Monthly Archives: December 2018

Catching Up With Jon Hershfield

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I first hosted Jon Hershfield in a Tuesday Q&A in 2015 and he’s done so much since then it’s time to have him back! With four books under his belt, he puts authors like me to shame, so I don’t know why I’m continuing to promote him. But, really, he has a wealth of practical advice to offer and always does so with humor and compassion. We’re lucky to have him in the OCD community.

A lot has happened since we last chatted! You may be the most ambitious person I know: You just published your fourth book, Overcoming Harm OCDOne of the most common questions I hear about harm-related intrusive thoughts is “How will ERP work for me? It’s not like I can walk around with a sharp knife.” How would you answer that question as a therapist?

Well, you can literally walk around with a sharp knife. Normally we do this when we’re on our way to divide a sandwich. But the question has to do with concern about causing actual harm in the course of doing exposure to a fear of causing harm. In ERP we do a lot of scary things, but what we don’t do is actually hurt people. In OCD there’s been some problematic training of the brain to assign “danger” to uncertainty about harm thoughts. So if I see a knife and I have an intrusive thought of causing harm with it, my brain may believe we are in danger. ERP works by getting in the ring with that uncertainty, resisting compulsions and other safety behaviors, and retraining the brain to have a different association with the uncertainty. So actually, yeah, handling a sharp knife in the presence of unwanted thoughts and other triggers can be really good ERP. I think it’s easy to get confused here because one might think we don’t have people stab strangers as exposure simply because it’s wrong. It is wrong, but that’s not really why we don’t do it. We don’t do it because that would fail to actually teach the brain how to handle uncertainty. For exposures where handling a knife may be complicated (e.g., you can’t bring one on an airplane), we have imaginal exposure where we use writing as a strategy to trick the brain into thinking we could be in danger. In this state, we practice resisting compulsions and we create new learning about being uncertain. People with harm OCD are not the ticking time bombs they think they are, but no amount of me telling them this will actually touch the OCD. They have to experience the exposure without the compulsions to truly understand this.

We know that getting the right diagnosis and proper treatment can take years, and I’ve always wondered if it takes longer for folks with harm obsessions. When I was worried I’d hurt a child, I was afraid to tell anyone, even a therapist, because I thought they’d deem me a risk to society and call the police. In your experience, are individuals with harm obsessions less likely to seek help than those with, say, a germ phobia? Or is their fear that they’ll hurt somebody so strong they feel they must be stopped before it’s too late?

Both of these things are very common in unwanted violent obsessions. A person with harm OCD may avoid treatment because of the concern that the treatment provider will have them hospitalized or arrested, or that disclosure of these thoughts will bring shame and scorn to them and their families. In more severe cases, anxiety can be so high and insight so low that a belief develops in the mind of the person with OCD that they must be defective at the core. Essentially, they imagine that going to treatment will reveal this defect and the borrowed time they’re living with before hurting someone will come to a sudden end. We can largely blame external stigma about mental health issues, especially as it relates to intrusive thoughts, for inhibiting people from seeking help. But self-stigma is even more powerful and the belief that having these thoughts makes us immoral or bad keeps a lot of people from asking for help.

We know reassurance seeking is a compulsion, and giving reassurance only adds roadblocks to the recovery process, so what is the best way to help a loved one with these upsetting intrusive thoughts?

Loved ones can educate themselves about the disorder. Knowing your loved one without OCD understands that you have OCD is reassuring in the best possible way. If the sufferer and the family member (or partner, etc.) can work together with compassion and an educated understanding of the disorder, navigating reassurance becomes easier. Collaborating on non-reassuring, but compassionate, responses makes a huge difference. So rather than constantly telling a person with harm OCD that they’ll never hurt anyone, they can find appropriate ways of telling them that they understand OCD is really painful, that they are proud of and support the work that’s being done to overcome it, and that there are several shows on Netflix right now that demand more attention than the question on the table at the moment. Of course, none of this type of interaction is possible without empathy and kindness. Helping them access treatment when possible, supporting that treatment, and never confusing the symptoms with who the person really is are all instrumental.

Speaking of not giving in to compulsions, let’s talk about your book When a Family Member Has OCDIt must be hard for parents to resist the urge to act as a therapist themselves, and to instead support their child through the recovery process. What would you tell a parent who is at his wit’s end and just wants to make life easier for his child, even if that means doing the “wrong” thing?

In writing When a Family Member Has OCD, I really kept in mind two audiences: one is the family member who wants to better understand a loved one with OCD and the other is the OCD sufferer who wants to be understood. Families operate as systems. There is no such thing as a child with OCD that exists in a vacuum where the child just gets fixed by the therapist and life goes back to normal. A child with OCD does hard work with CBT/ERP to master the disorder. The parent of that child must also be willing to do exposure to their own fear that they aren’t doing enough to relieve their child’s suffering. It’s excruciating, but when parents sabotage the treatment by providing reassurance and accommodating rituals, they just set the stage for more pain for everyone later. Reassurance actually doesn’t make life easier for the child because it sends the message to the child’s brain that there was something dangerous to reassure about and that they could not have coped without your intervention. Confronting the discomfort over withholding reassurance means sitting with uncertainty about how much pain you and your child can withstand in the face of OCD. It’s not easy. But parents who overcome this fear get a better understanding of what it’s like for their child to overcome fear and when the child improves, the parent’s relationship to anxiety changes too, and the whole system improves.

You co-authored Everyday Mindfulness for OCD with Shala Nicely, an inspiring read about how to enhance ERP with mindfulness techniques. I’ll admit that I always thought sitting in silence with my horrific thoughts felt a little like torture—and many people can’t believe we’re supposed to accept those thoughts.

It’s an interesting way we often put it—“to sit in silence with horrific thoughts.” There are some inherent problems in framing it this way. First, it implies that in the absence of distraction, it’s just the self and the thoughts alone in space. But this isn’t true. In the absence of distraction, we see things as they really are, which includes input from all five senses and, yes, thoughts. So it’s really being in the company of six streams of information and treating them all as such. Sound, touch, thoughts, and so on are all just objects of attention being projected onto the screen of the mind, so if we learn how to pay attention, there’s a lot more to look at than just sitting with obsessions. This highlights the other problem, that word “horrific.” We get so used to categorizing thoughts like movie genres that we easily forget how thoughts are just words and pictures. They don’t really have positive or negative qualities unless we decide that they do. Yes, the thought of harming my children abhors me. But if I write “harming my children” in red marker on a piece of paper, the only thing that’s changed about the paper is that it has red ink on it. The same is true of us. When we think a thought, the thought is just words scribbled on the mind. It doesn’t change who we are.

Tell us how mindfulness can help, and explain why it’s a myth that meditation means completely clearing our minds of all thoughts.

Two problems occur in the way the OCD mind operates that can both be addressed with mindfulness, which simply means watching the mind objectively. First, the mind wanders from the present, as it should, no different than a puppy sniffing things on a walk around the block. But we often fail to notice that it’s wandered and then, in a way, we find the puppy pooping on the neighbor’s porch. In other words, we get lost in our obsessive thoughts because we have trouble paying attention to where the mind is in any given moment. Then, when we discover that we’ve been pulled away by an obsession, the disorder sets a precondition for returning to the present. We feel obliged to neutralize the obsession (i.e., get certainty that it isn’t true), to do a compulsion, and then we get permission to return to wherever we were before we got distracted. If, on the other hand, we had the capacity to notice early on when the mind has been pulled away by an obsession and could simply start over in that moment as if it never happened, without permission from the OCD, we’d be much more in command. Meditation is an exercise that targets these two strengths, of recognizing where the mind is in each moment, and starting over when we see the mind distracted. By definition, this requires the mind to not be clear, but to see it clearly. Have all the thoughts, but know that they are thoughts and don’t try to fix them.

What’s next for you?

It’s been brought to my attention that I’ve written four books in the past five years or so. I’m hoping that Overcoming Harm OCD helps more than just the kind, gentle, and creative people I’ve encountered in my clinical work, but harm OCD sufferers everywhere. I also hope it serves as an excuse for me to slow down before I find myself writing something about sexual obsessions. So what’s really “next” for me is just continuing to build my practice and doing the best I can to help empower the most people in their OCD recovery.

Tuesday Q&A: Leah Adair

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Leah Adair is a delight! I’m lucky enough to know her, and today you get to know more about her and her journey with obsessive-compulsive disorder (OCD). Leah is full of positivity and insight and realizes that even with the torture that OCD has caused in her life she still has plenty to be thankful for. Thank you for being here, Leah!

When did you first experience symptoms of OCD, and how did you eventually realize what you’d been experiencing might be OCD?

I didn’t fully understand OCD until it upended my life five years ago. Prior to this time, I had symptoms, but they were manageable. As a child, I often apologized over and over and over again for things that weren’t even my fault. I had worries that I said something blasphemous to someone during a conversation. I would rerun conversations over and over in my head after talking with someone. I also had extremely inappropriate words get stuck on a mental loop in my head. Neither of these obsessions took a major toll on my life. I just chalked them up to being weird thoughts.

In the fall of 2010 I was hospitalized in the ICU with double pneumonia. I was on life support at the age of 28. It was a very scary time for my entire family. My parents are both medical professionals and they knew how dire this situation was. As I’ve done more research on OCD, I believe there could be a link to major medical experiences and OCD in some people. I had frequent ear infections as a child and ended up with tubes in both ears as well. Both of these major illnesses could have had an impact on my brain chemistry. Who knows—OCD also runs in families. My brother has it and I know of a few extended family members with an OCD diagnosis.

Five years ago I was in the throes of parent-teacher conferences, we were hosting some out-of-town guests, and we were getting ready to go out of state for the weekend. I was going about my day-to-day life when a thought popped into my head. Most people would just let a thought like this pass on by. My brain got stuck in this thought. It cycled through my brain nonstop. I couldn’t turn it off. Everywhere I looked, my obsession seemed to be there. It was torture. I couldn’t sleep for several months. I’d average three hours of sleep per night. I was barely able to eat and in a span of four months I lost over 30 pounds. This isn’t a diet I would recommend to anyone. I was tormented by this thought (obsession), and my compulsion was to ask for reassurance via my parents and the internet—I was constantly searching the internet to figure this out. I didn’t know it was OCD until I ran across an article about different forms of this illness. I always equated OCD with order and cleanliness. I’m someone who wants solutions to most everything. I scheduled an appointment with a therapist, started researching all of the natural remedies for OCD/anxiety, and dove into an intense workout regimen (thinking the endorphins would kick this nasty beast to the curb). The therapist I originally went to had no idea how to treat OCD. I also visited a psychiatrist and she basically just wrote me a prescription and said “good luck.” As I continued to scour the internet, I found a blog by Jackie Lea Sommers. Little did I know, she lives in the Twin Cities as well. She has a whole section of her blog dedicated to OCD. It was from interactions with her that I found out about exposure and response prevention (ERP) therapy. I went to Dr. Chris Donahue in Saint Paul for 15 weeks of ERP therapy. It was hard and intense, but I can now say my symptoms have improved by 85 percent. I’ve acknowledged that OCD is something that will never completely go away. When an individual has diabetes, they have to manage their insulin. If a person is in remission from cancer, they still need to go in for check-ups and have an awareness of their body. I view ERP as the tool box that helps me function. I also credit an amazing community of friends, a supportive and loving family, exercise, and medication.

Will you share your “stickiest” obsession with us? Did you have to approach it from a different perspective, or has a tried-and-true method helped?

Gah. Here I am thinking I’ve come so far . . . but I’m still afraid to share my stickiest obsession with the internet. OCD is so tricky. It’s like watching the worst movie you’ve ever experienced over and over and over again.

The website Beyond the Doubt has a short summary of different themes people have.

The main themes that have been present in my life are:

  • “just right” OCD—making sure I said or did something just right, and if I didn’t I replay the conversation or interaction over and over and over in my head
  • thinking I’ve said something blasphemous out loud, asking people for reassurance to find out if I actually did say something
  • fear of harming a loved one, but knowing I would never hurt anyone (harm OCD)
  • sexual obsessions—my entire life I’ve been attracted to boys and then men, but fearing that I’m living a lie (homosexual OCD)

Having OCD is difficult for anyone, but it can be particularly painful as a parent. You’re a new mother–how have you dealt with obsessions and compulsions while adjusting to a whole new lifestyle and set of responsibilities?

I was very open with family and friends prior to having our son. I wanted them to know I was afraid of how this disorder could manifest as a mom. Thankfully, it hasn’t been bad. During pregnancy my symptoms actually subsided quite a bit.  As a mom, things are so busy that I don’t have as much time to give to my obsessions. Parenting is hard, but it’s also been a great distraction. Once in a while I will get “stuck” but thankfully I am able to tell my husband or a close friend that I’m having a difficult time. I also have recognized when I need to have alone time, or do something to recharge. I’ve found that I get really exhausted in large groups where I don’t know a lot of people.

Speaking of family, how did you tell loved ones about your diagnosis and how they can help you?

When OCD first presented itself, I contacted my brother. I think he was diagnosed in high school or college. He was super helpful and encouraging. It also helped to know that I wasn’t alone. After telling my brother, I told my parents. It took me a few months to talk to my husband about it. I think a big thing I was afraid of telling him was that part of the OCD theme I struggle with had to do with him. Over the course of the year when I was diagnosed, I gradually began telling close friends. Then, one night a few years ago, I wrote a post about OCD. It was extremely liberating. It felt like I broke free of chains that were holding me back. Prior to this disorder wreaking havoc on my life, I had so many stereotypes and stigmas of people with mental health issues. I wanted society to know and understand that it could happen to anyone. Family and friends have been wonderful. It’s been beautiful to see awareness spread about this illness and to have people love me through it. My husband, Thom, has been amazing. He’s so calm and loving. I don’t expect him to ever fully understand OCD, but I’m glad he loves me through it. I thank God every day for the support system I have.

You’re the OCD Twin Cities secretary. Why did you want to get involved in a nonprofit dedicated to OCD awareness in your city? 

I felt like I needed to give back to the OCD community. I also have a strong passion for mental health awareness. The late Senator Paul Wellstone said, “We all do better when we all do better.” I believe this is true. We need each other to survive. No one is meant to fight alone. Your story isn’t fully written, and it’s definitely not over. I’ve loved getting to know the other individuals on the OCD Twin Cities board and helping create events and awareness about OCD. It’s so important for family and friends to have ways to support their loved ones as they navigate this diagnosis. I feel like OCD Twin Cities has events for everyone, whether you’re a mental health practitioner, an individual with OCD, a partner, a friend, or a family member.

I’m someone who cares deeply about others and I love helping people find ways to manage their symptoms. OCD can feel really isolating at times, and I want individuals suffering with the illness to know recovery is possible.

What do you consider the most harmful misconception about OCD, and how do you think we can help clear it up?

I think the most harmful misconception is that OCD is such an asset. I had a health provider during a physical say to me, “Your house must be so clean since you have OCD!” I didn’t have the energy to explain to her that my OCD symptoms have nothing to do with cleanliness. I think ways we can clear up misconceptions of any kind is to stop dehumanizing people. It’s so easy to make stories up about people and be fearful of mental illness. One in four people have OCD. It’s as common as childhood diabetes. Your friend, neighbor, pastor, barber, taxi driver, or family member could have OCD. It’s not something that is visible to people. It’s often something that individuals suffer with in silence. I hope and pray that our society continues to create more understanding around all mental health disorders.

If you could share just one piece of advice with other with OCD, what would it be?

The piece of advice I would share is: You’ve survived 100 percent of your hardest days; don’t be afraid to get help or admit you are not okay. A whole community is out there waiting to embrace you with loving arms.