OCD A to Z: K is For Kabat-Zinn and Mindfulness

I had a hard time thinking of a K word, but then Jon Kabat-Zinn popped into my mind. I first came across Full Catastrophe Living about 10 years ago, and what stayed with me was the idea that mindfulness was about focusing on the breath, and if your mind wanders, that is normal, and bringing it back to the breath is all you need to do, even if it only stays a split second. I appreciated the rock-bottom simplicity of this, even in the midst of a very exhausting state of OCD mind.

A few years ago, I also read The Mindful Way Through Depression which comes with a CD of mindfulness exercises, and I listened to them daily for almost a year. For much of my life, depression was intertwined with my OCD, and there are many clinicians researching mindfulness as part of the treatment of OCD in addition to depression. The theory is that the more we fight with our obsessive thoughts, the more entrenched they become, and mindfulness can be an adjunct to Exposure Therapy, a way to practice letting thoughts be there and lessening their charge.

As my therapist pointed out many times, when in the midst of OCD compulsions, I am not in the present moment. I am either in the past, worrying about something that happened, or in the future anticipating "what ifs." He believes the only functional moment is the present one. This is where we make our good decisions, respond to what's actually happening, are most alive. At first I doubted this, because I associated the "present moment" as the one where I was suffering, and compulsing. But slowly I have come to see that in that suffering I am digging into the past or racing into the future. This doesn't mean that the present moment is magical, always calm and peaceful, but it gives a better chance of getting better from OCD. My old rituals don't get me any closer to long term peace.

[Revisiting OCD A to Z from 2011]

Making a Decision to Share Hope: Janet Singer of ocdtalk and her book Overcoming OCD: A Journey to Recovery

I was updating my blogroll and discovered ocdtalk's book, Overcoming OCD: A Journey to Recovery, a chronicle of finding treatment for her son Dan's OCD, and being an advocate for OCD Awareness.

She mentions her book and her blog as two decisions she agonized over in her post OCD and Making Important Decisions.

Two of the most important decisions I’ve made over the past decade are starting this blog and writing my book. I truly agonized over both of them. Who am I to write about obsessive-compulsive disorder? I don’t even have the disorder! What could I contribute that would possibly be of any value? I’m no expert. All I have are my own thoughts and experiences to share. People will laugh, or even worse, criticize me. They’ll get angry. Of course, I could go on and on. I had no shortage of reasons why I shouldn’t write about my family’s experiences with OCD.

But even with all my  misgivings, I took the plunge. I had to. I owed it to myself and my son to try to find some meaning in his suffering from severe OCD. The results have gone way beyond my wildest dreams and in retrospect, my concerns about my “credentials” almost seem ludicrous. Being an expert is not what it’s about. My main goal, from the very beginning, has been to share our story so that others will find hope, and to spread the word that OCD, no matter how severe, is treatable.

She goes on to describe doubt being the cornerstone of OCD, and this describes much of my experience. Choosing to get treatment was very difficult for me because making any choice was enveloped in a cloud of doubts and compulsive researching. Calling for an appointment with an ERP therapist in 2006 took months of rehearsing what to say, and wondering if I was making a mistake, and of course, making phone calls is one of my most dreaded things anyway.

I do not regret making the decision to call, and the decision to persevere in treatment. Writing this blog was an exposure for me as well, and like Janet, I had doubts. Having OCD didn't make me feel "qualified" to write a blog, because I believed I had to write perfectly and with absolute certainty. Every post I published was a victory for my life over my OCD. Readers found me, and it was a relief to not be alone, and satisfying to be of help by sharing my story.

Though Your Hands May Tremble: Dr. Claire Weekes and Peace from Nervous Suffering

Discovering the Anxiety Coaches Podcast led me to rediscovering Dr. Claire Weekes(1903-1990), the pioneering Australian physician who wrote about how to float through anxiety in the 1960's. When I was in the depths of anxiety, I found a book by Claire Weekes at the library.

I recognized a kindred spirit right away.  She had suffered with anxiety(or as she puts it "nervous illness"), and knew how disruptive and painful it can be.  Dr. Weekes is clear that we are not alone in suffering anxiety, and we are not fundamentally broken or flawed.

Listen to her voice in the video below.  Though it reminded me of old movies in tone, it did not subtract to her thorough understanding of the panic cycle which feeds on "what if."


Claire Weekes Biography

Two Pieces of Peace from Nervous Suffering by Summer Beretsky

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.  

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.

Fear of Thoughts Getting Stuck: The Challenge of Reading OCD Self-Help Books

I had several responses to my review of J.J. Keeler's I Hardly Ever Wash My Hands: The Other Side of OCD, expressing fears that reading the book would give them ideas or cause anxiety.  I've been mulling this over, because it's a challenge to respond.

The simplest answer is that I don't know if J.J. Keeler's account of her OCD, and the specific things she worries about, will "stick" in your mind or create new OCD obsessions.

This is the nature of OCD that one person's trigger can seem completely harmless to someone else with a different form OCD; it's not only those without OCD who think that a particular obsession is incomprehensible.  There is a tendency to assume that other people's obsessions are easier to bear.  Conversely, if we suspect that a person's obsessions might be similar to ours, then there can be a desire to quarantine them, and not get anywhere near, as if the fears were contagious.  Or we are afraid of adding a whole new category of obsessing, and again, stay away.

This is OCD's mode of operation, to convince you that you can avoid the contagion of life, if you just screen out all things that might set you off, and enlist those around you to help in this task.   I know this from the inside.  Public health campaigns to raise awareness about various illnesses seemed designed by very cruel folks to torment me.  I was already highly aware of things that could go wrong, and I didn't want to know of any additional ways to monitor and worry about.  When I was a kid there was no internet but there were posters on the bus, public service ads on tv, special episodes of programs where someone had a disease, and magazine articles.  Women's magazines were the worst, and my mood would plummet if I was in a waiting room, reading one(which I picked up because I was anxious to be in the waiting room to begin with).

In college I was doing fairly well for awhile, avoiding obsessing about moles, until a classmate opened up his datebook, and I could see he'd written in an appointment for a mole removal.  I couldn't have predicted this.  Now, it might seem that you could at least keep yourself safe by avoiding what seems obvious, like Keeler's book or other OCD self-help books, or my blog, or the OCD Yahoo Group, or OCD support groups, but what is your definition of safe?  Avoiding all possibilities of help is not safety.  OCD would have you believe that it is possible to maintain complete quarantine, but triggers are part of life.

The irony is that when I was in an anxiety spike, I would then search out articles about whatever symptom was catching my attention, in order to reassure myself that I didn't have something serious.  There would be an initial calming effect if my symptoms didn't match, but then as I'd keep reading, I'd find something that again put doubt into my mind, or introduced an even more scary possibility.

I am not minimizing the abject fear of being seized by an OCD obsession.  I've been there.
But getting help for OCD is where the true hope of living beyond your obsessions resides.  OCD wants to maintain the status quo.  Don't get help.  Don't learn about how other people have coped.  Don't risk new pain.  

If you can't read a self-help book or OCD memoir because it's too terrifying, then this is a signal to find an exposure therapist, or a self-help group, where other people can help you.  I understand the irony in this.  I was once incredibly shy and my therapist suggested group therapy, and I was appalled.  How could I go to a group for help if I was terrified of groups??  But eventually, I realized that I didn't want to go on the way I was going:  the cost of my fear was too much, I was missing my life.

Keeler, in the preface to her book, writes of having severe fears of harming someone while at Disneyland, and self-loathing for what kind of person she must be, when a toddler ran over and hugged her leg.

It felt like she was telling me I wasn't what I feared.

I have no idea who this toddler was and I never saw her again.

But she saved part of me that day.  

Hopefully, this book can save part of someone else. 

 

 

Intrusive Thoughts and Harming Fears: A Review of I Hardly Ever Wash my Hands: The Other Side of OCD by J.J. Keeler

TLC Book Tours contacted me about reviewing J.J. Keeler's I Hardly Ever Wash My Hands: The Other Side of OCD, and I was intrigued by the title because my OCD doesn't manifest in handwashing rituals, and this is the short-cut metaphor for OCD much of the time.  After reading the book, I felt like I'd found an OCD-Soul-Sister and although I am never glad that someone else has OCD, and I am glad when they can write about it in an articulate and insightful way.  

I had to laugh when J.J. Keeler describes how her twin sister had hypochondria with fear of many diseases(a type of OCD I am very familiar with), but the author had only "had" one disease: AIDS.  In the irony of OCD, in elementary school she is triggered into worrying about AIDS when her parents mention a blood transfusion she had, but what her OCD latches onto is the risk of "dirty needles" which in her young mind means thumbtacks, staples, pine needles, with dirt on them.  Humor is a major component of Keeler's account of OCD, grabbing the edge of ridiculousness about OCD fears and pulling the whole thing apart, so that the sufferer can catch a glimpse of OCD's game of generating endless scenarios and holding life hostage.  

The second chapter, The Bomb in my Teddy Bear, is a marvel of encapsulating the experience of morphing OCD thoughts.  When she was 8 years old, neighbor gives her a teddy bear at a yard sale, and a chain of fears links itself around her.  She started getting a weird feeling about the bear, and wondered why a relative stranger would give her a teddy bear for free.  Then it came to her, "The reason was obvious.  There was a bomb in the teddy bear."  Keeler agonized over how to dispose of the bear, without harming anyone else, and then when it didn't explode, wondered if the neighbor would come back to finish the job.  Her rituals to keep the anxiety from exploding were a constant stream of "figuring out" and "analyzing" combined with tin cans at the door to let her know if there was an intruder, and plotting how she could take the bear on one of her father's fishing trips and throw the bomb overboard.

Eventually, OCD moves onto other topics in Keeler's life, but the same corrosive fear and desperate maneuvers to make the fear go away.  In addition to fears about AIDS(and calling the testing center before her test was even received, to check, check, check), she feared causing harm to others after being deluged with intrusive thoughts.  If you suffer from this very painful form of OCD, please read this book.  Keeler has known the despair that made her consider suicide, because she didn't want to harm anyone and yet these images would pop into her head, and she has survived, and now thrives.  

The most difficult part of reviewing I Hardly Ever Wash My Hands: The Other Side of OCD, is that I want to quote everything, but it would be better for my readers to go find a copy of this book and read it for themselves.  

Read J.J.Keeler's Introduction to Harming Obsessions on her blog.  

Find J.J. Keeler on Twitter

Related Post:

Fear of Thoughts Getting Stuck: The Challenge of Self Help Books for OCD

http://tlcbooktours.com/

Interview with Andrea Kayne Kaufman, Author of Oxford Messed Up: Part 2

Part 2 of my interview with Andrea Kayne Kaufman, author of Oxford Messed Up.
Check out Part 1 Here.

ExpWoman:  The image of Henry inviting Gloria into the tub 
of cold water to illustrate how over time one can habituate 
to the chill, just as exposures can habituate 
you to OCD fears, is very powerful.  

The tub is central as image in this novel--
did the image come first, 
or evolve as you explored the characters?

Andrea:  So glad you asked about the tub. I remember when we were learning about exposure response prevention, the doctors described it as stepping into cold water. If you pull your foot out right away, you will never get used to it. You will never habituate.  But if you stay, it will gradually become bearable.  I also really liked the tub/water as a metaphor for rebirth and renewal. The tub is the place of Gloria and Henry's greatest suffering as individuals and a couple. It also becomes the place of their reckoning, their paradigm shifts, and ultimately their redemption. When the novel first came to me, i saw Gloria scrubbing a claw foot tub with bare hands. I also saw them striking their deal in the tub. And i saw them making love in the tub. Although when i actually wrote that scene i realized it would be very hard to have intercourse for the first time in the tub— thus, it was next to the tub on the loo floor.

ExpWoman:   
Henry's addiction has many parallels to Gloria's OCD.  
How does the addictions recovery model resonate
with exposure therapy for you?  
Have you, or do you know people, who have experienced either of these?

Andrea:  Very true.  In addition to having experience with ocd, there is also experience in my extended family with drug addiction and recovery.  When the ocd in our family got out of hand— total conflagration as the doctors said— it required more and more compulsions, reminding me of a drug addict spiraling out of control, needing more and more drugs to get high.  I also think recovery models closely resemble the cbt paradigm.  Also, one never is totally rid of ocd, it can remerge and tempt you at different points in your life just like addiction.

ExpWoman:  
Your theme of "choosing happiness" resonated with me.  
When I  stopped writing poetry, and started making art, 
I did feel guilty at first for doing something 
that made me happy, making art that expressed joy & hope.  
Is there a particular point in your life that

you "chose happiness" and if so, can you tell us a little about it.

Andrea:  This is a really important theme for me. The courage to write the novel and put it in the world was really me choosing happiness for myself. I am one of those "people pleasers' who's renounced my own needs in favor of other people's needs.  It took me a long time to learn that happiness was something you have to affirmatively choose and not just wait for other people to give you.  Moreover, it took me a long time to learn that i was worthy of happiness and love.  I also experienced some tragic losses as a child and it took me so long to stop defining myself by the cloak of tragedy— which felt familiar and comfortable. I was worried that people might not like me as much if i came out of the closet and they knew i was happy.

ExpWoman:  
I remember being surprised when Oliver is revealed
as Gloria's OCD"voice" rather than an actual boyfriend
in the first pages of the novel, and impressed 
with how this gave a sense of how integral OCD can become
to one's person.  How did Oliver come to you as a character?  
What were the challenges in creating him?

Andrea:  As we were going through ocd in our family, it became clear that the ocd was a voice in the head demanding certain things. It was like a hostage takeover. The doctor encouraged that it be externalized and named. This helped distinguish what the ocd wanted from what the actual person wanted. As parents, it also made it much easier for us to participate in erp and cbt because we knew we were standing up to the ocd and not our child.  I also really felt like there was a dilemma about whom to listen to--  the ocd voice or us.  Thus the love triangle concept was born. Oliver was a challenging but wonderful character to write because i really do view it as a love triangle. And Oliver is so different than Henry. I have been approached by a major hollywood studio about doing a movie version and talking about how to portray Oliver in a film has been a lot more challenging but there are so many intriguing possibilities.

Interview with Andrea Kayne Kaufman, Author of Oxford Messed Up: Part 1

Andrea Kayne Kaufman, author of Oxford Messed Up, graciously agreed to answer some questions about her novel, which deals with OCD.

ExpWoman:  "What if" questions are a hallmark of OCD, 
usually with dire answers.  Your novel seems to be a 
"What if" with an optimistic answer.
How did the scenario of Henry and Gloria meeting 
come about?  As a "what if" of an extraordinary kind 
or did one of the characters come first?

Andrea: Gloria came to me when we were struggling with ocd with one of our children. There were some people close to us who doubted the efficacy of the medication and cbt/erp therapy we were going to embark on. They told us our child would be fine. Was so smart. Would go to yale and find his niche eventually.  That wasn't good enough for us as we watched needless suffering. So i think that is why i created gloria.  The "perfect" yale graduate, living a miserable existence.

After our child got better (very quickly by the way), Gloria seemed to be asking for her happy ending too.  I created Henry because our child's therapist once said that what seems like the worst thing possible may actually be the best thing possible. So that is why i gave Henry his condition, the worst germs possible.


ExpWoman:   What led you to have Henry be the agent of the 
Exposure Therapy(ERP) rather than a therapist?

Andrea: Henry or any lay person is not an ideal person to administer erp.  But given Gloria's parents undermining of her early erp and history of hospitalization, she has been closed off to full treatment for years. Henry is able to open her up to the process again. His efforts are supervised by his sister (unethically perhaps) and i tried to show in the chapter with the dog that Gloria realizes Henry needs to be replaced by a real professional.  In order for the erp to be successful, you need patient buy-in and Henry is able achieve buy-in.

ExpWoman:  Some of my readers, 
most who struggle with OCD, wondered at the
speed of Gloria's recovery from her contamination OCD 
after she begins doing exposures with Henry.  
I know that my progress for health anxiety, 
intrusive thoughts & perfectionism has taken longer.  

What led you to a more rapid progression?

Andrea: Our family experience was that once we started medication and cbt/erp rigorously and consistently, we saw dramatic reduction in compulsions within 3 1/2 months. That doesn't mean the ocd has gone away. It's a life long struggle that can be triggered with all sorts of life events, hormones, stress etc. Although, it can rear its head, it has never been as strong because we have the tools.  The novel was vetted by three experts and has been hailed by the ocd community. There may be some poetic license but i really wanted to show the true torture of ocd from the inside out and how cbt can be very effective. Some people think that it is archaic and cruel, denying someone the few things that provide comfort. But cbt is the only therapy proven to really work and if done well, it can work quickly.

ExpWoman:  Which books on OCD were most helpful to you in writing this novel?

Andrea: 

The Boy Who Couldn't Stop Washing By Judith Rapoport

Ocd In Children And Adolescents By Johns S. March And Karen Mulle

Freeing Your Child From Obsessive Compulsive Disorder By Tamar E. Chansky

What Do Do When Your Child Has Obsessive-compulsive Disorder By Aureen Pinto Wagner

Talking Back To Ocd By John S. March

ExpWoman:   Did someone in particular inspire you 

to take on the subject of  dealing with OCD?

Andrea:  As I said before, we experienced very bad ocd with one of our children whose courage and tenacity really inspired me. Also, his psychologist Amanda Holly (whose video is on my website) is my total hero. She is our "ocd whisperer" and really saved a life and our family. She is one of the experts who consulted on the book.

ExpWoman:  I grew up as the daughter of an English

professor, and then did an MFA in creative writing. 

Being in the academic world had its own set of challenges 

when suffering from OCD.  What insight would you offer to 

those readers who are currently in academia and struggling?

Andrea:  Academia can definitely be daunting for anyone and especially for those who suffer from anxiety disorders like ocd. Moreover, whether you are a student or faculty member, the work in school can be isolating which can lead to stoicism, keeping all the struggles inside until they build and build. It is so important to have good mentors and advisors that you can share with— not just academics but also social/emotional struggles. It is also important to know that transitions to college or going through tenure can trigger internal stress and anxiety disorders. It is good to be prepared and prophylactic.  Finally, the world of academia emphasizes grades, publishing, comparing, competing. This dynamic is not healthy for the person who suffers from perfectionism whether in ocd form or eating disorder or something else. It is so important to master the "good enough" standard and learn to be gentle with ourselves.

ExpWoman:  I will post Part 2 of the interview with Andrea Kayne Kaufman next week.  For Andrea's introduction to Oxford Messed Up, check out her video.

Review of Oxford Messed Up by Andrea Kayne Kaufman: Facing OCD

[Note: In celebration of love, life and hope, Andrea Kayne Kaufman will be offering the Ebook edition for $ .99 on Amazon from May Day thru Cinco de Mayo - May 1-5.]


When Grant Place Press contacted me about reviewing Oxford Messed Up by Andrea Kayne Kaufman, little did I realize the connections I would find with my own life.  The protagonist, Gloria Zimmerman, is traveling to Oxford to study feminist poets, and struggles with OCD.

I have a degree focused on feminist poets.  Reading poems written by these women, and writing my own poems gave me strength to deal with depression, OCD and other pain.   I was a very serious young woman, who didn't know she had OCD, but knew that I was often scared about symptoms in my body, and trying to be perfect.  Gloria knows she has OCD, but attempts to keep herself together with rituals, Klonopin, and Van Morrison's music.

Van Morrison's music is a source of strength to both Gloria, and her "loo-mate" Henry Young(the other protagonist who has had many traumas in his life).   As a girl, I  remember sitting on the floor going through my parents record collection, trying to understand what a Moondance was, and mesmerized by the album.

I was intrigued that one of the recommendations on the back of the book came from Susan Richman from OCD Chicago, a chapter of the International OCD Foundation.  Oxford Messed Up does indeed explore Exposure and Response Prevention Therapy(ERP), the standard for treating OCD, and is the only novel for the adult market that I've ever come across that does.

Henry is the catalyst for Gloria's ERP, and this shows the importance of rapport for willingness to do Exposures.  If I hadn't trusted my ERP therapist, I wouldn't have done any of the Exposures he suggested.  I believe that family and friends are often on the frontlines of working on Exposures with the ones they love who have OCD, and that self-help has been very important for many sufferers, especially Jonathan Grayson's book Freedom from OCD, and his model of GOAL support groups.

At the same time, though, I was ambivalent about Henry's quick study of ERP, and how unrealistic this might be.  I was able to suspend disbelief because I remembered reading somewhere that ERP, even incompletely done, can be better than years and years of talk therapy. I only wish more therapists were  quick as Henry--like the 6 or 8 of them I saw before I found Leonard, who actually specializes in OCD and was expert in Exposure Therapy, rather than asking me to simply avoid my triggers or use logic to make it all go away.  I would imagine a novelist's dilemma would be how to portray a series of ERP sessions with a therapist, in a way that would make good fiction.  

Gloria has contamination OCD, which I don't have, and which gave me a brief flash of disappointment, because this is the stereotype of people who have Obsessive Compulsive Disorder.   But she also has perfectionism, a mandate to be a "Superstar,"  which I identify with, and I liked that Kaufman showed how perfectionism can underlay everything, and that this may be slower to respond than other aspects of OCD.  If patterns have been in place for a lifetime, through family culture, personal history, combined with genetic heritage, that simply habituating to the "dirty world" isn't enough, and that compassion, love, understanding and hope are crucial to regaining a life that has been ordered by taking as few risks as possible, and trying to earn the love of others.  

I recommend Oxford Messed Up for it's improvisational dialogue both internal and external, for an inside look at the OCD thought process while facing fears, for the importance of hope, and of "fatalistic optimism"(as the characters describe the music of Van Morrison).

In celebration of love, life and hope, Andrea Kayne Kaufman will be offering the Ebook edition for $ .99 on Amazon from May Day thru Cinco de Mayo - May 1-5.

OCD: A Guide for the Newly Diagnosed: Review of Michael Tompkins' Book for Consumers

When New Harbinger Publications asked if I would consider reviewing Michael Tompkins book, OCD: A Guide for the Newly Diagnosed, I was heartened to know that there was a new book on this topic. The introduction is by Jeff Bell, who wrote an insightful memoir about OCD called Rewind, Replay Repeat, which I took to be a good sign.

The book fits nicely in the hand, and adds to the approachability for those who have just found out they have OCD. Actually, Tompkins starts with describing the process of getting a diagnosis, and I'm glad he addressed the difficulty of finding mental health professionals who are actually familiar with the many forms OCD can take. I would argue that the comprehensive diagnostic process described in this book really only happens with therapists who are specialists in OCD, or who have trained in Exposure Therapy, and have treated a lot of people with OCD. The therapist who diagnosed me basically said, yes, it sounds like you have OCD.

Tompkins does an overview of Exposure and Response Prevention Therapy(ERP), Cognitive Therapy, and medication as well as other treatments, as well as what questions to ask a potential therapist, and how to get the most out of sessions.

I particularly liked the chapter on developing a "Recovery Attitude" including accepting such things as uncertainty, imperfect outcomes, imperfect knowledge, learning to approach discomfort in order to get through to the other side, turning away from debate with your OCD, seeking support, not reassurance, and practicing everyday. As someone who has struggled with perfectionistic OCD, I constantly battled with the fear that I wasn't doing my treatment perfectly or that I didn't have perfect knowledge of my OCD. Tompkins points out that "good enough" treatment is indeed "good enough," and OCD is demanding perfection that doesn't exist.

The book closes with information about unhealthy coping, school and work issues, a list of treatment centers, and recommended reading. It's difficult to fit everything into an introductory book, an at times I wanted more detail, or found too much squeezed into a section, but overall this book would be an excellent addition to a public library's mental health collection, as well as college libraries and hospital consumer health libraries.

Michael Tompkins, PhD, is a licensed psychologist at the San Francisco Bay Area Center for Cognitive Therapy.

Review the Young Adult Novel about OCD, Zelah Green: One More Little Problem

Vanessa Curtis's Zelah Green: One More Little Problem, is the next in this series about a teenage girl with OCD. The review copy came in the mail in the midst of my back going out, and I spent an afternoon in bed reading, which reminded me of much of my adolescence. Curtis has a good grasp of how stress can make rituals worse, and the double-edged sword of getting immediate relief of anxiety by doing the rituals, but the ultimate pain caused when they interfere with important things like friendship, love and family. I was moved by the description of Zelah holding her father's time for the first time since she was twelve, and how his skin felt.

Zelah's therapist, Stella, is concerned that Zelah is trying to take control of all the out of control things in her life during her summer "off"(which is anything but off from her anxieties), including her father being out of work, Caro from her time at Forest Hill showing up on the doorstep, and the most stable adult in her life, Heather, being out of the the country.

"Hmm," said Stella. "The thing is, Zelah, that none of the things happening in your house should really be your responsibility at all. I am not surprised your rituals are getting worse."

But for Zelah, calling her therapist if things get overwhelming seems alien. There's something about being that age, and just assuming that of course it's your responsibility, and the OCD compounding this by offering a glimpse of control, an illusion that if you do the rituals, the anxiety and fear will go away. Fortunately, Zelah also has friends, who help her make connections to both herself and to adults who can help.

Review of the first novel in the series:

Zelah Green: Who Says I'm a Freak

Review of Zelah Green: Who Says I'm a Freak? Young Adult Fiction about OCD

When the publicist for author Vanessa Curtis contacted me about possibly reviewing the young adult novel, Zelah Green: Who Says I'm a Freak? , I was intrigued, because I was a voracious reader as a teen, but do not recall any books about characters with OCD.

Zelah is in the confluence of pain between her mother dying, her father remarrying to a woman who doesn't like her, followed by her father disappearing, and her persistent need to keep germs away, and elaborate routines of cleaning, counting and physical gestures. My OCD, although present from age 9 or 10, flared when my father left and my mother was depressed, when I was 16, so I resonated with the overlap of the traumas and the rituals and the flood of anxiety, and the fear of being a freak.

Zelah is from the UK and through various twists in the plot ends up in a group treatment home for teens, run by husband and wife behavior therapists. I don't know how representative this is of the British mental health system, but it does provide a setting for Zelah's growth as she discovers other kids who are "freaks" and finds commonality of experience, and also is guided into exposure therapy for her rituals--purposely touching faucets, and toilets and not washing and moving at an incredibly rapid pace.

My main ambivalence about the book was the tendency of the therapist to dictate what step Zelah would take next in combating her OCD, and her relative quickness in doing what was asked of her. On the other hand, I did appreciate that the therapist understood Zelah's thought process, her fear of bad things happening if she didn't do her routines exactly right, and the focus on addressing the compulsive actions directly, rather than assuming that if everything was made right in her family, then her fears would magically disappear.

I remember at age 13 or 14, noticing that all the young adult novels I read were about unpopular kids, outsiders, with lives in turmoil or chaos. I wondered about that, how the characters seemed on the margins. Of course, I was on the margins as well, and I kept reading the novels, hoping for some company, some acceptance. A book like Vanessa Curtis's could have helped me feel less alone with my anxieties, and my OCD. The closest I came to having this was when I read The Best Little Girl in the World by Steve Levenkron, about a teenage girl with anorexia.

Here is a page from my list of books. I recorded the title of each one, which was probably a compulsion.

What do you want your life to be about? Acceptance & Commitment Therapy for OCD

My friend J. came over today for coffee, and I told her I was avoiding doing my therapy homework for tomorrow, writing down my values. Her eyes lit up and she said, "Oh, let's do it now, together." I think she would've made an excellent Exposure Therapist in another life! At first I was like "Crap." But enough of the healthy part of me said, ok, let's do it. J. lost her job just before I lost mine, and we are going some similar re-evaluations of our lives.

My therapist is having me work through "Get Out of Your Mind & Into Your Life: The New Acceptance and Commitment Therapy" by Steven C. Hayes, PhD. Some of the ideas of ACT are really useful for dealing with OCD, especially learning to observe your mind and let the noise be there, but doing what you really value in spite of it. At times the scientific language bogs me down, especially with an OCD desire to understand it perfectly, and I'm glad I'm working on it in the context of therapy, so I can get help with the perfectionistic tendencies.

My homework for tomorrow was to write down what I truly value in 10 different domains of my life, such as friendship, relationships, family, parenting, work, recreation, spirituality, citizenship, personal growth and learning, physical health and well being. J. set the timer for 1 minute for each category and we started writing what we want our lives to be about in each of these areas. Then Hayes asks us to re-read what we wrote, as if no one else would ever see it, and whether these are things we really value or whether they are things we think we are supposed to value. All of this is ripe for OCD over-interpretation, but framing the exercise as an exposure helped--writing things down in a minute, without knowing for sure if they really *truly* are my values, not to mention judging whether these are things I *should* value.

OCD only values reduction in anxiety--there isn't much else it cares for except certainty. When I do what my OCD demands, I get a temporary drop in anxiety, but I don't get to live much of my life. I value connections with people, and making art. I don't want my life to be about my rituals. The temptation is to fall back into my perfectionism OCD, and berate myself for ritualizing, as if somehow this will help me change. But one of my values is compassion, and persecuting myself for having OCD is not compassionate, and I am slowly learning how to have compassion for myself.

Sometimes the motivation to do exposures is hard to find because the anxiety is so gripping. My therapist is arguing that my values can help guide me, and help give me courage to face the OCD. What do you value? What motivates you to do exposures?

You can download the full 2-page version of the values chart here.

For a useful summary of ACT, Dr. Russell Harris has a good article:Simple Overview of ACT: To download a simple, non-technical, easy-to-read overview of ACT ( called 'Embracing Your Demons', an article he wrote for Psychotherapy Australia magazine) click here. I read this article several years before getting any treatment for my OCD, and it stayed with me.

Mindfulness and OCD: Full Catastrophe Living by Jon Kabat-Zinn

Full Catastrophe Living by Jon Kabat-Zinn was one of the first books I read that helped me to observe what was going on in my mind, and not become the thoughts.

I was on vacation with my husband in the summer of 1999. I dreaded trips and the spike of anxiety that came with them.
Unfamiliar surroundings + free time + belief that I didn't have any right to enjoy anything + belief that if I did enjoy something, then something bad would happen=high anxiety. I came across Kabat-Zinn's book as we were checking out a local bookstore. Something about the title resonated with my sense of impending doom. I started reading that evening.

We went to visit old friends who lived on top of a mountain. As I sat in their living room, watching hummingbirds hovering at the feeder outside the picture window, my eyes glanced down at my arm, and a mole which I had fixated on the past suddenly became the total focus of my attention, and knocked my heart up into my throat. I excused myself and went into the bathroom, and examined the mole. I felt my knees sinking, a cloud of dread blocking out all peripheral vision, reducing my consciousness to the mole.

The observing part of myself saw how quickly the anxiety came, like an injection, and how much I hated it. Kabat-Zinn helped get me back in the room, back into a 3-D world. The present moment is all we have. If we exile it into trying to know the future(is this mole cancerous? Will my anxiety ever go away?), we are losing our lives. I went back into the living room to watch the hummingbirds. It wasn't like a conversion experience or magic, just a glimmer of being more than my anxiety and obsessions. It sucked having the wind knocked out of me by anxiety. I felt tentative, vulnerable, sad. I felt weak. And yet, my observing self was alive, and hanging on somehow.

Jeff Bell's Rewind, Replay, Repeat: A Memoir of Obsessive Compulsive Disorder

I read this memoir as soon as it came out, and was moved by the author's honesty and ability to communicate what OCD is like from the inside out. Jeff Bell is an accomplished radio host, and kept his obsessions a secret from those around him.

He opens with the image of being 6 years old and driving past another car, with a little boy shouting "Hi!" and having an urgent need to know who the boy was and why he said hello, repeatedly asking his mother about it. I remember at age 8 becoming obsessed that I might need to go to the bathroom after I got into bed, that I would not be able to sleep if I had any pressure in my bladder. When I first got into bed I would bolt out of it over and over, feeling the compulsion to keep checking, keep attempting to empty my bladder.

OCD is relentless, and I could feel Jeff Bell's pain as he started fearing he'd hit someone while driving, and feeling compelled to go back and check the road. That he somehow functioned at all is amazing, with this other full time job of struggling with the OCD. It's like the relay a gym teacher had my class do when I was in the 11th grade--we were to put on a full set of clothes over our swimsuit, swim to the other side, take off the clothes and give them to next person in the relay. We did it because our teacher said to, and OCD wants that kind of power. It says, "Drive to work, but if you hear any sound, go back to make sure you didn't hit someone."

Scheduling your life around these demands is exhausting, debilitating and destructive to yourself and those around you. It's like swimming in waterlogged clothing. It's also paradoxical--if as a child I was afraid I wouldn't be able to sleep, repeatedly getting up to empty my already empty bladder made sure that I wouldn't be able to sleep, but in the midst of the intense anxiety created by OCD, I did what it commanded.

Jeff Bell has a new book, When in Doubt, Make Belief, which I am looking forward to reading. Let me know if you've read it.

Another Good Book:
Freedom From Obsessive Compulsive Disorder

OCD Toolbox: Freedom from Obsessive Compulsive Disorder by Jonathan Grayson

This book, Freedom From Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty by Jonathan Grayson, was very important in moving me to get help for my OCD. I'd spent a lot of time reading about OCD, but assumed that because much of what I dealt with took place inside my head, rather than physical rituals, Exposure and Response Prevention Therapy wasn't really for me.

Grayson went right to the heart of this by identifying mental rituals, and describing how to write scripts that expose you to your "Pure O" fears, and learn to habituate to them, and live your life. He gets the "obsessing about obsessing" quicksand of the OCD mind. And even more importantly, he introduces the concept of learning to live with uncertainty. I recognized myself in his descriptions right away, a compelling desire to have absolute certainty that a feared consequence will not happen.

OCD makes a lot of demands for omniscient knowing, for complete understanding, for predicting the future and insisting that questions be answered that no human gets answered. It sucks to accept the reality of our tenuous existence, but Grayson points out that we tolerate uncertainty in many aspects of our lives, if it is not one of our OCD triggers. He has an example of how someone who has no fear of driving takes the risk of crashing their car just go see a movie. Last week, I thought of this example when I heard that some people I know from choir were in the hospital because they had a car accident on the way to see a movie.

We take risks everyday, but often we don't think about it, because life is in itself risky, and if we wish to experience the joys that life offers, we have to keep moving. On a bad OCD day, I really hate this revelation, because the OCD insists that I can have certainty of safety if I just ritualize, and it's hard to let go of the fantasy. But the fantasy is at the expense of having a life, a kind of living death.

Another Good Book:
Rewind, Replay, Repeat: A Memoir of Obsessive Compulsive Disorder