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Covid, Measles outbreaks, Mokeypox- it can feel overwhelming to manage the constant barrage of new threats. For most people, a significant behavioral change is needed to ensure safety, but for people with OCD or health anxiety, where do you draw the line? What are appropriate safety precautions, and what are compulsive safety-seeking or attempts to manage anxiety? Years ago, it would have been seen as obviously excessive for most people to wear a mask in public spaces, sanitize everything before bringing it into your home, and refuse people in your home, but now that may be exactly what’s needed to remain safe. An added component to this difficulty are the differences in how folks view these threats, complicating factors like having young children or being immunocompromised, and individual tolerance for risk. What might be excessive for one person may be necessary for another.
There is no one right answer to what is an “appropriate” level of safety precaution, again because each person will have a different set of circumstances to consider. The simplest way to explore if your safety precautions are appropriate, or potentially causing you more anxiety/distress, can be boiled down to three questions:
Is this in line with expert recommendations?
The more obvious way to assess your safety precautions is to find experts whose opinions and recommendations you trust. This could be medical doctors, scientists, government agencies, or ideally, a combination of several so you can ensure your information is reliable. For example, both the CDC and the Mayo Clinic advise washing your hands with soap and water for at least 20 seconds or, if that is not available, using hand sanitizer with at least 60% alcohol content. With this in mind, some folks may prefer to go a little beyond these recommendations, but it gives a good barometer for what is considered adequate for safety.
Is this safety precaution causing you harm in an effort to keep you safe?
This is truly the most important assessment. If washing your hands for 60 seconds feels more comfortable, there’s likely little harm and it could be appropriate to continue. However, if you begin using scalding water, harmful chemicals like bleach, or begin to experience peeling, cracking, or bleeding, it warrants an assessment of whether the safety precaution is appropriate.
Is this causing me to be unable to engage in necessary or preferred activities?
This is a slightly more challenging assessment because nearly everyone has experienced a decrease in their ability to engage in preferred tasks, or are having to engage in them in different ways than we used to. You might have to say no to a large gathering, or only meet with friends outside and masked when you would prefer not to. If you find yourself isolating, or feeling unable to engage in activities even when risk could be mitigated, it might warrant a closer look. Another major component to this question is how much time is being spent on the safety precaution. For example, there’s a major difference between a quick wipe-down on the groceries, and a 5 hour sanitizing deep clean. If you find yourself spending considerable time on safety precautions that you would normally spend on leisure activities, it may be worth exploring.
If you are noticing that your attempts to maintain safety are starting to become detrimental in other ways, please reach out, a trained therapist can help you find a balance between safety and anxiety that opens the door to joy and hope.
For more information, go to https://iocdf.org/expert-opinions/expert-opinion-contamination/
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Panic attacks feel different for everyone, but typically include sensations like a pounding heart, sweating, a feeling of terror, constricted or rapid breathing, and feeling as though the room is closing in on you or spinning. Regardless of how they present, a hallmark is that the normal things we might do to manage anxiety (deep breathing, CBT strategies, talking with a support person) often don’t work because our bodies and brains are too dysregulated to tap into those skills. If you’ve tried those things when a panic attack comes on and have been frustrated that they seem to not help, or even that they make things worse, you are not alone! Below you’ll find a few strategies that may be more successful in the midst of a panic attack, and can help get you to a place of nervous system regulation that will make it possible to tap into those other skills.
A panic attack is signaling to your brain that there is a perceived threat it wants to get away from as fast as possible. It’s often not practical to truly run from the thing that is causing intense anxiety (a test or work presentation, a social interaction, etc.) but movement helps our brain calm down by reassuring it that if we were truly in danger, we could escape if needed.
In the height of a panic attack, many people feel frozen even if their brain feels like it wants to run away. Larger movements like walking, jumping, or dancing can be the quickest way to reset the nervous system, however, many people find they are unable to do so in the moment. If that is the case for you, try focusing your energy on the smallest movement you can think of (lifting a finger or toe, wiggling in your chair, pressing your feet into the ground). Let these small movements build to larger movements to get the same calming effect and move through that feeling of being “stuck” or “frozen”.
2. Taste Something Sour.
When experiencing a panic attack, our nervous system is entirely focused on the perceived threat at hand (sometimes people report experiencing “tunnel vision”) and it can feel like our brain and body forget that anything else exists. Eating something sour (or adding surprising sensory input of any kind) can help reset your nervous system into taking stock of what else is happening outside of the threat. You’ll need to follow-up with other coping skills after, but it can be enough to pull you out of the feeling that the panic attack is never going to end. Many people find success keeping sour candies on hand, especially when you’re in locations or situations that are anxiety-inducing.
3. Lean In
This one feels counterintuitive, but for many people the quickest way to stop a panic attack is to not try to stop it at all. Anxiety heightens when we try to ignore it. Imagine there was a person telling you the house was on fire, but you repeatedly responded, “no it’s not, it will be fine”. I doubt that person would agree and move on, instead they’d probably start yelling louder and louder until you finally took them seriously. For some people, coping strategies (especially things like distraction or positive statements) heighten anxiety and make panic attacks last longer. Try to imagine the panic attack as a roller coaster or wave, and remind yourself that this is a temporary state with an end point. It doesn’t feel great while it’s happening, but many people are surprised by how quickly they can move through a panic attack this way.
It’s important to note that everyone responds to coping skills differently, and it can take some trial and error to create a toolbox of skills that work for you. These tips are meant for the immediate management of panic attacks, so if you are experiencing frequent panic attacks be sure to reach out to a therapist who can help you understand what might be triggering them and can work with you to identify strategies for long-term management.
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Have you ever felt completely overcome by an intense emotions? Have feelings at times felt challenging to manage and overcome? The experience of being “overwhelmed” is uncomfortable and impactful in your life at work, home, or school.
Emotional overwhelm entails more than being stressed. You can feel submerged life’s current problems, to the point where you lack efficacy and feel frozen or paralyzed.
Compare the feeling of being overwhelmed to being submerged in a rough wave. It’s a scary experience! You may not know which way is up or what way to swim. You may feel stunned and unable to react. You may be unable to think or act rationally or functionally.
Whether brought on by events in the world (ahem, global pandemic) or events in your work or family life, emotional overwhelm can occur for a short burst of time or over a much longer period.
Sometimes, like many are experiencing in 2020, a series of hardships and challenges occurring in rapid succession can trigger someone to feel overwhelmed. Common experiences that may have lead to emotional overwhelm this year include:
Here are some strategies that can help mitigate feelings of overwhelm:
Fighting against high anxiety doesn’t help. In fact, it can add on a “secondary anxiety” that makes you feel anxious about your anxiety. Instead, try to remember that anxiety is an expected response to being out of your comfort zone. It is a “normal” human emotion. The feeling is uncomfortable but not dangerous.
Acceptance means allowing for uncertainty and discomfort, mindfully acknowledging it, and keeping on with what you can do instead of dwelling on what you can’t. Sometimes “acceptance” means non-judgmentally sitting with the feeling in your body, assuring it that it’s “welcome,” and allowing yourself to experience it with curiosity.
If you’d like to learn more about this skill, check out “The Happiness Trap: How to Stop Struggling and start Living” by Russ Harris.
Distorted, negative thoughts build up as anxiety grows and can amplify your feelings of overwhelm. In his book “Feeling Good,” Dr. David Burns lists 10 common cognitive distortions that often fuel feelings of distress. By noticing negative thought patterns, stopping them in their tracks, and re-writing them with more balanced, neutral, and accurate thoughts, you should notice a reduction in distress.
If your feelings of overwhelm are future-oriented “what if” thoughts, try out 5-senses grounding skills to bring you back into the present. The Calm meditation app is a great resource for guided meditation and practicing being present.
Ruthlessly cut out extraneous and optional activities that don’t fully align with your top priorities and core needs. There aren’t as many “shoulds” and “have-to’s” in this life as sometimes our culture makes it seem. What are the true “essentials” in your life? Is there anything you can let go of for now?
If you are feeling powerless over world events and broken systems, center on your core values. Give your values a specific name (ex. Acceptance; Equality; Freedom). Imagine that your value is speaking to you right now. What does it whisper? Feel it encourage, uplift, and ground you. Imagine yourself feeling rooted in them.
Write down your to-do list and track activities on you schedule. When life becomes too busy, holding these things in your head is too much. Your thoughts can spin with all of your to-do’s so you don’t forget. Let a piece of paper (or your smart phone) hold on to the to-do’s for you. If you struggle with staying organized, you might try out Microsoft To Do, an app for organizing lists and tasks.
There are times in everyone’s life when it’s time to ask for help. A therapist is able to help you identify triggers for your feelings of overwhelm and craft a coping plan specifically for you. Help is available! You don’t have to do this by yourself.
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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:
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:
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:
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.
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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