THE OCD FAQ

These FAQs (and FGAs) are synthesized from the questions and comments I’ve received since 2011 on Everybody has a Brain, on my YouTube videos, and in online discussion forums.

The answers provided here are not a replacement for effective, evidence-based therapy. This is simply one person that has recovered from OCD, sharing ideas with others on a similar journey.

 


 

MEDS, FOODS, AND SUPPLEMENTS

What’s your opinion on Rodhiola Rosea or St. John’s Wort?

I’ve never heard their music but those are great names for punk bands.

If it’s a supplement and not a band, my thoughts on it would still be the same as any supplement or medication people want to take for anxiety or depression: It wouldn’t mean you get to skip making healthy changes and taking healthy action in your life. There is no supplement that can achieve your goals for you in life. Chasing the “right” supplement can easily become a compulsion on its own. On top of that, people are often trying to find a supplement that makes anxiety go away or helps them ignore intrusive thoughts. But OCD or any anxiety disorder is all about trying to make anxiety go away. That’s the problem, not the solution. Anxiety and intrusive thoughts are symptoms of the unhealthy things we need to change, in ourselves or in our environments. Trying to escape the symptoms doesn’t remove the problem. It’s like taking painkillers to get rid of the pain when a lion bites you. The painkillers won’t get rid of the lion. The lion is the real problem, not the pain. And if you get rid of the pain, you might be oblivious to the fact that the lion is eating all of you.

But if rodhiola rosea or St. John’s wort are bands, I look forward to checking out their music videos on YouTube 🙂

Permalink 1 2

Should I take medication?

First of all, I always remind people that I am not a doctor and I didn’t take any medication to recover from OCD and the related anxiety disorders and depression I struggled with. So I’m not an expert on prescribing or taking medication.

When people are making decisions about medication, I encourage them to not frame the question as: “Should I take medication?” but instead as: “What supports are going to empower me to make the healthy changes I need to make to be healthy and happy five years from now?” It helps to make treatment decisions around where you’re going and what you want to build.

Whether somebody takes medication or doesn’t take medication won’t change the fact that they need to make healthy changes in their life if they want to improve their mental health and prevent relapse in the future. If a person takes meds, they still need to make those changes. If a person doesn’t take meds, they still need to make those changes.

Changing your brain is just like changing any other part of your body. For example, let’s say somebody injured their leg while exercising and it became painful to run on it. They’re going to need to rehabilitate that leg if they ever want to run again and that’s going to involve working with a professional to help them change how they move the leg so it’s moving in a way that’s healthy. Going through that rehab process will be painful. They can decide to take medication to relieve that pain or not. In some cases, the medication might help them do more of the exercises, which means they’ll recover faster. In other cases, the side-effects from the medication might interfere with their recovery, or the lack of pain might lead them to exercise the leg in the old way again and cause further injury. But seeking relief from the pain is separate from doing the exercises that are going to ensure long-term health and recovery. Medication can be an enabler that empowers people to make the important changes that need to happen. Many people also make the same changes without medication. It’s those changes that matter.

Permalink 6 0

Have I been on medication too long to recover?

Whether you take medication, or took medication, or don’t take medication, you still have to do the work of learning how to handle uncertainty, anxiety and other feelings you don’t like in a healthy way.

Building great mental health and fitness is just like building great physical health and fitness. If you were somebody who didn’t run, and you tried running, it would be a very physically distressing and painful experience. You can take medication to relieve that pain and exhaustion, or you can recognize there’s an ability that you want to improve and you can start to practice running. It’s very difficult at first but by making changes in your life to support that practice and consistently pushing into your limits, it’ll become easier and easier. Overcoming issues with anxiety works exactly the same way. It’s about learning new skills, pushing into your limits, practicing consistently, and making changes throughout your life to support your practice. If you haven’t practiced these skills before, there’s no reason to expect yourself to have them or view yourself as deficient because they’re difficult.

People that don’t run far, can’t run far. That doesn’t mean they have an Endurance Disorder. That’s just how bodies work. If you don’t swim, you can’t swim. If you don’t lift heavy weights, you can’t lift heavy weights. If you don’t practice these things, you will be physically incapable of doing them. You can’t think yourself into being a physically fit any more than you can think yourself into being mentally fit. If you’ve been taking medication so you don’t feel anxiety or other feelings you don’t like, then you won’t have had the opportunity to develop the skills to handle those feelings. A person who spends all day sitting on the couch to avoid doing anything that causes discomfort, will experience difficulty doing things that cause them discomfort.

If you haven’t practiced experiencing anxiety and building the skills to handle it, that doesn’t make you’re deficient or incapable of developing those skills. Bodies are amazingly resilient and changeable. You are as capable of making these changes as anybody else, but it does take consistent work and significant life changes, just like any health and fitness practice.

Permalink 1 1

What are the best diet changes to make for recovery?

Eating disorders are part of the “OCD family”. So that’s the first question to ask: Are you adopting new compulsions to try to cope with and control the possibility of experiences or feelings you don’t like? Because that’s OCD, that’s not a treatment, that’s not recovery. That’s the problem, not the solution.

Another thing to remember is that compulsions relieve anxiety… temporarily. You may have heard somebody say they cut out a certain type of food or they started on a regimented supplement program and that’s “helped”. But it totally makes sense that adopting complex supplement or diet regimes would lead to short-term relief from anxiety or relief from the urge to engage in other compulsions. While struggling with OCD, it’s very common to notice that when you start engaging in a particular compulsion more and more, you might not engage in other compulsions as much. And we eat multiple times each day, so if your diet or supplement regime requires lots of time to prepare, that can quickly turn into several chunks of time every day devoted to compulsions. You might not be decreasing time and energy spent on symptoms–you might actually be spending more time and energy (and money).

Eating healthy is a great support for physical and mental health. Eat to fuel doing healthy things. But if you’re trying to use diet to avoid totally natural feelings, and you don’t learn how to handle those feelings in a healthy way regardless of what you’re eating, then you’re going to end up using food (or supplements) as just another compulsion that’s going to cause more of the problems with which you’re struggling.

Permalink 7 1

MENTAL FITNESS

How do you stop obsessing at night so you can sleep?

Stop compulsions during the day.

If you spend all day checking, and ruminating, and reacting to uncertainty, it primes your brain to act that way. It’s like training a puppy to jump up on you throughout the day and then getting upset at night when it want to keep doing what you’ve been training it to do all day.

Everything you do during the day is preparation for going to sleep at night.

Permalink 9 0

What’s the best meditation technique for relief from anxiety?

Personally, I think taking heroin to escape feelings can quickly become problematic and lock a brain into a vicious cycle of feeling terrible as a prerequisite to feeling better, which only leads to feeling terrible all of the time.

Oh… you weren’t asking about heroin?

Trying to get rid of feelings you don’t like is not a solution. It’s the problem. If you approach meditation like it’s a pain killer, meditation can quickly become a compulsion and only help you fuel the problems that are causing the pain. This approach also creates a strange incentive for meditation: that you must first be suffering before you practice meditation. But meditation is a great support for a healthy life. You don’t need to wait for a problem to start meditating.

When people only meditate as a reaction to a problem or stressful emotions, they tend not to meditate when they’re not having those experiences, which means they lose out on the everyday benefits of meditation. They lock themselves into a cycle of relapse, like somebody who only goes to the gym when they hate their body in the mirror. They’re going to keep experiencing the thing they hate so they can do the thing their body needs. They can just do the thing their body needs without waiting to hurt themselves first.

Anxiety can be a welcome signal to us that points at something in need of support or change in our lives. You don’t have to try to cover up that signal. Instead, it can help to recognize what needs changing, and make that change.

 

 

Permalink 1 0

I think ADHD is preventing me from recovering. Why can’t I focus?

It’s not possible to be awesome at focusing unless you practice focusing and push your limits, just like it’s not possible to be awesome at running unless you practice running and push your limits.

Here are five ways to practice focusing that have really helped me get my mind to stay in one place at a time:

1. Meditate. Start with short periods and then gradually extend the time you spend meditating. Setting aside three minutes every day for meditation and learning how to make that consistent can be a massive step in the right direction.

2. Stop checking your phone. When you get that urge to check, don’t. The more you respond to every distracting urge that pops up, the easier it becomes to be distracted. You’re training your brain to respond to urges automatically. That’s not going to help you.

3. Eat healthy. If your blood sugar is all over the place, your mind is all over the place.

4. Try uni-tasking. Try to be in your home, with no music or TV on, your computer and phone turned off, and then do something. Just do one thing. You could cook dinner and be present cooking dinner. Prepare the food and don’t think about anything else, not from the past or the future. Be mindfully present while doing one thing, once a day.

5. Eliminate all of your other compulsive behaviors. If you’re practicing reacting to urges and fears and uncertainties in many areas of your life, your brain is going to act that way in other areas of your life, whether you want it to or not. Eliminate compulsions one by one, starting with the easiest.

 

Permalink 1 0

Can I beat OCD with meditation?

Meditation is a great support for building better mental health and fitness. It can help you develop skills that are useful when overcoming OCD–like learning how to feel things with judgment, improving your ability to pay attention, keeping your mind present without running off to catastrophise about the future or ruminate on the past, etc. All of those will help you with cutting out compulsions and changing how you relate to the stuff in your head. But you still have to do that work. Meditation is not a replacement for the healthy changes you need to make. It’s not a quick fix.

You can meditate and engage in compulsions and keep practicing OCD and making it worse. You can approach meditation in a way that’s very symptomatic of OCD, just like you can bring your OCD practice into anything, like exercise or eating. Practice meditation in a healthy way and it will be healthy for you. Practice meditation as an attempt to avoid something you’re afraid of, and you’ll find more of that thing which frightens you.

Permalink 1 0

RECOVERY

With ERP, do you expose yourself to the situation or the thought?

Exposure is a component of ERP. I place a bigger emphasis on the Response Prevention.

You’re going to expose yourself to whatever triggers the compulsion that you’re eliminating. Instead of responding with that compulsion, you’ll practice accepting the thoughts or feelings you experience and then continue on with doing something healthy that aligns with your values. That could be a process that happens entirely in your head or it may involve places and things outside of your head.

Here’s an example: Somebody doing ERP to eliminate compulsions related to door locks will expose themselves to the situation of leaving the house and they won’t respond to the anxiety or any intrusive thoughts with a compulsion like checking the door lock. So they expose themselves in a situation where they’ll have the opportunity to not engage in the compulsion. Then, after they leave the house, they might be sitting in a meeting at work when the thought pops into their head that they didn’t lock the door. Now they’re exposed to a thought, not the actual door, but reacting to that thought by trying to remember if they locked the door, would still be a compulsion. So they would also prevent that response and just accept that the door might be locked or it might not be locked. They’re not going to try to mentally reassure themselves that they did lock it. And that entire ERP practice would happen while sitting in a meeting at work, choosing not to engage in mental compulsions.

Permalink 5 0

I practiced Acceptance but the thoughts are still there. What’s wrong?

Your brain is part of your body and it changes just like any other part of your body. Lifting weights once won’t turn you into a bodybuilder. Likewise, practicing Acceptance once won’t transform your brain. Like physical exercise, it’s something you keep doing if you want to maintain and improve your mental health.Consider how many years and how much energy you’ve invested in OCD. Now it’s time to invest the same energy in recovery. Recovery is a lifestyle, not a lobotomy, so it’s about living and adding things to your life, not taking things away. The more you do it, the easier it gets and the more benefits you’ll see, just like a consistent physical exercise routine.

Permalink 8 0

If I learn to accept intrusive thoughts like they’re just clouds floating by, that means I won’t have them anymore, right?

Why do you hate the clouds so much?

You already want the intrusive thoughts to go away, right? And how’s that been working out?

Accepting that the thoughts, feelings, voices, and urges intruding into our heads are nothing but clouds floating by doesn’t mean they have to disappear. Imagine if you wanted the clouds in the sky to go away–you’d probably want to check that they’d actually gone away. And how would you do that? By looking for them? And if you look for clouds in the sky, there’s a pretty good chance you’ll find at least one. And then you’ll get upset and anxious because you don’t want there to be any clouds. As long as you desire there to be no clouds, you’re going to be upset when there are clouds. But the problem isn’t with the clouds, it’s with the things you desire.

As long as you don’t want to have intrusive thoughts, your brain will check to make sure that you don’t have them. And then, you’ll have them. Why waste so much time and energy trying to control clouds? Just let them be there.

Permalink 13 0

How long does it take to recover?

Recovery from poor mental fitness takes as long as recovery from poor physical fitness–you never stop. Recovery is the opposite of making your health worse. Hopefully you’ll be doing things for the rest of your life to make your health better. Check out this video answer to the question:

Permalink 2 0

I don’t feel so much anxiety anymore so does that mean I’m fine? Did I even really have OCD?

Questions like this come partly from very popular misconceptions about anxiety, OCD, and mental illness in general.

First of all, OCD is not chronic. But you do have to put in the work to get over it. Saying you still have OCD after learning how to accept the stuff in your head and not engage in compulsions would be like somebody learning how to swim and then introducing themselves as a drowner. Your challenges in the past don’t have to continue to define you. They can. But they don’t have to.

Secondly, anxiety is a symptom, not the problem. It is not a useful gauge of how healthy you are and it’s definitely not a sign that you should go back to the old behaviors that caused the anxiety in the first place. Anxiety is a type of pain. It comes after doing something that causes pain. For example, if you experienced pain in your knee while running, that could be a sign that the way you’re running isn’t healthy for you. You could get help from an experienced trainer, do physiotherapy, take pain killers, etc, to get rid of that pain and learn new ways to run that don’t cause the pain. But once you’re running again without pain, you can’t go back to the way you were doing things before. That will only lead to the same result. This is also true with mental health. If you believe that the absence of pain is an excuse to go back to your old, unhealthy ways of doing things, you’ll just experience more pain again.

I encourage people to approach mental health and fitness the way they would approach physical health and fitness. Focus on your fitness goals, not the things from the past you’re leaving behind. For instance, let’s look at somebody that’s never exercised, they always eat unhealthy, they’re very obese, can’t run 100 meters with stopping several times. If they started to do lots of healthy things and they practiced running and they ate healthy and they made changes throughout their life to support that, they would gradually increase their cardiovascular endurance, their strength would improve, they’d start to move towards a healthy weight, they’d be able to run 1 km or more without stopping, they’d start sleeping better, they’d have more energy, they’d be able to do more. Eventually they would see the changes they wanted to see. So they can stop exercising and taking care of their health now, right? They’re fine. The problems they had in the past are gone, right?

Physical health and fitness, like mental health and fitness, is chronic. If you’re not taking care of them, they’re getting worse. Quite often, people will do some healthy things for a little while to deal with some anxiety issues, and then when they decide they don’t feel as much anxiety, they stop doing the healthy things they were doing. And they slide backwards and say that OCD is chronic, it’s jumped themes, they’ve relapsed, but they were doing so well and now this?!

But experiencing poor health is a natural result of not doing things to improve your health. Your health and fitness aren’t static. They’re a natural result of the decisions and activities you engage in every day. If you stop maintaining and improving your health and fitness, it gets worse. That’s totally natural. If you stop practicing running, your ability to run quickly diminishes. People seem to generally be aware of that when it comes to physical health and fitness, but seem less aware of that when it comes to mental health and fitness.

It helps to shift your focus to healthy goals you want to pursue, so that also means picking goals that are creative, about building and adding to your life rather than subtracting. What that means is not focusing on a goal like: losing weight. If you focus on weight-loss, you’ll keep losing weight and regaining weight and losing weight and regaining weight. And that makes sense because you’re measuring success by losing weight. So what do you need to be successful? You need more weight so you can lose it.

So be very careful about measuring success based on getting rid of OCD symptoms. If getting rid of them is what you need to be successful, they’ll keep following you around. Instead, I find that it helps to shift the focus to the healthy things you want to do in life. It doesn’t matter what you’re brain is doing because you know you can accept whatever happens up there and focus on actions that align with your values, that help you be healthy and happy in the long-term. What are goals you can pursue connected to the things that make you health and happy? Pick goals that are creative, about building things in life, not about trying to get rid of thoughts or feelings. It’s the difference between somebody that’s focused on losing weight and somebody that’s focused on being able to run faster or further this week than they did last week. The person that focuses on losing weight will keep falling back into their old habits. But the person that focuses on improving their ability to run will be able to keep improving their ability to run for the rest of their life.

OCD isn’t chronic. You can put it behind you. But don’t pick goals that require you to keep it in your life. What are mental health goals you can improve on the rest of your life? What goals are going to help you move far away from OCD?

Permalink 6 0

How do I handle the fear of relapsing?

Reacting to the fear of mental health worsening is no different than reacting to any other fear. The more you try to control that uncertainty, the more anxious you’ll get, the more compulsions you’ll engage in, and the more you’ll contribute to relapsing.

When you feel that uncertainty, it can be a great opportunity to practice trusting yourself. Whatever happens, you can get through it and you can keep making healthy choices. You have the skills now to take care of and improve your mental health. If you step off the path in the future, you can recognize that and then step back on the path again.

Permalink 7 0

STIGMA

When should I tell my partner that I have OCD?

In an ideal world, this wouldn’t be an issue because anybody entering a relationship would recognize that the other person has varying levels of mental health, just like they do. You share that with each other. You don’t have something strange that your partner can’t identify with.

But we don’t live in a totally ideal world so this urge to hide mental health and figure out how to confess it, persists. I think people run into difficulty with this because of an out-dated way of thinking about mental illness–that it’s static, permanent, and debilitating. But recovery is possible. That you’re struggling with OCD now doesn’t mean you’ll be struggling with OCD later if you take steps to address your mental health challenges. So framing a confession of OCD like you’re about to tell your partner that you have an alien growing inside of you and there’s nothing you can do to stop it from hatching and destroying the world, seems like a misperception of how brains work.

Because our brains can change, and because you’re taking steps to deal with your mental health issues (you are, right?), I always recommend that you explain mental health challenges framed around what you’re doing to deal with the challenges and improve your mental health. That really applies to any problem. Don’t define yourself by the problem. If you build your identity around the problem, the problem will always be following you around. Build yourself around the healthy things you’re doing to overcome the problem. Those are things your partner can participate in and support you in.

So when should you tell your partner that you’re actively taking steps to improve and support your mental health? As soon as possible. Sharing healthy, supportive activities and interests is a wonderful way to build a relationship.

 

Permalink 1 0

Should I be open about my mental illness at work?

This can depend on multiple different factors, the laws and legal precedent where you live, as well as the type of job you have. This isn’t going to delve into any of the legislation or legal structures. Instead, let’s talk about you. A big factor in how you decide to talk about mental health at work will be your own perspective on what you’re dealing with right now. When it comes to that personal perspective, here are four things that I would consider:

1. YOU CAN RECOVER FROM MENTAL ILLNESS. Everybody has varying levels of mental health and fitness they can improve or worsen. You are no different. As much as there’s been increased awareness of mental illness over the past couple of years, there’s also been increased awareness of treatment and recovery. So if you’re at work and you’re struggling with a task because it causes you anxiety, or you’re late for work because you had to go back home and do some OCD rituals, and you tell your employer about your challenges, don’t be surprised if they say something like: “Yeah, I struggled with compulsions and all sorts of anger and relationship issues for years. I got diagnosed with BPD and GAD and addiction. But when I started showing up late for meetings because of those compulsions and getting in fights with coworkers, I realized I had to do something about that. It’s been lots of work but so worth getting over. I wouldn’t be in the position I am today if I hadn’t taken my mental health more seriously. I’ve been compulsion free for five years now. Here’s a great book that helped me and here’s the number of an excellent therapist you can work with to learn some new skills to deal with this. I look forward to supporting you in getting over these challenges.”

You might find acceptance, but also an expectation that you’re going to do something about these challenges. If mental health challenges are interfering with your ability to do your job, that’s something you can change. And it’s going to involve you doing very tough work.

There is a growing community of people recovering from mental illnesses previously considered permanently debilitating. You are not alone in dealing with these challenges and you will not be alone in overcoming them.

2: HALF OF THE PEOPLE IN YOUR WORKPLACE WILL EXPERIENCE A DIAGNOSABLE MENTAL ILLNESS IN THEIR LIFETIME. The statistic that 1 in 5 people experience a mental illness in any given year is often thrown around in the media by mental health charities, but that statistic refers to the number of people with a mental illness in ANY GIVEN YEAR. Lifetime occurrence of mental illness is much higher. A Harvard Medical School study (http://www.ncbi.nlm.nih.gov/pubmed/15939837) identified the lifetime prevalence of mental illness at 46.4% of the population. And that only includes the people who will meet the DSM-IV criteria for a mental illness. That doesn’t include all of the other people that almost meet the criteria. So it’s reasonable to say that at least half of your workplace will experience a mental illness. It’s also likely that very many already have experienced a mental illness or are dealing with poor mental health. Nobody in your workplace has perfect mental health, just like nobody in your workplace has perfect physical health. Everybody you work with has to take steps every day to maintain and improve their health or it will get worse. Seek help with those steps. Also recognize that you can support others in your workplace with taking similar steps to care for and improve their mental health as well.

3. YOU ARE NOT YOUR FARTS. This is a useful lesson for two key reasons:

A) Mental health issues are just like flatulence issues: everybody around you already knows you’ve got a problem. They might not know what the problem is, they might be politely not mentioning that they’ve noticed, but they know. Anybody can smell that a mile away. So being open about how you’re dealing with those issues is going to help you and those around you. If you keep denying that the issue exists, that’s going to lead to people excluding you from things, they’re going to be inventing their own explanations for what’s going on, and they’re going to do all sorts of other things that are only going to feed your anxieties.

B) You are more than your bodily functions and malfunctions. You are dealing with a challenge that is only a tiny piece of who you are. Talking about mental health can sometimes be much more challenging than it needs to be because people conflate their identity with their mental illness symptoms. If you define yourself as nothing more than a bunch of symptoms nobody likes, it won’t be surprising if that affects how people interact with you. It also won’t be surprising if it affects how you relate to your self.

You are so much more than some brain malfunctions you can learn to overcome. Instead of defining yourself by farts, work with experienced professionals to understand what you can do about these issues, how you can change what’s going into your body that’s causing them, how you can make healthy changes throughout your life to eliminate the symptoms, etc. You are not a farter. You are you, and sometimes you fart. Maybe you just had a fart. That’s totally normal. You are not that fart.

4. TALK ABOUT HEALTH, NOT ILLNESS. You’re going to get a very different response from people if you talk about what you’re doing to take care of, support, and improve your mental health than if you talk about what you can’t do. Look at mental health through the lens of physical health and fitness: If you’re struggling with obesity, it can affect your work on a daily basis and, over the long-term, it’s linked to numerous health complications, just like mental illnesses. The causes of obesity, just like mental illnesses, are a complex mix of genetic, learned, environmental, socio-economic, and personal choice factors. Both issues are real, they are biological, they are not things you can snap your fingers and instantly resolve through brute force. They’re not issues you can magically think your way out of. However, with obesity and with mental illness, you can make consistent, holistic changes throughout your life that help you overcome them. So when you’re thinking of being open about the challenges you’re encountering, ask yourself whether you’re looking for support to continue having those challenges, or are you looking for support to overcome those challenges? It’s much easier to talk about being healthier than it is to talk about being unhealthy.

Permalink 0 0

Why do you say I shouldn’t identify with mental illness?

For a very important, entirely serious reason: YOU ARE NOT YOUR FARTS.

I suggest people not get too wrapped up in identifying with mental illness because it’s no different that building your identity around farting.

Farting is the result of things your organs do, influenced by genetic and environmental factors and the decisions you make each day, just like mental illness. Understanding the genetic and environmental context and the impacts of your decisions, empowers you to make choices that limit the amount of farting in your life. Or empower you to increase the amount of farting in your life. If you know something makes you fart, and you do that thing all of the time, you’re going to be farting all of the time. This happens with our brains, too.

But farting is transient. There’s a deeper identity you have beyond that. There’s a YOU that exists when you’re not farting and it’s the same YOU that exists when you are farting. You can build your identity around farting if you want to, but people are going to expect it from you. You’ll have to make that transient thing permanent. But maybe there’s going to come a day when you really don’t want to feel bloated and smell farts any more. Maybe you decide you’re sick of that thing that makes you fart and you don’t want to do it any more. But now everybody expects it of you. That’s who you are! That’s what you told them. You’re a farter! Keep farting! Tell us more stories about your terrible farts!

Then you’re stuck with it, even though you’d rather move on. The same thing can happen when building yourself around mental illness labels.

Here are some other reasons:

– I’ve been talking in public about mental health and recovery since 2011. That’s not a super long time, but it’s given me the opportunity to meet many people who have recovered from mental illnesses and many who have continued to struggle. Every person I know that’s recovered has made the switch to building a healthy life instead of fighting an illness. I can’t guarantee that’s going to be an anecdote that will be true forever, but so far, focusing on health instead of illness seems to really help prevent relapse.

Permalink 3 0

STUFF IN YOUR HEAD

Should I suppress the thoughts or ignore them?

What do you do with clouds that you dislike?

Trying to suppress a thought will keep it alive because you’re spending time and energy on it. Trying to ignore it wouldn’t be that different. You’re still trying to get rid of it and in an attempt to ignore it, you might avoid situations that could trigger it, which is putting the thought in charge of your life.

If somebody asked you to try to suppress a cloud in the sky, it would be very difficult and you would have to spend lots of time and energy figuring out a way to get to the cloud and get rid of it and you’d constantly be checking on it or trying not to look at it. Everything would be happening in reaction to the cloud. So it can help to treat thoughts the same way most people treat clouds: they don’t actively spend energy on surpressing them or trying to ignore them. They also don’t spend energy focusing on them or trying to do anything with them. Why bother with them at all?

When somebody is trying to figure out how to suppress or ignore a thought, it’s usually the case that the compulsion they’re actually struggling with is judgment. If you label that thought as bad, horrible, unwanted, etc, that’s going to create anxiety because you’re having a “bad” thought that you don’t want to have. You might be judging yourself for having that thought, afraid of what it means, afraid that people will find out you’re having that thought–and then you really want to get rid of it. So it can help to shift the focus to accepting thoughts, rather than trying to suppress or ignore “bad” thoughts. What’s the use of judging the clouds in the first place? You can put the clouds in the sky in charge of your life and your emotions, but is that going to be useful to you?

As long as you engage in that compulsion to judge your thoughts, you’ll keep putting yourself in the situation of trying to escape the unescapable.

Permalink 8 0

I’m not dealing with intrusive thoughts. They’re more like urges or feelings. Does that mean they’re real?

It’s all stuff in your head. Regardless of whether you label it as an urge, a feeling, an intrusive thought, or a penguin, that’s a label that you choose. It’s subjective. Somebody else might call that experience something totally different.

Personally, a big part of recovery was relearning everything I thought I knew about emotions and thoughts. OCD doesn’t fall from the sky. Everything in our lives is part of how our mental health deteriorates to the point of illness. So recovery involves making changes everywhere, and in how we do everything, and that’s likely going to involve relearning how you interpret your internal experiences.

No matter what’s happening in my head, it doesn’t change the healthy things I need to do everyday. It helps to shift the focus from the stuff in your head to your actions.

Permalink 7 0

How do you know if it’s a real memory or a false memory?

All memories are things in your head. And those things in your head are real things in your head. But that doesn’t mean they are or were real things outside of your head.

The labels you stick on the things in your head are under your control. If you choose to get into judging and discriminating between memories because you want to be certain about whether you did something or not, you’re setting yourself up for ruminating and worrying. It’s helpful to accept the stuff in your head as stuff in your head. Trying to put labels on that stuff is only going to lead to more misery. The problem here isn’t about knowing whether it’s real or not, the problem is the desire to know if it’s real or not and believing that you can somehow discriminate between real and unreal things in your head. That would be like trying to discriminate between good clouds and bad clouds. They’re all clouds.

Check out this video on “False/Real Memories”:

Permalink 7 4

How can you tell the difference between a rational worry and an irrational worry?

The label you stick on the worry isn’t going to change the actions that are going to be healthy for you and help you reach your goals in life. Besides, identifying the rational worries and the irrational worries is as easy as identifying the good clouds and the bad clouds. This video gets in-depth into the practice/compulsion of judging thoughts:

Permalink 1 0

But what if the worry is real?

All of the tips I share about accepting worries and engaging in healthy actions are for worries–any and all of them. Real or unreal, true or false, green or blue, sweet or sour–these are all labels and judgments you stick on the stuff in your head. You can label it a unicorn worry if you want. I’d still tell you to learn how to ride it if reacting to that worry is interfering with your ability to be happy and healthy and achieve your goals in life.

Permalink 9 0

This one obsession is ruining my life right now. How do I deal with it?

Asking how to tackle a specific obsession that’s causing lots of anxiety is like a person in the midst of running a marathon asking how to boost endurance because they’re struggling with feeling exhausted. They don’t like feeling exhausted, just like you don’t like feeling anxiety, so they want that to stop. That feels like the only problem they have–if they could just not feel exhausted they could win the race!

But building the ability to not struggle with that feeling is something they need to practice for many months before. Believing that there’s just this one problem is a mistake. What they’re experiencing is the result of many other decisions and contextual factors. A runner can’t get rid of exhaustion in the middle of a race. They can blame that problem if they want but overcoming it will involve many changes and supports throughout their life. Many of those changes or supports won’t seem directly related to preventing exhaustion during a race, but all of the supports are part of the big complex puzzle of fitness. If the runner insists they don’t need to stretch or eat healthy or follow a structured exercise regime or lift weights before the race because those aren’t things they struggle with–they only struggle with feeling exhausted during the race so that’s what they want help with–they’re never going to get better.Their ability to handle the issue that bothers them is determined by their daily practices in numerous other areas that don’t bother them.

Getting over OCD is about building better mental fitness. That’s also a big complex puzzle and will require many consistent changes on a daily basis. And those changes may not seem directly connected to what’s bother you. but if you recognize that what’s bothering you is poor mental fitness, then those changes are directly connected to what’s bothering you.

The simple reality is that if you’re struggling with physical health and fitness or mental health and fitness, you’re not dealing with a single problem or a single change that needs to happen. Recognize that there’s a difference between your health and the things that bother you about your health. It’s extremely likely that you’re making many decisions and engaging in many practices on a daily basis that are fuelling poor mental health.

 

Permalink 2 0

If I accept the horrible thoughts, will they go away?

Maybe 😉

Remember, as long as you don’t want something to happen, your brain is going to keep checking to make sure that unwanted thought or event or feeling or whatever isn’t happening. And the more you don’t want that thing, the more your brain will check. So if you’re trying to accept these thoughts because you really, really, really want to get rid of them because you hate them, then your brain is going to keep thinking about them.

If you really want to get rid of the thoughts, stop trying to get rid of them. You’ve given enough energy to those thoughts already. Instead of trying to get rid of things, what do you want to create in the world?

Permalink 4 0

How do you get rid of unwanted thoughts that interfere with your day?

Here are three things to consider:

1. Recognize that you’re judging the thoughts as unwanted and spending time and energy on them. Often, that’s because we attach lots of other meanings to the thoughts, like: What if that means I’m a horrible person, what if the thoughts come true, what if people find out I thought that, I’m going to go to hell for thinking that, something terrible will happen if I don’t correct that, etc.

So it helps to stop attaching all of that extra baggage to the thoughts. The reality of the thoughts is separate from all of the uncertainties that you attach to them. You had a thought. It’s just a thing that pops out of that organ sloshing around in your skull.

2. If you feel good when you get rid of these thoughts, your brain is going to keep giving them to you so you can get rid of them. The more you don’t want them, the more you’ll have them. That doesn’t mean you have to want them. But remember that hating something and disliking something requires time and energy. You’re choosing to spend your limited resources on these thoughts. Do you want to do that? What if the thoughts weren’t unwanted or wanted?

3. When people send me questions about getting rid of unwanted thoughts, I ask them: How do you get rid of unwanted clouds? Most people don’t judge specific clouds as unwanted. But if they did, it would be very stressful because there’s nothing they can do about the clouds. Judging clouds and trying to get rid of them can cause lots of anxiety. There are so many horrifying clouds in the sky each day, so how do you find the time to constantly be outside practicing acceptance with those clouds?

Permalink 6 0

Why do intrusive thoughts stick around?

Thoughts typically stick around as long as we react to them. Even searching online is just another reaction to the uncertainty the thought causes.

The more you react to a thought and enjoy getting rid of it, the more your brain will give you that thought so you can try to get rid of it and feel relief. As misguided as it may seem, your brain is trying to help you get what you want: relief from the intrusive thought.

Unfortunately, what’s the first thing you need if you want to get rid of a horrible intrusive thought? You need a horrible intrusive thought.

Permalink 7 0

Will I have to do deal with these uncertainties forever?

That’s entirely up to you.

To understand what happens through exercises like ERP or ACT, it might help to explore the answer to this question: Why don’t you spend all day thinking about ugly leaves?

You could pick any tree full of leaves and you could spend all day trying to be certain about whether each leaf on the tree is a good-looking leaf or an ugly leaf. And you’ll probably find many leaves that are somewhere in-between. You might try to find a way to be certain about those. However, it’s likely that you’ll have to live with the uncertainty of not knowing exactly which category they fall into. But if you believe that you should get rid of that uncertainty about which leaves are definitely ugly, it might be a heavy burden that you need to carry around with you. Especially if you believe you need to be certain about the leaves on every tree you see. That would completely bring your life to a halt unless your goal in life was to be certain about the leaves on the trees.

A person who is struggling to be certain about leaves does not have a problem with being certain about leaves. They do not have to learn skills to try to know what is true. Trying to get rid of uncertainty is the disorder. Wanting to be certain about the leaves is the problem. They could just go about their day, spending no time or energy even entertaining any uncertainty about whether the leaves are ugly or good-looking. They don’t have to approach recovery as a means by which they hope to be confident about the leaves. If they do that, they’re still putting the leaves in-charge of their life.

At first, learning recovery skills is going to involve handling some uncertainties. That’s normal after years of training our brains to try to be certain about those things. When we pass a tree, our brains want to go and be certain about the leaves because they’re trying to help us–we enjoyed being certain about the leaves. But there are better, more enjoyable things to spend our lives on. And through practicing doing the things we actually care about, those old uncertainties just become irrelevant. I don’t have to wrestle with uncertainty about my “true” feelings anymore than I have to wrestle with uncertainty about whether the leaves outside my window are good-looking or ugly.

The uncertainties you carry around with you each day are wrapped up in your beliefs, desires, and judgments. They are choices. If you feel plagued by uncertainty about something, explore changes you can make to those three.

Permalink 4 0

THEMES

How do I handle the compulsion to correct people every time I think they say something wrong?

From getting into fights in online forums, to insisting on correcting every slightly incorrect thing that comes up in conversation, to sending an endless stream of letters to newspapers, this compulsion comes in many forms but they’re all about control.

Compulsive attempts to control things or other people are a big part of OCD. A person who gets upset by misaligned cutlery and has a compulsion to fix it a certain way is engaging in the same compulsion. Or somebody might believe they “should” look a particular way, and they’ll engage in all sorts of compulsions to try to control how they look because they judge themselves as wrong. Scrupulosity is the same type of compulsion but directed at yourself instead of others. But it’s really the same whether you judge yourself as wrong/sinful or you judge others as wrong/sinful.

One of the most useful supports in recovery for me has been learning to practice non-judgment. The compulsion to control people comes after the compulsion to judge them. Learning not to judge is very useful because if you don’t engage in that first compulsion, you don’t experience the pressure to engage in the next compulsion. Judgment is a compulsion that fuels many compulsions.

Permalink 2 0

What OCD themes did you have?

The same ones you do–the ones where you’re uncertain about something that has happened or could happen and then you do things to try to make that uncertainty go away.

A common challenge to overcome when tackling mental health issues is something called “special snowflake thinking”. That’s when somebody believes that their symptoms are different from another person’s symptoms unless that other person describes their symptoms in exactly the same way.We are unique and special snowflakes and nobody can understand what we’re going through!

But all OCD symptoms follow identical patterns. It’s OCD that pushes us to judge and discriminate and try to fit things into tiny boxes of certainty. The problem is that this can prevent us from getting the help we need unless the things we’re hearing or reading fit into those tiny boxes. Because of that, I try to keep my videos and stories as general as possible. I was very lucky to have never heard about the concept of OCD themes before joining online mental health communities. On the recovery journey, it was very helpful to tackle everything is a single beast.

When you catch your brain judging things as not being applicable to you or specific enough, recognize that as part of OCD. That’s your OCD trying to get in the way of recovery. There aren’t different solutions to different themes. They all follow the same basic patterns.

Permalink 5 0

Why does my OCD keep switching themes?

Because you think it is.

One of the components of an anxiety disorder is rigid, black-or-white thinking, with lots of judging and discriminating and labelling. It’s not surprising that people struggling with OCD have developed all of these different classifications–that’s part of the illness.

The superficial elements of the specific fear are irrelevant. If you were worried about hitting somebody with a car and now you’re worried about accidentally poisoning your friends by under-cooking food you’re serving them, then you’re worrying about the exact same thing. There’s an uncertainty about causing people harm and you’re engaging in compulsive behaviors to cope with, check on, or control that uncertainty.

Tackle OCD at the most basic, fundamental level possible. Learning to accept each little fear separately leads to a very long, drawn-out, exhausting process. All anxiety disorders are essentially about engaging in behaviors to avoid something you don’t want to feel. A person controlling their eating and constantly checking the mirror or the scale in the hopes avoiding a particular feeling, is no different from the person constantly checking their email and writing and rewriting responses to their work colleagues in the hopes of avoiding a particular feeling.

Permalink 5 0

How do I resolve existential uncertainties?

Trying to be certain about existence, the meaning of life, eternity, etc, is no different than trying to be certain about safety, cleanliness, love, or any of the other uncertainties we might try to resolve with compulsions.

If somebody wanted to feel certain about their safety before leaving the house each day, they would eventually get to a point where they could never do enough compulsions to feel safe, and then they wouldn’t leave the house. The same can happen with trying to resolve existential uncertainties before moving ahead with life–eventually it just paralyzes you.

The solution isn’t to resolve the uncertainties, it’s to move ahead with them. They can be there as you do the things that will make you happy and healthy.

One of the challenges with existential uncertainties is that we often believe we should know the answers and we should be certain about life and we need to know.

So cutting out the compulsions that fuel these anxieties will help but it’s also likely you’ll need to throw out some unhelpful beliefs and desires that you’re holding.

It’s impossible to be certain about life so as long as you desire certainty about it, or believe you should be certain about it, these uncertainties will cause you distress.

Permalink 8 0

TREATMENT

I tried therapy but it didn’t work. Now what?

Therapy is like exercise. And exercise works. However, there might be multiple factors that led to your particular experience with a therapist not being beneficial–the therapist might not be very proficient, environmental factors might have interfered with therapy, you might not have implemented the homework exercises properly, the type of therapy practiced by the therapist might be out-dated, etc.

As you try to figure out where to make changes, try to remember that your experience with therapy doesn’t mean therapy doesn’t work. That’s like saying: “I went to the gym but it didn’t work so exercising is pointless. Give me a better way to get into shape!”

If you’re doing an evidence-based therapy for recovery from OCD, like ERP or ACT, you’re going to be cutting out compulsions. So it should be working very quickly. If you’re not cutting out compulsions, that can help point you to the issue that’s getting in the way of therapy. Why aren’t you eliminating compulsions? Is it because that’s not something your therapist does? Are there challenges you need to overcome at home so you can do the homework exercises? Are you not getting homework exercises from your therapist? What changes need to happen beyond OCD to support the process of recovery?

If exercises isn’t “working”, ask: why?

Permalink 0 0

How can I use journalling to cope with OCD?

Coping is a tricky business. Many OCD compulsions are about coping–you feel all sorts of things you don’t like and then you try to avoid those feelings and replace them through “coping”. But those are compulsions. They’re behaviors you use to not feel things. That only cause more of the feelings you don’t like.

With OCD, the compulsions seem like they relieve the pain but they actually cause more of it. The pain, however, is not the problem. Instead of trying to relieve the pain, it helps to deal with the source of the pain. If you were getting hit in the face every day with a hammer, that would cause lots of pain. You could journal about that and it might help provide an outlet for expressing frustration about what you’re experiencing. There might be some catharsis through processing that experience. That might relieve some of the pain. You might get a different perspective on it. But relief from the pain doesn’t change the fact that you’re getting hit in the face with a hammer every day. In fact, getting relief from the pain might not be such a great idea if it convinces you that getting hit in the face with a hammer isn’t so bad. Whether you feel the pain or not, the more you get hit, the more damage there’ll be. The real solution is to stop getting hit in the face with a hammer. And the reality is that you’ll likely discover you’re the person hitting you in the face with a hammer.

So journalling as pain relief isn’t necessarily something I would expect to help with long-term recovery. If you’re trying it as a way to avoid doing the hard work of cutting out compulsions, then it’s only an exercise in procrastination and distraction. We know how to get over OCD so it can help to get started on cutting out compulsions as soon as possible.

But if you’re journalling or blogging as a way to express yourself and have a creative outlet and even help others on their journey of recovery, then you might find it quite enjoyable. Journalling for the sake of journalling, as a practice that’s about feeling more instead of trying to feel less, can be very fulfilling.

Permalink 2 0

But if ACT involves accepting that bad things could happen, doesn’t that contradict the Law of Attraction and “The Secret”?

When I first started out on treatment, I was worried about my fears coming true, too. My intrusive thoughts didn’t seem unreal or false to me at all. They were totally real. So accepting them was equivalent to them actually happening. It was very tough to accept those things and then carry on engaging in healthy actions each day that aligned with my values. But there has been nothing more amazing than the experiencing of moving beyond anxiety disorders through that process. For years, trying to run from my fears and control them with positive thoughts, and corrections, and rationalizations, only led to things getting worse, not better.

So, yes, the scientifically researched and effective approaches of Exposure & Response Prevention and Acceptance & Commitment Therapy may seem to contradict the “Law of Attraction”, but treatment contradicts many old compulsions and beliefs we practiced for many years. They might also contradict something a purple unicorn sang to you in a previous life, or something an iguana whispered in your ear while you were on shrooms at Burning Man. However, like any worry, we accept that fear of contradiction, and do healthy things that are going to help us move towards our goals.

Permalink 7 0

How do you motivate a family member to get treatment if they don’t want to admit there’s a problem?

This is a very common issue and one where we can learn lots from physical fitness. Improving mental health and fitness is just like improving physical health and fitness. So when this question comes up, I always ask people: “If your family member was in very poor physical shape and you knew they had to start exercising or they risked serious health complications, how would you get them to start an exercise program and make changes throughout their life to support that?”

It’s not going to be easy. Nobody gets into great shape because they’re forced to do it. Personally, I started to get help for my mental health issues because I saw that they were interfering with my goals in life. I couldn’t do the things I wanted to do. At that point, I still didn’t think any of my compulsions were weird or unusual–I had reasons for all of them–but I was aware I wasn’t able to do things I knew that I could do. And that’s likely a factor for many people that start on a physical fitness program. They see that they’re not able to run or walk or be active like they could in the past. Their participation in the life they want becomes diminished or challenging. That can spark a change, but it doesn’t always. Many people will run into challenges and say that’s who they are and those are things they can’t do and they leave it at that.

Something else that helped me was seeing other people taking care of their mental health. I had a friend who was open about how he had overcome mental health challenges and how he was maintaining recovery and improving his mental health. That was the first person I talked to about what I was going through. Just like with physical fitness, it helps if you’re around people who are also doing the difficult work of improving their mental health and fitness and making major life changes to support that. It can be very difficult to imagine what change looks like if you’re not close to people who are practicing change on a daily basis. So if you want to tell a family member get into better shape, consider how you would want to be told to get into better shape. Who would you take advice from on something like that? Would you take fitness advice from somebody that doesn’t exercise themselves? How would you like to hear somebody tell you that you need to get into better shape?

Permalink 0 0

What’s the best way to beat OCD? Therapy? Medication? Supplements? Meditation?

It’s easy to get into a debate about the best way to solve the problem of any mental illness. You could get into the exact same debate over something like obesity–some will claim beating it’s all about a strict diet without gluten, refined sugars, or caffeine and alcohol; others will insist the focus should be on accepting bodies, not changing them; others will swear by surgery; others will do intensive programs and then swing back to their old ways after the program is done and they’ll say the program doesn’t work; others will encounter poverty and education issues that get in the way; others will blame genes; others will say it’s chronic and a lifelong battle; others won’t engage in the debate and they’ll just focus on getting into great shape and engaging in dialogue around how to get into great shape, and bringing supports into their life to keep moving towards their fitness goals.

I definitely prefer the last category. If you want to reach your fitness goals, focus on them. What do you need to do every day to succeed with your mental fitness goals?

Focusing on the best way to beat OCD is like focusing on the best way not to drown. If that’s your goal, you’ll have to keep trying to drown so you can check if you’re succeeding. Instead, learn to swim. Be a great swimmer. Make swimming part of your life. Enjoy it. What are the swimming skills you want to develop?

It’s completely possible to get over OCD but if you measure success by beating OCD, then you’ll need to keep OCD around so you can beat it. I think it’s helpful to shift the focus to where you want to go and what you want to do instead of OCD.

Permalink 1 0

Will my OCD get better over time?

It gets better over time if you do things that will help it get better and stop doing things that make it worse. Mental health is chronic, just like physical health. You will always have varying levels of health and you can always do things to improve or worsen your health. I don’t have any symptoms of OCD now, but I could always go back to having OCD if I chose to start engaging in compulsive behaviors again. I get lots of questions about curing OCD but “curing” OCD would be like curing slowness–you get rid of slowness by practicing running on a regular schedule, challenging yourself to push past your limits, and making changes throughout your life to support running. If you stop doing all of the healthy things to support your running program and you stop practicing running, then you’ll very quickly go back to being slow again. You won’t become a better runner by hoping that slowness goes away on its own, and you won’t get over OCD by hoping it’ll get better on its own. Health isn’t something you hope for, it’s something you need to do, every day. Unfortunately, when people wait for anxiety disorders to resolve themselves, they often end up avoiding the things that make them anxious or challenge them, progressively shrinking their lives, until they live in a tiny cage built from from their fears and unhealthy beliefs about what they can or can’t do. So get out there and get running up and over the OCD hill in front of you.

Permalink 2 0

I can’t find help for Pure O. What do I do?

“Pure O” is no different than any other OCD theme. You deal with it in the exact same way you would deal with any other OCD symptoms: you accept the stuff in your head, don’t engage in coping, checking, or controlling compulsions, and then you do things aligned with your values.

When you’re seeking help, I also recommend being open to the possibility that you don’t have “Pure O”, that you have OCD, and it’s just that some of the mental compulsions bother you more, which is why your focus is on the compulsions in your head.

Overcoming OCD requires making changes throughout our lives. We’re often engaging in many compulsions that we think are totally normal but are actually causing OCD symptoms we really dislike.

Focusing only on a narrow definition of our symptoms can become a barrier to recovering. We can start to seek out the “right” way to recover, similar to other compulsions we might engage in to feel or do things in a certain way because we’re afraid that not doing it the “right” way will lead to something bad happening. But that’s a compulsion. Trying to do recovery perfectly to avoid relapse is the practice of OCD.

Permalink 2 0