Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

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2440 M Street, NW
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Washington, DC 20037

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OCD By Any Other Name . . .Is Just OCD

By Lynne Gots, posted on December 1st, 2017.

OCD is a shape-shifter. Its content often changes, especially with primarily internal obsessions and compulsions (involving thoughts about harm, sexual orientation, and relationships). For many with the disorder, addressing the ever changing obtrusive thoughts is like playing Whack-a-Mole.

The internet is full of articles about “hOCD,”(OCD about sexual orientation), “rOCD,” (OCD about the “rightness” of a relationship) and “Pure O” (obsessions in the absence of compulsions) OCD. Although these designations can be appealing if you’re trying to make sense of distressing thoughts, I find this alphabet-soup approach to OCD problematic for several reasons.

  • It places too much emphasis on form over function. OCD isn’t about what it seems to be about. Every subtype of OCD has at its root the inability to tolerate uncertainty.
  • It encourages compulsive checking and reassurance-seeking. Many of the forums and sites dedicated to OCD subtypes list the differences between OCD doubting and signs of a genuine issue, such as sexual identity conflicts or relationship problems. Checklists contain generalizations. But individuals don’t necessarily fall into neat categories. So more confusion results, leading to an endless cycle of checking and searching for reassurance.
  •  It implies a definitive, black-and-white answer. In reality, OCD won’t accept yes or no. If doubts about a specific content fade, new ones will surface unless the driving mechanism—intolerance of uncertainty—has been addressed.
  • In the case of so-called “Pure O” OCD, it’s inaccurate. OCD by definition involves obsessional thoughts and compulsive actions performed to neutralize the distress from the thoughts. The compulsions may not observable to others, as they are with, say,hand-washing; they may involve covert mental rituals, such as reviewing, comparing, or silently repeating prayers, words, or numbers. Rumination and worry in the absence of compulsions do exist but are more likely symptoms of generalized anxiety or depression, not OCD.

Addressing the form OCD takes is important only in designing a treatment plan for ERP (Exposure/Response Prevention).  To keep the OCD from becoming a pattern in which one obsession dissipates only to have another pop up, focus on accepting uncertainty.

Here’s how to begin the process of response-prevention:

1) Refrain from checking and analyzing.

2)Acknowledge that OCD is causing you to doubt yourself and that no amount of research will help you arrive at an answer you’ll believe.

3)Don’t try to categorize your OCD.

4)Give up trying to figure out if your fears are justified.

5)Stop seeking advice from internet forums.

Taking these steps will start you on the path to recovery and keep the moles from lying in wait to ambush you.

 

 

 

 

 

 

 




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Five Common Myths about OCD

By Lynne Gots, posted on July 9th, 2017.

The people I treat for OCD hate it when someone says, “I’m so OCD!,” usually as a way of explaining pickiness or excessive neatness. I do, too. Not only does the comment minimize the severe suffering a person with actual OCD experiences; it also perpetuates a number of prevalent misconceptions about the disorder.

  1. OCD isn’t a personality quirk. It’s a  neuropsychiatric illness involving persistant, intrusive mental images or thoughts (obsessions) that create extreme emotional distress–typically anxiety, but sometimes disgust. Compulsions develop as a way of alleviating the intolerable feelings.
  2. OCD isn’t perfectionism. Perfectionism is one thinking style commonly, but not always, seen with OCD. Other cognitive patterns, such as an excessive sense of responsibility, a tendency to overestimate danger, and an intolerance of uncertainty also frequently accompany OCD.
  3. Not everyone with OCD is a neat freak. Neatness may be characteristic of people with OCD who have a compulsion to create order and symmetry to feel “just right.” Or the need to clean and wash may be a response to contamination obsessions. But other forms of OCD involve primarily mental images and rituals often invisible to the casual observer.
  4. OCD is easy to spot. Washing and checking compulsions may be obvious to family and friends. But many other obsessions and compulsions occur strictly in the sufferer’s mind, making them hard to detect even for mental health professionals. Given the shameful nature of these mental intrusions, such as thoughts of committing a violent act, people afflicted with this type of OCD may suffer in silence for years–seventeen, on average–before obtaining the proper diagnosis and treatment.
  5. OCD is hard to treat. Many traditional mental health practitioners hold this view. In fact, with the correct, evidence-based treatments (Cognitive-Behavioral Therapy and medication, if needed), people with OCD can feel relief within a few months.

These myths do a disservice to those in the grips of OCD. Let’s set the record straight.

 

 

 

 




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Don’t Bow Down to OCD

By Lynne Gots, posted on November 14th, 2016.

OCD is a tyrant. It will control you with threats of the most horrific consequences if you don’t follow its commands.

“Don’t touch that or you’ll get sick and die.”

Go back and check the stove five…no, ten…no, fifteen times or the apartment building will burn down and it will be your fault.”

“Don’t hug your niece. If you put your hand in the wrong place, she’ll be scarred for life.”

“That bump you felt while you were driving was a body. The police will arrest you for a hit-and-run and you’ll go to jail for the rest of your life.”

“You had a bad thought while you were in church. If you don’t repeat the prayer the right way, you’ll go to hell for eternity.”

Who wouldn’t be terrified by such thoughts? They may seem preposterous to people who don’t suffer from OCD, but to those who do, they’re grimly familiar.

To break free from OCD, you have to refuse to follow its orders. Its demands are unreasonable. You may think you can appease it to arrive at an uneasy truce. But unless you say no to the rituals, OCD will keep escalating its requirements and make you its prisoner.

So you have to stand firm. Push back. Do the opposite.

Terrifying? Yes! But it’s a tactic—called “response prevention”—that works.

In his book, Stopping the Noise in Your Head: the New Way to Overcome Anxiety and Worry, psychologist Reid Wilson outlines specific steps you can take to break free from the tyranny of anxiety. One of the messages he drives home is that OCD worries are NOT ABOUT THE CONTENT despite what  OCD is brainwashing you into believing.

So if you’re doing rituals to protect yourself from contamination, repugnant or blasphemous thoughts, or the risk of being responsible for harming others, you can shift your perspective instead of blindly following OCD’s orders. Don’t try to convince yourself you’re protecting yourself from the content of your fears; instead, remind yourself you’re doing compulsive behaviors to eliminate doubt about something that feels threatening.

Practice moving towards those feelings of uncertainty, and you’ll be on your way to freeing yourself from the stranglehold of OCD.




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This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.

Contact Dr. Gots

202-331-1566

2440 M Street, NW
Suite 710
Washington, DC 20037

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If you don't receive a response to an email from Dr. Gots in 48 hours, please call the office and leave a voicemail message.

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