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Exposure and Response Prevention for Effective OCD Treatment

Exposure and Response Prevention for Effective OCD Treatment

Exposure and Response Prevention (ERP) is a form of Cognitive Behavioral Therapy (CBT) that involves purposefully exposing yourself to feared stimuli or situations in order to learn a new way of responding to them.

 

If you struggle with OCD, this explanation of ERP may sound counterproductive or terrifying, but the goal of ERP is to do more than cope with intrusive thoughts and instead completely change the way you respond to them.  We have excellent research on the effectiveness of ERP for long-term reduction of symptoms. Let’s break down why it works.

 

People with OCD experience intrusive thoughts, images, or obsessions that can focus on all sorts of content. Examples might include:

  • “Did I turn the stove off?”
  • “Did I just run someone over with my car?”
  • “I’ll get sick and die if I don’t wash my hands before eating”
  • “I looked at that person too long, am I attracted to them?”

 

When this happens, you’ll likely experience an anxiety response. Increased heart rate, sweaty palms, nausea, vision changes, and shallow breathing are all part of the body’s physiological response to a perceived threat. If the threat it’s responding to is a bear charging at you, there are some obvious courses of action to take to find safety, but what happens when it’s our thoughts that feel like the threat? In people with OCD, the brain finds alternate ways to feel safe, typically in the form of compulsions.

Compulsions can come in many different forms:

  • counting
  • checking to see if you or others are safe
  • excessive cleaning or organizing
  • reviewing memories
  • repeating phrases to yourself
  • google searches, etc.

 

Once you do the compulsion, you signal to brain that you are now safe, and the fear response subsides. Sounds fine right? If I’m experiencing a fear of contamination and it subsides when I wash my hands, I’ll just wash my hands when I feel fearful. Unfortunately, when someone continues this pattern a couple of things can happen:

 

  1. The brain learns that the only way we can feel safe from this perceived threat is by doing the compulsion, and if we are somehow prevented from doing that compulsive behavior it can cause significant distress and, or sometimes the compulsive behavior itself is problematic or dangerous.

 

  1. The brain feels temporary relief from the specific thought you had (I checked that the front door was locked four times, now no one can get in the house”), but we then start a pattern that to feel safe from any uncertainty, we must perform compulsive behavior, for example “But what about the back door?”, “But what if they can pick the locks?”, “But what if I didn’t actually lock it properly?”. As soon as we attempt to maintain absolute certainty that things are safe and all is well, OCD will run through other scenarios, often escalating the anxiety we were so desperately trying to reduce.

 

You may have previous experience with clinicians or well-meaning loved ones telling you to do things like deep breathing, thinking positive thoughts, or mantras to remind yourself you are safe. These can be wonderful tools for some people and can be temporarily relieving for people with OCD, but they have likely been unsuccessful in long-term management of obsessions and compulsions. This is where ERP comes in.

 

With the help of a skilled clinician, you will confront specific feared situations, thoughts, objects, images, etc, whatever spikes that familiar and uncomfortable anxiety you would typically seek to relieve with a compulsion. In ERP, clients make a commitment to not engage in the compulsive behavior no matter how uncomfortable the distress becomes.

 

You might be asking yourself why would I do this? Willingly make myself anxious? The answer is the brain’s incredible ability to experience habituation. When you expose yourself to your fears and tolerate the anxiety and uncertainty long enough without performing compulsive behaviors, the brain eventually experiences a reduction in anxiety and (this is the important part!) learns that it can still be safe even when it experiences these thoughts. It learns it no longer needs the compulsive behaviors to be safe and comfortable.

 

With consistent practice both in and out of sessions, you’ll habituate to each of the fears you expose yourself to so that the once feared obsession, intrusive thought or image no longer feels like a threat, and rather just a thought.  Over time, the way that your respond to uncertainty as a whole will shift, so you’ll feel better prepared to respond to any fears that come up in the future.

 

For more information about ERP or OCD, please visit the International OCD Foundation’s website at www.iocdf.org.

About the Author

Kate Scolatti is our on-site OCD and ERP specialist. Here’s a link to her bio where you can learn more about Kate and her work: https://starmeadowcounseling.com/counselors/kate-scolatti/

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Coping with Scarcity and Scarcity Mentality

Coping with Scarcity and Scarcity Mentality

Are you among the millions of people that have lost work since a state of emergency was declared last month? Employment numbers keep rising across the country. And those numbers don’t account for those whose applications for unemployment remain in limbo.

There is an understandable financial strain; the impact of which is palpable. Calls to the Substance Abuse and Mental Health Services Administration (SAMHSA) increased 891% compared to this same time last year.

 

But what is it about this experience of scarcity that triggers so much stress?

Abraham Maslow theorized these basic physiological needs for human survival:

  • The need for health
  • The need for food and water
  • The need for shelter
  • The need for sleep
  • The need for clothing

Maslow teaches that BEFORE you have a chance of feeling “safe” and “secure,” your physical needs MUST be met. This is why we cope with ACTUAL scarcity by prioritizing basic needs.

With that in mind, here are a list of local resources that can help with basic needs during this crisis:

 

 

Emergency Food Assistance:

Housing & Utility Assistance

If changes to your personal pocketbook aren’t enough, news reports trickle in day by day, hour by hour, reminding us of the faltering state of our economy.

 

ABOUT SCARCITY MENTALITY

What happens if your financial situation is indeed secure, but you don’t feel secure? Maybe you begin to take precautions as if you were under financial threat. Maybe you hoard food, ration the toilet paper, and cut back on expenses. Perhaps you bolster your savings. Or maybe you just feel anxious when spending money, as if that fear will prevent you from overdoing it.

 

Scarcity mentality is defined by a sense that there is never enough. It impacts our thought life, our feelings of fear and caution, and drives us to action.

 

Impact of Childhood Experiences

Many of those that experience scarcity mentality (but are otherwise financially secure in the present) have had past experiences of insufficiency.

 

  • Past experiences with homelessness, hunger, or poverty
  • Difficulties affording basic needs
  • Sense that there’s “not enough” to cover the “wants” of life (For Example: the cost of engaging in sports or music lessons)
  • Sometimes subtle messages that there isn’t enough to go around (“clean your plate so nothing goes to waste” or “we need that to last all week”).

 

Those past experiences fuel a belief system that predicts future instability in order to protect against a similar lack of resources.

 

If you are experiencing scarcity mentality, a counselor can help by:

 

  1. Helping you process past experiences feeding your current distress (which may be stored in your brain as a ‘trauma’ memory)
  2. Using Cognitive-Behavioral Therapy (CBT) to help you shift out of negative thought patterns
  3. Teaching you skills (such as thought defusion) that help you ‘let go’ of unhelpful intrusive worries.
  4. Coaching you on how to use (and take a break from) ruminating thoughts.
  5. Giving you a toolbox of other skills for lowering overall anxiety, including:
  • Mindfulness
  • Meditation
  • Grounding
  • Thought-stopping
  • And many other skills, depending on the theoretical orientation of the therapist

Having Difficulties Affording Therapy?

At Star Meadow Counseling, we know there are people who may be unable to pay for therapy as a result of the COVID-19 crisis. This is why our graduate student counselor is currently offering pro bono services to those impacted by the crisis. She has immediate openings for telehealth and is ready to help!

 

 

Pandemic Survival Skills from an Anxiety Counselor

Pandemic Survival Skills from an Anxiety Counselor

As we adjust to a new normal that includes self-quarantining, a shift in plans and routines, and significant uncertainty, it’s important to find ways to maintain our mental and emotional health. We’ve gathered some recommendations here, but strongly encourage you to reach out if you feel you’d like more support. Our clinicians are now offering telehealth sessions in order to continue serving our community.

 

1. Acknowledge and feel any emotion that comes up. Feeling uneasy? Strangely calm? Frustrated that events or services you were looking forward to are canceled? Fearful of financial insecurity? Struggling to adjust to increased time with family members or how to juggle working remotely with others around? We all respond to high stress in different ways. Allow yourself to notice and feel whatever comes up without judgement.

 

2. Ground yourself in the present. When facing uncertainty, our brains attempt to “prepare for the future” and our body’s response to this is a feeling of anxiety. While this can be a helpful motivator to encourage us to take appropriate precautions, left unchecked it can lead to feelings of panic, lots of “what if” questions, and a feeling of lack of control. To combat this, try to ground yourself in the here-and-now instead of the past (“I should have..”) or the future (“what happens if…”). Try finding ways to utilize all 5 senses, cook a comforting meal, light your favorite candle, specifically choose comfortable clothing, put on music you enjoy (nostalgia can be great here!), and organize or arrange things in your home in a way that feels cozy.

 

3. Get creative in the way you engage in activities. A significant number of your usual events and activities are likely canceled, but you don’t have to go without them for the duration of this time, but you might have to get creative.

  • Your standing weekly movie night with friends? Try Netflix Party, where groups can get together virtually to watch Netflix titles on their computers at the same time, including a chat room to share reactions as you go!
  • Did you have tickets to a concert or show that’s been cancelled? Some of your favorite artists may be finding alternate ways to still share this experience. NPR has an excellent resource to find these.
  • Do you enjoy cooking interesting meals, but have limited ingredients on hand? Round up what’s in the fridge and challenge yourself to make a Chopped-inspired meal using only those ingredients.
  • Enjoy exercise but your gym or fitness studio is closed? Many local and large-scale companies are offering free extended trials or low-cost online courses (check out Peleton, Planet Fitness, Down Dog, Nike Training Club, or investigate local options).
  • Like to learn? Many colleges and universities are offering free online classes, try something new!

 

4. Prioritize. Regular contact with family, friends, coworkers, and service providers can be a vital resource in maintaining a sense of connection and reducing loneliness. Our typical schedules can be demanding and we can find ourselves not having enough time with the people we care about. Use this time you reconnect with loved ones; call an old friend, email a favorite former co-worker,and have impactful conversations with family members.

 

5. Stick to a flexible routine. You’ve likely heard this one before, because it’s frankly good advice any time, but times like this warrant some additional focus here. Things like waking up at a similar time every day and completing your morning routine, but it’s also important to allow flexibility in your schedule. That exercise class you go to every Wednesday at 5pm? Substitute it with a walk or online class and fit it in when you can. It’s important to strike a balance between finding comfort in routine, and routine and feeling distressed when the routine is inevitably different.

 

6. Start (or grow!) your mindfulness meditation practice. Studies show the powerful benefits of mindfulness meditation, and this is an excellent time cultivate a practice. Start by using an app with guided meditations, some to check out are Stop Breathe and Think, Insight Timer, and Calm. It can feel odd at first, but with practice it can be a wonderful tool to increase physical and mental relaxation,

 

For those who must continue to work and interact with others (healthcare workers, sanitation workers, grocery store employees, etc.) now is the time to increase self-care and ways you de-stress. What we’re experiencing is not “just part of the job” and it is normal to feel overwhelmed. Talk to others in your field to foster a sense of community and support, and recharge yourself in whatever way is most beneficial to you. Know that your community appreciates you and will support you in whatever way it can!

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3 Ways to Kindly Say “No” to Invites for Introverts

3 Ways to Kindly Say “No” to Invites for Introverts

Life is challenging when you’re an introvert. What are simple interactions for many people can feel anxious and uncomfortable to you. The mere idea of taking part in certain social events can be exhausting and emotionally draining to an introvert.

While some social functions, such as business meetings, cannot be missed, there are social gatherings that can be, and it is totally okay for you to say no. This may feel almost as uncomfortable to you as actually attending the party or event, but it’s important to put your own needs ahead of others in times like these.

If you are an introvert that generally has a hard time saying no to invites, here are some ways you can do it kindly:

 

Be Honest-ish

We tend to feel a lot of pressure to give myriad details on why we can’t accept an invite to an event. If we don’t have a “good enough” excuse, some of us will blatantly lie, which then makes us feel bad.

There is no need to lie and no need to give more details than necessary. You can simply say, “Thanks so much but I already have plans.” We all have plans all of the time. You may plan on doing the laundry that night or watching Game of Thrones while eating pistachio ice cream (which is a great plan, BTW). That is the truth but it is no one else’s business but yours.

 

Be Gracious

Before saying “no,” be gracious and thank the person very much for inviting you in the first place. It will make the other person feel good that they made you feel good by thinking of you.

 

Practice What to Say

It’s easy to say no in a text or email, but when you will see that person in person, saying no can feel incredibly awkward. The best thing to do is just practice saying, “Thank you so much for asking but I already have plans that day/evening,” so that it comes out naturally and so that you feel at ease saying it.

I would like to suggest that, before saying no to an invite, you really weigh the pros and cons. I know being introverted can be challenging, but I also know that it can get pretty lonely at times. Saying yes once in a while may not be as bad as you think. While saying no to a huge, loud party may make sense for you, be open-minded and look for those new social situations you actually might be able to handle and enjoy. You never know the kind of fun you could have or new friends you could make.

 

Introversion vs. Social Anxiety

Introverts tend to feel exhausted after social interactions, but so do people with social anxiety symptoms.

How can you tell the difference between the two? Be curious about why you’re avoiding social interaction.

  • If you’re worried about what other people think about you, that is likely social anxiety.
  • If you feel nervous, worrying about the “right” thing to say, that’s probably social anxiety.
  • If you ruminate about or replay a social experience on repeat after the fact, that’s probably social anxiety.

 

A person can be an introvert AND have social anxiety. A therapist can help you honor your introversion needs, while working to overcome social fears.

 

 

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We live in a society that worships the overachiever. Burning the candle at both ends and denying yourself pleasure until the work gets done is seen as honorable. And while having a good work ethic is definitely key to living your best life, it is also important to balance your work life with a sense of play and freedom. If you don’t, you could experience burnout.

 

The Dangers of Being Addicted to Work

You may think that a workaholic would be every boss and manager’s dream employee. After all, if you’re someone who’s addicted to work, you’re generally the first one to arrive, last to leave, refuse to take vacations and take on mountains of work.

But workaholics are often not seen as team players, don’t delegate, and can’t handle their workload efficiently.

And, because these individuals refuse to take time off of work, they can become sick. Workaholics experience far more work-related stress, anger, anxiety and depression, which can result in physical symptoms like headaches, migraines, GI upset and insomnia.

 

Are You a Workaholic?

Wondering whether you are a workaholic? Here are 10 signs you may be addicted to working:

  • You work over 50 hours each week.

  • You feel the need to be constantly busy.

  • You have trouble relaxing and/or having fun when not working.

  • You are a perfectionist.

  • Writing to-do lists is fun for you.

  • Your loved ones complain about how much you work.

  • You’re often caught not listening or paying attention to conversations because you’re focused on work.

  • You’ve often been called a “control freak.”

  • You are neglecting other aspects of your life, like attending your child’s play or music recital.

  • You become highly stressed when you are forced to turn off your cellphone and other digital devices.

 

 

Workaholism is a Real Disease

Workaholism is an actual disease like alcoholism that tends to be passed down from parent to child. Work addicts use work as a means to cope with emotional discomfort and feelings of inadequacy. Because there is a real, intense need for work as a distraction, other areas of their life tend to suffer. And the cycle goes on and on.

Workaholics can benefit greatly from cognitive behavioral therapy where they can learn coping strategies that allow them to feel better and work less.

If you or someone you know is addicted to work and would like to explore treatment options, please get in touch with us. A counselor on our team can help you work to find more balance in your life.

 

 

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6 Reasons Why Yoga Might Be the Missing Link in Your Mental Health Toolkit

6 Reasons Why Yoga Might Be the Missing Link in Your Mental Health Toolkit

We invited our friend, Eve Parker at Simply Yoga, to share this guest blog, which provides information about the positive impact of yoga on a person’s mental health and overall wellness.  After reading the article, if you’d like more information about Simply Yoga, we encourage you to visit their website to learn more about the work they’re doing in the Vancouver, WA community.

 

Yoga postures, breathwork, and meditation can support mental health – from daily stress, frustration, and sadness to clinical anxiety, depression, and trauma so that you, your loved ones, and those you serve can benefit from a holistic practice to feel better. Yoga can be a powerful adjunct to traditional mental health treatments like psychotherapy and medication, but shouldn’t be used as a replacement for those interventions. 

 

  1. Yoga can help us find balance in our nervous systems. 

When our nervous systems get out of whack, we might find ourselves stuck too revved up (hyperarousal or fight-or-flight) or not able to get our engine going (hypoarousal or shut down). 

 

If we’re feeling too low energy, depleted, lethargic, sluggish, or depressed we can do certain movements, poses, and breathing techniques to increase our energy. Try yoga poses that are standing, backbends, side bends, and flowing, faster movements. Try breathing with a longer inhale and try turning the lights on brighter or putting energizing music on. Studio classes in this category might be Vinyasa or Hatha. 

 

If we’re feeling high energy, stressed, anxious, rushed, flighty, or irritable we can do different things to bring that energy down. Try seated poses or ones on the back, forward bends and twists at a slow pace or even held for a few minutes. Try making the exhale longer and dim the lights or put on calming music. Studio classes to look for include Yin, Restorative, and Gentle. 

 

  1. Yoga can improve brain functioning and overall daily functioning. 

When we moderate and calm our breathing, this sends signals to our brain to lower cortisol and adrenaline – two hormones present when we are stressed or anxious – slowing the heart rate, reducing blood pressure, improving sleep, and improving digestion. 

 

Yoga and other mindfulness practices help improve attention, memory, and emotional resilience. We spend a lot of time moving through the world without paying much attention to the details or embodying our own bodies. Mindfulness practice, or paying attention fully to the present moment and present experience without judging it, helps us become aware of what is really happening in the present moment. This helps us find response instead of reaction by taking a breath and reflecting on what is going on around us. 

 

  1. Yoga helps trauma survivors. 

Yoga has been found to be more effective than some more traditional talk therapies at supporting trauma survivors. Oftentimes when we experience a trauma that hits us hard, we might have feelings of dissociation like we don’t quite fit in our bodies or the world around us. Or we might feel like we are reliving events from the past. Yoga can help us bring ourselves back into our bodies and into the here and now. Grounding techniques in which we draw attention to our feet as we stand or our legs as we sit help us to feel present. We can practice this in our yoga postures and throughout the day.

 

  1. Yoga builds reconnection to the self and improves self-worth. 

Yoga can help us prioritize self-care, carving out that hour of time that is just for us so that we can go back to doing the awesome things that we do with more energy to give. As we gain flexibility, strength, and endurance to get through difficult classes, poses, and days, we might find ourselves feeling more confident not just on the mat but off it. We might even feel greater appreciation and acceptance of our bodies for being able to take us through yoga classes. 

 

As we gain more awareness of how our bodies feel when we practice yoga, we might start to prioritize other things that make us feel good in our bodies like improving sleep, eating healthfully, and putting down the stress of work, family, friends, and life when we prioritize self-care. 

 

  1. Yoga comes with a community. 

Whether you’re practicing with a video or in a studio, you’re practicing with others, a global community of people just like you, seeking wellness in their lives. Interconnectedness and compassion promote healing on all levels. When we breathe and move in unison with others, our nervous systems start to coregulate and attune to each other. In a society of so much running around and doing and trying to obtain, spending some time to be in harmony with others is crucial. For those who feel disconnected from self and others, coming to the studio and seeing the same familiar faces week to week can help build that missing support and connectedness. 

 

  1. Yoga might be the thing to make us feel more whole. 

The word “yoga” derives from the Sanskrit word “yuj” meaning “to yoke” or “union.” This union can mean many things, but for me it means bringing together all parts of the self that have been fragmented – the physical body and its sensations, the breath, the mind and its thoughts, the emotions, and the spirit or soul that makes each of us alive and vibrant and unique. When we move our bodies and breath together in unison, these elements start to come together and many people start to say they feel more aligned with themselves, more relaxed, more balanced, or like they’re coming home. 

 

 

We want you to have the best success on your yoga journey and we’re here to answer any questions you have. We would love to direct you to the perfect class for your needs, experience, and background. Please email us at Simply Yoga and we’ll get you started on your wellness journey. 

 

 

Simply Yoga is a non-profit yoga studio and wellness center in Salmon Creek WA offering classes in a variety of styles and times of the day to suit all needs and ages (we even have kids yoga classes!). Using a wide umbrella of mental health awareness, our mission is to implement mindfulness and movement practices that are inclusive to all populations and income levels, with an increased focus on programs available for our children, youth, and first responders. We offer several donation-based classes as well so you never need worry about whether you can afford to come. We want everybody to experience yoga. Find out more and sign up for a class at SimplyYogaCenter.org

Eve Parker, LICSW, RYT-200 is a mental health therapist and yoga instructor in Vancouver WA, bringing 7 years experience in the mental health field to her yoga and mindfulness teaching. She is dedicated to bridging the gap between therapies for mind and body to treat mental illness, addictions, and trauma from a holistic standpoint. Eve values cultivating a safe, trauma-informed space in which consent is paramount, making classes accessible to each student’s individual anatomy through empowering students to learn and listen to their bodies and through creative use of props and cues. You can find out more about her at EveParkerWellness.com.