ocd – Barb Shepard, LMHC, PLLC

If you have been working on anxiety reduction strategies for a while and not experiencing progress, you might too focused on stress management, and not enough on the behavioral changes that are necessary to address anxiety at its root.

Let me explain…

“Anxiety” is often used as a blanket term to describe any feeling of unwanted stress or unease.

Although there are similarities between stress and anxiety, anxiety is not the same as stress.

Stress is typically caused by an identifiable external trigger. It causes both mental and physical symptoms, such as irritability, fatigue, digestive troubles, and insomnia. Stress comes and goes.

Anxiety, on the other hand, is defined by chronic, excessive worries (otherwise known as obsessions) – even in the absence of an objective external stressor.

Stress management techniques address…stress! Things like breathing techniques, exercise, and other types of coping skills are an extremely important part of our lives. These methods help keep cortisol levels down; help us manage challenging situations; improve our reactivity; and are conducive to overall physical and mental health. We all need coping skills!

However…stress management does not address one of the most important parts of clinical levels of anxiety: compulsions.

Anxiety involves a complex process that involves cognition, biology, past experiences, and behavior. A big component of what fuels clinical anxiety is the behavioral component (aka, compulsions, which can be internal or external).

Compulsions associated with anxiety include excessive mentally reviewing situations; avoidance of feared situations; time-consuming worrying about the future; or other behaviors geared toward finding certainty about a situation.

If you have clinical levels of anxiety, you have compulsions.

Contrary to popular belief, compulsions are not limited to OCD. All anxiety disorders have some level of compulsive behavior and thought processes.

Even if you do not meet criteria for an anxiety disorder – all HUMANS have some obsessions and compulsions! Everyone can benefit from this work. You might Google things; ask for reassurance; replay that conversation with your coworker 100 times before going to sleep; or wonder constantly if you offended someone.

If you have been diagnosed with generalized anxiety disorder, the “flavor” of the types of things you fear *might* be different than with OCD – but in general, these two diagnoses are more similar than they are different.

Although everyone is different and there are always exceptions, generally speaking, stress management strategies will help you feel good, but they are not going to help you with the core of what drives compulsions.

In order for obsessions (worries) to get better, we have to treat the compulsions.

People often get stuck trying to use logic to assure themselves that their fears are irrational. While reasoning is initially a part of the treatment process to help you discern what situations truly require action vs. what is the noise of anxiety, you cannot logic your way out of anxiety by disputing your thoughts entirely or using coping skills to avoid these thoughts.

The key to reducing anxiety is to progressively face the things that you fear head-on. A very effective, evidenced-based model for doing so is called Exposure and Response Prevention Therapy. Let’s consider an example.

Let’s say that you have a lot of fear about making a mistake that you can’t take back. You might be scared that you’re going to send an email with typos in it to your boss. Before sending an email, you re-read the email countless times before sending, and then check it again several times even after sending. You still fear that you did make a mistake because you don’t trust your own memory, so you approach your boss and try to get a sense of whether or not they seem annoyed at you in a search for further evidence that things are okay.

Even if your boss was in a good mood and did not seem put-off, you might still go home worried that maybe they didn’t actually see the email yet, so you do another re-read before going to bed. You might end up losing sleep because you’re replaying that conversation with your boss over and over in your head, and also trying to imagine your worst fear happening tomorrow so that you’re mentally prepared if things do go badly.

You might try to consider “evidence for” and “evidence against” this thought that you made a mistake in an effort to convince yourself once and for all that nothing bad did happen or will happen. You might also work on breathing skills to calm down. So why don’t those methods work for this particular scenario?

When you are caught in a loop like this where you are seeking certainty, there is no amount of thinking, checking, or reassurance that will permanently and completely close that loop.

There is always lingering doubt that you missed something. You might feel better taking a few deep breaths, but it is only a matter of time before anxiety pops back up.

The solution? Radically accept the uncertainty about the situation. Say things like, “Maybe I did mess up, maybe I didn’t. I’ll have to deal with that if a problem arises, but right now there is no problem known to me.” You make a conscious choice to stop engaging in compulsions and accept that some things are just not knowable & will unfortunately remain uncertain no matter how hard you try to get clarity.

Uncertainty is the answer that none of us want, but all of us need when it comes to treating anxiety.

Accepting uncertainty paired with reducing compulsions creates measurable changes in the brain! When you stop engaging in compulsions, your brain learns that it does not have to be “on” all the time for an emergency.

You learn through experience that the bad thing often does not happen, and if it does, that you handled it better than you thought you could (the scientific term for this is called inhibitory learning).

You learn to tolerate embrace the positive side of uncertainty – what if it goes way better than you thought?

You get live life dictated by your VALUES, instead of your fears.

You get to experience so much more freedom and joy.

Exposure work can be hard, but if obsessing and engaging in compulsions and avoidance worked, you would have found your answers by now and there wouldn’t be anxiety.

Aren’t you ready for another way?

There is so much life to be lived and a lot of hope for you if you’ve been struggling with OCD or anxiety. I’m rooting for you in your path forward!

Resources for Anxiety and OCD:

If you or a loved one are struggling with anxiety or OCD, I’ve got a list of resources to point you in the right direction!

Posts:
Check out my website at barbshepardcounseling.com (linked below) to learn all about the differences between Generalized Anxiety, OCD, and Panic Disorder, as well as evidenced-based treatment strategies.
https://lnkd.in/e8Ys2yVt

Podcasts:
“All the Hard Things,” hosted by Jenna Overbaugh, provides incredible free content with everything you would ever want to know about anxiety or OCD.
https://lnkd.in/eYMdG5Ch…

Self-paced courses:
Nathan Peterson provides a self-paced course on Anxiety and OCD treatment that is extremely comprehensive and helpful! This might be for you if you are having a hard time finding an OCD specialist in your area; if therapy is not financially accessible to you right now; or if you are already in therapy, but interested in learning more outside of session.
https://lnkd.in/eNutnY-u

OCD online directory:
OCD is a very nuanced diagnosis that requires treatment with someone who has training and experience with Exposure and Response Prevention Therapy. Fortunately, there is a directly that can connect you to therapists in your area, and many insurance are also accepted!
https://lnkd.in/eMfwDWgm

Books:
“Stopping the Noise in Your Head” by Reid Wilson is a MUST READ for anyone with anxiety.
https://a.co/d/2XvhUgB

Enter your email and hit SUBSCRIBE to receive this directly to your email inbox on a monthly basis, and follow me on Instagram @syracusetherapy for more mental health content.

This photo was taken a few weeks ago up in the Adirondacks, one of my family’s favorite spots. Before sitting down for dinner, we set my son loose in a big open soccer field to “get his ya-yas out” first. We all ended up laughing a lot as the toddler repeatedly face planted in the grass (clearly still getting used to his new sneaks) and would just get right back up and keep running and giggling. In this moment I was thinking, “this is perfection,” which was closely followed by “…now when will the other shoe drop?”

The conundrum of joyful moments is that they are often entangled with a shadow of fear lurking around the corner. The “what ifs” and “when will it” and “how will I cope when it does” whispering in the background when everything in that moment is “right.”

When we let our guard down to joy, anxiety leaps into the foreground in an effort to protect us from an imagined threat that has not happened (and may not ever happen).

This is our wiring, our biology, intended to help us survive. What do we do about these moments? How do we enjoy life while managing this voice in the background?

First, start by gently acknowledging that your anxiety is actually meant to be a protector that is trying to help you. Sometimes that protector is in overdrive due to your life experience, genetic predisposition, or combination of both.

Anxiety tends to latch on to things we care about and create a lot of false urgency around the need to fix, solve, plan, and prevent. When we attempt to stop thoughts from being there, our stress increases. When we engage in behavioral compulsions, rumination, or mentally review a situation repeatedly – we don’t ever close the loop. We might feel better temporarily, but then the anxiety comes back, full-fledged. We create suffering.

While we can’t control what thoughts will pop into our brains, we can influence the extent to which we suffer as a result of them.

As the saying goes, “what we resist, persists.” The more you try to suppress thoughts, the stronger they get. Instead, it better serves us to meet our anxiety head-on.

The second step is to observe what thoughts are surfacing. When we can observe our thoughts in a nonjudgmental and nonreactive way, we can then start to make decisions.

Once you have identified what is making you anxious, ask yourself, “What things are within my control that are sensible to give to attention to?”

One challenge that people with anxiety often experience is discerning what is a reasonable worry vs. what is irrational. It can help to ask the question, “what would 90% of people I know think or do in this situation?” Asking this question can help us to properly discern when our thoughts are unreasonable, and this can help us to take the next reasonable action.

For example, if you’re feeling anxious about an upcoming meeting or presentation, you could think about specific action steps you could take to prepare for this. It is reasonable to have an appropriate amount of stress about public speaking. This allows you to properly plan, prepare, and complete the task effectively.

Once you have prepared sufficiently, any further rumination or worrying would be treated by increasing your tolerance to the uncertainty. Obsessing about the situation then enters the unreasonable realm, as you have already done everything within your control.

The antidote to obsessive worrying is NOT to convince yourself that the bad thing won’t happen.

As counter-intuitive as it may sound, the response that will help you the most in the long wrong is to build your tolerance to the unknown and accept that there could actually be a less than ideal outcome!

You might say things like, “maybe I will mess up, maybe I won’t, but I trust myself to handle whatever comes my way.” When there is a problem to address, you will solve it then. This strategy is the foundation of Exposure and Response Prevention Therapy, which research has shown is one of the most effective treatments for OCD and other anxiety disorders.

When a shoe does drop (it will, this is life) – you must learn to trust that future you can solve whatever problems come your way.

When we can radically accept that uncertainty is a part of life and learn to tolerate this, rather than try to fix or plan our way out of it, we experience relief. We must accept that many things in life are out of our control. The bad thing might actually happen at some point. We have to understand that this is the nature of being human and that all that we can tackle is what is right in front of us today.

Try saying it out loud or writing it down on a sticky note. “I trust myself to handle tomorrow’s problems, whatever those might be.” Visualize those worries of later or tomorrow like leaves floating down a stream that you are sitting next to. Watch the thoughts come and go without picking them out of the water and then creating a story about them. Thoughts are simply thoughts and do not necessarily mean anything. As you coexist alongside your thoughts as they float by, bring your attention to what’s happening in this moment.

Here are some questions to get in the habit of asking yourself when you need to hop out of your worries and back into this moment:

What are the facts of what’s happening right now? How can I reasonably respond to those facts?

Is this a problem that needs my attention right now, or is this something I need to postpone worrying about until I have more information?

What do you feel, see, hear, smell, & taste? Scan your environment for something that can ground you and help you savor beauty in the present.

This way of looking at life, of working with our anxiety (as opposed to fighting against) is a constant practice. It takes repetition, moment after moment, day after day, year after year.

This work is hard work, but it does get easier in time. Eventually, you build your tolerance to the unknown and to uncertainty with repeated practice. Your fears will still pop up, but you learn to respond to them in a completely new way that no longer interferes with living your life. Treatment works and there is hope.

If you or someone you love is struggling with anxiety, intrusive thoughts, or any other mental health crisis, here are some resources below:

Suicide and Crisis Lifeline

988

OCD Support

https://www.treatmyocd.com/

Tag: ocd

The Difference between Stress and Anxiety – and Why This Matters in your Anxiety Treatment

“Anxiety” is often used as a blanket term to describe any feeling of unwanted stress or unease.

However…stress management does not address one of the most important parts of clinical levels of anxiety: compulsions.

If you have clinical levels of anxiety, you have compulsions.

In order for obsessions (worries) to get better, we have to treat the compulsions.

When you are caught in a loop like this where you are seeking certainty, there is no amount of thinking, checking, or reassurance that will permanently and completely close that loop.

Uncertainty is the answer that none of us want, but all of us need when it comes to treating anxiety.

How to Stop Waiting for the Other Shoe to Drop

When we let our guard down to joy, anxiety leaps into the foreground in an effort to protect us from an imagined threat that has not happened (and may not ever happen).

While we can’t control what thoughts will pop into our brains, we can influence the extent to which we suffer as a result of them.

Once you have identified what is making you anxious, ask yourself, “What things are within my control that are sensible to give to attention to?”

The antidote to obsessive worrying is NOT to convince yourself that the bad thing won’t happen.

When a shoe does drop (it will, this is life) – you must learn to trust that future you can solve whatever problems come your way.

This way of looking at life, of working with our anxiety (as opposed to fighting against) is a constant practice. It takes repetition, moment after moment, day after day, year after year.

“Anxiety” is often used as a blanket term to describe any feeling of unwanted stress or unease.

However…stress management does not address one of the most important parts of clinical levels of anxiety: compulsions.

If you have clinical levels of anxiety, you have compulsions.

In order for obsessions (worries) to get better, we have to treat the compulsions.

When you are caught in a loop like this where you are seeking certainty, there is no amount of thinking, checking, or reassurance that will permanently and completely close that loop.

Uncertainty is the answer that none of us want, but all of us need when it comes to treating anxiety.

Share

Like this:

When we let our guard down to joy, anxiety leaps into the foreground in an effort to protect us from an imagined threat that has not happened (and may not ever happen).

While we can’t control what thoughts will pop into our brains, we can influence the extent to which we suffer as a result of them.

Once you have identified what is making you anxious, ask yourself, “What things are within my control that are sensible to give to attention to?”

The antidote to obsessive worrying is NOT to convince yourself that the bad thing won’t happen.

When a shoe does drop (it will, this is life) – you must learn to trust that future you can solve whatever problems come your way.

This way of looking at life, of working with our anxiety (as opposed to fighting against) is a constant practice. It takes repetition, moment after moment, day after day, year after year.

Share

Like this: