple and effective.

It is also interesting that they have split ROCD into two different groups: type I or type II. The only downside is that I could not find much information about the effectiveness of different treatments for ROCD i.e. what works best and what doesn’t to improve ROCD.

https://sites.google.com/site/drguydoron/rocd

The questionnaire is here:

http://rocd.net/measures/

This second link is for an NHS website relating to tools in mental health. I really liked these tools as I have used the depression tool with my family doctor before and after I started my medication and counselling. It was great to see how I had improved my score over time. You will find more tools there to measure mood, stress and depression. What I really like about this link is that after you do the tests, it will give you a score, interpret it and direct you to other websites on how to improve your current situation.

http://www.nhs.uk/Tools/Pages/Toolslibrary.aspx?Tag=Mental+health

Exercise

Ask yourself – Is this information going to help me move towards better mental health? Is it providing short, medium and long term solutions for my ROCD, anxiety and depression?

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Tip #13 Lies and more rOCD lies

A ROCD brain is like Pinocchio. It likes to tell a lie here and then by sending false messages. The only difference is that it has no nose to grow and thus making it very difficult to spot the lies. Sometimes, we can see a nose growing when our anxiety increases…

Some of the ROCD brain’s favourite lies are:

“If I am attracted to other people, then I do not love my boyfriend/girlfriend” – Attraction is part of human nature. It is not like a switch that can be switched on and off. Choice is what makes us love our partners.

“If I find the right person, I will not feel anxiety anymore” – The anxiety is not caused by the other person. It is caused by how our brains interpret a possible danger.

“I always feel anxiety when I am around my boyfriend/girlfriend so there must be a problem with our relationship” – Same as above.

“I can’t feel anything anymore, this means I do not love her/him.” Feelings of infatuation will run its course over time. In addition, it is not unusual for people with high levels of anxiety to become emotionally drained or numb.

“Why can’t I feel that special feeling. Maybe this is not right anymore” – From experience, wanting to feel a certain way whenever something happens is not realistic. For example, the first kiss will not be the same as the tenth kiss as the excitement might be gone.

And much more

There is only one truth in all these lies. The brain wants to keep itself engaged with rumination and analysis. This will not solve the ROCD problem and will only make it worst over time. The only way to get better is to stop this cycle.

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Tip #7 Where are you now?


A big part of getting better from ROCD is making a plan on how to get better (I will cover this in a later blog!). But before we start this recovery journey, we need to understand where we are. The reason why we need to do this is simple. It will help us decide the next steps to take. Not everyone is at the same stage in their ROCD journey to recovery. Speaking with many different ROCD sufferers, I realised that not everyone has the same level of understanding of the condition, how to tackle it and how to cope living with it.

Knowing where we are in our journey can sometimes  be a very difficult thing to do as well. On my road to recovery from ROCD, there were some very distinguishable landmarks:

  1. Finding out about ROCD
  2. Figuring out if I had ROCD
  3. Accepting ROCD
  4. Committing to daily change
  5. Learn and develop better coping strategies
  6. Moving forward with courage and patience
  7. Accepting and embracing uncertainty

I guess a big part of ROCD sufferers are stuck in number 2. And the worst thing is that they do not even realise it. What we need to understand is that knowing that we do have ROCD is not the end of our journey but just the beginning. And we should treat it as such. Even if you do not have ROCD, most likely you are suffering from some sort of anxiety related condition that will need proper attention as well.

Can you see where you are on your ROCD journey?