Webb Therapy Uncategorized OCD: tips for self-management

OCD: tips for self-management

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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.

Related Post

The Four Options for any Problem (Linehan, 1993)The Four Options for any Problem (Linehan, 1993)

Marsha Linehan, the creator of Dialectical Behavior Therapy, gives four options for any problem that you face: Solve the problem, change your perception of the problem, radically accept the situation, or stay miserable.

When we are overwhelmed by a life challenge, one way we might naturally respond is by defending our position. Perhaps, we’ll resort to an effective yet temporary coping strategy like denial, projection, victimhood, or blaming. We attempt to cope in ways that lessen the stress – the internal discomfort and unpleasantness. Coping strategies that offer temporary relief generally make the situation worse in the long run, especially when fostering relationships at work and in our personal lives. For example, crawling back into bed when you need to work or have commitments with friends. Maybe you over-eat, use chemicals or resent the world, which alleviates the immediate emotional pain, then feel guilty or ashamed afterward. 

Sometimes, in an effort to take action, people attempt to solve problems cognitively – problems that cannot be solved, becoming more and more frustrated when their efforts don’t work. Others become paralyzed or dissociate, unable to decide what to do. Intense emotions can be overwhelming, fatiguing, and compromise our ability to think with an open heart and a clear mind. Searching endlessly for the right solution adds to anxiety and distress.

Marsha Linehan, the creator of Dialectical Behavior Therapy, gives four options for any problem that you face: Solve the problem, change your perception of the problem, radically accept the situation, or stay miserable.

Choice 1: Solve the Problem.

There are many problem-solving strategies, but most use the same steps. First, define the problem. Be as specific as possible. Use numbers whenever possible. For example, “I’ve been late for work four days this week.”

Next, analyze the problem. Is it in your power to solve the problem? If not, then consider one of the other three options. If yes, then continue to analyze the problem.

What are the reasons you’ve been late? Is the reason always the same?  Does it depend on your mood or what time you went to bed? Does it depend on what tasks you have to do at work? Who you work with? Where you went the night before?  Consider the who, what, when, and where of the behavior you want to change.

The third step is to consider possible solutions. Think of various solutions that could solve the problem. Evaluate the solutions carefully to determine which might work best for you. What are the pros and cons of different actions? What could go wrong? What can you do to make the solution more likely to work?

For example, if you decide to give yourself a weekly budget and to freeze your credit cards in a block of ice, what would you do in case of an emergency? Would giving yourself a certain amount of spending money for the day work better than an amount for the week?

A key variable to remember is how difficult it is to make changes in behavior. A strong commitment to change is important. Be specific in stating the change you want to make. Be willing to make small changes at first. Implement the solution: Take action. Trouble-shoot as you go along, tweaking it to resolve any issues you didn’t anticipate.

Choice 2: Change Your Perception.

Changing your perception of the problem can be a challenge. An example of changing your perception of a problem might be to see a difficult boss as an opportunity to work on coping with someone who is disorganized and demanding. If you feel irritated because your house is cluttered with toys, maybe change your perception to one that the clutter is a signal to be grateful for young children in the home. Changing your perception could also mean changing your view of emotion. Instead of trying never to feel anger, look at your frustration as a source of information, perhaps a signal that you need to speak up for yourself.

Choice 3: Radically Accept the Situation.

Radical Acceptance means wholeheartedly accepting what is real. Radical acceptance is like saying, “It is what it is,” and giving up your resistance to the situation. Radical acceptance could be about issues we can’t control or concerns that we decide not to change, at least for the time being. It doesn’t mean you agree with what has happened or that you think it is reasonable.

Choice 4: Stay Miserable.

Of course, staying miserable is not a choice anyone wants to make, and no one would want to consider it as an option. But if you can’t solve the problem, can’t change your perception, and you aren’t ready to radically accept the situation, then staying miserable is the only option left.

Staying miserable may be all you can do in certain situations. Sometimes staying miserable may be what you have to do until you are ready to do something else. There are ways to cope that can help until another option can be used.

In future posts, we’ll look at specific skills that enhance your ability to problem-solve, change your perception, or radically accept situations. We’ll also consider ways to get through the times when you can’t make any of those choices.

Polyvagal Theory and Trauma – Dr. Stephen PorgesPolyvagal Theory and Trauma – Dr. Stephen Porges

Stephen Porges, psychiatry professor and researcher, on the polyvagal theory he developed to understand our reactions to trauma:

[Paraphrased] Polyvagal theory articulates three branches of the autonomic nervous system (ANS) that evolved from primitive vertebrates to mammals. First, there is a system known as ‘freeze’, which involves death feigning or immobilisation. Second, the ANS has a ‘fight or flight’ system, which is a mobilisation system. And third, with mammals, there is what Porges calls, a social engagement system (SES), which can detect features of safety, and actually communicate them to another. The SES may also be referred to by some as ‘rest and digest’, which Porges theory suggests is a function of the Vagus Nerve – the tenth cranial nerve, a very long and wandering nerve that begins at the medulla oblongata. When an individual experiences feelings of safety (within an SES state), the autonomic nervous system can support health restoration. In terms of dealing with a life threat, an ordinary person will most likely go into a feigning death, dissociative state of ‘freeze’.

Polyvagal theory in psychotherapy offers emotional co-regulation as an interactive process between therapist and client which engages the social engagement system of both therapist and client. Social engagement provides experiences of safety, trust, mutuality and reciprocity in which we are open to receiving another person, just as they are.

The following extract has been retrived from https://www.theguardian.com/society/2019/jun/02/stephen-porges-interview-survivors-are-blamed-polyvagal-theory-fight-flight-psychiatry-ace

Polyvagal theory has made inroads into medical and psycho-therapeutic treatment, but how should it inform how people treat each other?


“When we become a polyvagal-informed society, we’re functionally capable of listening to and witnessing other people’s experiences, we don’t evaluate them. Listening is part of co-regulation: we become connected to others and this is what I call our biological imperative. So when you become polyvagal-informed you have a better understanding of your evolutionary heritage as a mammal. We become aware of how our physiological state is manifested, in people’s voices and in their facial expression, posture and basic muscle tone. If there’s exuberance coming from the upper part of a person’s face, and their voice has intonation modulation or what’s called prosody, we become attracted to the person. We like to talk to them – it’s part of our co-regulation.

So when we become polyvagal-informed, we start understanding not only the other person’s response but also our responsibility to smile and have inflection in our voice, to help the person we’re talking to help their body feel safe.”

Clink on the link below to hear Dr. Bessel van der Kolk, one of the world’s leading experts on developmental trauma, explain how our long-term health and happiness can be compromised by prior exposure to violence, emotional abuse, and other forms of traumatic stress.

https://youtu.be/53RX2ESIqsM