Category Archives: OCD (Obsessive-compulsive disorder)

The Therapeutic Alliance: The Essential Ingredient for Psychotherapy

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umbrellas

 I am currently writing on the ‘therapeutic alliance’ – its relation to mindfulness, psychotherapy, understanding, and ‘being listened to…’   What follows is an interesting article that I came across that may interest some of you…

Excerpt:

Have you ever tried to change the way you do something? It could be anything — the way you hold your tennis racket, blow into a flute, meditate — you name it. If so, think about that experience. No matter how motivated you were to change, and no matter how much you knew that it would help your serve, musicality, or sense of inner peace, it can be difficult and scary to change even the smallest thing. In order to change, you have to give up your old way of doing something first and then try the new way. That means that for a while you’re in a free fall — you no longer have your old habit to rely on and you don’t yet have the new one.

The anxiety of trying to change something as complex and entrenched as how you relate to people close to you or manage stress takes the feeling to a whole new level. Yet, that’s just what you do when you enter psychotherapy. Just as you had to put yourself into the hand of your teachers and coaches, in therapy you need to gradually do just that with your therapist to help you through what can be a harrowing adventure. The foundation for therapy is called the therapeutic alliance (1, 2). When it’s there, you know that your therapist is there to help you, no matter how hard the going gets.

The therapeutic alliance might be the most important part of beginning a psychotherapy. In fact, many studies indicate that the therapeutic alliance is the best predictor of treatment outcome (3-5).

See entire article:

http://www.huffingtonpost.com/deborah-l-cabaniss-md/therapeutic-alliance_b_1554007.html

 

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A mad world A diagnosis of mental illness is more common than ever – did psychiatrists create the problem, or just recognise it?

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Unfortunate Events

When a psychiatrist meets people at a party and reveals what he or she does for a living, two responses are typical. People either say, ‘I’d better be careful what I say around you,’ and then clam up, or they say, ‘I could talk to you for hours,’ and then launch into a litany of complaints and diagnostic questions, usually about one or another family member, in-law, co-worker, or other acquaintance. It seems that people are quick to acknowledge the ubiquity of those who might benefit from a psychiatrist’s attention, while expressing a deep reluctance ever to seek it out themselves…

…While a continuous view of mental illness probably reflects underlying reality, it inevitably results in grey areas where ‘caseness’ (whether someone does or does not have a mental disorder) must be decided based on judgment calls made by experienced clinicians. In psychiatry, those calls usually depend on whether a patient’s complaints are associated with significant distress or impaired functioning. Unlike medical disorders where morbidity is often determined by physical limitations or the threat of impending death, the distress and disruption of social functioning associated with mental illness can be fairly subjective. Even those on the softer, less severe end of the mental illness spectrum can experience considerable suffering and impairment. For example, someone with mild depression might not be on the verge of suicide, but could really be struggling with work due to anxiety and poor concentration. Many people might experience sub-clinical conditions that fall short of the threshold for a mental disorder, but still might benefit from intervention.

See link for interesting article on psychiatry…and bits about the importance of psychotherapeutic intervention…

http://aeon.co/magazine/being-human/have-psychiatrists-lost-perspective-on-mental-illness/

How Buddhist Rituals Helped My OCD

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Our society likes to portray obsessive-compulsive disorder (OCD) as a cute quirk, a goofy, if irritating, eccentricity. It is not. For the person undergoing OCD experience, it is a form of mental terrorism.

This terrorism takes the form of what psychologists call ‘intrusive thoughts’ — unwanted, painful thoughts or images that invade one’s consciousness, triggering profound fear and anxiety. This is the ‘obsessive’ part of OCD, and it can arise in even the most mundane circumstances. Sitting here typing, for example, I sometimes feel modest pain in my fingers, and my mind kicks into gear: You’re typing too much and causing permanent damage to your hands. Feel those little irritations at the second knuckle of your left ring finger? Those are the harbingers of arthritis. This is how it starts.

read the rest of the article by Matt Bieber here at Aeon.

The dreadful, breathless and uncomfortable Mr. Anxiety

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Have you been afraid of the dark?

You’re Not The Only One

Anxiety disorders refer to a high prevalence group of problems, which include excessive levels of fear and anxiety. Anxiety is a normal reaction to stress, threat, or danger and often serves us well. It enables us to deal with threatening situations by triggering the fight/flight response so that we can take evasive action. However, it is when this response is persistent, excessive and interferes with our functioning in daily life that it is referred to as an anxiety disorder; at this point a psychologist or counselling service may be required.

  • Excessive Worry/Generalised Anxiety: This is characterized by excessive anxiety and worry lasting 6 months or more. It is accompanied by central nervous problems including bodily tension, restlessness, irritability, fatigue, poor concentration and sleep disturbance. Worries usually relate to education, work, finances, safety, social issues and often minor issues such as being on time.
  • Social Phobia/Social Anxiety: Persistent fear of situations in which we are exposed to possible scrutiny of others, such as public speaking engagements, social gatherings or communication with the opposite sex. This form of anxiety elicits fear of intenseElettroshockfinalsolution_by_LucaRossato_flickr panic in such situations and avoidance of or escape from social environments
  • Panic Attacks: This form of anxiety can manifest in sudden, intense and unprovoked feelings of terror and dread often culminating in heart palpitations, dizziness, shortness of breath and an out of control or very frightening feeling. When we suffer this disorder we generally discover strong fears about when we might experience the next panic attack and often avoid places we feel we might have a panic attack or where escape may be difficult such as movie theatres, shopping malls or social gatherings.
  • Obsessions and compulsions which are characterized by persistent, uncontrollable and unwanted feeling, thoughts or images (obsessions) and/or routines or repeated behaviors(compulsions) in which individuals engage to try and prevent or rid themselves of anxiety provoked by the obsessions. Common themes through compulsions may include repeated actions such as; washing hands or cleaning the house excessively for fear of germs or checking something over repeatedly for
    PTSD

    PTSD

    errors. When we are caught in the cycle if obsession and ritual our lives are constrained and our time otherwise used for living is consumed.

  • Post Traumatic Stress: Witnessing or experiencing a traumatic event including severe physical or emotional trauma such as a natural disaster, serious accident or crime may expose us to the risk of post traumatic stress. Post Traumatic Stress can be characterized by thoughts, feelings and behaviour patterns that can become seriously affected by reminders of events, recurring nightmares and/or flashbacks, avoidance of trauma related stimuli and chronically elevated bodily arousal. These reactions mat arise weeks even years after the event.

Anxiety treatment at Sydney Emotional Fitness also covers specific phobias, a related disorder to Panic. Specific Phobias involve marked, persistent and intense fears about certain objects or situations. Specific phobias may include things such as enclosed spaces, encountering certain animals or flying in airplanes. Exposure to the feared situation or object usually elicits a panic attack leading to a tendency to avoid the feared object.

For all information regarding Anxiety TreatmentPsychologist CounsellingAnger CounsellingGrief CounsellingAnger ManagementRelationship CounsellingStress Management and Depression Treatment in Sydney, or any of our services that may assist you in leading a more rewarding life please call us on 1300 790 550.

INTROVERTS…

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ImageThose that tend toward introversion – often confused with shy individuals – face a number of difficulties (or challenges) each day.  Many can circumvent the issues, sometimes more easily than other times.  The following article addresses some of the more important considerations, especially as psychiatric entities attempt to pathologize introversion, shyness…One can certainly be pleased that this topic is being talked about more openly now…in the news, in professional journals…

http://www.huffingtonpost.com/2013/08/20/introverts-signs-am-i-introverted_n_3721431.html

Obsession and Love

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I invite you to take a peek into the life of someone in the grip of a fairly devastating mental disorder, generally considered to be organic in nature (but…that’s not the whole story, as you’ll find out). This fellow has a degree of courage that I find fairly astounding. He’s clearly speaking in front of some kind of support group, which is wonderful, but he tells a personal story that unlike any I’ve heard before. Notice the sudden cessation of symptoms at one point in the story. Think about what that means, why that might be. Definitely thought-provoking.

The range of human variety is astounding. I would hug this fellow just for sharing, if I could. What I CAN do is invite you to listen to him. It doesn’t take long.

Note also – this is actually a poetic utterance, incredibly enough. Poetry, I will assert, is in us all, and sometimes it emerges at the most unexpected moments. It pays to be alert for them.

She was the most beautiful thing I ever got stuck on

The Most Honest And Heartbreaking Reason To Leave Your Front Door Unlocked I’ve Ever Heard

Inspiration: Movies about mental illnesses

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– submitted by Ruth Levine, MD, University of Texas Medical Branch, Galveston

Black Swan (2010), Darren Aranofsky

Brilliant psychological movie. Dissociation?

 

Anxiety and Anxiety Disorders Bipolar Disorder/Mania
Copycat (panic/agoraphobia) Mr. Jones
As good as it gets (OCD) Network
The touching tree (Childhood OCD) Seven Percent Solution
Fourth of July (PTSD) Captain Newman, MD
The Deer Hunter (PTSD) Sophieís Choice
Ordinary People (PTSD) Sheís So Lovely
Depression Psychosis
Ordinary People Shine
Faithful I Never Promised You a Rose Garden
The Seventh Veil Clean Shaven
The Shrike Through a Glass Darkly
Itís a Wonderful Life (Adjustment disorder) An Angel at my Table
The Wrong Man (Adjustment disorder) Personal
Dissociative Disorders Man Facing Southwest
The Three Faces of Eve Madness of King George (Psychosis due to Porphyria)
Sybil Conspiracy Theory
Delirium
The Singing Detective
Substance Abuse
The Long Weekend (etoh) The Days of Wine and Roses (etoh)
Barfly (etoh) Basketball Diaries (opiates)
Kids (hallucinogens, rave scenes, etc.) Loosing Isaiah (crack)
Reefer Madness Under the Volcano
Long Day’s Journey into Night Ironweed
The Man with the Golden Arm (heroin) A Hatful of Rain (heroin)
Synanon (drug treatment) The Boost (cocaine)
The 7 Percent Solution (cocaine induced mania) Iím Dancing as Fast as I can (substance induced organic mental disorder)
Eating Disorders
The Best Little Girl in the World (made for TV)-Anorexia Kateís Secret (made for TV)-Bulemia

Axis II Disorders

Personality Pathology
Cluster A Cluster B
Remains of the Day- Schizoid PD Borderline PD
Taxi Driver-Schizotypal PD Fatal Attraction
The Caine Mutiny- Paranoid PD Play Misty for Me
The Treasure of Sierra Madre -Paranoid PD Frances
After Hours
Cluster C Looking for Mr. Goodbar
Zelig-Avoidant PD
Sophieís Choice-Dependent PD Histrionic PD
The Odd Couple-OCPD Bullets over Broadway
Gone with the Wind
A Streetcare Named Desire
Antisocial PD
A Clockwork Orange
Narcissism Obsession
All that Jazz Taxi Driver
Stardust Memories Single White Female
Zelig The King of Comedy
Jerry Maguire Triumph of Will
Alfie
Shampoo Mental Retardation
American Gigolo Charly
Citizen Kane Best Boy
Lawrence of Arabia Bill
Patton Bill, On His Own

Miscellaneous Issues

Family Early Adult Issues
Ordinary People Awakenings
The Field The Graduate
Kramer vs Kramer Spanking the Monkey
Diary of a Mad Housewife
Betrayal Latency and Adolescent Issues
Whoís Afraid of Virginia Woolfe Stand by Me
The Stone Boy Smooth Talk
The Great Santini
Doctor/Patient Relationship Boundary Violations
The Doctor The Prince of Tides
Mr. Jones
Idealized “Dr. Marvelous” Psychotherapy
Spellbound Suddenly Last Summer
The Snake Pit Captain Newman, MD
The Three Faces of Eve Ordinary People
Good Will Hunting

Steve Hyler directs an APA course on this topic, and
would be a good person to check with.
For more details, you can call me (409) 747-1351. Hope to see you in Maine!

Ruth Levine
University of Texas Medical Branch


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Taming Obsessive Thoughts

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Taming Obsessive Thoughts

 

Obsessive thinking can be tamed using cognitive-behavioral techniques.
Published on June 28, 2010 by Robert London, MD in Two-Minute Shrink

Have you ever gotten a thought stuck in your brain, akin to an awful pop tune from the eighties that just keeps replaying in your mind and won’t go away? A person I’ll call Rachel came to me to help her with a horrifying obsessive thought that was starting to affect her daily functioning. In it, she was being destroyed by a plague of locusts, much like the one that had attacked Egypt in biblical times.

cycleA successful physics professor at a West Coast university, Rachel needed professional help for this recurring, obsessive thought, which had become so vivid over the years that living with it had become almost unbearable. She tried five years of psychotherapy, and then switched to a psychiatrist, who recommended medications that were ineffective and caused unpleasant side effects. Finally, the patient tried a “geographic cure”– a sabbatical to New York. But Rachel continued to experience the terrifying obsessive thoughts. At that point, she was referred to me.

As always, I took a thorough history. I then explained the type of treatment I had in mind. The time frame was to be three or four sessions lasting 90 minutes each. I planned to apply two cognitive techniques and one behavior modification strategy to treat the patient’s obsessive thoughts.

First, we discussed the P&P (possibility and probability) concept. There was certainly a possibility that the locusts could attack her (this generated some humor), but the probability of this happening was significantly slim. As a physicist, she easily related to that concept. That discussion lasted about 30 minutes.

Next, we discussed Newton’s third law of motion: For every action, there is an equal and opposite reaction. When translated into her treatment strategy, this became “for every thought, there is an equal and opposite thought.”

She easily accepted that theory, and it helped to relieve the anxiety of her obsessive thoughts. Taken further, that concept evolved into thinking that for every thought there is a lesser thought — and possibly even no thought. The no-thought concept helps the patient get long-term relief from the obsessive thought.

Finally, we applied the practice of thought stopping. Thought stopping is a method in which the patient induces the thought that is so distressful and is then taught how to stop it. We used guided imagery to induce the terrifying thought of the locust attack.

Here’s how it worked: I asked Rachel to imagine a large movie screen, onto which I invited her to project the scene she had so often envisioned. As she progressed into this stressful imagery, I made a loud noise by hitting my desk with a ruler and simultaneously shouting “Stop!” In that procedure, the image she was thinking or projecting was automatically interrupted, blocked, and stopped. We practiced several times. After six trials, I stopped using the ruler and just shouted “Stop!” It worked. As we proceeded through this technique, Rachel began to take over the entire strategy and began to shout the word “Stop” to control the obsessive thought.

Moving along, we reached a point at which she was able to subvocalize the word “stop” and get the same result as if an outside force had interrupted, blocked, and stopped the thought.

Rachel’s treatment was completed in three 90-minute visits. She was quite pleased that she had gained control over her obsessive thoughts. To reinforce our work together, we audio taped the sessions so she could review them whenever the obsessive thinking began to recur. Having learned how to use the movie-screen approach to project an obsessive thought, Rachel now had a tool she could use on her own. I explained that she could also change images from the obsessive thought to a pleasant scene to help reduce the anxiety that the thought produced.

When Rachel returned to her university, she resumed her thriving and demanding academic career free of that terrifying obsessive thought.

Behavioral treatments like these are hard work, for both the therapist and the patient. Often, we need to structure the treatment to the patient’s thinking, career, and lifestyle, as I did in this case by using the laws of physics for the physics professor. In this, as in so many cases, I am continually amazed at how resilient and changeable the human mind is when people really want to heal, and customized cognitive and behavioral approaches have proven time and again to provide a quick and effective solution.

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This blog aims to present psychiatric/psychological information to a general readership, offering insights into a variety of emotional disorders, as well as social issues that affect our emotional well-being. It includes the ideas and opinions of Dr. London and other leading experts. This blog does not provide psychotherapy or personal advice, which should only be done by a mental health care professional during a personal evaluation.

ocd-

From “glee”
“Emma” has OCD