Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

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How to Keep Your Anxiety from Spreading Like a Virus in the Face of COVID-19 [Updated]

By Lynne Gots, posted on March 7th, 2020.

The new Coronavirus outbreak has infiltrated our public consciousness, and it is exhausting. When the media are constantly bombarding us with updates about fatality counts and quarantines, even the most unflappable are finding it hard to stay calm. Everyone seems to be running to the nearest supermarket to stockpile disinfectant wipes, bottled water, and canned goods. So how are people with health anxiety and OCD—who are already prone to excessive worry about uncertainty, contamination, and illness— supposed to cope?

In treating anxiety, I use the evidence-based approach called Exposure/Response Prevention to help people tackle their fears and limit the compulsive behaviors, such as excessive washing, designed to make them feel less anxious about risk. But some of the practices my colleagues and I would typically recommend for someone with contamination worries, such as limiting hand-washing and avoiding the use of hand-sanitizer, fly in the face of current public health recommendations. Even so, if you keep in mind the rationale for exposure-based approaches to anxiety, which is to learn to tolerate discomfort and uncertainty, you can still come up with a personal plan allowing you to follow reasonable disease- prevention guidelines without letting your anxiety skyrocket and control your behavior.

  1. Take reasonable precautions.
    Use only one source, such as the CDC, to create your “response-prevention plan,” or rules for practicing sensible health habits without giving into compulsions. Follow the plan you’ve made in advance so you don’t let anxiety dictate your behavior in the moment.
  2. Less is better than more if you have OCD. For example, the CDC says “clean frequently…wash your hands often…for at least 20 seconds.” The words “frequently,” “often,” and, “at least” are ambiguous—and potential landmines for the OCD brain. Accepting uncertainty is a vital component of OCD treatment but, in this case, vague guidelines are not helpful. Decide you’ll wash your hands for 20 seconds, not 40 or 60 “just to be safe.” Don’t let anxiety make you doubt, second- guess, or modify the plan.
  3. Limit your consumption of the news and social media. You will be informed enough without knowing every detail about the outbreak. Decide which news outlets you will follow, how long you will spend reading them, and put yourself on a predetermined schedule for checking your sources. Don’t go down a rabbit hole seeking information. Unless you are on the frontline of the public health effort, you don’t need to know as much as the experts. And don’t look to random internet sources for preventative measures. According to a recent Washington Post column, Craig’s List is selling DIY Coronavirus vaccines. Which don’t exist.yet.
  4. *Don’t modify your activities just because you’re anxious. Unless your employer has implemented a mandatory telework policy, continue to go to work. Take your kids to the playground. Eat out if you normally enjoy going to restaurants. Spend time with friends. Shop at the supermarket. Get haircuts and manicures (sadly, many of my Chinese manicurist’s clients have been cancelling appointments out of misplaced fear). Of course, you should follow your response-prevention plan for washing when you are in public places where you are coming into contact with a lot of people. *See update below.
  5. Practice mindfulness and acceptance techniques. Whether you use meditation, yoga, prayer, or exercise, focusing your attention on the present moment, rather than ruminating about a catastrophic, uncertain future, can help you cope.

This is a challenging time for all of us. But we don’t need to make it worse than it already is by fueling our anxiety. If we practice responding to the uncertainty with reason and thoughtfulness rather than reacting out of panic, everyone will benefit.

Update: When I wrote this post only ten days ago, the coronavirus situation was very different from how it is now. The current national emergency mandates strict social-distancing practices, which make my advice to carry on normal activities no longer medically sound. or feasible.

I will be writing another post in the coming days with tips for staying sane while stuck in the house.

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Posted in Anxiety, COVID-19 Mental Health, General, Health Anxiety, Mental Health and the Media, Obsessive Compulsive Disorder |

The “Reality” of Real-Life OCD

By Lynne Gots, posted on November 23rd, 2019.

Most people turn to the Internet for information when a physical or psychological problem worries them, but people with OCD find its allures particularly irresistible. Seeking reassurance by doing research and comparing their symptoms to others’ is one of the most common compulsions.

The need to find comfort in numbers has led to a proliferation of on-line communities for “subtypes” of OCD, such as harm OCD, relationship OCD,  “pure O,” and now, one I’ve only recently discovered, “real-life” OCD. In a previous post, I discussed why breaking OCD into categories based on content is misleading and possibly even counter-therapeutic. When treating OCD, I stress the irrelevance of content. OCD often changes its focus from one theme to another but all its many manifestations share a common underlying cognitive feature: intolerance of uncertainty.

Discussions about so-called “real-life” OCD imply that obsessions about events that actually happened, rather than about future-oriented, hypothetical possibilities, are somehow more valid. Such logic has all the earmarks of an OCD trap!

Is “real-life” OCD real? Is it different from other forms of OCD? Does it require another treatent approach?

The answers are in my blog post for the Anxiety and Depression Disorders Association.

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Posted in Anxiety, Obsessive Compulsive Disorder |

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 |

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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© 2008-2021 Lynne S. Gots, PhD. Photographs by Steven Marks Photography.