The Mindfulness Workbook for OCD: Just Right OCD

I was glad to see a chapter on this form of obsession of doing things "just right, " also known as symmetry OCD, organizational OCD, and perfectionism OCD.  The authors get the fact that the opposite of "just right" feeling is "feeling dead wrong," which has emotional intensity.

The one compulsion that resonated the most with me was:

• Checking to see see if things appear as you feel they should(for example, reviewing the placement of two pillows on a bed to make sure they are in the perfect position.)

When my health anxiety would be active, I would check whatever symptom I had against the opposite side of the body.  This summer I had a feeling of a something stuck in my throat, and my urge was to keep checking to see if my tonsils were parallel, and then feeling ashamed that I looked in the mirror, and berating myself for my vigilance.  

An Acceptance tool for Just Right OCD is allowing the "off" feeling to be there, noticing the body sensations, and carrying it with you "on your way to doing something greater than your compulsive fixing."  

An Assessment tool for Just Right OCD is dealing with all or nothing thinking.  When I used to sew for Home Ec class, I would become so fixated on any small asymmetry of top stitching, and therefore the whole garment was "ruined," even though other people would have a different frame of reference, and not even notice the stitches, but rather overall shape of the garment.  Ironically, I won an award for excellence in Home Economics in 9th grade, even as I was convinced any flaw meant I was incompetent.

Taking Action for Just Right OCD includes recognizing that focusing on perfection can mean a tiny trigger can feel as disturbing as something more obviously huge, so setting up a hierarchy of exposures can seem impossible.  

It's important to get in there and take any opportunity to let things feel "off" rather than trying to fix it.   Trying to decide if I had a hierarchy of exposures "just right" could take up all my time and it helped that my ERP therapist understood this and encouraged me to practice tolerating the thought that I might do my exposures wrong.  

Summary of Part 1 of The Mindfulness Workbook for OCD by Jon Hershfield and Tom Corboy.

New Harbinger Publications offered to send a review copy of The Mindfulness Workbook for OCD by Jon Hershfield and Tom Corboy(2013).  Since I was in the middle of taking a mindfulness class, it was interesting to read this book with specific connections to OCD.

I am familiar with the writing of Jon Hershfield, as he was the moderator of the online support group PureO for many years, and he had a way of describing obsessive thoughts and ways to face them that was very helpful.

Part 1 covers definition of mindfulness and cognitive behavioral therapy(CBT) terms.

The authors define mindfulness as, "the state of acknowledging and accepting whatever is happening in the present moment exactly as it is(p. 8)."  In my experience, when I have an anxious thought or sensation, I race way ahead of the present moment in trying to figure out what it is or what it means.

The authors argue that, "The problem of OCD isn't that you think too much.  It's that you confuse the intensity, volume or visibility of your thoughts with their importance(p. 12)."  Practicing hanging in there with the intensity or stickiness of the thoughts can allow your mindful self to choose what you want to do with your life, rather than listening to the loudest voice.

The book provides a cognitive behavioral therapy background on distortions of thinking that you can identify in your own thoughts, not as a way to "solve" or "figure out" the thoughts, but to practice seeing them as thoughts.  One of the things that really helped me when I was in therapy for OCD was writing down my thoughts as they happened, as if it were a transcript, but then labeling the distortions in the margin, so I got better at identifying what my mind was up to.

One such distortion is Catastrophizing/Predicting/Jumping to Conclusions.  Accepting I can't predict the future is a bedrock of mindfulness.   As scary as the uncertainty can be, the racing ahead brings forth even more fear.

The book does an overview of Exposure and Response Prevention therapy, and the use of Imaginal Exposure Scripts, another component that helped me in therapy.

Part 2 of the book addresses mindfulness and CBT for specific obsessions with a 3 step process.

1. Acceptance of the presence of OCD thoughts and feelings.  You are accepting that the thoughts are there, not any meaning that you attribute to those thoughts.
2. Assessment using CBT to assess the value of the OCD thoughts, as a nonpartial observer, labeling possible distortions, and returning to the present.
3. Action using behavioral skills to expose yourself to OCD thoughts in order to habituate to them and overcome your fears.

I suspect many readers will turn immediately to Part 2 in hopes of clues to particular obsessions, as the authors say, "The reason we separate obsessions into categories is that for every obsessive-compulsive cycle, there's a way to break it.  There's a way in, and knowing the way in is important  When you understand the mechanics of an obsession can identify the compulsions that hold it in place, you can begin the process of letting both of them go(p. 84)."

I will discuss some of these chapters in future posts, as well as some thoughts on the book as a whole.  

Making Room for Your Life: TEDx Lincoln Talk with Khara Plicanic

I came across Kara Plicanic on Instagram.  She is a wedding photographer with a creative eye, and I was intrigued that she had done a TEDx talk called Anything is Possible ~ and That's the Problem.  Or is it? about her experience with OCD.

She recommends reading Jeff Bell, and I concur that he is an eloquent writer and speaker about facing OCD and making a life.

It helps to find kindred spirits who are artists as I am, and who have made room for their creative spirit amidst the crowding of OCD thoughts.

Dealing with Health OCD as a Teenager

I received a poem written by a 16 year old girl who suffers from OCD, and she gave me permission to write about it on my blog.  I feel kinship with her, since I was in the midst of health anxiety OCD at her age.  I didn't have the internet to look up symptoms, but I went to bookstores and libraries and read medical reference books.  I am including a few excerpts from Eliza's poem: 

OCD

In a crowd, it seems impossible to feel so alone . . .

I tell my friend I have a sharp headache,

And I wonder if she knows that the second class lets out

I will immediately look up symptoms

And pick the worst disease

And that I will convince myself that I have

A brain tumor

***

It’s this stupid disease,

That makes me obsess over a single worry,

It’s this stupid disease,

That makes me think I have a million others,

It’s this stupid disease,

That makes me hate myself

But I continue, and no matter how hard it can be

I get through it

And because the worry and fear overcomes me,

It just makes it all the more welcoming

When happiness

Knocks the wind out of me

Health Anxiety OCD is indeed the "stupid disease/that makes me think I have a million others."  I hated myself at 16, hated how quickly and intensely I would worry about pains and spots on my skin and symptoms of any kind.  I believed this was a defect in myself, that I couldn't control the worry.  

I had moments "When happiness/knocks the wind out of me" and these gave me a glimpse of hope that I could feel something besides fear.  

I had never heard the phrase "Obsessive Compulsive Disorder" or the acronym "OCD."  I knew I had anxiety, but that was it.  When I was 19 or 20, my mother was taking classes to become a counselor, and I picked up her DSM, a manual of diagnoses for mental illness.  I don't remember seeing "OCD" but "Generalized Anxiety Disorder" jumped out at me for describing much of what I experienced.  It was a relief that someone could describe this fear.  

The missing component was treatment, and it took about 15 more years until I was diagnosed with OCD and found an Exposure and Response Prevention Therapist.  There was a strong part of me that hung on, in spite of the fear, and I honor that part of myself and that of Eliza.  You are stronger than you know.

Avoidance is not Benign in OCD or for the Body

I did an exposure by calling a physical therapist about my shoulder pain.  Part of my health anxiety assuming I must know what is wrong with me, choose the right kind of therapy, and "know before knowing."  The PT said I have a frozen shoulder, which in part arises from avoiding moving a shoulder that is painful, and the more you avoid, the more stuck it gets.

What a metaphor for mindfulness, facing fears, doing exposure therapy for OCD!

Avoidance can bring on the very thing we fear:  anxiety, pain, suffering.

Of course, frozen shoulder is somewhat of a mystery, as to how it arises in the first place. Uncertainty stirs my OCD.

But I am proud of myself for choosing to do something, one step at a time, rather than continuing to wait until the "perfect " time to call and the perfect kind of professional(family doc, physiatrist, physical therapist, massage therapist, chiropractor).

What do you avoid?  What step can you take toward it?

One Word for the Year in Dealing with my OCD: Practice

I assume I suck at practice.  Actually, I have amazing practice skills ~ practicing old rituals and patterns. I am going to a Mindfulness Meditation group, using the book Mindfulness: A Practical Guide to Finding Peace in a Frantic World by Mark Williams and Danny Penman.  The defining word is "practice."  Practicing being present.  Practicing being with my body sensations and all the attendant thoughts.

It's been a hard few months, with medical tests and uncertainty, with one problem receding and another advancing, and all the old health anxiety stuff surging up.  I knew I needed to do something to help take care of myself.

Check out the free mindfulness meditations on the Mindfulness site.

What would be your one word for the year, in dealing with your OCD?  A word that inspires you to make progress.