Treatment options

Just one piece of advice

Hi everyone,

I know that I have not been posting often and this has been a deliberate decision on my part. But I have not stopped blogging. With limited time on my part, I try to reply to as many emails as I can instead. People around the world email me and I have at least one or two new people emailing everyday. And, I will always reply to emails. I also try to limit the information on this blog to the essential bits. Information overload is present everywhere and it can get very confusing very quickly when we are trying to manage OCD.

On a more personal note, my little boy (Christian) is 7 months todays. He has been a great joy for us as parents and I am glad that I made the decision to tackle OCD head on almost 3 years ago. So I have been thinking and have been asked what sort of advice would be most useful, for  a rOCD sufferer.  Here is what I think:

 

Keep things simple. Take one day at a time. Do not focus on goals (e.g. getting “cured” from rOCD) but rather focus on the process (e.g. I will practice mindfulness for 15 minutes a day in the evening).

 

And that’s it. Useful things on the process could be: eating healthier, seeking for medical advice, getting the right medication, avoiding rumination, and many other things that I have already covered in this blog.

 

 

 

Revisiting OCD

So that everyone knows that what I have been writing here is not complete nonsense 🙂 , I decided to steal some paragraphs from PsychCentral – as always I do not advocate spending  a lot of time going from blog to blog and spending a lot of time reading other people’s experiences or discussing your own. The bottom line is that for those that want to get better they have to put some effort in…

Here is an excerpt of the story:

What if? What if… were constant questions in his mind. Sometimes he felt as if his brain were going to explode because it was racing a thousand miles per hour. He was sure about one thing: he needed 100 percent assurance regarding his thoughts and doubts. He spent countless hours looking for evidence to erase his doubts. It was never enough. He could never arrive at a feeling of peace.

Do you recognize this one?

Individuals with mental obsessions will try to pick apart their thoughts in order to figure them out and resist them.  They can spend hours scrutinizing the answers. It doesn’t matter how long they search through their mind for reassurance or how long it takes them to find the answer on the Internet. The answers will not satisfy the uncertainty they experience.

And what about this one?

And I really really really like how they ended the article:

When OCD tries to creep in, they will learn to recognize it and use the skills to keep it at bay. And lastly, they will learn that living with uncertainty is okay — because the truth is, uncertainties surround us all. Once people with OCD learn to accept this truth, they know they don’t have to be slaves to their OCD ever again.

The only thing that the article does not mention is MINDFULNESS. I think it is a good alternative for CBT and you can practice it at home at your own pace and getting a self-help and mp3’s is definitely worthwhile.

Here is the link for the article

http://psychcentral.com/lib/2012/what-ocd-feels-like-being-absolutely-uncertain/

The point I want to re-make is that the problem is not the R in ROCD. But rather the O.

Tip #16 How can mindfulness help?

There are different ways of defining mindfulness and mindfulness practice. I like to think about mindfulness as a tool that help us realise that our bodies and minds are entities of their own and that we are not at fault for most of the things that are going own. For example, if you have a bad thought that does not make you a bad person. If you have a thought that comes into your mind, that does not mean that the thought is true either.

Mindfulness goes beyond raising awareness of thoughts and looks at feelings and other bodily sensations. We start slowly to realize that we go through cycles of feelings, body sensations and thoughts and that all these are part of being human. If we are serious about recovering from ROCD then we need to develop serious mindfulness skills.

By increasing our awareness, we also increase our acceptance. By increasing our acceptance, we start to become comfortable with the uncomfortable and our anxiety decreases. We start to see more clearly with this new understanding. The objective is not to feel better but to feel better.

In my previous posts I have talked about other techniques and they can be put in context like this:

CBT – Understand and disarm your enemy

ERP – Fight your enemy

Mindfulness – Do not mind your enemy

I have also given quotes for the other two therapies. The quote for Mindfulness would be this one:

The greatest victory, is the battle not fought. Chinese Proverb

Exercises:

Read more about mindfulness, buy a book on the subject, watch some videos on Youtube

Here is a good starting point – MINDFULNESS VIDEO

 

Think and visualise your anxious thoughts as leaves in a stream. Observe the constant flow of thoughts coming and going.

Learn how to incorporate mindfulness practice into your daily routine. 

Tip #15 How can ERP help?

ERP stands for exposure and response prevention. It is one of the psychological treatments of choice for Obsessive and Compulsive Disorders.

The idea behind it is to decrease your anxiety levels by exposing you to the things that make your anxiety spike. This sort of therapy normally starts by gradual increase of anxiety triggers e.g. start with the things that might you spike less and slowly work towards those that make you spike more.

I read a quote once that said something like this: “It is best to suffer the worse right now than to live in perpetual fear of it”

The same it is with anxiety related ROCD. And this is what ERP intends to do: to take the perpetual fear of something and put it into the present, enabling us to face our fears. The more we do this, the less fearful or anxious we become.There are different methods of delivery for this type of therapy: self-help through books, online-phone sessions and face to face sessions. One might be more beneficial for some than others.

Tip #14 How can CBT help?

CBT stands for cognitive behavioral therapy and it seems to help sufferers in many types of mental disorders. It can be a complement to medication or stand alone therapy. I will not go into much detail about CBT as there are entire books written about it. I would rather explain how CBT can help people with ROCD.

CBT intends to explain the relationship between thoughts, bodily emotions and feelings. And it goes beyond explanation to help change and develop better thinking habits. It is helpful in a number of ways for people with ROCD:

  1. Starting to realise that the cause of anxiety is internal rather than external
  2.  Develop healthier thinking patterns
  3. Develop more realistic expectations
  4. Understand that latent anxiety can also trigger ROCD thoughts i.e. sometimes we do not realise that having anxiety in our bodies (physical reactions) can trigger thoughts in our minds (not just vice-versa) See below


5. Understand the anxiety cycle (below)

By gaining a better understanding of our own thinking and learned/automatic behaviors we are much more equipped to “battle” OCD. Check out the quote below:

It is said that if you know your enemies and know yourself, you will not be imperiled in a hundred battles; if you do not know your enemies but do know yourself, you will win one and lose one; if you do not know your enemies nor yourself, you will be imperiled in every single battle. Sun Tzu

Drawing from personal experience, I do not believe that CBT is a complete approach for “solving” ROCD. The reason for this is that sometimes ROCD sufferers develop different obsessive problems about their partners and the themes just change without “solving” anything, The REAL problem that needs to be solved is that of obsessive thinking that causes anxiety. I believe Mindfulness and ERP can help much more here – I will cover these in my next posts.

Tip #12 Meds or no Meds

A few weeks ago, I came across a blog advocating the non-use of drugs for mental illnesses such as depression and anxiety. People that wrote this blog were trying to say that pharmaceutical companies do not have the evidence to support drug use in these types of mental diseases and only have interest in their “agenda”. Funny enough, at the end of the same blog the authors were pushing their own agenda – selling their alternative therapeutic services.

I think this is quite an irresponsible way of approaching the issue of drugs in a mental health setting, so I decided to write this post.

One thing that many people do not realize is that treating a mental condition is not the same as treating diabetes or high cholesterol. It is much more complex due to the mental factors. What might work for me in regards to my anxiety or depression might not work for another person. Drugs can be processed by our body differently amongst  different individuals (due to genetics) which might explain why certain drugs work for certain people and others not. It also explains why treating the same condition might require different daily doses.

A couple of things to take into consideration:

-Is the drug treating anxiety, depression or OCD? -(Unfortunately no ROCD drug exists!)

-What is the drug supposed to do? (This helps build better expectations about the drugs)

-What are the possible side effects?

-How long will the drugs need to start making a noticeable effect?

During my initial ROCD period, I was treated with a drug for anxiety and depression. Even though the initial two weeks of treatment were difficult because of the side effects, “fixing” my anxiety and depression symptoms helped me put my mind and body in a better place to benefit from psychotherapy and mindfulness. I also worked with my doctor in setting my daily doses. I was very reluctant in taking high doses because I knew that it might take me longer to get off them.

Will drugs be needed in every case? No. Can drugs benefit certain individuals progress faster? Yes. Ultimately, the decision to take these types of drugs is ours and no one else’s. What we shouldn’t do is take someone else’s experience as the main yardstick in our decision making.