Category Archives: Obsession & Compulsion

Introducing “Freedom From OCD: A Personalized Recovery Program for Living with Uncertainty”

By Jonathan Grayson PhD.

By Jonathan Grayson PhD.

I picked this book from Kinokuniya Kuala Lumpur in September (RM80.36), out of the desperate desire to really help the patients in the clinic and people out there with Obsessive and Compulsive Disorder (OCD). And I have to say this is really the book that I’ve been looking for; so much that I contacted the author Jonathan Grayson, got his permission and translated the materials into Mandarin Chinese so that it can help some non-English populations **.

The author is a definite advocate of Exposure Response Prevention (ERP) therapy. With his extensive experience working with people suffered from OCD since over three decades ago, his writing made you feel that he really understands you, your OCD and how you feel, BUT he gives you no certainty, no absolute answer, no 100%, in fact he provides almost no reassurance in his book, unlike many other OCD books that I’ve read. And this is why I like it about, and why I think it’s helping people.

Not just that, the book also contains various scripts and examples that you can record and listen to, and this is really important to help you in doing ERP. He also provides you with great details as of what to do when you’re in doubt, what to do if you slip during the treatment etc. For those CBT trained therapists, the book also tells us how we should adapt CBT to make it more workable and effective for OCD, and how traditional CBT may make the problems worse.

So whether you have been suffering from OCD, have a family or friend who suffer from it, or you’re like me, have been looking for a good OCD treatment book, this is definitely worth reading!

Are you willing to learn to live with Uncertainty? 

**For the downloads of materials, worksheets and tools in Chinese, please check here!

The English versions are available on the author’s website www.freedomfromOCD.com

Addiction to Speed (Fast! Faster!)

Are you hooked on fast?

Your Behaviour

  1. Do you want to slow down, but you cannot? Have you lost control?
  2. Do you keep adding activities without taking any away?
  3. Do you work longer and longer hours, but don’t ever finish?
  4. Do you treat other problems: sleep, anxiety, depression?
  5. Do you act first and think later?
  6. Do you check your email and reach for your phone first thing and last?

Your Feelings

  1. Do you feel internal pressure to live fast and act fast, which becomes a craving to “connect” more rapidly?
  2. Do you feel empty if you are not in constant action?
  3. Do you feel nervous without your tech gear in hand or pocket?
  4. Do you feel the beep of your phone as a comfort that gives you a shot of adrenaline?
  5. Do you feel you belong when you are rushing, stressed, and in action?

Your Beliefs

  1. Do you believe you have no limits and you are entitled to live without limits?
  2. Do you believe you should think, feel, react, and behave instantly?
  3. Do you believe you will fall behind if you slow down?
  4. Do you believe success equals fast and faster, and slowing down is failing?
  5. Do you believe you should only feel good, only feel high; other feelings are a sign of failure?
  6. Do you believe stress is the price of success and chaos is normal?
  7. Do you believe that the “new intimacy” is through technology; less time for off-line relationships is the price of success?
  8. Do you believe instant action is a virtue and you can overcome anything with enough willpower?
  9. Do you believe all change must be big to count?

 

Adapted from Speed: Facing Our Addiction to Fast and Faster – And Overcoming Our Fear of Slowing Down, by Stephanie Brown Phd.

So, How to Unhook from Speed?

Unusual Obsessions and Compulsions

Over the years I’ve come across a lot of OCDs in the clinic, some have more “normal” rituals, such as hand washing, reassurance seeking etc. Most people “stick” to their rituals over the years, sometimes better, other times (especially when they’re under great pressure, or facing major life events or life transiting periods) worse. Many of them have more than one or two compulsions, but they usually have similar underlying causes (obsessions).

Recently I was introduced to this man in his mid 50s. He has a brother who suffers from chronic schizophrenia. He is quite a sensitive person, very easily upset by remarks from others. Initially he was having obsessional ruminations, but responded well to the SSRIs. Subsequently he had a relapse, and started to always feel agitated, wanting to hit people and things he see. This recurrence with violent contents stay with him for quite a few years, however, he managed to function and work.

Over the years he has seen many psychiatrist doctors but to no avail. Then he came back again, still feeling anxious he might do harm to himself or others. Few months ago when he came, the violent content subsided a little, but he is now having this urge to swallow little things (e.g. coins, keys etc). And another two weeks later, it became less about harming people, but he still wants to smash things, especially glasses, big or small, so when he notices others’ smartphones (glass screen!), he gets really anxious with the urge.

Then few days ago, he said he’s been struggling to ride his motorcycles, because he keeps imagining driver/rider coming out from another junction/corner and he accidentally hit them or get hit! So he literally slows down or even stops in every junction, and was almost hit by a car following him. “Yet I’ve to stop!” he added, even knowing he might get hit from the back.

I tried to sit down and think how they are all related, what the underlying obsession is? – “fear of harming self/others/things” is what I concluded. What say you?

 

Previous entries about “unusual” OCD:

Learn about this man’s obsession (to do with his toilet habit)

Compulsive Voyeurism 

Emotional Blackmailing

He is in his early 30s, was diagnosed with OCD over 10 years ago, when he was finishing high school and about to start college. He was doing very well academically, and in school he was very popular.

Since the diagnosis, he had tried to get a degree, but failed all his 6 attempts. His washing, checking, chanting, counting, all compulsions occupied almost all his time that he couldn’t attend class, sit for exam, or do anything else.

But he had a very supportive family, especially the mother and the sister. For the past few years, he had been staying home most of the time, so the mother cooks, washes, and prepares everything for him. Whereas the sister allows him to live in her house, and supports him financially. They also take turn to take him to see doctor.

Recently, the sister called up, saying that the patient is asking to enrol himself to a course again in either US or Canada. She had tried very hard to explain to patient that not just she has no money to support him, but also the fact that his illness wouldn’t allow him to complete the study. But the patient was very stubborn, for him, the only way out of his current life is to get a degree first (but not to conquer his OCD symptoms). He asked the sister to get a loan, borrow money, he doesn’t care what she does, but he must get to study (not locally, but overseas). He is the center of his life and all family members’ lives, they must obey to what he says.

The sister doesn’t know what to do. The family members know him well. When they refuse him, he will start screaming and shouting, until everyone in the building and nearby know it, as if the family is abusing him. And then the next stage, he would start saying that if he couldn’t go for study, he would just end his life. And yes, he’s done it before previously, taking pills excessively on one attempt and drinking insecticides on another.

No matter how hard they try, they couldn’t persuade him out of this idea of studying overseas. They can give him a chance this time, which is the 7th attempt to get a degree, but they also know how it’s going to end up and then another cycle starts again…

They can only accept to be blackmailed, continuously, endlessly… till the day they give up on him, or he finally has the courage and wisdom to have his OCD treated.

Does it make me an OCD if I can’t stand these?

So did you struggle to look at those pictures in one of my older post?

How about these ones?

kitkat
1. This is a no-no for a lot of people.

light
2. Some people don’t even notice what’s not right in this one. That’s good, maybe.

punchhole
3. Hate it!!! So what are we going to do with it now!

ringfolder
4. I thought it was only me who can’t stand this? It definitely has nothing to do with OCD.

smallcar
5. This is 99.9% not any obsession or compulsion. In fact, I drive a small car and I really like to park “deeply inside”. (No, it’s not for the sake of annoying others… It’s just ehmmm.. a habit!)

switch
6. What do you think?

tissue dispenser
7. Grrrrr!

toiletroll
8. Grrrrrr #2!! I could end up wasting a lot of paper just to make it “nice”.

toiletseat
9. Not acceptable. And it’s for hygienic reason!

wall
10. Not very professional.

waterdispenser
11. I’d rather not drink and stay thirsty.
bullytheblind
12. This is bullying!! And could be very dangerous.

coins
13. I never realized that I’d always stop it deliberately.

cutlery
14. Who did that?

doggies
15. So cute!! But can’t the two on the right switch their position??

Tips for Succeeding in Your OCD Treatment

Adapted from Fred Penzel, PhD “25 Tips for Succeeding in Your OCD Treatment” (to make it more suitable and applicable to Asian culture)

  1. Always expect the unexpected. You can have an obsessive thought at any time or any place. Don’t be surprised when old or even new ones occur. Be prepared to use your therapy tools at any time, and in any place. Also, if new thoughts appear, be sure to tell your therapist so you can keep them informed.
  2. Be willing to accept risk. Risk is an integral part of life, and as such it cannot be completely gotten rid of. Remember that not recovering is the biggest risk of all.
  3. Never seek reassurance from yourself or others. Instead, tell yourself the worst will happen, is happening, or has already happened. Reassurance will cancel out the effects of any therapy homework you use it on and prevent you from improving. Reassurance-seeking is a compulsion, no matter how you may try to justify it.
  4. Never analyze, question, or argue with obsessional thoughts. The questions they raise are not real questions, and there are no real answers to them.
  5. Try to not be a black-and-white, all-or-nothing thinker — don’t tell yourself that one slip up means you are now a total failure. The good news is that you are in this for the long haul, and you always get another chance. It is normal to make mistakes when learning new skills, especially in therapy. It happens to everyone now and then. Accept it. Even if you have a big setback, don’t let it throw you. Remember the saying, “A lapse is not a relapse.” This means that you never really go back to square one. To do that, you would have to forget everything you have learned up to that point, and that really isn’t possible. Also remember the sayings, “Never confuse a single defeat with a final defeat,” (F. Scott Fitzgerald).
  6. Remember that dealing with your symptoms is your responsibility alone. Don’t involve others in your therapy homework (unless your therapist tells you to) or expect them to push you or motivate you. They won’t always be there when you need them, but YOU are always there for YOU.
  7. Don’t get too impatient with your progress, or compare yourself to someone else. Everyone goes at their own pace. Instead, try to simply focus on carrying out each day’s therapy homework, one day at a time.
  8. When you have a choice, always go toward the anxiety, never away from it. The only way to overcome a fear is to face it. You can’t run away from your own thoughts, so you really have no choice but to face them. If you want to recover, you will have to do this.
  9. When faced with two possible choices of what to confront, choose the more difficult of the two whenever possible.
  10. If your therapist gives you an assignment you don’t feel ready to do, you can speak up and tell them so. As half of the therapist–patient team, you should be able to have a say in your own therapy. The goal is for the homework to produce some anxiety for you to get used to tolerating — not to overwhelm you with it and cause you a setback. On the other hand, don’t be afraid to stretch yourself a bit whenever you can.
  11. Don’t wait for the “perfect moment” to start your therapy homework assignments. Procrastination is a feature of many people’s OCD, so start your therapy homework assignments the day you get them. The perfect moment is whenever you begin doing them. When starting the homework immediately isn’t applicable or possible, at least plan an exact date and time to start it.
  12. Don’t be side-tracked by perfectionism. Perfectionism can be another feature of OCD. You may find your OCD telling you that if you don’t do your homework perfectly, you won’t recover. If you do find yourself obsessing about having to do your homework perfectly, you risk turning it into another compulsion. Watch out for having to do your homework according to the same rigid rules each time you do it. Also, don’t do your homework so excessively that it takes up your whole day. Remember that you still have a life to live.
  13. Don’t forget to go back to the old homework assignments you have done and materials you’ve read before. Don’t assume that you know them all and will not forget them.
  14. Give your homework your full attention, focus on what you are doing, and let yourself feel the anxiety. Try to not let yourself tune out when doing certain assignments, so that you don’t have to feel the anxiety. People sometimes let the homework become routine and do it in a very automatic way as a kind of avoidance. Also, don’t do homework while carrying out other distracting activities. You are building tolerance to what you fear, and for that to happen you have to be in the moment with it.
  15. When faced with a challenging assignment or an unexpected challenging situation, try to look at it as a positive. View it as another opportunity to get better instead of saying, “Oh, no. Why do I have to do this?” Instead tell yourself, “This will be good for me — another chance to practice and get stronger.”
  16. Try to not rush through your therapy homework so that you don’t have to feel as much anxiety. Take your time, and see if you can view it in terms of all the good it will do you. Getting it over with as quickly as possible is not the goal — raising a moderate level of anxiety and staying with it is the goal.
  17. If your homework doesn’t really give you any anxiety, tell your therapist about it. If your exposure homework doesn’t cause at least some anxiety, it isn’t going to help you that much. On the other hand, try doing all new assignments for at least a week before deciding that they don’t make you anxious. Some assignments can cause reactions later on, and it may take doing them a few times before the anxiety occurs.
  18. It is sometimes possible for OCD to try to make you doubtful about your homework. It may tell you that you are not in the right treatment, that your assignments cannot possibly make you better, or that you really don’t understand what you are doing and won’t be able to make it work. Remember that OCD was known as the Doubting Disease, and it will try to cast doubt on anything that is important to you. Don’t try to argue, analyze or question it, just continue what you have to do and over time you’ll find the answers.
  19. Never forget that you have OCD. This means that you will not always be able to trust your own reactions or the things you think and feel, especially if they seem to be telling you very negative and extreme things. If you are unsure if something is really a symptom, treat it as a symptom. Better to do a bit more exposure than not enough.
  20. Remember that in OCD, the problem is not the anxiety — the problem is the compulsions. If you think the anxiety is the problem, you will only do more compulsions to get rid of it (which will only create more anxiety). If you recognize that the compulsions are the problem, stop doing them, and stay with the fearful situation, then the anxiety will eventually go away as you build up tolerance.
  21. Always take a moment to be proud of your own efforts and recognize your successes. It’s a good way to help keep up your motivation. Look back at earlier assignments that are no longer challenging if you believe you aren’t making progress.
  22. Overall, never forget that OCD is very paradoxical and rarely makes much sense. The things that you thought would make you better only make you worse, and the things you thought would make you worse are the very things that will make you better.