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.

Behavioral and fMRI studies of cognition: A Chance to Participate in OCD Research before January 10, 2014

I posted information about this previously.  Mt. Sinai is closing their study by January 10, 2014, and still needs 2-3 more patients before then.

Behavioral and fMRI studies of cognition in healthy individuals and patients with anxiety

Study Description The current study is a neuroimaging study involving fMRI.  Specifically, we seek to examine the neural mechanisms underlying switching attention between internal thought, such as imagination,  and external stimuli.   

For OCD patients, participation consists of 2-3 sessions totaling 5-7 hours, and participants are reimbursed at $25 an hour.  The first session involves a clinical assessment and paperwork to confirm the patient's eligibility (~3 hours total), and the second session involves completing computer tasks while in the scanner (~2.5 hours total).  Payment is given to participants in cash upon completion of their participation.

Link http://icahn.mssm.edu/research/clinical-trials/11-1344

Doctors Can be Anxious Too

Doctors can be anxious too.  I have assumed that I am always the anxious one, and most other people are calm.  A month ago I went to see my family doctor about some body pain, and she gave me some medicine and told me to call her the next week to check in.  When I did, and I wasn't 100% better, she said to make a specialist appointment just in case it still wasn't gone the next week.  When I checked in again, and told her that my specialist appointment was October 21, she freaked out and said that was completely unacceptable, and I needed to be seen in the next 2 weeks.  This in turn ratcheted up my anxiety!  She also ordered a test for an ailment that would manifest pain in a different location, "just in case I had an atypical presentation."

My husband said, "Your doctor is anxious.  I don't know if that is good for you."  What we decided to do was have him do a search for treatment guidelines, rather than have me search, which is my primary compulsion with health anxiety.  I felt blessed to have someone who would help me get more information, but who would stop long before I would ever feel "done" if I was searching myself.

I got an earlier appointment with the specialist, who said the medicine hadn't had enough time to work, and that we could set aside the test for the unlikely ailment.  She did schedule a different test for October, but it was one my husband had found as the next step in the diagnosis process.

It's been a long week, with a dental appointment and a gynecology annual exam.  Preventive healthcare is important, but my OCD gets all stirred up.  Not to mention that I still don't feel good.  The challenge is to keep doing things important to me, even if I don't feel 100% or know what's wrong with 100% certainty.  Maybe my family doctor is right, and I have something unusual going on.  Maybe it's just that I live in a malpractice prone part of the country.  Maybe she lost someone to a disease and she never wants to lose someone again.