Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

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Why Telling Someone with OCD to “Trust Your Gut” is Bad Advice

By Lynne Gots, posted on August 19th, 2019.

The idea of making a decision based on a “gut instinct,” or intuition, may have some theoretical merit but for someone with OCD, it’s like kryptonite.   

Neuroscientists have constructed complex processing theories to explain the concept of “just knowing,” or intuition. Our brains are like computers, constantly comparing new sensory information and events with memories of past experiences and stored knowledge to come up with predictions of what will happen next. This process occurs so quickly and subconsciously that we’re not aware it’s happening—hence, the idea of a gut feeling. The opposite of intuition is methodical analytical thinking. Both can be helpful, depending on the situation. But people with OCD tend to overanalyze decisions, while also falling prey to emotional—typically, anxious—reasoning. The result? Uncertainty and decision-making paralysis.

One common OCD worry is whether a relationship is “right.” Typical obsessive questions include: “Do I feel love for my partner?” “Do we share enough in common?” “ What if my feelings change?” “How can I be sure I want to be in this relationship?” Constant analysis—compulsive checking for the elusive, correct emotional reaction, seeking reassurance from relationship websites and forums, asking friends and family for advice—doesn’t resolve the doubt and causes more anxiety, making it impossible to experience a rewarding emotional connection.

A site dedicated to forming healthy relationships describes a gut instinct as “your immediate understanding of something,” requiring “no need to think it over or get another opinion—you just know” [italics mine].

This type of popular wisdom—the idea that you can “just know”–adds to the distress many people with OCD experience in the face of major life decisions—not only about whether to get married or divorced, but also about whether to have children, go to graduate school, change jobs, or buy a house. OCD makes it virtually impossible to trust your gut because one of its major cognitive manifestations is doubt. It’s more likely to kick you in the gut and overwhelm you with incessant questions about your choices than to allow for intuition to help you.

So if you have OCD, don’t expect a feeling to inform your decisions. Rely, instead, on analysis (but not too much), experience, values, and common sense to guide you. And make room for a healthy measure of uncertaintly about the choices you ultimately make.




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Posted in Obsessive Compulsive Disorder |

OCD in the Age of #MeToo, revisited

By Lynne Gots, posted on June 1st, 2019.

In the wake of the #MeToo movement, I wrote a post last year about the spate of men I was seeing in my practice who worried about being perpetrators of sexual assault. It struck a chord and prompted many emails to me from men across Europe, where treatment for OCD is limited, saying they’ve been tormented by similar thoughts.

As the piece resonated with so many people, I decided to revise the original for the Anxiety and Depression Association of America website.

You can read it here.




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Posted in Anxiety, Obsessive Compulsive Disorder |

How to Weather a Setback without Getting Discouraged: Understanding Trigger Stacking

By Lynne Gots, posted on March 9th, 2019.

I learned a new term this week:  “trigger-stacking.” I wasn’t attending a professional conference or catching up on my journals.  I heard the phrase from a veterinary behaviorist.

Six months ago we adopted Clifford, a three-year-old Australian Shepherd who had been a stray in rural New Jersey. Let’s just say the adjustment has been very rough.

During the three-hour drive from New Jersey, he draped himself across my lap, instantly claiming me as his ”person.” But he has what the Aussie rescue groups euphemistically call “a strong guardian instinct,” causing him to be overly protective of his turf, his food, his toys, and…me.  So from the moment he entered our house, he treated my husband as an enemy invader.

Whenever my husband crossed a threshold into a room I was in, Clifford launched a canine air-missile strike.  We began to feel under siege, on constant alert for the next attack.

Fast forward six months. Thankfully, through a combination of medication prescribed by the veterinary behaviorist and lots of counter-conditioning—which derives from the same learning principles underpinning the treatment approaches I use for anxiety—we now have a much more relaxed dog. I’ve stopped my Google searches for “Farms that Take Unadoptable Animals,” and Clifford has gradually been forming a tentative bond with my husband. We’re cautiously optimistic.

But because behavior modification isn’t linear, the aggressive displays we’ve been working so hard to eliminate will occasionally resurface.  And even though I should know better, I was disheartened one day last week to observe a spike in Clifford’s territorial barking along with his refusal to come back into the house after he went out in the yard while I was at work. He stood on the deck for two hours, nervously casting glances at my husband, who tried to lure him back inside with a smorgasbord of tasty treats. Even steak couldn’t entice him.

After reviewing the behavioral log I keep to remind myself of Clifford’s progress (a practice I heartily recommend, by the way, if you’re working on changing your own behavior), the cause of his regression became clear:  trigger-stacking.

I identified three major triggers, each of which individually heightened Clifford’s arousal and, cumulatively, pushed him over the edge: 1) A stressful visit to the vet for a vaccination the previous day; 2) Loud noises overhead while workmen repaired our roof; and 3) Repeated invasion of his territory while my husband walked in and out of his office moving books.

In hindsight, it makes perfect sense. But at the time, I had trouble convincing myself we weren’t back to square one.

When you experience an uptick in the anxiety or compulsive behaviors you’ve been working hard to manage, you might assume a setback means you haven’t made progress. Not so. A bad day at work, a fight with a partner, a sick child, a sleepless night—any one of those triggers might be manageable alone but in combination might just be too much to handle without reverting to the coping behaviors you’ve been trying to change.

So when you suffer a setback, don’t view it as a relapse. Instead, ask yourself if you’ve been facing more triggers than usual. Cut yourself some slack—but don’t make excuses to justify avoidance–by taking on lower intensity challenges, if necessary, to keep yourself from slipping back into old habits.

And, then, start back where you left off, as we did with Clifford. For a week, he continued to balk at coming inside whenever my husband let him out in the yard. But a few days ago, the sight of his leash brought him back in the house. And, for the first time, they walked around the block together.




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Posted in Behavior Change, Dogs |

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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© 2008-2019 Lynne S. Gots, PhD. Photographs by Steven Marks Photography.