People living with obsessive-compulsive disorder are encouraged to follow three general tips for effective self-management. They are: challenge the obsessive thoughts and compulsive behaviours (this includes use of distraction skills, and resisting the compulsion), maintain high self-care (you may need to put your needs first a lot – this is NOT selfishness or self-centredness), and reaching out for support. I want to clarify that I am not trained or qualified in OCD treatment – this is an extract from an article posted on the Australian Institute of Professional Counselling website.

The following information has been retrieved from AIPC Article Library | Self-help Strategies for OCD and OCPD. I think it’s also important to reinforce that if you have been living with OCD for years, you’re probably the expert on what is already most effective for you, and some of the following suggestions may make you roll your eyes. It can be very helpful/useful to talk to other people who live with OCD. They may understand your experience better than health workers, and this can be comforting, validating and healing.

Challenge the obsessive thoughts and compulsive behaviours. In addition to refocusing, the OCD client can learn to recognise and reduce stress. Some of the strategies here are counter-intuitive. You can urge clients to “go with the flow” by writing down obsessive thoughts, anticipating OCD urges, and creating “legitimate” worry periods. Tell them to:

Write down your obsessive thoughts or worries. Keep a pen and pad, laptop, tablet, or smartphone nearby. When the obsessive thoughts come, simply write them down. Keep writing as the urges continue, even if all you are doing is repeating the same phrases over and over. Writing helps you see how repetitive the obsessions are and also causes them to lose their power. As writing is harder than thinking, the obsessive thoughts will disappear sooner.

Anticipate OCD urges. You can help ease compulsive urges before they arise by anticipating them. For example, if you are a “checker” subtype, you can pay extra attention the first time you lock the window or turn off the jug, combining the action with creating a solid mental picture of yourself doing the action, and simultaneously telling yourself, “I can see that the window is now locked.” Later urges to check can then be more easily re-labelled as “just an obsessive thought”.

Create an OCD worry period. Rather than suppressing obsessions or compulsions, reschedule them. Give yourself one or two 10-minute “worry periods” each day, times you are allowed to freely devote to obsessing. During the periods, you are to focus only on negative thoughts or urges, without correcting them. At the end of the period, let the obsessive thoughts go and return to normal activities. The rest of the day is to be free of obsessions and compulsions. When the urges come during non-worry periods, write them down and agree to postpone dealing with them until the worry period. During the worry time, read the list and assess whether you still want to obsess on the items in it or not.

Create a tape of your OCD obsessions. Choose a specific worry or obsession and record it into a voice recorder, laptop or smartphone, recounting it exactly as it comes into your mind. Play the recording back to yourself over and over for a 45-minute period each day, until listening to it no longer causes you to feel highly distressed. This continuous confrontation of the obsession helps you to gradually become less anxious. When the anxiety of one worry has decreased significantly, you can repeat the exercise for a different obsession (Robinson et al, 2013).

Maintain good self-care. A healthy, balanced lifestyle plays an important role in managing OCD and the attendant anxiety (generally present with OCD, even though the disorder is no longer classified as an “anxiety disorder” per se), so the helpfulness of the following practices – truly not rocket science – cannot be underscored. Encourage OCD clients to:

• Practice relaxation techniques, for at least 30 minutes a day, to avoid triggering symptoms.
• Adopt healthy eating habits, beginning with a good breakfast followed by frequent small meals – with much whole grain, fruit and vegetable – throughout the day to avoid blood sugar lows and to boost serotonin.
• Exercise regularly; it’s a natural anti-anxiety treatment. Get 30 minutes plus of aerobic activity most days.
• Avoid alcohol and nicotine, as these increase anxiety after the initial effects wear off.
• Get enough sleep; a lack of it exacerbates anxious thoughts and feelings (Robinson et al, 2013).

Reach out for support. Staying connected to family and friends is the best defense an OCD client can muster against intrusive obsessions and compulsive urges, because social isolation exacerbates symptoms. Talking about worries and urges makes them seem less threatening. Also, involving others in one’s treatment can help maintain motivation and guard against setbacks. To help remind the client that s/he is not alone in the struggle with OCD, ask him or her to consider joining a support group, where personal experiences are shared and attendees also learn from others facing similar problems.

OCPD: Self-help strategies for survival

For both the person diagnosed with OCPD and also for his family and friends, dealing with this disorder requires patience, compassion, and fortitude. To start with, the ego-syntonic nature of OCPD means that the person does not necessarily agree that he has anything wrong at all. For those who staunchly continue to insist that their relational problems arise because of others’ faults, treatment is complicated. Given the OCPD’s general world view of “I am correct; you are wrong”, the prognosis for change is often poor. Transformation is likely to occur only when the OCPD’s relational skills and outlook are shifted. This is not a job for medication (at least not for long and not alone), and yet psychotherapy is not always available. When it is, the OCPD is not always willing to avail himself of it.

Regardless of this less-than-ideal context for managing OCPD, there are some things that the client himself and also friends and family can do to alleviate some of the tension and conflict that goes with living with the disorder. As a therapist, you can encourage the client and those around him to utilise some of these strategies.

Bibliotherapy. It’s a good idea to read up on OCPD, not only in order to know what to expect, but also for tips in dealing with it. Your client may also come upon writings that link some behaviours and lifestyle choices to the disorder in ways not understood before. When comprehension deepens, so, too, does the prospect of compassion.

Gentle confrontation (agreed beforehand). While we agree that OCPD clients have a mammoth need to be right, those clients who truly seek to feel better may be willing to make agreements with family and friends in which OCPD behaviours, when noticed, are gently challenged; the operative word here is gently.

Self-insight through journalling or tape-recording. We noted above that many OCPD clients are intelligent, sensitive people. Thus, keeping a diary or making voice recordings to note anything upsetting, anxiety-provoking, overwhelming, or depressing is a step toward the self-insight that will eventually help to manage the disorder. Too, family and friends may agree to note their observations and share them in a constructive, non-confrontational manner.

Good self-care. OCPD is a disorder about exaggerated need for control, so keeping on an emotional even keel can help reduce the unconscious need to micro-manage all of life. Strategies to achieve this are listed above under Tip 2 for maintaining self-care with OCD. They revolve around the basic life efforts of practicing relaxation techniques, adopting healthy eating and exercise regimens, getting decent sleep, and avoiding excessive alcohol/drug consumption (the last is not hard for the OCPD).

Reaching out for help. OCPD individuals tend to be loners, and relationships are hard for them to build and maintain. Nevertheless, it is helpful to the ultimate reduction of OCPD-engendered tension to go for support. This can be in the form of self-help groups, informal support from partner, family, and friends, or even from joining online communities of people dealing with the disorder. Whatever the form of the support, it may be helpful for OCPD clients to own their places of dysfunction when they see others owning their imperfect humanness – and surviving (Robinson et al, 2013)!

References

• Long, P. (2011). Obsessive-Compulsive Personality Disorder. Internet mental health. Retrieved on 18 April, 2013, from: hyperlink.
• Robinson, L., Smith, M., & Segal, J. (2013). Obsessive-Compulsive Disorder: Symptoms and treatment of compulsive behaviour and obsessive thoughts. Helpguide.org. Retrieved on 24 April, 2013, from: hyperlink.

I want to preface this post by stating that the concepts and suggestions I’ve made below are my own thoughts, opinions, and suggestions based on my own experience working in the mental health sector and lived experience. There may also be numerous grammatical and logical errors. I know that you’re intuitive enough to understand what I’m attempting to describe and explain. Therefore, there will be no references section at the end. This is merely an expression of thoughts, a stream of consciousness (William James coined the term Stream of Consciousness).

Episodic, acute, and chronic anxiety can be miserable and debilitating. Individuals living with anxiety have generally experimented with many techniques to cope with anxiety symptoms, and they have often been practicing these techniques for months, years, or decades. Anxiety is life changing. Current treatment can be efficacious at reducing the intensity or frequency of symptoms for the vast majority of people living with anxiety, but only at best. I, myself, have tried the deep breathing technique commonly advised by mental health professionals, and it can be about as useful as taking a sugar pill. There is credible science that supports deep breathing exercises can improve symptoms and recovery rates for stress, anxiety and depression levels – but what about for an anxiety attack or a panic attack or intense chronic symptoms of anxiety?

Sometimes nothing is effective enough for immediate relief. It is my contention that building a relationship with a trained psychiatrist, specialised in this domain, is an essential first step. Your treating specialist(s) will need to have extensive experience and a comprehensive understanding of the debilitating impacts of anxiety, anxiety attacks, and/or panic attacks. I recommend psychiatry because you will need someone who can prescribe short-term medication, schedule 4 or greater, to alleviate the pain rapidly. All symptoms a person may experience from any condition in the anxiety family present a risk for searching for any immediate relief. This is true for you or me or anyone. Without prompt and effective medical care readily available, many people who do not have a plan for managing anxiety will potentially search for an unhealthy substitute to acquire relief.

These substitutes are often unhelpful long term but effective short term. We all know what they are: alcohol and other drugs, sexual promiscuity or sex addiction, love addiction, gambling, excessive or unhealthy eating habits, self-injury, addictive forms of gaming, impulse spending, co-dependent or dependent behaviours on people, people pleasing, running away (avoiding reality), raging, reckless driving and other criminal behaviour, and relying on pharmaceuticals (legally prescribes or otherwise) that will have long-term unhealthy side effects. People know how to “doctor shop”, and although this area of medicine is becoming much more regulated, it still occurs. Unfortunately, there are people who do require certain types of legal drugs, in a timely manner, to find relief as a means of not engaging in any of the previously mentioned behaviours.

Some people may not have much faith in the field of psychiatry or psychology – HOWEVER – you may find yourself in a situation one day where you will need a doctor who knows your history to increase the likelihood of prescribing medication to treat anxiety when you need it most. This medication usually has addictive properties. An ethical psychiatrist will usually be unwilling to prescribe more than a single repeat of potentially addictive medication to treat their patients. This is standard, regulated medical practice in Australia.

Anyone working in the drug and alcohol sector or has regular contact with a person living with anxiety, or any form of addiction, will know that patients – people – are not being seen in a timely manner top treat anxiety before the patient starts looking elsewhere. Even once the patient has accessed some type of medical care, the length of care is not long enough for the patient to be “well enough” after discharge or ending their hourly session, to be on their own in the community safely without becoming vulnerable to their condition in a short time and looking for more relief to ease their pain and improve their well-being.

If a person or a patient cannot depend on the medical system in the way they need to feel safe and well, they will almost certainly begin to lose faith and trust in health professionals, and ‘the system’. This perpetuates their internalised stigma being reinforced, yet again.

I am not saying the patient doesn’t have a significant responsibly of their own to make valuable choices outside of medical treatment. I quote what someone once said to me, “You may not have asked for this disease, but it becomes our responsibility to stay well”. That is our duty as the person living with a health issue of any kind. There are things we certainly must do (or not do) to stay as healthy as possible. The help make not be there in a timely manner the next time we need immediate help.

It can take weeks or more to enter a detox facility. It can take months to enter a rehabilitation facility. It can take months for an available appointment to open with a psychiatrist. It becomes our responsibility to know that even when we’re feeling well and back to “normal”, we must continue those relationships with medication professionals. It becomes our responsibility to try alternative medicines if that’s something you’re interested in. Let’s face it, psychiatrists cease their practice, our professional relationship has reached it’s potential for adequate, loving care, or we want to try something new.

Start the process of finding a reliable, qualified, and credible psychiatrist today. I would recommend finding a counselling psychologist or other mental health professional that you have a productive and friendly working relationship with – and if you want to practice Buddhism, or acupuncture, or hypnotherapy, or any other complementary and alternative medicine – do it. If you want to connect with God – do it. If you want to see a naturopath – do it. Whatever it is, this may very well be a lifelong journey for you. Based on my own experience, don’t stop because you think you’re “all better now”. The previously mentioned professions or treatment options or lifestyle choices can be extremely expensive, but I would encourage you to save for it, find less expensive options. Sitting in church is free, or listening to an online guru can be the price or maintaining your mobile service bill.

I once knew of a fellow peer in treatment alongside me who said he saved money for years to travel overseas to have a procedure not available in Australia at the time for this purpose. He wanted blood transfusions and heat therapy for chronic pain that didn’t doctors could not determine had physiological origins. The peer was sure it had to, and medical investigations in Australia come up negative. The peer explained the theory behind blood transfusions and heat therapy – he believed – were supposed to improve his blood circulation and blood flow to treat the chronic pain he’d been living with for years after a workplace accident. Even this procedure overseas proved ineffective in mitigating his chronic pain. So, next he tried the wim hof method. He changed is diet. He exercised differently. He tried hypnotherapy. Finally, he turned psychology to treat stress and process childhood trauma. He was being treated for this a private facility where I was a patient at that time. I lost contact with him after I ended my own treatment episode. I don’t know if he’s still living with chronic pain or not.

The following are some very basic and well-known strategies in the Western world of psychology that you can begin to practice today, and then practice every day after that too – even for 5-20 minutes:

– learning about anxiety – your specific “causes” and the conditions more generally

– mindfulness

– relaxation techniques

– correct breathing techniques

– dietary adjustments

– exercise

– learning to be assertive

– building self-esteem

– cognitive therapy

– exposure therapy

– structured problem solving

– support groups

My firm believe is this:

Strong, healthy, quality relationships are essential to treating anxiety and other psychological illnesses. This about your life today: are you lonely (romantically or otherwise), are you a stressed individual, do you regularly feel like you job is stressful or unfulfilling, do you feel sad a lot, are you feeling pointless a lot, or feeling helpless a lot, feeling shame a lot, getting angry a lot over considerably minor things? etc. etc. etc. I would strongly encourage talking to a professional and begin exploring what options you have available to you.

Try, explore, play with a few methods of treatment. However, this must take a priority in your life. It must balance will all the many other obligations and responsibilities people encounter daily.

Type alternative medications or approaches to psychology. There are so many. It can be fun to try out a few when your finances permit. Even planning a holiday every 3-6 months is taking care of your well-being.

Many blessings friends.

Historical Context

Historically, mental illness and addiction have been misunderstood and stigmatized. For much of history, these conditions were seen as moral failings or character flaws rather than medical issues. This has led to a persistent stigma that continues to influence societal attitudes.

Lack of Awareness and Education

There is still a significant lack of awareness and education about mental health and addiction. Many people do not understand that these conditions are medical issues that require treatment, just like physical illnesses. This lack of understanding contributes to negative attitudes and discrimination.

Media Representation

Media often portrays mental illness and addiction in a negative light, reinforcing stereotypes and misconceptions. These portrayals can shape public perception and contribute to the stigma surrounding these conditions.

Criminalization

Addiction, in particular, has been heavily criminalised. This has led to a perception of addiction as a criminal issue rather than a health issue, further entrenching stigma and discrimination.

Internalised Stigma

Individuals with mental illness or addiction often internalise the stigma they experience, leading to feelings of shame and low self-worth. This can prevent them from seeking help and support, perpetuating the cycle of stigma and discrimination.

Healthcare System

Even within the healthcare system, biases and stigma can affect the quality of care provided to individuals with mental illness or addiction. This can lead to inadequate treatment and support, further exacerbating the issue.

Social and Cultural Factors

Social and cultural factors also play a role in how mental illness and addiction are perceived. Different cultures have varying attitudes towards these conditions, which can influence how they are treated and supported.

The differential treatment of treatment-resistant substance use disorder (SUD) and treatment-resistant cancer by society can be attributed to several factors:

1. Perception of Control

Substance use disorders are often perceived as a result of personal choices or moral failings, whereas cancer is seen as an uncontrollable disease. This perception leads to stigma and blame towards individuals with SUD, while those with cancer are more likely to receive sympathy and support.

2. Historical Stigma

Historically, substance use has been stigmatised and criminalised, leading to a societal view that addiction is a choice rather than a medical condition. In contrast, cancer has been recognized as a medical condition requiring treatment and compassion.

3. Media Representation

Media often portrays substance use in a negative light, emphasising criminality and moral failure. Cancer, on the other hand, is often depicted with empathy and urgency, highlighting the need for medical intervention and support.

4. Healthcare System

The healthcare system has historically been more equipped to handle cancer treatment, with extensive research, funding, and specialized care. SUD treatment has lagged behind, with fewer resources and less comprehensive care options.

5. Complexity of Treatment

Treatment-resistant SUD involves complex psychological, social, and biological factors, making it challenging to treat effectively. Cancer treatment resistance, while also complex, has seen significant advancements in research and technology, leading to more effective treatments.

6. Social and Cultural Factors

Cultural attitudes towards substance use and addiction vary widely, with some societies viewing it as a personal failing. Cancer is generally viewed more universally as a disease that requires medical intervention.

REFERENCES

Substance Use Disorder and Stigma

Australian Government Department of Health and Aged Care. (2024). Initiatives and programs. Retrieved from https://www.health.gov.au/about-us/what-we-do/initiatives-and-programs

Morrison, A. P., Birchwood, M., Pyle, M., Flach, C., Stewart, S. L. K., Byrne, R., Patterson, P., Jones, P. B., Fowler, D., & Gumley, A. I. (2013). Impact of cognitive therapy on internalised stigma in people with at-risk mental states. The British Journal of Psychiatry, 203(2), 140-145. https://doi.org/10.1192/bjp.bp.112.112110

Wood, L., Byrne, R., Burke, E., Enache, G., & Morrison, A. P. (2017). The impact of stigma on emotional distress and recovery from psychosis: The mediatory role of internalised shame and self-esteem. Retrieved from https://repository.essex.ac.uk/21927/1/woodpr2017.pdf

Cancer Treatment and Stigma

American Cancer Society. (2023). Cancer treatment and survivorship. Retrieved from https://www.cancer.org/treatment/treatments-and-side-effects.html

National Cancer Institute. (2022). Cancer treatment (PDQ)–Patient version. Retrieved from https://www.cancer.gov/types/treatment-pdq/patient/cancer-treatment-pdq

World Health Organization. (2021). Cancer treatment and palliative care. Retrieved from https://www.who.int/cancer/prevention/diagnosis-screening/cancer-treatment-palliative-care/en/