Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

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If You Have OCD, Don’t Try This!

By Lynne Gots, posted on July 27th, 2022.

With summer travel in full swing, you may be tempted to look for “hacks” to make your packing and departure easier. Many are perfectly innocuous and even helpful. Rolling your clothes to maximize suitcase space or stuffing your shoes with your socks and underwear? Good ideas!

But if you have OCD and get stuck checking appliances, light switches, and door locks prior to leaving on a trip (or even for just the day), I would strongly advise you not to listen to the Lifehacker tip to take photos of your stove, thermostat, and appliances prior to travelling to ease your anxiety about having left something turned on.

It may be tempting to sidestep the checking process by snapping pictures to reassure yourself that you won’t have started a fire or caused a burglary.  For a short time, your anxiety may lessen. But if you have OCD, the relief you feel will undoubtedly be short-lived.

Compulsions such as checking do serve to relieve anxiety in the short run. But they tend to escalate and demand more and more time because the doubt returns. The intolerance of uncertainty is a core feature of the thinking patterns fueling compulsive checking and other OCD behaviors. 

Rather than checking over and over (or taking pictures) to feel certain, you need to train your mind to accept the lingering feeling of doubt by practicing—preferably before you go away for an extended period of time—setting a limit on the number of times you allow yourself to check and leaving even if you feel the urge to go back for another once over. The key is deciding ahead of time, rather than letting anxiety guide your actions. If you typically check appliances or the door ten times, say, start by cutting back by ten percent. When that becomes easier, reduce the number of checks again, and so on, until you are down to one or two.  

When leaving for vacation, you can allow yourself an extra check (but only if you decide on the number in advance). Taking a picture might seem tempting, but it won’t lessen your discomfort if you have OCD. I’ve had patients tell me they’ve tried the picture hack only to question whether they might have turned the stove back on or plugged the iron in again after taking the photo.

So come up with a plan in advance, practice over and over before your trip, and save the photos for the sights you want to capture on your travels.

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Posted in Anxiety, Obsessive Compulsive Disorder |

How to Cope with Returning to “Normal” after Lockdown

By Lynne Gots, posted on March 25th, 2021.

With vaccine distribution increasing and states relaxing restrictions on indoor gatherings, many of us are contemplating the prospect of resuming activities long abandoned over the last year. Some people can hardly wait to board a plane for a Hawaiian vacation or gather at a favorite restaurant with friends; others are feeling, as one patient of mine put it, “not ready for things to go back to ‘normal.’”

And what does “normal” even mean in the current context? 

We know from studies conducted after the quarantines imposed during the SARS epidemic that the mental health ramifications of even short (more than 10 days) periods of enforced isolation are not trivial. Reactions included post-traumatic stress disorder, avoidance behaviors, and anger, lasting in some people for several years.  Research conducted in the aftermath of the COVID pandemic is already uncovering similar—and even more pervasive, given the duration—patterns.

The absence of in-person social interactions over the last year may make it especially hard to go back to seeing people face-to-face (or, mask-to-mask, as it likely will be for quite some time) for those prone to social anxiety. Avoidance is a prevalent coping mechanism, albeit not a healthy one. It might relieve anxiety in the short run but over time, avoiding triggers backfires because it prevents practice.

Returning to the office or seeing friends in the flesh might feel awkward because social skills have grown rusty.  And heightened body awareness might add to the uneasiness. Wearing “hard pants” after a year of working from the couch in sweats can feel strange and uncomfortable, especially for those (22% by one estimate) who have put on some weight during the pandemic.

People with OCD may fear seeing even fellow vaccine recipients unmasked and cling to washing and decontamination rituals adopted early in the pandemic, even if they are no longer deemed necessary. The over-estimation of danger is a thinking style common to all anxiety disorders. And as one recent study showed, news reported by media outlets in the US skewed overwhelmingly negative—87% of COVID coverage in national US media, compared with 64% in scientific journals, emphasized bad news—adding to the atmosphere of threat for those hypersensitive to it.

Even in the absence of preexisting mental-health issues, nearly all of us will experience some degree of post-traumatic stress, complicating our return to a BC (Before COVID) life. The trauma of actual illness and of losses—of lives and livelihood for many—have left deep emotional scars. Navigating the reentry into the world will take time, patience, and understanding, of others and ourselves. We all are grappling with a confusing mixture of emotions: excitement, fear, and even nostalgia for the early days of quarantine, when decisions were more black-and-white and unambiguous, and a sense of being “in it together” prevailed. Current times present a much higher level of uncertainty, making life far more complicated.

Acknowledging difficult feelings and allowing them to surface rather than trying to push them away are important strategies for coping with any challenge to emotional equilibrium. The road to the new “normal” will be rocky. But cultivating an attitude of acceptance will make the path less treacherous.

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Posted in Acceptance and Mindfulness, Anxiety, COVID-19 Mental Health |

Quarantine-Induced Agoraphobia and Other Anxieties

By Lynne Gots, posted on July 27th, 2020.

As states have been opening up, life has become more complicated. Many people found shelter-in-place mandates easier to navigate because they didn’t have to make decisions about whether to go out. But now, we have to consider the personal importance, and relative risks, of various activities, such as attending a protest, meeting friends for drinks at an outdoor patio, eating a meal at a restaurant, or getting a haircut. Having more choices leads to more uncertainty and, often, more anxiety.

Leaving the safety of home and feeling anxious, perhaps even panicky, about venturing into the world mimics the condition of agoraphobia, which means, literally, “fear of the market place, or place of assembly.” Agoraphobia is classified as a panic disorder because panic attacks typically occur in crowds or on public transportation, where escape is difficult. Subsequence avoidance of situations where a panic attack has occurred often leads to a narrowing of safety zones. People with agoraphobia may, if untreated, become completely housebound.

After several months of quarantining at home, going out can feel very strange. If you’ve been staying inside since March, not even taking a walk around the block, you may find yourself feeling nervous and jittery the first time you leave your apartment or house. The best approach is to start with just a short outing, gradually increasing the time and distance away from home to build tolerance. 

Another consequence of the quarantine may be heightened social anxiety, which often takes the form of excessive concerns about being evaluated negatively and judged by others. For example, someone with social anxiety might worry about being seen as irresponsible for not wearing a facemask when walking in a park (and social media only adds to the confusion, with accounts of assaults on both masked and unmasked people.) If you’re uncomfortable meeting others for a socially distant get together, then don’t. Everyone has a different tolerance for risk, and you shouldn’t feel pressured into accepting someone else’s decision about what is safe or embarrassed by your greater need for caution.

Setting limits with friends and family about safety practices can also be difficult for someone who worries about disappointing others. Should you let your parents, who are more casual about taking precautions than you, fly to visit you? Should you agree to meet your friends for an indoor meal at a restaurant because they are pleading with you to join them? Should you allow a lonely friend to join your quarantine pod?

In these unprecedented times, we cannot rely on social convention to help us decide what choices to make. And we can’t expect friends or family to help because they may have vastly different interpretations of risk. So we need to decide what feels right for us.

But if you are so fearful that you have become housebound, you will want to begin returning to the world, using reliable scientific sources, and not anxiety, to guide your decisions about what activities are reasonably safe. Both sunlight and exercise can ease stress and strengthen the immune system. So take those first steps and go outside for a walk.

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Posted in Anxiety, COVID-19 Mental Health |

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.

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© 2008-2022 Lynne S. Gots, PhD. Photographs by Steven Marks Photography.