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/

How To Stop Beating Yourself Up

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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

“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.

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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)

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/

How to Ruminate Purposefully

How to Ruminate Purposefully

Do your thoughts ever end up stuck in the past, replaying a conversation or event in your head?

Susan Nolen-Hoeksema from Yale University describes ruminating as “a mode of responding to distress that involves repetitively and passively focusing on symptoms of distress and on the possible causes and consequences of these symptoms.”

You’ll know you are ruminating when:

  • You replay the same old memory over and over, like watching a video on a loop
  • You examine the memory in detail, play-by-play
  • You think (and re-think) about what you could have said or done differently to cause a different result
  • You try to remember exactly how another person reacted in order to evaluate yourself

Most people do not enter into ruminating thoughts on purpose. Instead, ruminating tends to be an automatic response and force of habit. You might even ruminate without realizing it consciously until you start feeling slightly (or a lot) embarrassed, anxious, disappointed in yourself, or guilty. Because the thoughts operate on auto-pilot, they are often unproductive. The thoughts can leave you with hyper-judgmental inner thoughts that have gone nowhere to propel you forward.

Have you ever paused to wonder: WHY ARE THESE THOUGHTS HAPPENING TO ME? WHAT’S THE POINT?

In her book, “The Language of Emotions,” Karla McClaren suggests ruminating might not only be replaying the past, but is in fact is the brain looking for NEW information. This new information might be of help to you in future, similar circumstances.

What if ruminating thoughts bring with them a powerful GIFT? What if you could channel their efforts into something that DOES help and DOES move you forward?

Here are some tips for ruminating more effectively and purposefully:

  1. Notice when you are ruminating and name it: “I’m ruminating.” This will help you shift into on-purpose self-reflection and away from a spiral into automatic negative thinking.
  2. Reflect back looking for learning points. What would I have done or said differently if I had a do-over? What did I miss that I’d want to watch for in the future?
  3. Avoid judging yourself. Labeling yourself harshly (Example: “failure”) serves no practical purpose and only causes you harm. In fact, rumination that is laden with negativity about yourself amplifies your experience of depression or anxiety.
  4. Be kind to yourself and intentional about practicing self-compassion. That means assuming the best about why you did or said what you did in those moments. In that moment, you probably did the best with what you knew. If practicing self-compassion is difficult for you, a counselor may be able to help.
  5. Some events we ruminate on were not in our control. Don’t take ownership of stuff that’s not yours, especially if it’s related to an experience of abuse.
  6. Know when to stop. The moment you realize that reflecting back is not helpful (HINT: You’re finding no further learning points), call it quits. There are a number of different strategies you can take to help you let go of unhelpful intrusive thoughts. Try out a cognitive defusion technique, prayer, or confirm to yourself out-loud: “These are just thoughts. They’re not helping anymore. I’m letting them go.” Some intrusive thoughts are harder to shake than others, especially if they’ve been around for a long time or if there’s trauma involved. Be patient with yourself and don’t be afraid to ask a counselor for help.

 

If you’d like assistance shifting out of a destructive pattern of rumination, a therapist at Star Meadow Counseling might be able to help. We love to see clients shift ruminations into something more constructive, useful, healing, and less self-critical.

THOUGHT DEFUSION: An Alternative Approach to Handling Intrusive Negative Thoughts

THOUGHT DEFUSION: An Alternative Approach to Handling Intrusive Negative Thoughts

Automatic negative thoughts are a natural part of the human experience. For the most part, we don’t conjure them up or think them on purpose. They happen instinctively.

 Negative thoughts get directed toward ourselves (“I can’t believe I’m running late again today! I’m going to get fired!”), toward others (“There’s Jim, walking in late; he’s so lazy.”), and toward our environment (“Stupid Portland traffic! It’s making me late!”). Sometimes negative thoughts are so pervasive that they can tank your mood for the day, or leave you stuck in a spiral of worries. These natural, instinctive thoughts can take on a life of their own!

In the book, “The Happiness Trap,” Steven C. Hayes describes what happens when we become “fused” with our negative thoughts:

  • Thoughts are reality: as if the awful thing we are imagining is actually happening
  • Thoughts are the truth: we completely buy-in
  • Thoughts are important: we treat them seriously and urgently, giving them our full attention
  • Thoughts are orders: we must obey them
  • Thoughts are wise: we assume they know best and we follow their advice
  • Thoughts are threats: we let them bother us or terrify us

He suggests that some “fused” thoughts may be helpful and others might not be as helpful. Those thoughts that ARE helpful and constructive are worth giving your time and emotional energy. For example, the thought that says “I can’t believe I’m running late again today” might prompt you to examine your morning routine, adjusting it to allow for more margin.

On the other hand, some thoughts are downright self-defeating and serve no useful purpose but to shame you, worry you, or leave you feeling stuck. It’s up to you to determine which thoughts are, in fact, not helpful. Those will be the thoughts you might be ready to “defuse” or disconnect from.

Here are some creative strategies for creating distance for those pesky negative thoughts that you need some space from:

  • Label your thoughts as thoughts (Example: “I’m having a thought that I’m worthless” feels different than “I’m worthless”).
  • Imagine your thoughts like clouds in the sky, just passing by. They can come and go as fast or slow as they please, simply watch and observe them without judgment. Become a fly on the wall observing thoughts, labeling them (“there’s a thought”), and letting them go on their way. Some thoughts are recurring visitors, appearing over and over. That’s okay! You can simply notice them and watch them pass on by.
  • Try out one of your particularly “fused” negative thoughts using the voice of a movie or cartoon character (how does it feel differently to say the negative thought using the voice of Micky Mouse or the voice of Al Pacino from The Godfather?).
  • Try singing the thought to the tune of “Happy Birthday” or “Jingle Bells.” Does it still feel the same?
  • Don’t only observe your thoughts, but also try shifting your focus to observing your body. Notice your breath–See if you can track your breath from the moment it enters your nose (cool and refreshing) to the moment it exits your mouth (warm and rushing). Notice how your feet feel in your shoes, where you feel tension, and where you feel at ease.

If you’d like to learn more about thought defusion, “The Happiness Trap” is an excellent resource guide. Thought defusion skills are an integrated part of Acceptance and Commitment Therapy (ACT). Cognitive-Behavioral Therapy (CBT) is another therapeutic approach that has been specifically designed for helping shift unhelpful, negative thought patterns in a more direct manner. A professional counselor can guide you in customizing coping skills so that you can shift out of negative thought ruts and feel free from their persistent haunting.