Ruminating on reasons you can’t recover because your symptoms are different or you have very unique circumstances that prevent you from moving forward… is one of the most common symptoms. You’ll always be able to think of reasons why you can’t cut out compulsions, why you need to keep doing unhealthy things right now, why some other time in the future is going to be a much better time for recovery–our brains are so imaginative!
So what do you say to people who continue to have debilitating symptoms, despite thorough treatment? Being consistent and compliant with various forms of CBT (ERP and ACT), mindfulness, physical activity, healthy eating, multiple medications, as well as more experimental treatments such as TMS? What do you say to people who don’t even have a chance to relapse, because treatment doesn’t sufficiently alleviate symptoms? What do you say to people who continue to suffer despite continuing to do the things you recommend?
Your message completely ignores those people whose mental illness is refractory, and is, quite frankly, ignorant and a bit offensive. While you may have personal experience of recovery, and I understand that your video is probably addressed to people who have not yet tried or have not yet been compliant with standard OCD treatments, the issue of ‘recovery’ is more complicated than this video makes it appear.
Thanks for your questions. Here are some of my thoughts on them:
So what do you say to people who continue to have debilitating symptoms, despite thorough treatment?
If somebody is working with a therapist and things are getting worse, there’s four areas I always suggest people look at to uncover the barriers that are getting in the way of progress: the therapist, the patient, possibly both of them, or the environment.
Being consistent and compliant with various forms of CBT (ERP and ACT), mindfulness, physical activity, healthy eating, multiple medications, as well as more experimental treatments such as TMS?
I’m assuming that you’re dealing with OCD because you mentioned it later in your comment so I’m going to speak specifically about OCD here: from that list of things you mentioned, many aren’t proven methods for treating OCD. In fact, if somebody isn’t getting expert advice on things like mindfulness, exercise, and healthy eating, I would expect them to simply become new ways of practicing compulsions. Personally, I have no experience with any medications or TMS, but I am familiar with the research, and it wouldn’t be a statistical anomaly if those delivered no results. I’ll talk about ERP and ACT in the next answer…
What do you say to people who don’t even have a chance to relapse, because treatment doesn’t sufficiently alleviate symptoms?
There’s a quote you’ll often see in ACT books that “the solution is the problem”. That’s specifically referring to attempts to “solve” feelings/thoughts/urges that people dislike. Acceptance and Commitment Therapy is all about learning to accept whatever you’re experiencing, recognizing that those experiences aren’t things you have to get rid. The compulsions are the symptoms, not the internal experiences you dislike. In many ways, OCD is all about trying to cope with, check on, or control uncertainty, anxiety, and other feelings we don’t like. The more we engage in compulsions as a reaction to those feelings, the more we experience them. With ERP and ACT, the focus is on cutting out compulsions while experiencing those feelings/thoughts/urges we dislike. So if you’re encountering difficulty eliminating the compulsions, that’s where I’d suggest working with your therapist to figure out ways to make it easier to eliminate compulsions. But, just like with physical fitness, keep in mind that building better mental fitness does involve doing a lot of difficult exercises. Cutting out compulsions through ERP or ACT is almost certainly going to be accompanied by extreme levels of anxiety. It does involve choosing to experience feelings we dislike so that in the future, we experience them less.
What do you say to people who continue to suffer despite continuing to do the things you recommend?
What I always recommend is to cut out coping, checking, and controlling compulsions in reaction to uncertainty, anxiety, and other feelings you dislike, and then to act according to your values to help yourself be healthy and happy over the long-term. Personally, what I like about that approach is that each day, regardless of what’s going on in my head, I can do the things I value. I’ve found it immensely freeing to cut out compulsions and change my relationship with all of the thoughts, images, urges, and feelings that I tried to avoid and control in the past. Learning to accept whatever I’m experiencing as I do the things I value has been life changing. But if people cut out all of their compulsions and change how they relate to the stuff in their heads and they start doing the things they value, but they’re still suffering, then maybe they’ll find a different approach more useful.
I guess what I was really trying to say is that sometimes it doesn’t matter how hard someone works- sometimes (for what I acknowledge is a minority of people) the hardest thing to accept is that mental illness will be chronic for them.
On a personal note, I generally agree with most of what you say- particularly regarding cutting out compulsions and accepting that thoughts can’t be controlled. It just that your views on recovery come across as way too ‘black and white’ for my taste.
I find your positive energy to be really refreshing and it has personally helped me to look at my OCD in a completely different way. I thank you so so much for all your positive encouragement your videos have been an anchor for me through difficult times. But the “person” above seems like the old dilemma (no offense meant) you cannot please everyone. The whole issue of making a problem complex is the PROBLEM, what Mark is saying is OCD is all the same, and it is if you can look at it from more of a external perspective, when you personalize it and make it your own precious problem the OCD bug has got you????
This is why OCD is so hard to fix you have to think out of the box….
thanks for your video man… i have ocd when i was kid almost 8 years i live with ocd,it’s hard if i live without ocd,i am trying to make my ocd gone is difficult, my friend say i am a frick sick person,now i am try live normal but it’s difficult
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November 19, 2015 @ 6:11 pm
So what do you say to people who continue to have debilitating symptoms, despite thorough treatment? Being consistent and compliant with various forms of CBT (ERP and ACT), mindfulness, physical activity, healthy eating, multiple medications, as well as more experimental treatments such as TMS? What do you say to people who don’t even have a chance to relapse, because treatment doesn’t sufficiently alleviate symptoms? What do you say to people who continue to suffer despite continuing to do the things you recommend?
Your message completely ignores those people whose mental illness is refractory, and is, quite frankly, ignorant and a bit offensive. While you may have personal experience of recovery, and I understand that your video is probably addressed to people who have not yet tried or have not yet been compliant with standard OCD treatments, the issue of ‘recovery’ is more complicated than this video makes it appear.
November 19, 2015 @ 8:55 pm
Thanks for your questions. Here are some of my thoughts on them:
So what do you say to people who continue to have debilitating symptoms, despite thorough treatment?
If somebody is working with a therapist and things are getting worse, there’s four areas I always suggest people look at to uncover the barriers that are getting in the way of progress: the therapist, the patient, possibly both of them, or the environment.
Being consistent and compliant with various forms of CBT (ERP and ACT), mindfulness, physical activity, healthy eating, multiple medications, as well as more experimental treatments such as TMS?
I’m assuming that you’re dealing with OCD because you mentioned it later in your comment so I’m going to speak specifically about OCD here: from that list of things you mentioned, many aren’t proven methods for treating OCD. In fact, if somebody isn’t getting expert advice on things like mindfulness, exercise, and healthy eating, I would expect them to simply become new ways of practicing compulsions. Personally, I have no experience with any medications or TMS, but I am familiar with the research, and it wouldn’t be a statistical anomaly if those delivered no results. I’ll talk about ERP and ACT in the next answer…
What do you say to people who don’t even have a chance to relapse, because treatment doesn’t sufficiently alleviate symptoms?
There’s a quote you’ll often see in ACT books that “the solution is the problem”. That’s specifically referring to attempts to “solve” feelings/thoughts/urges that people dislike. Acceptance and Commitment Therapy is all about learning to accept whatever you’re experiencing, recognizing that those experiences aren’t things you have to get rid. The compulsions are the symptoms, not the internal experiences you dislike. In many ways, OCD is all about trying to cope with, check on, or control uncertainty, anxiety, and other feelings we don’t like. The more we engage in compulsions as a reaction to those feelings, the more we experience them. With ERP and ACT, the focus is on cutting out compulsions while experiencing those feelings/thoughts/urges we dislike. So if you’re encountering difficulty eliminating the compulsions, that’s where I’d suggest working with your therapist to figure out ways to make it easier to eliminate compulsions. But, just like with physical fitness, keep in mind that building better mental fitness does involve doing a lot of difficult exercises. Cutting out compulsions through ERP or ACT is almost certainly going to be accompanied by extreme levels of anxiety. It does involve choosing to experience feelings we dislike so that in the future, we experience them less.
What do you say to people who continue to suffer despite continuing to do the things you recommend?
What I always recommend is to cut out coping, checking, and controlling compulsions in reaction to uncertainty, anxiety, and other feelings you dislike, and then to act according to your values to help yourself be healthy and happy over the long-term. Personally, what I like about that approach is that each day, regardless of what’s going on in my head, I can do the things I value. I’ve found it immensely freeing to cut out compulsions and change my relationship with all of the thoughts, images, urges, and feelings that I tried to avoid and control in the past. Learning to accept whatever I’m experiencing as I do the things I value has been life changing. But if people cut out all of their compulsions and change how they relate to the stuff in their heads and they start doing the things they value, but they’re still suffering, then maybe they’ll find a different approach more useful.
All the best as your journey continues.
November 19, 2015 @ 9:23 pm
I guess what I was really trying to say is that sometimes it doesn’t matter how hard someone works- sometimes (for what I acknowledge is a minority of people) the hardest thing to accept is that mental illness will be chronic for them.
On a personal note, I generally agree with most of what you say- particularly regarding cutting out compulsions and accepting that thoughts can’t be controlled. It just that your views on recovery come across as way too ‘black and white’ for my taste.
Best wishes to you as well.
March 2, 2016 @ 7:46 am
Hi Mark
I find your positive energy to be really refreshing and it has personally helped me to look at my OCD in a completely different way. I thank you so so much for all your positive encouragement your videos have been an anchor for me through difficult times. But the “person” above seems like the old dilemma (no offense meant) you cannot please everyone. The whole issue of making a problem complex is the PROBLEM, what Mark is saying is OCD is all the same, and it is if you can look at it from more of a external perspective, when you personalize it and make it your own precious problem the OCD bug has got you????
This is why OCD is so hard to fix you have to think out of the box….
June 1, 2016 @ 8:09 am
Greetings from Russia. Thank you for your help Mark. It works!
June 2, 2016 @ 10:42 am
thanks for your video man… i have ocd when i was kid almost 8 years i live with ocd,it’s hard if i live without ocd,i am trying to make my ocd gone is difficult, my friend say i am a frick sick person,now i am try live normal but it’s difficult