OCD Myths, Debunked #2: OCD Is Completely Illogical

OCD Myths, Debunked #2: OCD Is Completely Illogical

by | Anxiety, Obsession, OCD

Welcome back to my series about the myths and misconceptions surrounding OCD! The goal of this series is to provide support to people who want to understand OCD for what it really is, rather than what it’s been built up to be in society, media, and pop culture. These misconceptions impact clients and clinicians alike, and deserve to be debunked.

 

The misconception of the day: OCD is completely illogical.

 

While OCD can certainly be based in magical thinking, or have little connection to reality, real life OCD is infinitely more complex and personal to the person who experiences it.  One method of treating OCD, called Inference Based CBT (I-CBT), bases treatment on the idea that an individual person’s OCD themes will be related to the stories we tell ourselves about why our OCD keeps us safe.

 

For example, if I have harm OCD themes, I may be scared of the possibility of harming my loved ones by accidentally poisoning their food. I can come up with many reasons why this could happen…

  • Food safety standards are often very precise, and I could easily mess them up.
  • I’ve read many news articles about food poisoning that happened unintentionally.
  • One time, I even undercooked my own eggs and it made my stomach hurt later that day.

 

See? I can absolutely find stories that let me logically justify my OCD fears. I might use compulsions in reaction to these fears…

  • Rigorous handwashing (many minutes, very hot water, strong cleansers)
  • Checking my food (measuring and remeasuring food temperature, checking and rechecking for raw meat)
  • Avoiding food prep in the first place I feel like I’m preventing sure harm.

These compulsions follow an important logic clearly based on my experiences and knowledge.

 

However- and this is a big one- OCD logic is not infallible. Nothing happening in the here and now is actually telling me that any of these stories are happening.

  • My food thermometer told me my chicken was cooked to a safe temperature.
  • Visually looking at my food tells me there’s no giant patches of mold waiting to cause illness.
  • The smell and taste of the food I’m enjoying tells me it’s not spoiled.

 

These stories feel important to me because I’m invested in them connecting to each other. What’s more, I care so much about my loved ones that the idea of harming them feels so devastating that these stories feel very important to react to. The reality is though, I don’t need to do my compulsions to prevent harm, because the stories telling me harm is imminent aren’t actually relevant right now. The logic exists, and matters to me, but reality and my senses tell me that I’m safe anyway. Some questions I can ask myself when I’m having these doubts could be…

  • Is there anything in the here and now that is a threat?
  • What are my 5 senses telling me?
  • Is the logic I’m using based on what’s actually happening right now, or is it based on past experiences, stories, and things I’ve heard from others?

 

When we push the idea that OCD needs to be ”illogical”, we discount the core experience of obsessive thoughts in the first place, and belittle the people dealing with those obsessions. Dismissing these very real fears based on very real stories just creates a rift in understanding and can increase the stigma of OCD. Diagnosis may even be missed by people who believe OCD can’t make sense and still be OCD. A more accurate statement would be that the logic of OCD is not based in the present. It exists, and it’s important to understand nonjudgmentally, and it also doesn’t represent real danger. This nuance is crucial. That’s where the work is!

 

 

Wanna Learn More about OCD?

Check out our first blog in this series:

OCD Myths, Debunked #1: Compulsions Are All Visible Behaviors

If you’re ready to meet with an OCD specialist, Star Meadow Counseling is able to help! Reach out today to schedule your first appointment.

 

 

OCD Myths, Debunked #1: Compulsions Are All Visible Behaviors

OCD Myths, Debunked #1: Compulsions Are All Visible Behaviors

by | Anxiety, Obsession, OCD

OCD is a complex mental health condition that is often missed and misunderstood by clinicians and people with OCD alike. The International Obsessive Compulsive Disorder Foundation (IOCDF) estimates that 1 in 40 people in the US will meet the criteria for an OCD diagnosis at some point in their lives. That works out to be around 8.2 million people, or about the population of the state of Washington. That’s a lot of people! Even still, it takes the average person 7 years to get an OCD diagnosis from the time that symptoms emerge.

 

What makes OCD so tricky to diagnose, if so many people experience it? A major factor is our collective understanding of what OCD is in the first place. Pop culture often depicts OCD as intense cleanliness, a desire for perfectionism, or meaningless rituals that the characters themselves have no real connection to. If this is all you know OCD to be, it’s very easy to not recognize yourself in that portrayal, and never seek support or answers. Further, if clinicians have this narrow view of OCD, they might miss important signs and further extend the amount of time it takes to get real support.

 

Let’s get into some important misconceptions about OCD, so that we can all move forward with a better understanding of what this very common diagnosis actually is. This series will attempt to provide an overview of topics that deserve further discussion, one myth at a time.

 

The misconception of the day: Compulsions are all visible behaviors.

 

Think about stereotypical compulsions that immediately come to mind when you think of OCD. You may think of…

  • Hand washing
  • Rigorous cleaning and organizing
  • Switching lights on and off
  • Tapping or blinking rituals

 

While many compulsions are based on physical activities, it’s just as likely that compulsions are invisible, at least to people on the outside.

 

You may have heard of the term “Pure O” OCD, as a way of describing OCD that occurs as obsessions without any compulsions. While this label can be affirming for folks who have never experienced physical compulsions, it is more likely that people with “Pure O” OCD do have compulsions, they’re just internal. Some examples of internal compulsions may be…

  • Mental reviewing/rumination: thinking through memories or anticipating future events over and over again, scanning for danger/embarrassment/feared outcomes
    • Example: rethinking a conversation with your spouse from last week, for hours and hours, reviewing what you said and how they reacted until you feel totally sure that they aren’t secretly planning on breaking up with you.
  • Thought neutralization/blocking: forcing comforting, repetitive, or nonsense thoughts to “drown out” anxiety and obsessions
    • Examples: when having obsessive thoughts about harming a loved one, interrupting those thoughts by thinking “NO, NO, NO, NO” on repeat, imagining a big red stop sign over and over, or repeating the phrase “I am okay” internally until there’s an internal sense of things being “neutralized”.
  • Internal checking: responding to a distressing thought or sensation by repeatedly “testing” to see if it’s real, still there, or changing.
    • Examples: noticing a sore throat and repetitively checking to see if it’s getting worse, checking desire to harm a loved one by repeatedly imagining them in a feared scenario and seeing if you have an emotional response

 

Mental compulsions are very real and often fly under the radar in a way that physical compulsions don’t, simply because other people may not notice they’re happening. However, one of the sneakiest ways OCD reinforces itself is based on behaviors that aren’t happening at all.

 

Huh? How could something not happening impact OCD? Through avoidance!

 

Avoidance is one of the easiest signs of OCD to miss, because it relies on having a deep understanding of your personal OCD. Avoidance can keep OCD around in subtle ways for a very long time. Some ways that OCD shows up are…

  • Avoiding things because they trigger obsessions
    • Examples: not cooking for fear of triggering anxiety about food poisoning, not dating for fear of worrying that someone is cheating on you, not texting or writing for fear of saying the “wrong thing”.
  • Avoiding things because they trigger compulsions
    • Examples: not showering because your hygiene routine is so rigorous/time consuming/painful, not speaking with loved ones because your mental reviewing compulsions are so distressing after the fact, not driving because you’ll feel the need to check and make sure you didn’t hit anyone.
  • Avoiding contact with objects, places, or people that seem “contaminated”
  • Avoiding contact with kids or animals for fear of pedophilia, beastiality, or other “taboo” OCD themes being triggered

 

Both avoidance and mental compulsions are often missed during assessments and screeners for OCD, and can contribute to a delay in receiving effective care. It’s important to break the misconception that OCD is all behavioral, because that really only covers a small part of the ways that OCD can impact someone’s life. Getting better at recognizing all the many aspects of OCD ensures that we are better at talking about it and supporting people who are dealing with OCD in the future, including ourselves.

 

 

Schedule with an OCD Specialist

If you’re ready to meet with an OCD specialist, Star Meadow Counseling is able to help! Reach out today to schedule your first appointment.

 

 

 

 

Contamination Fears In a Contaminated World: What’s Appropriate And What’s Compulsive?

Contamination Fears In a Contaminated World: What’s Appropriate And What’s Compulsive?

by | Anxiety, Obsession

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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Exposure and Response Prevention for Effective OCD Treatment

Exposure and Response Prevention for Effective OCD Treatment

by | Anxiety, Obsession

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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by | Apr 1, 2019 |

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Making New “Glory Days”: How to Stop Obsessing About Youthful Successes

Making New “Glory Days”: How to Stop Obsessing About Youthful Successes

by | Obsession, Self-Esteem

“Ahh, the good ol’ days.” How often have we heard or uttered this familiar phrase? It can be a source of great pleasure and amusement to reminisce on a time when we were younger, remembering a special event or activity.

We tend to look at our past experiences through a filter that magnifies the positive while diminishing the negative. While there’s no harm in basking in a memory, it can be harmful if you spend so much time looking at your past, that you neglect your present and future.

If you’re someone who spends too much time thinking about the “glory days” of your youth, you might think it’s because your life has become dull and monotonous. With the carefree days of your youth behind you, you might long to be back in that time period to escape your present. But if you take a closer look and examine your life, you may be surprised to notice that you look back not because your past was so great, but rather because your present is not.

The more time you spend reminiscing, the worse your current life becomes, neglected by daydreaming of the past instead of imagining new heights to which you can aspire.

Get Rid of Unneeded Memorabilia

Sometimes a memento is a special memory of a special time, and sometimes it’s just an object that’s imprisoning you in your past. Getting rid of an excess of items associated with the past will help you stop living in days gone by, and free you to live in and enjoy the present.

Fully Appreciate Each Day

As Eleanor Roosevelt once said, “The purpose of life is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experience.” One way to stop living in the past is to enjoy and appreciate each day. Start keeping a journal and jot down three things you’re grateful for each day. Take a walk, or cook a special meal. Enjoy the sights, sounds and smells of every day.

Make Future Plans

Nothing can keep you from looking to the past quite like looking to the future. Plan a vacation or create a goal you want to reach in the near and distant future. Maybe you want to learn a new language, start playing the piano, or read all the classic novels. There’s a lot of life waiting to be lived, so make the most of it.

While there’s certainly nothing wrong with a moment of nostalgia, it’s important to live in the present, and spend your time enjoying your life as you live it. If you make the effort to create a better life for yourself today and in the future, you’ll not only bring yourself great happiness and satisfaction, but you’ll create many more memories to relish in the days to come.

If you’re struggling and looking for support and guidance to create a better, more satisfying life, a licensed professional can help. Call our office today and let’s schedule a time to talk.

What Is a Mood Tracker?

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by | Feb 20, 2026 | , , ,

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Q & A with TMS NW: Everything You’ve Wanted to Know about Transcranial Magnetic Stimulation (TMS)

Q & A with TMS NW: Everything You’ve Wanted to Know about Transcranial Magnetic Stimulation (TMS)

by | Depression, Obsession

Have you tried (and tried) medication management for your depression or OCD but never received full results? We invited Piper Buersmeyer, Julia Swofford, and Brendan Roe from TMS NW to provide this Q & A about Transcranial Magnetic Stimulation (TMS), a non-medication alternative for treating chronic depression and OCD. After reading the article, if you’d like more information about TMS, we encourage you to reach out to TMS NW, local in Vancouver, WA.

 

What is TMS?

TMS stands for Transcranial Magnetic Stimulation. Brainsway’s Deep TMS is a non-invasive treatment that uses an MRI strength magnet to either stimulate the part of the brain that causes depression or calm down the area of the brain that causes OCD.  TMS is a safe and evidence-based outpatient procedure that encourages rewiring and improved firing of neurons.

 

Who is eligible?

TMS is indicated by the FDA for the treatment of depressive episodes in adult patients suffering from Major Depressive Disorder who have failed to achieve satisfactory improvement from previous therapy and medication treatment. It is newly FDA cleared in 2018 for the treatment of obsessive compulsive disorder that has been resistant to treatment with therapy and medication.

TMS should NOT be used if you have metal implants in or around your head (except for standard amalgam dental fillings). These include but are not limited to a cochlear implant, implanted cardioverter defibrillator (ICD), pacemaker, deep brain stimulator, vagus nerve stimulator, or metal aneurysm clips or coils, staples, or stents. TMS should not be used in patients with an active seizure disorder.

 

How does TMS work?

In each TMS therapy session, the patient is comfortably seated in a chair and a custom cloth cap is placed onto the head followed by a cushioned helmet. The helmet houses a coil that generates brief magnetic pulses, at a similar amplitude to that used in magnetic resonance imaging (MRI) systems. The rapid magnetic pulse that runs through the coil wire produces an electric field that passes unimpeded through the brain.

During the TMS session, patients hear a tapping sound and feel a tapping sensation in the head area. The patient wears earplugs during treatment. Patients can drive to and from sessions and can immediately resume their daily routines.

 

How frequent are sessions?

TMS requires daily sessions Monday through Friday over 6-9 weeks. Treatment sessions build on one another, so it is best to follow the recommended treatment course. Some clients also benefit from maintenance or repeated treatment.

 

What are the most common side effects?

The most common side effect is temporary, mild pain or discomfort at the area of the treatment site and occurs only during the TMS session. This typically happens only during the first week of TMS  treatment. Other side effects may include muscle twitching, headache and jaw pain, and also typically resolve after the first few days.

 

How does TMS compare to ECT?

TMS and ECT are very different from one another. Brainsway Deep TMS therapy does not require hospitalization or anesthesia, and does not entail risks for memory loss, systemic side effects or an indefinite drug regimen. In contrast to electroconvulsive therapy, TMS does not induce convulsions/seizures. Seizure risk is very low with TMS.

 

How is deep TMS different than traditional TMS?

Deep TMS offers effective results in almost half the time of other treatments (19 minutes per session compared to 37 with traditional TMS). Deep TMS penetrates more deeply and broad than traditional TMS and therefore is more robust and effective.

 

Is TMS effective?

Yes. Brainsway Deep TMS therapy has been tested in over 60 clinical trials. An extensive multi-center study for treating treatment-resistant depression, with Brainsway Deep TMS, enrolling 230 patients, Brainsway Deep TMS therapy significantly reduced depressive symptoms and generated improvement. Following this study, the FDA approved Brainsway Deep TMS therapy for major depressive disorder in patients who did not benefit from any number of previous medication treatments. Approximately one out of three patients treated with TMS therapy experience complete remission of symptoms at the end of six weeks. It is important to note that some clients may experience a partial response during the initial 36 treatments followed by a robust response in the weeks following the completion of treatment.

 

What else is TMS approved for?

In the U.S. FDA approved indications include depression and OCD. TMS is considered investigational as a treatment for all other indications, including but not limited to: smoking cessation, PTSD, bipolar disorder, schizophrenia, bulimia nervosa, migraines, fibromyalgia, panic disorder, Parkinson’s disease, alcohol dependence, chronic pain, Alzheimer’s, ADHD and Autism.

 

Will I be able to stop medication?

It is possible to achieve and sustain remission from depression following TMS treatment. This can mean medication doses can be lowered or tapered off completely.  This all depends on the client’s needs. Clients are stabilized on their regimen prior to treatment medications are continued during the treatment.

 

Will my health insurance cover TMS treatment?

Health insurance companies cover TMS for patients who meet that insurance’s specific requirements. Most insurances require a diagnosis of either depression or OCD, failure of at 3-5 antidepressants, sometimes from multiple families of medications, and a history of at least six weeks of outpatient psychotherapy. If you typically have a co-pay for office visits, you will also have this for each TMS treatment. Your insurance will not cover your copay, and payment of copays is due at time of service. If TMS NW is out of network for your insurance, you may be able to contact your insurance and ask for a single case agreement.  Otherwise, it will be considered out of network and coverage from your insurance is likely minimal to no coverage at all.

Insurance TMS NW Accepts

  • Aetna
  • Blue Cross Blue Shield
  • Bridgespan
  • First Choice
  • LIfewise
  • MODA
  • Pacific Source/Reliant
  • Premera BCBS
  • Regence BCBS
  • Molina

TMS NW is not affiliated with Star Meadow Counseling. To contact TMS NW directly, you can call them at 360-719-2449 or view their website: https://tms-nw.com/.